Lifestyle-related diseases among the elderly have been brought to light by many investigaters. However, it remains unclear whether age-related frailty in the basic activities of daily living (ADLs) affects mortality independently of lifestyle. To clarify the relationship of lifestyle and frailty to elderly mortality, we conducted a three-year prospective study on 66 elderly people with reduced vital functions newly certified as requiring nursing care (frail elderly) and 72 elderly people living on their own (independent elderly) in Unnan City, Shimane Prefecture. The mortality rate for the frail elderly tended to be higher than for the independent elderly. However, this difference was not statistically significant. Gender was the only factor related to mortality in the frail elderly, who had advanced frailty. Furthermore, mortality rates were significantly higher for men than women. No relationship was observed between lifestyle and frailty. In the independent elderly, smoking and unstable gait, respectively, were significantly related to mortality. The present findings indicate that lifestyle and frailty are independently related to elderly mortality.

Methods of writing a scientific paper and forming a working hypothesis were lectured. The concept mapping method has the possibility of evaluating learners' organization of knowledge in research. We tried an application of concept mapping to the research process of nursing. Concept mapping would clarify the conceptual framework, and develop research ability and problem-solving capability.
concept ; Research ; Investigations ; Nurses ; Lower case dee

  A long-term care insurance law was enacted in 2000 for the purpose of socializing elderly care. Since then, the Japanese government has come to shoulder an unexpected financial burden because of a large increase in the number of the slightly frail elderly. Based on the need of frail elderly individuals, five care levels were established by the insurance law. Predictive factors for changes of the care level of such individuals are not yet clear. We conducted an analysis of the relationship between changes of care levels of frail elderly people residing in Izumo City, Shimane, and such factors as gender, age, activity of daily life (ADL) and care services utilization, in a cohort study of 1,965 certified elderly individuals in 2000, and of 2,547 such individuals in 2002. We arbitrarily set the care levels into three categories:maintenance/improvement, deterioration, and death; we then tracked the care levels of each cohort over a two-year period. At the end of 2-year tracking, 39.9% of the 2000 cohort were in the maintenance/improvement level, 37.7% in deterioration and 22.4% had died; for the 2002 cohort, the results were 51.8%, 25.8% and 22.5%, respectively. The elderly in all care levels in the 2002 cohort, especially those with the higher ADL (support necessary and care level 1), improved their ADL but showed no significant differences in death rate, compared with the 2000 cohort. The certification method of care level for long-term care did not substantially change between 2000 and 2004. The improvement of care level change in the 2002 cohort was not related to either level of care or dementia, or to utilization rates of services at home. Therefore, the attitude of the users of services and the quality of home care may have contributed to the improvement of care levels from 2000 to 2002.

Objectives: Despite the increasing utilization of in-home services, the assessment of in-home services used by those that have certified levels of care needs has been limited to the actual changes in individual outcomes. The purpose of the present study was to determine factors affecting how the utilization of in-home services could have sustained and/or improved or deteriorated the care needs levels of frail persons. We also examined the effect of in-home services used in the lower level of care needs subgroup and the higher level of care needs subgroup during a two-year period.
Subjects and Methods: We used longitudinal data from Izumo City of those individuals with certified levels of care needs to analyze the changes in care need levels in Izumo City between 2002 to 2004. In 2002, 2,651 persons had certified levels of care needs. All permanent residents of care facilities, at care needs level 5 in 2002, those who died since 2002 and people who could not be traced during the two-year follow-up period were excluded. The remaining data from 1,788 frail persons were ultimately analyzed. We arbitrarily divided the changes in care needs levels into two categories: sustained/improved and deteriorated. The care needs levels were also stratified into a lower level of care needs subgroup and a higher level of care needs subgroup at the baseline. Simple statistical analysis and binary logistic regression analysis were used to analyze factors that were thought to be related to in-home service utilization data to predict changes in care needs levels.
Results: Approximately 63.3% of the respondents had a sustained or improved care needs level, and 36.7% of the respondents showed deteriorated of care needs levels. In the lower level of care needs subgroup, utilization of home help/bathing (OR=2.59) was associated with significant sustained/improved care needs levels. In the higher level of care needs subgroup, day care service (OR=0.90) and short stay services (OR=0.87) were significantly related to deteriorated care needs levels, respectively.
Conclusions: This study shows that home help/bathing care in the lower level of care needs subgroup was a significant predictor of sustained/improved levels of care needs for frail persons but that short stay services and day care services in the higher level of care needs subgroup have a negative impact on sustained/improved levels of care needs. Our results suggest that utilization of home help services can prevent deterioration of these levels of care needs in frail persons.

