[in Japanese]

View full abstract

Purpose This study was conducted to examine age-related differences in cognitive function, and their relation to higher-level competence of elderly living in an urban community.
Method Participants were 438 individuals (males 168, females 270) aged 70 to 84 years living in an urban community in Tokyo. Three cognitive performance tests, the Wechsler Adult Intelligence Scale-Revised (WAIS-R) Digit Symbol, Word Fluency Test, and the WAIS-R Digit Span, were employed for estimating cognitive function, and the TMIG Index of Competence for measuring higher-level competence. In the Index, three constructions: “Instrumental Self-Maintenance”, “Intellectual Activity”, and “Social Role” were involved.
Results and Conclusions Age-related differences in the cognitive tests were analyzed using ANCOVA controlling for educational year. Age-related differences between younger elderly (70-79 years old) and older elderly (80-84 years old) were observed with the WAIS-R Digit Symbol, Word Fluency Test and the WAIS-R Digit Span. The results indicate that information processing speed, executive function and primary memory in community-dwelling elderly continue to decline in old age, and this trend is salient in the old-old.
 We carried out partial correlation analysis and multiple regression analysis for exploring the relationships between cognitive function and the sub-scales in the TMIG Index of Competence, controlling for age and educational year. Cognitive function was significantly and positively related with the sub-scales in the Index, this being especially robust for “Intellectual Activity”. The results suggest that higher-level competence can be modestly determined with reference to cognitive function, and “Intellectual Activity” may have a stronger relation with cognitive function than the other two sub-scales in the Index.

View full abstract

Objective In Japan, a long term care insurance system for elderly people was introduced in April, 2000. We have conducted a survey using a questionnaire in order to explore consequent changes in community health and welfare services.
Methods We sent questionnaires to all municipal goverments (671 cities, 1,991 towns, 567 villages and 23 wards) in Japan in November, 2001, and obtained replies from 441 cities (response rate: 65.7%), 800 towns (40.2%), 197 villages (34.9%), and 16 wards (69.6%). The questionnaire included questions concerning the budget and manpower for community health and welfare services, the state of the long term care insurance system, and the activities of public health nurses.
Results A total of 57% of all municipal governments was found to be carrying out the long term care insurance program in collaboration with other governments. In order to clarify the changes in welfare services for elderly people from the budgetary viewpoint, we calculated the ratios of the 2000 and 2001 fiscal budgets applied for welfare services for elderly people, in comparison with the 1999 fiscal year. The budgets for elderly people declined to about 40% in 2000 and 2001 compared with 1999, since the budget for care services was transferred to the account of the long term care insurance system. The activities of public health nurses employed by municipal governments were not affected by the introduction of long term care insurance system. About 80% of all municipal governments suggested that both the amounts of care services received by each elderly people and the number of elderly people who received care services were increasing, and about 70% indicated that the quality of care services was improved with introduction of the long term care insurance system.
Discussion Most municipal governments consider that introduction of the long term care insurance system has had a good influence on community health and welfare services. Moreover, our results suggest that the long term care insurance has a beneficial impact on care services themselves.

View full abstract

Purpose The purpose of this study was to clarify environmental conditions determining the social activities of the elderly, by analyzing levels of activity in individuals belonging to clubs for senior citizens.
Methods In 1998, we conducted a surver of over 10,000 elderly subjects, 65 years of age or older, who belonged to 228 clubs for senior citizens in a region of Saitama Prefecture, using a ‘Check list’ developed for self-evaluation of social activities. The proportions of ‘active’ and ‘inactive’ seniors, as judged by the ‘Check list’ for each of the four different aspects of social activities (1. individual activities, 2. social participation/volunteering, 3. education/training, 4. employment), were compared with those of the standard elderly population.
Results Two hundred and seven clubs for senior citizens (90.8%) participated in this study. About 82.0% of the members of each club filled out the ‘Check list’. High levels as compared to the standard population were demonstrated for two aspects of social activity: individual activity and social participation/volunteering. Women had higher levels of both types of social activity than men. Men aged 74 years or younger had lower than average levels for three aspects of social activity: social participation/volunteering, education/training, and employment. Members who resided in urban areas with easy access had higher levels of individual activity, social participation/volunteering and education/training. On the other hand, those residing in suburbs with large spaces for agriculture had higher levels for employment.
Conclusion Our results for social activities of elderly subjects belonging to clubs for senior citizens indicate that strong correlations exist with environmental conditions, including communication facilities and local or industrial structure.

