Association of housing adaptation services with the prevention of care needs level deterioration for older adults with frailty in Japan: a retrospective cohort study.

BACKGROUND: Housing adaptations are aimed at minimizing the mismatch between older adults' functional limitations and their building environments. We examined the association of housing adaptations with the prevention of care needs level deterioration among older adults with frailty in Japan. METHODS: The subjects comprised individuals who were first certified as having care support levels (defined as frail, the lowest two of seven care needs levels) under the public long-term care insurance systems between April 2015 and September 2016 from a municipality close to Tokyo. The implementation of housing adaptations was evaluated in the first six months of care support certification. Survival analysis with Cox proportional hazards model was performed to examine the association between housing adaptations and at least one care needs level deterioration, adjusting for age, sex, household income level, certified care support levels, cognitive function, instrumental activities of daily living, and the utilization of preventive care services (designed not to progress disabilities). We further examined the differences in the association of the housing adaptation amount by categorizing the subjects into the maximum cost group (USD 1,345-1,513) or not the maximum cost group (< USD 1,345). All the subjects were followed until the earliest of deterioration in care needs level, deaths, moving out of the municipality, or March 2018. RESULTS: Among 796 older adults, 283 (35.6%) implemented housing adaptations. The incidence of care needs level deterioration was 19.3/1000 person-month of older adults who implemented housing adaptations, whereas 31.9/1000 person-month of those who did not. The adjusted hazard ratio (aHR) of care needs level deterioration was 0.69 (95% confidence interval (CI): 0.51-0.93). The aHRs were 0.51 (95% CI: 0.31-0.82) and 0.78 (95% CI: 0.57-1.07) in the maximum and not maximum cost groups, respectively. CONCLUSIONS: Housing adaptations may prevent care needs level deterioration of older adults with frailty. Policymakers and health professionals should deliver housing adaptations for older adults at risk of increasing care needs.

Implementation and costs of housing adaptations among older adults with different functional limitations in Japan.

BACKGROUND: Accessible housing is crucial to maintain a good quality of life for older adults with functional limitations, and housing adaptations are instrumental in resolving accessibility problems. It is unclear to what extent older adults, who have a high risk of further functional decline, use housing adaptation grants acquired through the long-term care (LTC) insurance systems. This study aimed to examine the utilization of housing adaptation grants in terms of implementation and costs, for older adults with different types of functional limitations related to accessibility problems. METHODS: The study sample included individuals from a suburban city in the Tokyo metropolitan area who were certified for care support levels (indicative of the need for preventive care) for the first time between 2010 and 2018 (N = 10,372). We followed the study participants over 12 months since the care needs certification. We matched and utilized three datasets containing the same individual's data: 1) care needs certification for LTC insurance, 2) insurance premium levels, and 3) LTC insurance claims. We conducted a multivariable logistic regression analysis to estimate the likelihood of individuals with different functional limitations of having housing adaptations implemented. Afterward, we conducted a subgroup analysis of only older adults implementing housing adaptation grants to compare costs between groups with different functional limitations using the Mann-Whitney U and Kruskal-Wallis tests. RESULTS: Housing adaptations were implemented among 15.6% (n = 1,622) of the study sample, and the median cost per individual was 1,287 USD. Individuals with lower extremity impairment or poor balance were more likely to implement housing adaptations (adjusted odds ratio (AOR) = 1.290 to AOR = 2.176), while those with visual impairment or lower cognitive function were less likely to implement housing adaptations (AOR = 0.553 to AOR = 0.861). Costs were significantly lower for individuals with visual impairment (1,180 USD) compared to others (1,300 USD). CONCLUSION: Older adults with visual or cognitive limitations may not receive appropriate housing adaptations, despite their high risk of accessibility problems. Housing adaptation grants should include various types of services that meet the needs of older people with different disabilities, and the results indicate there may be a need to improve the system.

The association between nurses' burnout and objective care quality indicators: a cross-sectional survey in long-term care wards.

