Purpose: The present study aimed to determine the problems of the Japanese version of the Center for Epidemiologic Studies Depression (CES-D) scale when applied to Japanese independent community-dwelling elderly focusing on its factor structure. Methods: The subjects were 1791 community-dwelling independent elderly aged 60 and over (848 males and 943 females). This study used the Japanese version of the CES-D scale to assess depression in the elderly. Results: From the results of an exploratory factor analysis, the four factors of somatic symptoms, depression affect, positive affect and relation with others were interpreted. These factors were the same as those in the previous study, but the items making up each subscale differed. Therefore, the construct validity of each subscale was not necessarily assured. In the confirmatory factor analysis, goodness-of-fit was high for both the first and second-order factor models. In examining the validity by Akaike's information criterion (AIC), the second-order factor model assuming depression as a higher-order factor among the four factors was a better fit than the first-order factor model. Although the reliability of each subscale was not sufficient, adequate reliability was assured in the total scale. Conclusion: An assessment of depression using the Japanese version of the CES-D scale should be conducted using the total score, while a re-examination of items making up each subscale is needed.
Japanese language ; 2-Chloroethyl 2-(4-1,1-dimethylethyl) phenoxy-1 methylethyl ester ; Upper case dee ; Elderly ; Cancer patients and suicide and depression

The purpose of this study was to clarify the application range and utility of an ADL index for disabled elderly people (Demura et al., 2000), by examining the ADL characteristics of an elderly population when this index was applied to disabled and independent elderly people. Subjects of this study were 697 Japanese institutionalized disabled elderly people and 482 independent elderly people (ID) living at home. Disabled elderly people were classified into four groups based on conditions of use of assisting devices for movement; D1 did not use assisting devices; D2 used a stick or a walker; D3 used a wheelchair; D4 was immobile. From the findings of comparing achievement proportions, ADL score and the distribution of total score among elderly groups, it was suggested that this ADL index can assess gradually from disabled elderly people who cannot move to independent elderly people. Since this index classifies independent elderly people and disabled elderly people with high probability, it can evaluate if elderly people can maintain a functional level needed for independent living, and can recognize the symptoms of disability. Furthermore, this study proposed useful activities to discriminate the functional level for each elderly group. Although it is important to comprehensively assess ADL ability, further use of this ADL index to discriminate the functional level of an elderly population, by making use of these useful activities, is expected.
Elderly ; Activities of Daily Living ; Disabled Persons ; Persons ; livin

A 68-year-old female who had suffered from lumbar vertebral fractures due to osteoporosis six years before was admitted to our hospital because of thoracodorsal pain of an unknown origin, and systemic contact dermatitis, on November 2000. The patient had been forced into a bedridden state due to severe pain. A bone scintigram showed multiple high accumulations in the thoracispinal region, but malignant disease could not be detected. Furthermore, a MRI demonstrated multiple thoracolumber vertebral compression fractures. Keishi-bushi-to was administered to control severe and superficial pain, and the presence of cold limbs. Pain was gradually diminished and the patient could be started on rehabilitation one month after treatment. Furthermore, several Kampo formulas, such as Ogi-kenchu-to, Keikyososo-oshinbu-to and Hachimi-jio-gan were administered on the basis of pain and skin condition. In the end, the patient could stand up with support eleven months after treatment.
Based on this experience, it is suggested that Keishi-bushi-to may be an effective treatment for severe pain arising from multiple fractures with osteoporosis.

Objective: Many studies on patient satisfaction are conducted in community pharmacies.  In contrast, the present study assess the community pharmacy function and to the best of our knowledge, appears to be the first to evaluate the professional functions of pharmacists.
Methods: In September 2010, in 1 week, we conducted a survey that focused on pharmacists’ professional abilities.  I subjected the responses to factor analysis and covariance structure analysis.
Results: We obtained 2,506 effective responses (appropriately completed and returned questionnaires) of the 4,633 questionnaires originally distributed.  Data of seven dimensions were obtained for factor analysis.  In all, the various information provision services rendered by a pharmacist were not significant.  According to the covariance structure analysis, “safety” (a pharmaceutical management item) and “responsiveness” (a complimentary element) were significant factors.  Differences in the degree of influence were confirmed for each parameter in the analysis, depending on the parameter.  In addition, the information provision services were significant during the acute period.
Conclusion: Because the information provision services were not significant, the influence of “asymmetric information” warrant further analysis according to the specialty.  I believe that it is necessary to examine asymmetric information in greater detail in the future.  In addition, I think that an interventional study that is based on these results is also necessary.

Objectives: This study aimed to determine the activity groupings reflecting functional characteristics required in daily life for the institutionalized dependent females in the old-old elderly group, by examining the interrelationships of activities based on actual achievement characteristics. Methods: The participants were 697 dependent elderly living at welfare institutions in Japan and 344 old-old females were used for analysis. Factor analysis, based on Promax with the Kaiser Normalization method, was conducted using 74 activities of daily living (ADL) items to determine activity groups. Furthermore, whether each activity group could be classified into sub-groups was confirmed by applying factor analysis to the activities consisting of each activity group. Results: Four activity groups of lower extremity activities, manual activities, changing and holding posture activities, and upper extremity and dexterous manual activities were interpreted. Except for the manual activity group, these activity groups were classified into two sub-groups. Conclusions: These activity groupings were characterized by similarities of the body parts used in achievement and the difficulty of activity. The activity groupings obtained in this study are considered to be useful in ADL assessment focusing on evaluating functional characteristics of the dependent elderly.
Elderly ; Old episode ; Manuals ; livin ; g <3>

