Purpose : This study aimed to explore the factors which interfere with advance decision-making with regards to artificial hydration and nutrition (AHN) in the senescent population.
Methods : Subjects were local residents aged 60 years or older who were leading an independent life and who could go out by themselves. A cross-sectional study using a self-administered questionnaire was conducted from August to November 2011. Valid responses were obtained from 116 subjects, for a valid response rate of 90.6%. Advance AHN decisions, knowledge about AHN, intentions regarding advance directives and end-of-life care, experience providing long-term care, in addition to other questions, were analyzed using a multiple logistic regression model.
Results : With respect to advance decisions regarding AHN, 25 respondents (21.6%) indicated that they could not make a decision, while 91 respondents (78.4%) could. Sixteen respondents (13.8%) desired some component of AHN, while 75 respondents (64.7%) did not desire any AHN. Factors related to difficulty with advance decisions regarding AHN were : 1) lack of adverse experiences associated with decreased cognitive function (“experience of failure”) (OR=12.0, 95%CI=1.42-100.41, p<.022), 2) lack of experience providing long-term care for a family member (“experience of caring”) (OR=3.0, 95%CI=1.04-8.53, p<.042), and 3) desire to defer such decisions to others in the event of unconsciousness or other incompetency rather than an advance decision (“reliance on others”) (OR=5.6, 95%CI=1.95-16.24, p<.001).
Conclusion : Factors related to difficulty with advance decisions regarding AHN in the senescent population were lack of adverse experiences associated with decreased cognitive function, lack of experience providing long-term care for a family member, and desire to defer such decisions to others in the event of unconsciousness or other incompetency rather than an advance decision.

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Objective : To determine the factors associated with the survival duration of elderly individuals aged 80 years and older.
Methods : Forty three elderly individuals, aged ≥80 years, who had undergone a health check-up in Wara Village (Gujo, Gifu Prefecture) between 1991 and 1995 (baseline evaluation) were followed-up until March 31, 2011. The relationships between survival duration and age, sex, body mass index (BMI), history of hypertension or diabetes, serum total and high-density lipoprotein-cholesterol concentrations, and smoking status were analyzed.
Results : The average age at baseline examination was 81.9 years. On Cox proportional hazards models, there was a significant correlation between survival duration and history of diabetes, but no such association was found for age, sex, BMI, history of hypertension, total and high-density lipoprotein-cholesterol concentrations, or smoking status.
Conclusion : The present study suggests that a history of diabetes is associated with a shorter survival duration in those aged ≥80 years who had undergone health check-ups.

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Introduction : With the increase in proportion of female physicians in Japan, breaks in their career associated with life events have become more apparent. We are making efforts to improve the program of work-life balance for female students at Jichi Medical University (JMU) who have a 9-year obligation to practice in a rural area following graduation. The purpose of this study is to research the needs for career development and work-life balance programs desired by female students at JMU.
Methods : A questionnaire was distributed to all 187 female students enrolled at JMU.
Results : The proportions of those wanting to marry and give birth during their 9-year obligation term were 71% and 68.6%, respectively. The proportions of those feeling anxious about childbirth and work-life balance after graduation were 80.0% and 78.1%, respectively. Over 80% of subjects answered that they wanted to attend lectures by female physicians and group meetings with such physicians, and to receive information regarding support systems and career development.
Conclusion : Female students at JMU tend to have greater concerns about life-events, but have an advantage in having opportunities for contact with female physicians who have contributed to rural practice. Clarifying role models for female medical students appears to be an expectation that our students have from our work-life balance programs.

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Objectives : A pharmacotherapeutic system for safe and proper use of warfarin was developed through physician-pharmacist cooperative practice ; its effects on patient adherence to therapeutic regimens and the therapeutic benefit of warfarin were assessed.
Methods : Subjects were 12 outpatients or home-care patients receiving warfarin. Patients' level of understanding of warfarin therapy and time in therapeutic range (TTR) were used as indices of adherence and therapeutic benefit, respectively. Before the physician examination, patients were interviewed by pharmacists using point-of-care testing with the CoaguChek ^®XS to check their prothrombin time-international normalized ratio (PT-INR). Pharmacists reported status of warfarin administration, any adverse effects, and medication management status to each patient's physician using the medication record or inter-institute information exchange sheet. Patient adherence was assessed before and after the pre-examination interview and changes in TTR were evaluated.
Results : Levels of understanding of warfarin therapy were significantly higher after pharmacists provided medication counseling (immediately before 4.8±1.9 vs 24 weeks after 6.8±2.4 ; P=0.0079, Wilcoxon signed-rank test). TTR significantly improved at 24 weeks after the interview (pre-interview 20.9±29.8% vs post-interview 60.5±30.5%, respectively ; P=0.0024, Wilcoxon signed-rank test).
Conclusion : The results suggest that patients'adherence to warfarin regimens and the therapeutic benefit of warfarin is improved by pharmacists'obtaining information on PT-INR before patients'medical examinations, as well as by utilizing this information to establish a cooperative pharmacotherapeutic system for good TTR management, as supported by a common protocol across pharmacies and medical institutions.

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Introduction : To detect major symptoms of dementia, especially symptoms of non-Alzheimer-type dementia, we tried to develop an informant-based questionnaire, the Dementia differentiation questionnaire-41 items (DDQ41).
Methods : The DDQ41 consisted of 11 questions on symptoms of early dementia (Q-Dementia11), 8 on Alzheimer's disease dementia(Q-ADD8), 9 on dementia with Lewy bodies (Q-DLB9), 8 on vascular dementia (Q-VD8), 5 on frontal lobe signs (Q-Frontal5), and additional 2 questions on urinary incontinence and speech disturbance. Caregivers of the 575 outpatients, who included only 1 diagnosis of dementia disease, checked the DDQ41.
Results : Mean score of Q-Dementia11 in the MCI group was significantly lower than that in the other dementia groups. Mean score of Q-ADD8 in the ADD group was not significantly different from that in the other dementia groups. Mean score of Q-DLB9 in the DLB group was significantly higher than that in the other dementia groups. Area under the ROC curve of Q-DLB9 was 85.6%, and sensitivity and specificity were 82.6% and 77.7%(cut-off : 3 items/4 items), respectively, for DLB.
Conclusion : We developed the DDQ41, an informant-based questionnaire sheet, for detecting symptoms of dementia. It may be useful in detecting frontal lobe signs and symptoms of non-Alzheimer-type dementia, especially those of DLB.

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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