Purpose: We examined the safety and efficacy of cataract surgery and postoperative management in our hospital and at the homes of the patients who live on medically underserved remote.
Patients and methods: A total of 27 patients (54 eyes), who were followed in our hospital or at their homes were enrolled in this study. Cataract surgery was performed on them between January 2009 and January 2010 and we could follow up six months postoperatively. We divided these patients into two groups:group I (GI) consisted of 13 patients who could come to our hospital regularly during both preoperative and postoperative periods, and group II (GII) consisted of 14 patients who could not come to our hospital regularly during either preoperative or postoperative periods. Cataract surgeries were performed on all the patients in GI and GII in our hospital. The patients in GI were hospitalized for three days and those in GII were for seven days. After cataract surgery, the patients in GI had their eyes checked regularly in our hospital and those in GII were in their homes where the doctor visited. Postoperative ophthalmic clinical tests were conducted to examine visual acuity, intraocular pressure and fundus.
Results: GI comprised three males and 10 females. Their age averaged 79.3. GII comprised four males and 10 females. Their age averaged 82.6. Preoperative ophthalmic examinations found that preoperative average visual acuity (LogMAR and decimal visual acuity in parentheses) and spherical equivalent in GI and GII were 0.69 (0.41), 0.80 (0.33) and -0.43 dioptors, -0.42 dioptors respectively, showing no significant differences between the two groups. Postoperative ophthalmic examinations found that, best corrected visual acuity (LogMAR) was significantly increased to 0.36 (0.66) and 0.44 (0.53) in GI and GII respectively, showing no significant differences either.
Conclusions: We concluded that we could get safe and efficient cataract surgery and postoperative management combined with prolonged hospitalization and house calls on the patients who live in the isolated islands.

 The effects of bathing in a solution of artificial bath additive including inorganic salts and carbon dioxide (CO2-bathing: 41°C, 10 minutes; the concentration of carbon dioxide was 160-180 ppm, and that of inorganic salts was about 64 ppm) on the cardiovascular system, body flexibility, muscle stiffness and the subjective feeling of bathing were compared with those of no bathing and plain water bathing in the healthy subjects.  The deep body temperature and skin blood flow increased after bathing, and the increases after CO2-bathing were significantly greater than those after plain water bathing. Body flexibility after CO2-bathing was similar to that of no bathing and plain water bathing.  Stiffness of the trapezius muscle was decreased at both 15 min and 30 min after CO2-bathing and plain water bathing, with no change in no bathing. The changes at 15 min after CO2-bathing and plain water bathing were statistically significant. Stiffness in the latissimus dorsi muscle decreased at both 15 min and 30 min after CO2-bathing and plain water bathing, with no change in no bathing. However, only these changes at 15 min and 30 min after CO2-bathing were statistically significant.  A large decrease in the stiffness of the trapezius muscle by its isometric contraction was observed during both CO2-bathing and plain water bathing, and the decrease after CO2-bathing was greater than that after plain water bathing. These changes did not reach statistical significance.  Improvements in subjective feeling of bathing were observed after both plain water bathing and CO2-bathing. Improvements after CO2-bathing in stiffness of muscle, ease of movements and mental relaxation were statistically greater than those after plain water bathing.  Compared with plain water bathing, CO2-bathing showed additional effects on muscle stiffness and subjective feeling of bathing. Further research is needed to confirm the effectiveness of the CO2-bathing alone and combined with isometric movements on muscle stiffness.

BACKGROUND: The burden of dementia is growing rapidly and has become a medical and social problem in Japan. Prospective cohort studies have been considered an effective methodology to clarify the risk factors and the etiology of dementia. We aimed to perform a large-scale dementia cohort study to elucidate environmental and genetic risk factors for dementia, as well as their interaction. METHODS: The Japan Prospective Studies Collaboration for Aging and Dementia (JPSC-AD) is a multisite, population-based prospective cohort study of dementia, which was designed to enroll approximately 10,000 community-dwelling residents aged 65 years or older from 8 sites in Japan and to follow them up prospectively for at least 5 years. Baseline exposure data, including lifestyles, medical information, diets, physical activities, blood pressure, cognitive function, blood test, brain magnetic resonance imaging (MRI), and DNA samples, were collected with a pre-specified protocol and standardized measurement methods. The primary outcome was the development of dementia and its subtypes. The diagnosis of dementia was adjudicated by an endpoint adjudication committee using standard criteria and clinical information according to the Diagnostic and Statistical Manual of Mental Disorders, 3rd Revised Edition. For brain MRI, three-dimensional acquisition of T1-weighted images was performed. Individual participant data were pooled for data analyses. RESULTS: The baseline survey was conducted from 2016 to 2018. The follow-up surveys are ongoing. A total of 11,410 individuals aged 65 years or older participated in the study. The mean age was 74.4 years, and 41.9% were male. The prevalence of dementia at baseline was 8.5% in overall participants. However, it was 16.4% among three sites where additional home visit and/or nursing home visit surveys were performed. Approximately two-thirds of dementia cases at baseline were Alzheimer's disease. CONCLUSIONS The prospective cohort data from the JPSC-AD will provide valuable insights regarding the risk factors and etiology of dementia as well as for the development of predictive models and diagnostic markers for the future onset of dementia. The findings of this study will improve our understanding of dementia and provide helpful information to establish effective preventive strategies for dementia in Japan.
Aged ; Alzheimer Disease/genetics* ; Dementia/genetics* ; Environment ; Female ; Humans ; Incidence ; Japan/epidemiology* ; Male ; Middle Aged ; Prevalence ; Prospective Studies ; Risk Factors