BACKGROUND: Worldwide, rather few studies have examined the association between burnout and care quality using objectively measured quality indicators, with most of the studies have relied on perceived quality outcomes. This study aimed to examine the association between staff nurses' burnout and selected objective quality metrics in long-term care wards in Japan. METHODS: This is a secondary analysis of a cross-sectional survey. Nurse managers and staff nurses working at randomly selected hospitals with long-term care wards-the equivalent of skilled nursing homes in Western countries- completed self-administered, anonymous questionnaires. The questionnaires collected data regarding care quality indicators, staff nurses' burnout, and other confounders (e.g., ward size, participants' years of experience, and patients' conditions). All statistical analyses were conducted at the ward level. A multivariate regression analysis was used to examine associations between burnout and outcome indicators. RESULTS: Data from 196 wards in 196 hospitals (196 nurse managers and 2473 staff nurses) across Japan were analyzed. Multivariate regression analysis showed that higher emotional exhaustion was associated with higher rates of pneumonia and pressure ulcers (p-value = .036 and .032, respectively), and that reduced personal accomplishment was associated with higher rates of tube feeding (p-value = .018). A larger ward size was also associated with low rates of pneumonia (regression coefficient = -.001, p-value = .019). CONCLUSIONS: Staff nurses' burnout is a significant determinant of care quality in long-term care wards, implying that organizations that implement burnout reducing strategies may see greater benefits in patient outcomes. A large ward size was significantly associated with better care outcomes-specifically, low rates of pneumonia. Future research needs to determine feasible quality improvement measures in small-scale long-term care facilities, and to provide more comprehensive insights on ward-level variables that influence care quality in long-term care settings.

Continuous laxative use and its relationship to defecation among residents of nursing homes: A longitudinal observational study using the interRAI.

AIM: To clarify the association between constipation, diarrhea, and long-term laxative use in Japanese nursing home residents. METHODS: Data from 306 residents with chronic constipation aged over 75 years for basic characteristics, medication use, activities of daily living, and concurrent illness were collected via two consecutive 6-monthly surveys conducted using the Japanese interRAI assessment tool. We used bivariate and multivariate analyses to examine the associations between chronic constipation, diarrhea, and continuous laxative use. RESULTS: Chronic constipation persisted in 74.5% of residents despite their continuous use of laxatives. Additionally, 14.4% experienced chronic diarrhea while on laxatives. Residents using salt laxatives had significantly lower chronic constipation than those not using salt laxatives (adjusted odds ratio [AOR] 0.52), while residents using novel laxatives had significantly higher chronic diarrhea than those not using novel laxatives (AOR 4.28). CONCLUSIONS: Our findings reveal that bowel movement-related problems remain a concern and highlight the need for further research on the use of novel laxatives in nursing home residents. Geriatr Gerontol Int 2024; 24: 133-139.

Impact of family involvement and an advance directive to not hospitalize on hospital transfers of residents in long-term care facilities.

OBJECTIVE: With the rapidly aging population, the number of residents transferred to hospitals from long-term care facilities (LTCFs) is increasing globally. The objective of this study was to investigate the association between family involvement and an advance directive (AD) for not hospitalizing and hospital transfers among LTCF residents with dementia. METHOD: Using the InterRAI assessment database from September 2014 to June 2019, we included 874 residents from 16 LTCFs in Japan. RESULTS: Of the 874 participants, 19.0% had an AD for not hospitalizing, and 20.5% were transferred to hospitals. An AD for not hospitalizing decreased the likelihood of hospital transfers (p = 0.005). Multilevel logistic regression analysis showed that family involvement was not associated with hospital transfers (odds ratio [OR]: 1.18; 95% confidence interval [CI]: 0.77-1.80), while an AD for not hospitalizing was significantly associated with decreased hospital transfers (OR: 0.50; 95% CI: 0.28-0.89) among the LTCF residents. CONCLUSIONS: Although ADs are not legally defined in Japan, we found that an AD for not hospitalizing decreased hospital transfers. Given that many older people tend to hesitate to express their wishes in clinical decision-making situations in Japan, regular discussions are necessary to help them express their care preferences while also documenting the discussions to ensure the residents receive high-quality care.

Differentiating between Central Nervous System Lymphoma and High-grade Glioma Using Dynamic Susceptibility Contrast and Dynamic Contrast-enhanced MR Imaging with Histogram Analysis.

