Search

We evaluated the usefulness of measurements of the inferior vena cava (IVC) diameters on abdominal echograms as an indicator of changes of venous return in subjects with orthostatic intolerance (OI) induced by simulated microgravity. We performed a standing test and recorded the IVC diameters on abdominal echograms in 12 subjects placed on a 20-day 6 degrees head-down-tilt bed-rest experiment. We found that different patterns of changes in IVC diameter occurred in the standing test on day 10 of the experiment; in five subjects with a marginal decrease in pulse pressure, IVC diameters in the upright position were markedly decreased compared with those in the supine position. In five subjects with feelings of discomfort, the IVC diameters in the upright position distended or did not decrease from those in the supine position. These results suggested that the changes in IVC diameter on the standing test indicated the presence of various types of hemodynamic responses of OI caused by simulated microgravity. In this study, we also evaluated changes in body-water compartments by conducting multifrequency bioelectrical impedance analysis. Longitudinal data analysis showed that the total body-water-to-fat-free mass and extracellular fluid-to-fat-free mass ratios decreased during the experimental period and recovered thereafter, and that the ratio of intracellular fluid to fat-free mass decreased during the experiment. No significant difference in changes in body-water compartments was seen among subjects with different patterns of changes in IVC diameters. Measurement of IVC diameter was useful to estimate hemodynamic changes in subjects with OI.

Background and Aims: Using longitudinal data analyses, we examined the effects of aging on functional decline, based on activities of daily living (ADL) and instrumental activities of daily living (IADL) during a 5-year follow-up among older people living in a community in Japan., Methods: The baseline survey in July 1988 involved all elderly residents aged 60 or older in Saku City, Nagano, Japan (N=13418). All survivors of this cohort were asked to participate in follow-up surveys conducted in 1989, 1990, 1991, 1992 and 1993. Five items of ADL and five of IADL were measured on each survey. A generalized estimating equations (GEE) analysis was used to examine the effects of aging on the increase of the proportion of subjects with functional dependence., Results: These results indicated that the proportion of subjects who were dependent in ADL increased during the 5-year period by 2.2 times (p<0.001) and the proportion of those who were dependent in either ADL or IADL increased during the same period by 1.8 times (p<0.001). Gender did not appear to be significantly associated with functional decline., Conclusions: The GEE analysis in this study identified the statistically significant effect of aging on the increase of the proportion of subjects with functional dependence based on ADL and IADL.

Falls are common in elderly people. Possible consequences include serious injuries and the post-fall syndrome, with functional decline and limitation of physical activity. The present randomized controlled study sought to clarify the benefits of a combined long-term and home-based fall prevention program for elderly Japanese women. The subjects were individuals aged over 73 years, living at home in a western suburb of Tokyo, who had attended a comprehensive geriatric health check. Persons with a marked decline in the basic activities of daily living (ADL), hemiplegia, or those missing baseline data were excluded. Fifty-two subjects who expressed a wish to participate in the trial were randomized, 28 to an exercise-intervention group and 24 to a control group. Baseline data for age, handgrip force, walking speed, total serum cholesterol, serum albumin, basic ADL, visual and auditory impairments, self-rated health, and experience of falls did not differ significantly between the two groups. Beginning from June 2000, the intervention group attended a 6-month program of fall-prevention exercise classes aimed at improving leg strength, balance, and walking ability; this was supplemented by a home-based exercise program that focused on leg strength. The control group received only a pamphlet and advice on fall prevention. The average rate of attendance at exercise class was 75.3% (range, 64% to 86%). Participants showed significant improvements in tandem walk and functional reach after the intervention program, with enhanced self confidence. At the 8-month follow-up, the proportion of women with falls was 13.6% (3/22) in the intervention group and 40.9% (9/22) in the control group. At 20 months, the proportion remained unchanged, at 13.6% in the intervention group, but had increased to 54.5% (12/22) in the control group, which showed a statistically significant difference between the two groups (Fisher's exact test; P = 0.0097). The total number of falls during the 20-month follow-up period was 6 in the intervention group and 17 in the control group. We conclude that a moderate exercise intervention program plus a home-based program significantly decreases the incidence of falls in both the short and the long term, contributing to improved health and quality of life in the elderly., (Copyright 2004 Springer-Verlag)

The World Health Report 2000 placed Japan first for overall health system attainment: a surprising development considering that, aside from discussing excessive expenditure, health care professionals and the Health Ministry have paid little attention recently to the quality of health care. Japan's free access policy and the universal health care system have actually fostered a very relaxed attitude toward evaluation. Concerned about the possible risks to patient safety, physicians established a volunteer association to promote quality health care issues. Then in 1995, the Japan Council for Quality Health Care (JCQHC) was founded to implement the third party accreditation of hospitals. Concurrent with the formation of the JCQHC, the sharply rising costs of malpractice litigation motivated the authorities and medical facilities to work toward protecting patient safety at different levels. Despite the WHO's positive review, critics maintain that significant inequities still exist in Japanese health care. Examples include, financial inequities between private and public hospitals, and the number and quality of hospitals and physicians between rural and urban areas. To protect patient safety and improve the quality of care, every effort must be made to eliminate inequities in the health care system. JCQHC accreditation is an important tool for furthering these efforts.

