Nippon Ronen Igakkai Zasshi. Japanese Journal of Geriatrics
Print ISSN : 0300-9173
Volume 29 , Issue 5
Showing 1-19 articles out of 19 articles from the selected issue
  • Y. Goto
    1992 Volume 29 Issue 5 Pages 345-349
    Published: May 25, 1992
    Released: November 24, 2009
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  • Y. Kumamoto
    1992 Volume 29 Issue 5 Pages 350-360
    Published: May 25, 1992
    Released: November 24, 2009
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  • M. Hiroi
    1992 Volume 29 Issue 5 Pages 361-363
    Published: May 25, 1992
    Released: November 24, 2009
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  • Kazutomo Imahori, Hajime Orimo
    1992 Volume 29 Issue 5 Pages 364
    Published: May 25, 1992
    Released: November 24, 2009
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  • Daisaku Maeda
    1992 Volume 29 Issue 5 Pages 365-367
    Published: May 25, 1992
    Released: November 24, 2009
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    Though Japan is noted for the custom of respect for the elderly, gerontological education is not widely practiced. At present it is only done in the training of several professionals and semi-professionals in health and welfare services for the elderly, i.e., medical doctors, nurses, social workers, and care workers for the disabled and older persons.
    In the training of social workers who are expected to serve as the pivot of a team for psycho-social help and caregiving, gerontological education is given as a part of social work education.
    In schools for care workers for the disabled and older persons that are two-year vocational schools, practical gerontological knowledge and skills needed in the care of the elderly are taught as an important base for their future work.
    In schools of nursing, most of which are two-year or three-year vocational schools in Japan, gerontological education is included as an indispensable component of the curriculum and is being given increasing importance these days.
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  • Yoshinosuke Fukuchi
    1992 Volume 29 Issue 5 Pages 368-371
    Published: May 25, 1992
    Released: November 24, 2009
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    There are 13 academic geriatric departments among 80 medical schools in Japan as of November 1991. The first independent department was established in 1962 at Tokyo University. The undergraduate education program includes lectures in geriatrics (20 hours/year in 11/12 medical schools), bedside teaching at geriatric ward (6/12 medical schools, 66 hours on average per year). The theme of lectures are diverse and incorporate all the three major fields in gerontology: biology of aging, clinical geriatrics and socio-economical aspects of aging society. The postgraduate geriatric education is carried out mainly at university setting and most of the medical schools (83%) accept graduate students who are trained at independent geriatric ward (92%) as well as at outpatient clinics. In 1989, Japan Geriatrics Society started a new certification system by which 687MDs have been temporarily certified in geriatrics. The first examination will be given by the society in 1992 and the eligibility to sit in the examination requires three years geriatrics fellowship after certification in medicine or general surgery. The curriculum proposed by the society shares many items of training in common with those found in north America and in Europe. Some points of suggestions and recommendations were presented for future improvement in the education of gerontology in Japan.
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  • B. Lynn Beattie
    1992 Volume 29 Issue 5 Pages 372-374
    Published: May 25, 1992
    Released: November 24, 2009
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    The undergraduate programs of geriatric education in medical schools across Canada are variable, and there has not been definition of core content or core clinical experience, although these processes are underway. At UBC in June 1990, the first Canadian Summer Institute took place in Vancouver and medical students representing 16 medical schools in Canada attended the week-long program. Students left the program keen to start student interest groups in their schools. Many students were indicating commitment to careers in geriatrics, both clinical and research.
    There is a Certificate of Special competence by examination in Canada, administered by the Royal College of Physicians and Surgeons of Canada. The standards for the program have been in place since 1981, and since 1984 candidates for the examination must have a minimum of two years training in Geriatric Medicine after at least three years training in Internal Medicine. To date, there are less than 75 certified Specialists in Geriatric Medicine in the country.
    The College of Family Physicians of Canada encourages training in care of the elderly during the two-year training program in Family Practice. In some schools (e.g. UBC) at least one month is mandatory. There is a Joint Committee with representatives from the Royal College and the College of Family Physicians making recommendations for geriatric training in Family Practice programs in Canada. The College of Family Practice has elected not to have a program for certification in geriatrics for family physicians.