PURPOSE: We evaluated the diagnostic performance of histogram analysis of data from a combination of dynamic susceptibility contrast (DSC)-MRI and dynamic contrast-enhanced (DCE)-MRI for quantitative differentiation between central nervous system lymphoma (CNSL) and high-grade glioma (HGG), with the aim of identifying useful perfusion parameters as objective radiological markers for differentiating between them. METHODS: Eight lesions with CNSLs and 15 with HGGs who underwent MRI examination, including DCE and DSC-MRI, were enrolled in our retrospective study. DSC-MRI provides a corrected cerebral blood volume (cCBV), and DCE-MRI provides a volume transfer coefficient (Ktrans) for transfer from plasma to the extravascular extracellular space. Ktrans and cCBV were measured from a round region-of-interest in the slice of maximum size on the contrast-enhanced lesion. The differences in t values between CNSL and HGG for determining the most appropriate percentile of Ktrans and cCBV were investigated. The differences in Ktrans, cCBV, and Ktrans/cCBV between CNSL and HGG were investigated using histogram analysis. Receiver operating characteristic (ROC) analysis of Ktrans, cCBV, and Ktrans/cCBV ratio was performed. RESULTS: The 30th percentile (C30) in Ktrans and 80th percentile (C80) in cCBV were the most appropriate percentiles for distinguishing between CNSL and HGG from the differences in t values. CNSL showed significantly lower C80 cCBV, significantly higher C30 Ktrans, and significantly higher C30 Ktrans/C80 cCBV than those of HGG. In ROC analysis, C30 Ktrans/C80 cCBV had the best discriminative value for differentiating between CNSL and HGG as compared to C30 Ktrans or C80 cCBV. CONCLUSION: The combination of Ktrans by DCE-MRI and cCBV by DSC-MRI was found to reveal the characteristics of vascularity and permeability of a lesion more precisely than either Ktrans or cCBV alone. Histogram analysis of these vascular microenvironments enabled quantitative differentiation between CNSL and HGG.

NMDA-dependent proteolysis of presynaptic adhesion molecule L1 in the hippocampus by neuropsin.

Synaptic plasticity requires an activity-dependent, rapid, and long-lasting modification of synaptic character, including morphology and coupling strength. Here we show that a serine protease, neuropsin, directly and specifically modifies the synaptic adhesion molecule L1, which was localized to the presynaptic site of the asymmetric synapse in the mouse hippocampus. Increased neural activity triggered the rapid, transient activation of the precursor form of neuropsin in an NMDA receptor-dependent manner. The activated neuropsin immediately cleaved L1 and released a neuropsin-specific extracellular 180 kDa fragment. This neuropsin-specific L1-cleaving system is involved in NMDA receptor-dependent synaptic plasticity, such as the Schaffer collateral long-term potentiation.

High-spatial-resolution MR cisternography of the cerebellopontine angle in 90 seconds with a zero-fill interpolated fast recovery 3D fast asymmetric spin-echo sequence.

BACKGROUND AND PURPOSE: Although the 12-minute 3D fast asymmetric spin-echo (FASE) protocol for imaging the inner ear has been satisfactory, reducing imaging time to minimize patient discomfort and maximize system throughput is desirable. We therefore evaluated the performance of a zero-fill interpolated (ZIP) fast recovery 3D FASE sequence in screening for cerebellopontine (CP) angle lesions in 90 seconds. METHODS: Thirty consecutive patients known or suspected to have CP angle lesions underwent MR imaging at 1.5 T with use of bilateral quadrature phased-array coils designed for examination of the CP angle. Conventional 3D FASE images (4000/240/1 [TR/TE/NEX]) were obtained in 11 minutes 48 seconds with a field of view (FOV) of 16 cm, matrix of 512 x 512 x 40, section thickness of 0.8 mm, and echo train length of 80. Then, ZIP fast recovery 3D FASE images (2000/240/1) were obtained in 90 seconds by using the same FOV. Contrast-enhanced T1-weighted 3D spoiled gradient-echo (SPGR) images were obtained as the reference standard. Three radiologists evaluated the images independently. Conventional 3D FASE and ZIP fast recovery 3D FASE images were reviewed at separate sessions. RESULTS: On 3D SPGR images, 10 tumors were detected in 10 of the 30 patients. All lesions were depicted with both 3D FASE protocols. There were no false-positive results with either 3D FASE protocol. Both protocols showed 100% sensitivity and 100% specificity for all three reviewers. CONCLUSION: High-spatial-resolution MR cisternography with the ZIP fast recovery 3D FASE protocol in 90 seconds results in a substantial reduction (by a factor of about eight) in the time required for screening for CP angle lesions compared with the previously reported conventional 3D FASE protocol, while maintaining high sensitivity and specificity.

Fast recovery 3D fast spin-echo MR imaging of the inner ear at 3 T.

High-resolution MR imaging of the inner ear with a heavily T2-weighted 3D fast spin-echo sequence has been performed successfully at 1.5 T. However, at 3 T, the longer T1 time of CSF necessitates a longer TR, resulting in significantly prolonged imaging times. In this study, the fast recovery 3D fast spin-echo sequence, which permits the TR to be reduced while maintaining T2 contrast, was optimized at 3 T for imaging of the inner ear. The optimized sequence parameters are as follows: 1500/294 (TR/TE); echo spacing, 18.1 ms; bandwidth, 38 kHz at 512 readout; and imaging time, 13 minutes.

Visualization of the lenticulostriate artery with flow-sensitive black-blood acquisition in comparison with time-of-flight MR angiography.