This study examined the present state and longitudinal changes in higher-level functional capacity in a Japanese urban community. Persons aged 65-84 years living in a suburb of central Tokyo participated in a baseline survey held in 1991 (n = 814) and followed-up for 8 years. Outcome measures were disabilities in: instrumental self-maintenance (IADL), the intellectual activity scale (intellectual activity) and the social role scale (social role), as measured by subscales of the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-index of competence). At baseline among the three subscales, both older men and women had the highest prevalence of disability in social role, followed in turn by intellectual activity and IADL disability. The 8-year longitudinal survey on subjects who had no initial disability (229 men and 235 women) in all three subscales of TMIG-index of competence demonstrated that they were most likely to lose social role function with advancing age, followed in turn by intellectual activity and IADL. The Cox proportional hazard model analysis for all 814 participants revealed that baseline level of social role and intellectual activity significantly predicted the new onset of IADL disability during the 8-year follow-up period even after controlling for gender, age, and chronic medical conditions. In summary, disability in social role and intellectual activity do not only likely precede IADL disability, but also predict significantly the future onset of IADL disability in a Japanese urban community older population.

Objective: We assessed variations in the use of breast conserving surgery (BCS) for operable breast cancer paticnts among hospitals in Japan, and then compared the length of stay (LOS) and total charges during hospitalization between patients who received BCS and those who received mastectomy., Setting and Study Participants: We used a database from the Voluntary Hospitals of Japan Quality Indicator Project that involved 10 teaching hospitals in Japan. We selected female operable breast cancer patients who were admitted to five of these hospitals from January 1996 to December 1999 (n = 614)., Main Outcome Measures: Proportion of the use of BCS, LOS, and total charges during hospitalization., Results: Twenty-six percent of 614 subjects in the five hospitals received BCS. Proportions of the use of BCS varied from 9% to 51% across five hospitals during the 4-year period. Multiple logistic regression analysis revealed that when we selected as a reference one hospital that had the same proportion of the use of BCS (26%) as the average proportion among all hospitals, three hospitals were 0.3, 2.0, and 2.6 times more likely to use BCS than the reference (P < 0.05). LOS for BCS [mean 25.0 days, standard deviation (SD) 11.8 days] was significantly shorter than for mastectomy (mean 27.3 days, SD 8.6 days), and total charges during hospitalization for BCS (mean US$7771.5, SD 2676.7) were significantly lower than for mastectomy (mean US$8502.5, SD 2044.0). Linear mixed models confirmed that the use of BCS was significantly associated with shorter LOS (P < 0.001) and lower total charges (P < 0.001)., Conclusion: This preliminary description of breast cancer care in five teaching hospitals in Japan revealed variations in the use of BCS.

We examined functional transitions in both the activities of daily living (ADL), and instrumental activities of daily living (IADL), over a 1-year interval among older Japanese living in a community, then estimated their physically active life expectancy (PALE) and instrumentally active life expectancy (IALE). In 1992, all residents aged 65 or older who lived in Saku City, Nagano, Japan, were followed-up over the 1-year interval. A self-administrated questionnaire, which involved age, sex, five ADL items, and five IADL items, was used for each survey in both 1992 and 1993. Of the baseline cohort (n=10,098), we received 9533 analyzable questionnaires at the follow-up survey in 1993. During the follow-up, 92 and 87% of subjects who were initially independent in ADL and IADL remained independent, respectively. PALE for men and women were estimated to be 16.0 and 18.9 at 65 years of age, respectively. IALE for men and for women were estimated to be 12.8 and 14.6 at the age of 65, respectively. Proportions of the PALE to total life expectancy (TLE) at any age did not greatly differ between men and women; however, men had a slightly larger proportion of IALE to TLE at any given age than women.

This study evaluated changes of mood status and depressive and neurotic levels in nine young male subjects during a 20-day 6 degrees head-down tilting bed rest and examined whether exercise training modified these changes. Participants were asked to complete psychometrical inventories on before, during, and after the bed rest experiment. Depressive and neurotic levels were enhanced during bed rest period according to the Japanese version of Zung's Self-rating Depression Scale and the Japanese version of the General Health Questionnaire. Mood state "vigor" was impaired and "confusion" was increased during bed rest and recumbent control periods compared to pre-bed rest and ambulatory control periods according to the Japanese version of Profiles of Mood State, whereas the mood "tension-anxiety", "depression-dejection", "anger-hostility" and "fatigue" were relatively stable during experiment. Isometric exercise training did not modify these results. Microgravity, along with confinement to bed and isolation from familiar environments, induced impairment of mental status., (c2002 Elsevier Science Ltd. All rights reserved.)