On effects of various organophosphorus insecticides such as chlorfenvinphos (phosphate type), EPN (phosphonothionate type), fenitrothion (phosphorothionate type) and mecarbam (phosphorothiolothionate type), and carbaryl (carbamate) on serum pseudocholinesterase, serum nonspecific esterase, serum lipoprotein lipase, adipose tissue lipase and epinephrineinduced lipolysis, this investigation was caried out in vitro. The results were as follows;
1. These insecticides caused a dose-dependent inhibition of serum nonspecific esterase activity as well as serum pseudocholinesterase. Chlorfenvinphos exhibited the strongest inhibition of serum pseudocholinesterase, but severe inhibition of serum nonspecific esterase was recognized carbaryl rather than chlorfenvinphos.
2. Carbaryl and fenitrothion caused slight stimulation of the serum lipoprotein lipase activity with addition of 10^-5 M, but inhibited this enzyme with 10^-3 M of these insecticides
3. Addition of ^10-3 M of these insecticides caused inhibition of adipose tissue lipase in lipolytic system using ediol as substrate. These insecticides also inhibited epinephrineinduced lipolysis as well as inhibition of the adipose tissue lipase.
4. On the base of these findings, it was suggested that these insecticides caused the inhibition of lipolysis by direct suppression of adipose tissue lipase without reference to cAMP dependent proteinkinase.

Some fragments of gravid proglottids of diphyllobothriid cestodes were evacuatedspontaneously, and complete strobila with scolex was expelled after the treatment with bithionol from a 35-year-old man in Ehime Prefecture, Where diphyllobothriasis has scarcely been recorded. The cestodes was identified as Diphyllobothrium latum by the following morphological characters: thin, weakly muscled strobila, with clavate scolex: distal end of uterus extending posteromediad to uterin pore, forming an acute angle with ventral surface of segment, genital pore and uterine pore widely separated; vagina turning abruptly ventrad just ventral to seminal vesicle, forming an angle of near 60°; there is a constriction between segments and often an area without testes and vitellaria; ovary with no anterior horns seen; the smooth surface of the egg-shell with shallow and widely spaced pits (scanning electron micrograph)

  Recently, the deficiency of emergency care system has become a social issue by the decline in the number of emergency hospitals due to the shortage of doctors in Japanese rural communities. Although the number and distribution of doctors were taken into account when secondary-medical care areas were designated, real transportation time required to reach the emergency hospitals has not been considered enough. The main objective of this study was to clarify the characteristics of accessibilities to emergency hospitals by secondary-medical care sectors in Shimane Prefecture, excluding islands, using a Geographical Information System. We categorized areas within 3 min., 10 min., and 30 min. transportation time to evaluate the accessibility to emergency hospitals by calculating the population of each area. The western areas of Shimane such as Ooda, Masuda and Hamada had a higher proportion of residents with over 30 minutes of transportation time than the eastern parts. This result indicated that there was a disparity in terms of accessibility to emergency hospitals between the eastern and western parts of Shimane Prefecture. Furthermore, we estimated that residents in the Ooda area were forced to take longer transportation time after the closure of the Ooda City Hospital emergency unit. Our study suggested that not only the discussion of healthcare resources but also the consideration of accessibilities to emergency hospitals in a region was important for the planning of health and medical service.

Recent changes in social needs and the health care system have prompted the development of new teaching strategies and methods in which active learning by students in small groups is emphasized. We created an “early exposure” training program to enable freshman medical students to obtain practical experience at medical and welfare institutions. This program was designed with the following features 1) student-centered and self-directed learning, 2) integrated education for knowledge, skills, attitude and ethics, 3) training in communication skills, and 4) tutor-assisted and small-group discussion. Tutors were recruited from basic medical science departments. In a self-evaluation survey, 92% of students found this early exposure training to be excellent or good. Most students achieved improvement in communication skills, attitude and ethics among the educational objectives. However, a few students did not fulfill any objectives, and thus we should consider further improvements in the tutorial system.

　　This study aimed at clarifying the effects of intervention with the composite Dementia Prevention Program. Subjects were 46 elderly people who had participated in the program. The study method included intervention trials to test the effects on the changes in BMI, physical function, and cognitive function of the program participants before and after the trial. Those aged 75 and up (old-old participants) had significantly stronger grip strength before the intervention than those below the age of 75 (young-old participants), but there was no difference in cognitive and physical functions between old-old and young-old participants. The average number of steps taken in the young-old group had significantly increased from approximately 4,000 steps before intervention to approximately 7,000 steps after intervention. When it comes to physical functions, the time taken for the 5-m walking exercise was significantly shortened from 3.8±0.8s to 3.5±0.5s in the young-old subjects; a change from 3.5±0.8s to 3.7±1.0s was observed for TUG in the young-old subjects and from 4.1±1.0s to 3.6±1.0s in old-old subjects. As regards cognitive function, episodic memory of the young-old subjects improved significantly, from 47.9±7.5 points before intervention to 56.5±8.8 points after intervention. The improvement in the old-old subjects was gradual. Episodic memory was improved without bearing on the changes shown in the 5-m walking tests (β＝-0.751, p＝0.020). The physical functions and episodic memory in cognitive function had both improved. This study suggested early intervention could increase the dementia prevention effect.