PURPOSE: To evaluate the capability of flow-sensitive black blood (FSBB) acquisition to visualize the lenticulostriate artery (LSA) in comparison with time-of-flight (TOF) angiography. MATERIALS AND METHODS: Twenty-one healthy subjects (13 males and 8 females, 19-44 years old) were enrolled in this study after obtaining written informed consent. Magnetic resonance imaging (MRI) examinations were performed with FSBB and TOF to visualize the LSA using a 1.5T MRI unit. In FSBB acquisition a motion probing gradient of b = 4 sec/mm(2) was applied to dephase blood flow. Images were reconstructed into coronal sections and were evaluated in terms of number, length, and image quality at origins and distal areas of visualized LSA branches with a four-point scale. RESULTS: In all, 145 LSA branches were visualized with FSBB and 66 branches with TOF. There was no LSA visualized only with TOF. In all evaluated terms, FSBB was significantly better than TOF. CONCLUSION: We could better visualize the LSA with FSBB than with TOF, both quantitatively and qualitatively. FSBB is a promising method, although it remains to be evaluated in clinical cases.

Whole-heart coronary magnetic resonance angiography with parallel imaging: comparison of acceleration in one-dimension vs. two-dimensions.

PURPOSE: To evaluate visualization of the whole-heart coronary arteries accelerated with parallel imaging (PI) applied in two-dimension (2D) in comparison with one-dimension (1D). MATERIALS AND METHODS: Seventeen healthy subjects were studied with a 1.5-T scanner equipped with a whole body phased array coil system and 16-channel receivers. Using 16 coil elements, whole-heart coronary magnetic resonance angiography (CMRA) was acquired in two conditions of 1D-PI and 2D-PI. The former scan was accelerated in phase direction by factor of 2 and the latter in phase and slice directions by factors of 2.5 and 2, respectively. Visualized length of right coronary artery (RCA), left anterior descending artery (LAD), and left circumflex artery (LCX) was measured. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) was also measured. The CMRA quality was assessed in segment-wise with a five-point scale. RESULTS: The average scan time decreased to 5.3+/-2.2 min in 2D-PI from 11.6+/-3.5 min in 1D-PI, reducing the scan time to 45%. The visualized length, SNR, and CNR in average were smaller for images of 2D-PI compared with those of 1D-PI, however, statistically significant results were observed only in RCA (P<0.05). Score reduction of 2D-PI image quality was limited to 0.34 in average, and only two out of fifteen segments (#2, 6) showed significant score deterioration (P<0.05). CONCLUSIONS: Compared with the relatively limited degree of image degradation, 2D-PI offered a large reduction of the acquisition time, which is of large benefit in clinical situations.

Facilitated acquisition of whole-heart coronary magnetic resonance angiography with visual feedback of respiration status.

Three dimensional (3D) whole-heart (WH) coronary MR angiography (CMRA) requires an extended imaging time, but it may be reduced by providing a subject with visual feedback (VFB). Thirteen healthy volunteers were scanned and quality of 3D WH-CMRA images was compared among three scan conditions: free breathing (FB) with and without VFB (FB + VFB and FB - VFB, respectively) and multiple breath-holds with VFB (MBH + VFB). All but two subjects were able to complete all scans. The average scan times were 10.0 +/- 2.2, 10.0 +/- 2.5, and 8.2 +/- 1.3 min for FB - VFB, FB + VFB, and MBH + VFB, respectively. In the MBH + VFB condition, scan time was significantly reduced by 18% compared with both FB scans. No significant difference in image quality was observed between the FB - VFB and MBH + VFB conditions, but scores were significantly deteriorated at some segments in the FB + VFB condition. The MBH + VFB scan can be performed with a shorter scan time without failure or impairment of image quality.

Decidualization induces the expression and activation of an extracellular protease neuropsin in mouse uterus.

Uterine decidualization is accompanied by the remodeling of the cell-matrix and cell-cell interactions around the endometrial stromal cells to allow an appropriate invasion of trophoblasts. This remodeling is thought to require the proteolysis of extracellular matrix proteins or cell adhesion molecules; however, the molecular mechanism remains poorly understood. In this study, decidualization induced the expression and activation of an extracellular serine protease neuropsin in the mouse uterus. Although nonpregnant uteri contained little neuropsin, the protein content and enzymatic activity increased markedly and peaked at the midgestational period in pregnant uteri. Neuropsin expression and activity was also upregulated in artificially induced deciduomata but not in nondecidualized pseudopregnant uteri. Neuropsin is the first extracellular protease to show the evident induction of expression and activity by decidualization and might contribute to the remodeling of extracellular components after decidualization.