View full abstract

Objectiveds According to recent changes in the prevalence of diseases and innovations in medical technology, the requirement for blood products and blood plasma fractions has increased dramatically in Japan. The difficulty in meeting demands is making resort to importation of blood products from other countries necessary. Hokkaido, the prefecture with the highest consumption of blood products, uses 10 times more albumin than that of the lowest blood consumer, Kouchi, This study analyzed the factors, underlying these differences in albumin consumption between prefectures, to provide pointers to meet most appropriately blood products utilization.
Method The questionnaire regarding management of blood products, total amount of consumption of blood products, sex, age and diagnosis of patients, examinations of albumin concentrations in the blood before and after the use of albumin product, operations etc. was distributed to 8,334 medical institutes, collected and analyzed.
 We divided all 47 prefectures into 4 groups, according to albumin consumption amount, and compared factors for 45-84 year old patients.
Results The results showed the proportion of patients with the top 20 diseases to be significantly higher in the highest albumin consumer group than in the others.
 In addition, the percentage of non-examinations of albumin concentrations in the serum before and after the use of albumin products was significantly higher in the highest albumin consumer group. Furthermore, the concentrations of albumin in the serum both before and after their application were significantly higher in the highest albumin consumer group than in the others. There was no significant difference in bed usage among the groups.
 Comparison of the results for the 4 groups indicated that the use of albumin in cases of liver fibrosis, cirrhosis, hepatoma and gastric cancer may have a spcial impact on the total consumption of albumin per person. Albmin may be used in the highest albumin consumer group without sufficient consideration for the shortage of albumin products.
Conclusions There are some factors causing difference in albumin consumption among prefectures, such as whether or not albumin concentrations in the blood are examined before and after the usage, The importance of adopting measures to assure appropriate consumption of albumin clearly needs to be emphasized.

View full abstract

Purpose There is still uncertainty whether flatfoot, characterized by lower height of the medial longitudinal arch of the foot, is associated with foot symptoms in adults. Furthermore, few studies have been conducted to examine any association with obesity in older people. In this study, we therefore assessed the prevalence of flatfoot among community-dwelling older men and women using a footprint method, and analyzed relationships with foot symptoms and obesity.
Methods The study sample consisted of 242 women and 98 men aged 60 years or older who were neither institutionalized nor disabled in activities of daily living. We collected footprints of both feet, data on weight and height, and information on foot symptoms and daily activity. From the footprints, we identified the H line by connecting the tip of the second toe and the intersection of the internal surface tangent of the foot and the external one. Then flatfoot was defined as concavity of the medial arch situated medial to the H line in either foot. Foot symptoms (pain and fatigue) were assessed using a 3-scale questionnaire: no pain (fatigue); present only when walking or standing; or present anytime. If present, the place of the pain or the fatigue was further identified. We analyzed associations with these symptoms and also with obesity assessed in terms of the body mass index (BMI).
Results We identified flatfoot in 26.5% (95% Confidence Interval: 22.0-31.0) of the men and 25.7% (95% Confidence Interval: 20.2-31.2) of the women. In both sexes, the affected individuals had a higher prevalence of foot pain and fatigue than those unaffected. The association with the latter in women was particularly significant. There was a linear association between prevalence of flatfoot with the BMI category in women. In addition, the prevalence was lowest in the least obese category in men although this did not reach statistical significance.
Conclusions Flatfoot was significantly associated with the presence of pain and fatigue in women. Furthermore, a significant positive association with obesity was noted.

View full abstract

 In order to investigate the implementation about pharmacy services focusing on home care and to identify differences in functional characteristics in accordance with pharmacy location, questionnaire surveys were conducted on all 75 pharmacies belonging to T-City Pharmaceutical Association in a suburban area and on all 161 belonging to K-Ward Pharmaceutical Association in a central downtown district. Using data, a principal component analysis was performed. The following services were investigated: medication guidance for patients and their families; provision of drug information to patients; management of patients' drug history; dispensing; advice to physicians; inquiries; management of presciptions for home infusion services; sales of items such as over-the-conter [OTC] drugs [commercially available drugs that do not require a physician's prescription]; display and catalogue sales of nursing items; consultation on home care; holding events such as health education programs; guidance for drug management by home visits; and information exchange with other medical professionals and social workers.
 The results of these surveys were as follows. (1) The following services were regularly performed in both urban and suburban areas: medication guidance for patients and their families; provision drug information to patients; management of patients' drug history; dispensing; advice to physicians; inquiries; and sales of OTC drugs. (2) The following services were not dufficiently regularly performed in both areas: display and catalogue sales of nursing items; consulation on home care; holding events such as health education programs; guidance for drug management by home visits; and information exchage. (3) As to principal component analysis, pharmacy functions were divided into 3 components and the dispensing service strongly influenced the functional characteristics in T-City. Whereas, in K-Ward, pharmacy functions were divided into 4 components and consulation and information exchange were strong influences. (4) Home care-relate pharmacy services were closely associated with information exchange on both areas. This implies that enforcing information exchange among pharmacists and other health practioners and social welfare practitioners is an essential factor to expand implementation of home-care related pharmacy services.