    Gerontology and geriatrics are being incorporated into undergraduate and graduate curriculae, driven by the demographic imperative. There remains much to be done. Particularly, incorporation of quality research into the academic fold will assist in both the education and clinical efforts.
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  • Gary R. Andrews
    1992 Volume 29 Issue 5 Pages 375-377
    Published: May 25, 1992
    Released: November 24, 2009
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    Courses in Gerontology and Geriatric medicine are now provided in most undergraduate training programs for medical, allied health and social work professionals in Australian Universities. The depth and coverage varies between schools but almost all undergraduate social workers, nurses, medical practitioners and allied health professionals will receive some training and in several cases more extensive optional programs are offered.
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  • John L.C. Dall
    1992 Volume 29 Issue 5 Pages 378-380
    Published: May 25, 1992
    Released: November 24, 2009
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  • Edward L. Schneider
    1992 Volume 29 Issue 5 Pages 381-384
    Published: May 25, 1992
    Released: November 24, 2009
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    Since the confirmation of the Older American's Act (OAA) in 1965, the growth of gerontology and geriatrics, has literally come of age in the United States. Although individual aging courses were offered in higher education prior to passage of the OAA, few gerontology programs had been established. On campuses where gerontology courses were available, they represented electives connected with a pre-existing discipline, such as social work or family studies. However, 1965 was a watershed year for gerontology instruction since it heralded the provision of federal funding support, beginning with that of the Administration on Aging (AoA), to help develop, pilot, and oversee gerontological programs in American institutions of higher learning.
    Initially, instruction was at an undergraduate level, but later gerontology degree programs were established at the master's level, with the first gerontology degree program originating at North Texas State University, in 1967. This program was followed a year later (1968) by a program at the University of South Florida. While funding from AoA began in 1966, funding from other federal agencies (e.g., the Bureau of Health Professions (BHP); the National Institute on Aging (NIA); the National Institute of Mental Health (NIMH), Mental Disorders of Aging Branch; and the Veteran's Administration (VA))-the five agencies that became the basis for a 1984 and 1987 Report on Education and Training in Geriatrics and Gerontology, -did not begin until the mid 1970s.
    The mid 1970s reflected the growing awareness of the demographic shift in America and around the world, particularly in developed nations. Demographers and economists outlined the changing (i.e., aging) nature of societal populations and emphasized the necessity to prepare for the education and training of persons in the fields of gerontology and geriatrics.
    This paper traces the growth of gerontology and geriatrics in the United States. It focuses on the Ethel Percy Andrus Gerontology Center and the Leonard Davis School of Gerontology as a case study in the calibre of programs currently available for educating and training future generations of gerontologists and geriatricians.
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  • Nozomi Arai, Akihiro Hara, Haruo Kaneko, Masanori Umeda, Tatsuo Shirai
    1992 Volume 29 Issue 5 Pages 385-389
    Published: May 25, 1992
    Released: November 24, 2009
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    Recombinant human granulocyte colony-stimulating factor (rhG-CSF) was given in combination with chemotherapy in elderly patients(≥65 years old) with malignant lymphoma, and the therapeutic efficacy and the incidence of side effects were determined. The subjects consisted of 5 males and 8 females with a median age of 74 years. One patient had Hodgkin's disease and 12 had non-Hodgkin's lymphoma. Regarding lymphoma stage, 2 were in stage II, 3 were in stage III, and 8 were in stage IV. The chemotherapy used was COP-BLAM in 8 patients, COP-BLAM III in 2, IMV-triple P in 2, and ACVP-16 in 1. Treatment with rhG-CSF (1.5μg/kg/day) was commenced during or after the 2nd course of chemotherapy when the neutrophil count dropped to≥1, 000/μl, and was continued until the recovery of either the neutrophil or leukocyte count to 10, 000/μl or 20, 000/μl, respectively. The neutrophil nadir in the non-G-CSF group was 367.3±231.6/μl. In the G-CSF group it was 754.6±116.4/μl for the second course, with the difference between the 2 groups being significant (p≤0.05). Also, the following time periods were significantly shorter in the G-CSF group than the non-G-CSF group: 1) the duration of a neutrophil count <1, 000/μl, 2) the duration of fever (≥37.5°C), and 3) the time to recovery from the neutrophil nadir. The side effects were bone pain in 1 patient, fever in 1, hepatic dysfunction in 1, elevation of the LDH level in 1, and elevation of the ALP level in 2 patient. These results suggested that G-CSF was a useful adjuvant therapy for malignant lymphoma in elderly patients, and was also effective for the prevention of infection. However, the incidence of side effects (although none were serious) seemed to be higher than in younger patients. Thus, the optimum dose and duration of treatment require further investigation in the elderly.