Age and gender differences in ADL ability were investigated using 568 Japanese partially dependent older people (PD, Mean age=82.2 ±7.76 years) living in welfare institutions. The subjects were asked about 17 ADL items representing 7 ADL domains by the professional staff working at subjects’ institutions. Each item was assessed by a dichotomous scale of “possible” or “impossible”. Item proportions of “possible” response were calculated for gender and age groups (60s, 70s, 80s and 90s). Two-way analysis of variance (ANOVA) using the arcsine transformation method indicated no gender differences. Significant decreases in ADL ability with aging were found in 13 of the 17 items. The dependency of ADL in the PD significantly increases with aging, and there is no significant difference in this trend between men and women. The dependency of more difficult activities using lower limb increase from the 70s, and independency of low-difficult activities such as manual activities, feeding and changing posture while lying is maintained until the 80s and over.
Activities of Daily Living ; Ability ; Gender ; PUPILLARY DISTANCE ; age differences

Objective: As a “family pharmacy and pharmacist,” high-quality medical service is demanded.  Many patient satisfaction investigations are performed to evaluate community pharmacies, but it has been impossible until now to do so using an improvement index of the medical quality.  Therefore, I investigated the influence and evaluation structure of two evaluation concepts regarding quality of medical service and patient satisfaction and intention to use again, which becomes the important key as a “family” pharmacy.
Methods: I used anonymous patient survey data gathered for the purpose of duties improvement in July 2009.  I subjected the responses to factor and covariance structure analyses.
Results: Dates for four dimensions were obtained for factor analysis.  As a whole, covariance structure analysis showed that, in terms of privacy and only for service quality, entertainment primarily influenced satisfaction.  The ingestion instruction had a big effect on both sides.  General satisfaction was also substantially influenced by service quality.  The difference in influence degree was confirmed at each parameter.
Conclusion: It was found that not only satisfaction but also quality of service were equally demanded in community pharmacies.  It is necessary to increase these because most are influenced by ingestion instruction as a factor in service quality.  However, future investigation is necessary to clarify the detailed ingestion instruction contents.

OBJECTThe purposes of this study were to investigate the actual status in subjective symptoms of fatigue (SSF) and lifestyles of young male students living in two different life spheres of the Tokyo metropolitan area and a rural area, and to find, regional differences in these characteristics and relations between SSF and lifestyles in school life.

METHODSA questionnaire regarding SSF and lifestyle was administered to 412 healthy male students (16-18 yr) attending the two National Colleges of Technology located in the Tokyo metropolitan area (MA) and a local city (LC). Statistical techniques such as a chi-square test and Hayashi's Quantification Theory I analysis were used to examine relations between SSF and lifestyles.

RESULTS AND CONCLUSIONA significant difference was found only in "feeling of physical disintegration,", and the MA group was higher than the LC group. The MA students showed shorter sleeping hours and earlier awaken time compared with LC students. In the relations between SSF and lifestyles, sleeping habit was an important factor significantly relating to SSF in both groups. Paying attention to good sleeping habits is an important countermeasure for preventing SSF in the male students.

PURPOSEThe present study aimed to determine the problems of the Japanese version of the Center for Epidemiologic Studies Depression (CES-D) scale when applied to Japanese independent community-dwelling elderly focusing on its factor structure.

METHODSThe subjects were 1791 community-dwelling independent elderly aged 60 and over (848 males and 943 females). This study used the Japanese version of the CES-D scale to assess depression in the elderly.

RESULTSFrom the results of an exploratory factor analysis, the four factors of somatic symptoms, depression affect, positive affect and relation with others were interpreted.These factors were the same as those in the previous study, but the items making up each subscale differed. Therefore, the construct validity of each subscale was not necessarily assured. In the confirmatory factor analysis, goodness-offit was high for both the first and second-order factor models. In examining the validity by Akaike's information criterion (AIC), the second-order factor model assuming depression as a higher-order factor among the four factors was a better fit than the first-order factor model. Although the reliability of each subscale was not sufficient, adequate reliability was assured in the total scale.

CONCLUSIONAn assessment of depression using the Japanese version of the CES-D scale should be conducted using the total score, while a re-examination of items making up each subscale is needed.

A study was conducted to examine sex differences in subjective symptoms of fatigue in men and women with reference to the experience of awareness and cognitive appraisal based on symptom of fatigue content. A total of 54 questionnaire items were administered to 730 people (290 men and 440 women) . The subjects indicated whether or not they were aware of the content, and to what degree the content of the question for each item was important. Sex differences in the response to the ratio of awareness and the degree of importance were then. The mean importance scores for subjective symptoms of fatigue in men and women were 3.9-5.4 and 4.5-5.6, respectively. It was found that a majority of the men and women showed awareness of each item. A significant difference was recognized in the factor of awareness in all items as a result of two-way ANOVA of the degree of importance by which the presence of awareness and its sex difference were assumed to be factors, and those who were aware deemed the degree of importance high. On the other hand, the 28 items for which a significant sex difference was recognized showed a high value, and there was a marked content of Languor, Loss of Vigor, and A Feeling of Impatience and Physical Disintegration in women. In the same items, it was inferred that persons who were more aware than the persons who were not aware regarded subjective symptoms of fatigue as important. Most items in which a main effect of sex was recognized were content of Loss of Vigor and a Feeling of Impatience and Physical Disintegration. It was thought that women considered these symptoms more important than men. The sex difference in symptoms of fatigue was inferred to be due to the difference in the level of acknowledgment based on experienced knowledge.