View full abstract

Purpose The purpose of this study was to determine health problems of citizens of the city of Obihiro with reference to the Healthy Japan 21 plan.
Method The subjects were a total of 2,000 men and women (6-74 years old) who were selected at random from the resident ledger of Obihiro. The questionnaire included the 6 fields (nutrient intake/dietary habits, physical activity/exercise, rest/mental health, tobacco, alcohol, dental health) of Healthy Japan 21. The path-analysis model was used by sex, in order to examine the relationship between lifestyle factors (dietary habits, restful sleep, stress, smoking habits, alcohol intake) and subjective health.
Results A total of 979 subjects (49.0%) responded. The items that showed a higher proportion than for all Japan were as follows: the proportions of persons who felt stress, required a drug or alcohol to sleep, drank heavily, and were female smokers. In questions about the harm caused to health by smoking, the following items showed lower awareness than deserved: bronchitis, gastric ulcer, problems with regard to pregnancy, and periodontitis.
 The following characteristics were found in the path-analysis: 1) If sleep rest is sufficient, subjective health is unaffected by stress in men and women; 2) Smoking affects dietary habits in men and women, especially in the latter; 3) Heavy smoking affects subjective health in men and women independent of whether dietary habits are good; 4) There is a positive relation between drinking and subjective health in women.
Conclusion This study showed that stress and smoking are problems for the health of citizens of the city of Obihiro, and suggested that the best measure to counter stress is sufficient sleep, while to counter smoking spread of knowledge about the harm to health caused by smoking is best.

View full abstract

Purpose The purpose of this study was to determine airborne fungal concentrations in dwellings and to evaluate the relationship between indoor air concentrations of fungi and those of indoor air pollutants, temperature and relative humidity.
Methods Indoor and outdoor concentrations of total fungi, xerophiles (xerophilic fungi), indoor air pollutants such as formaldehyde, nitrogen dioxide, carbon dioxide, carbon monoxide, temperature and relative humidity were measured in 54 dwellings in Nagoya, Japan. This study was performed in summer and winter from 1995 to 1998. The airborne fungal concentrations were analyzed using a pinhole air sampler and dichloran 18% glycerol agar (DG18), and compared with the levels assessed with potato dextrose agar (PDA).
Results 1. DG18 can be recommended as an excellent medium for determining viable fungi concentrations in indoor air.
 2. In indoor air, geometric means of total fungal and xerophile concentrations in summer were 237-301 CFU/m³ and 24.1-26.8 CFU/m³, as compared to 78.7-87.5 CFU/m³ and 18.2-29.5 CFU/m³, respectively, in winter. In outdoor air, geometric means of total fungal and xerophile concentrations in summer were 208 CFU/m³ and 9.2 CFU/m³, and 72.7 CFU/m³ and 10.1 CFU/m³, respectively, in winter.
 3. The predominant genera in indoor and outdoor air were Cladosporium spp., followed by Penicillium spp. and Aspergillus spp.. The major Aspergillus spp. was A. restrictus.
 4. Indoor as well as outdoor air concentrations of total fungi were significantly higher in summer than in winter (P<0.01), whereas differences in total fungal concentrations between indoor and outdoor air were not. Airborne xerophile concentrations in summer and winter were significantly higher in indoor air than in outdoor air (P<0.01), while indoor as well as outdoor air xerophile concentrations in summer were similar to those in winter.
 5. The total fungal and xerophile concentrations were not dependent on dwelling factors such as the type of dwellings, the type of flooring materials and the use of air-conditioners and/or heaters.
 6. The total fungal and xerophile concentrations were not significantly correlated with the concentrations of all the indoor air pollutants. In winter, the total fungal and xerophile concentrations significantly increased in proportion to the average relative humidity (P<0.01).
Conclusion The total fungal concentrations in indoor air were significantly correlated with those in outdoor air, while xerophile concentrations were not. The indoor air concentrations of total fungi and xerophiles were not dependent on those of indoor air pollutants.

View full abstract