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  • Kenji Kuboki, Makoto Sakai, Iwao Kuwajima, Shigeru Maeda, Shin-ichiro ...
    1992 Volume 29 Issue 5 Pages 390-395
    Published: May 25, 1992
    Released: November 24, 2009
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    In order to investigate whether intravenous bolus injection of isosorbide dinitrate (ISDN) is a safe and efficient therapy in aged patients with congestive heart failure, we studied acute hemodynamic effects in 11 patients. Peak effects on preload were observed after 5 to 10 minutes of bolus injection and unloading effects continued effectively for 60 minutes. At peak effect, pulmonary systolic pressure decreased from 50.2±2.6 to 36.2±2.6mmHg (-28.5%, p<0.01) and pulmonary end diastolic pressure decreased from 25.0±2.2 to 18.5±2.1mmHg (-26.0%, p<0.01). Mean pulmonary artery wedge pressure decreased from 23.4±2.2 to 16.0±2.1mmHg (-31.6%, p<0.01). Mean right atrial pressure decreased from 10.5±1.8 to 7.4±2.0mmHg (-29.5%, p<0.01). Blood pressure, heart rate, cardiac index, systemic and pulmonary vascular resistance showed no significant changes. Thus, intravenous bolus injection of ISDN showed a potent vasodilator effects on preload, and may be a safe and useful treatment for aged patients with acute congestive heart failure.
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  • Makiko Kitamura, Kanichi Asai, Fumio Kuzuya
    1992 Volume 29 Issue 5 Pages 396-402
    Published: May 25, 1992
    Released: November 24, 2009
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    The clinical significance of measuring glycated fibrinogen (G Fbg) in plasma was studied using a simple, rapid method for determining plasma G Fbg developed by the authors. This method is based on modified fibrin clot formation for purification of plasma Fbg, and G Fbg was estimated by improved colorimetric fructosamine assay. The values of plasma G Fbg were expressed as glycated polylysine equivalents (μmol/l). In this clinical study, 106 examinees who underwent a screening test for diabetes mellitus (DM) because of glycosuria or hyperglycemia were investigated. According to the WHO diagnostic criteria, they were divided into 3 groups: non DM group (n=35), impaired glucose tolerance (IGT) group (n=31) and DM (non-treated) group (n=40). In addition, healthy controls (n=40) and treated diabetic patients (DM treated) were involved. Plasma G Fbg/Fbg, fasting plasma glucose (FPG), fructosamine and glycated hemoglobin (HbA1c) were also analyzed in subjects of the 5 groups. Non-treated DM patients showed high levels of plasma G Fbg, which were significantly higher than those of any other groups. G Fbg levels in IGT group were significantly higher than those in healthy controls or the non-DM group. Together with a significant positive correlation between G Fbg and FPG, these results indicate that the levels of plasma G Fbg depend on plasma glucose levels. Plasma G Fbg levels also significantly correlated with both fructosamine and HbA1c. When appropriate treatment was started in three poor-controlled DM patients, their plasma G Fbg levels were found to decrease almost in parallel with FPG, suggesting the clinical usefulness of measuring plasma G Fbg for the evaluation of recent blood glucose levels. When diabetic retinopathy was assessed in the DM group (non-treated), the levels of G Fbg or G Fbg/Fbg in the group with retinopathy were not significantly different from those without retinopathy. Whether G Fbg is involved in coagulation or fibrinolysis as a cause of diabetic complications remains to be elucidated. However these results suggest the clinical significance of measuring plasma G Fbg in diabetes mellitus.
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  • Nobuyuki Sugihara, Masunori Matsuzaki, Yukiko Kato
    1992 Volume 29 Issue 5 Pages 403-410
    Published: May 25, 1992
    Released: November 24, 2009
    JOURNALS FREE ACCESS
    The authors assessed the affect of bone calcium metabolism on aortic valve calcification (AVC) in 189 septua- and octogenarians (49 males and 140 females, 81.0±4.4yrs). Both AVC and mitral annular calcification (MAC) were evaluated by two-dimensional echocardiography, and then the degree of AVC was classified into three categories; C-1: calcification seen in one cusp of the aortic valve, C-2: calcification in two cusps, and C-3: calcification in three cusps. Bone mineral content (BMC) of three lumbar vertebral bodies was obtained by quantitative computed tomography using a calibrated phantom. Serum calcium, phosphate, parathyroid hormone, calcitonin, and osteocalcin were also examined within a month. The patients were classified into age-matched five groups in both sexes; Group-C: MAC (-) and AVC (-) (n=79); Group-A1: MAC (-) and AVC (+) with C-1 (n=35); Group-A2: MAC (-) and AVC (+) with C-2 (n=19); Group-A3: MAC (-) and AVC (+) with C-3 (n=15); and Group-AM: MAC (+) and AVC (+) in any cusp (n=42). In males, BMC decreased in the order of Groups-A3 (83±27mg/cm3), -C(67±50), -AM(62±62), -A2 (61±38), and -A1 (59±58), but there was no significant difference between any of the five groups. In females, the BMC in Group-AM (29±24) was significantly less than that in Group-C (48±35) (p<0.05). There was no difference in BMC between Groups-A1 (44±33), -A2 (52±36), -A3 (42±32) and -C. In both sexes, serum examinations showed no significant differences between the five groups. It was concluded that AVC was not related to bone calcium metabolism in either sex, and that there was no significant relation between the incidence of intracardiac calcification and the humoral factors related to calcium metabolism, and furthermore, that AVC might be mainly caused by other factors, such as blood pressure or stress loading.
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  • Ken-ichi Meguro, Tomo Yamaguchi, Chika Doi, Takashi Nakamura, Kiyohisa ...
    1992 Volume 29 Issue 5 Pages 411-415
    Published: May 25, 1992
    Released: November 24, 2009
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    In order to protect against infections in the elderly patients, bactericidal clothes were used. Ninety elderly patients were divided into two groups; the control group and the other group with bactericidal clothes. In period I neither group received particular treatment for three months and in period II only the treated group used bactericidal clothes for three months. The control group in period II used regular clothes throughout. Cause of fever (>37°C) extending more than 10 or 15 days were significantly lower in the treated group than in the control group. It was suggested that the bactericidal clothes reduce infections in elderly patients.
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  • Yoshihisa Matsumoto, Seigo Ueda, Tomio Tsukazaki, Youichi Katou, Shige ...
    1992 Volume 29 Issue 5 Pages 416-422
    Published: May 25, 1992
    Released: November 24, 2009
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    In an 82-year-old female case of endocardial cushion defect (ECD), a systolic regurgitant murmur was heard at the apex, and her ECG showed atrial fibrillation without right bundle branch block or left axis deviation. An echocardiogram demonstrated atrial septal defect (ASD) and a cleft of the anterior mitral leaflet with calcification. She died of refractory congestive heart failure. Autopsy revealed ECD (intermediate type) with mitral and tricuspid cleft, and ASD (ostium primum type, 2.0×1.0cm in diameter). In addition, mitral ring calcification and calcification of the cleft mitral valve was disclosed, causing mitral stenosis in addition to mitral regurgitation due to the cleft mitral valve. This was the second oldest Japanese autopsy case of ECD. We concluded that echocardiographic examinations, including color flow imaging, in aged patients with heart murmur are necessary to confirm the diagnosis of congenital heart disease in the aged.
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  • H. Nogaki, K. Matsumoto, Y. Ohba, M. Morimatsu, Y. Fukuoka
    1992 Volume 29 Issue 5 Pages 423-425
    Published: May 25, 1992
    Released: November 24, 2009
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  • H. Nogaki, M. Morimatsu
    1992 Volume 29 Issue 5 Pages 426-427
    Published: May 25, 1992
    Released: November 24, 2009
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  • 1992 Volume 29 Issue 5 Pages 428-438
    Published: May 25, 1992
    Released: November 24, 2009
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