Atsuko Satoh

Factors associated with late post-partum depression in Japan

AIM Postnatal depression is one of the life-threatening events faced by women. As the factors associated with postnatal depression have not been investigated fully in Japan, we studied the factors associated with postnatal depression. METHODS One-hundred-and-sixty-nine women who visited the health center of a city in Aomori Prefecture, Japan, at 4 months after childbirth for regular examination fulfilled the selection criteria and completed self-reporting questionnaires on postnatal depression using the Edinburgh Postnatal Depression Scale (EPDS) and a life and social events scale. RESULTS The primiparas showed a significantly higher EPDS score than the multiparas. The EPDS score decreased with the frequency of delivery in the groups of mothers in their twenties and thirties. For the multiparas, the number of participants who suffered obstetric events was lower, the number of participants who went back to their home was higher, and the number of participants who were taken care of by their mother was lower than for the primiparas. General health abnormalities, sociability, and worries about baby care were significantly associated with the EPDS for both the primiparas and multiparas. The cooperation of the husband was associated with a decreased EPDS score, both for the primiparas and multiparas, irrespective of the family structure. CONCLUSION The EPDS score decreased with an increased frequency of delivery, suggesting that the experience of delivery would impact on postnatal depression, partly because of decreased obstetric events. However, a social assistance system is needed for women with general health abnormalities, less sociability, worries about baby care, and limited cooperation of the husband for both primiparas and multiparas.

Emotional therapy for patients with dementia.

Although treatment of Alzheimer’s disease (AD) has been extensively investigated, there is no medicine to dramatically treat or prevent AD. Donepezil, a centrally active acetyl-cholinesterase inhibitor that increases acetylcholine (Ach) in the brain, improved patients by an average of 2–3 points out of 30 in the Mini-Mental State Examination (MMSE) for 2–3 months after starting a prescription of donepezil, but the improvement decreased to only 1 point at 6 months compared with a non-treated AD group. Therefore, the effect of donepezil on AD is very limited. Apart from pharmacological treatment, several authors have proposed rehabilitation strategies aimed at improving degenerating progressive memory disturbance in AD and in community diverted older adults. There is increasing interest in targeting interventions on AD, as even small effects may translate into major public health gains. Preserved plasticity of cognitive processes raises the intriguing possibility of appropriately designed cognitive training regimens. The problem is in identifying what kind of activities will help cognitive decline in AD. In a previous study, we examined educational therapy for patients with AD by retired high school teachers and observed a remarkable improvement of cognitive function of AD. Educational therapy consisted of education at the low grade primary school level. During the course, it was realized that patients with AD responded or were often interested in social and cultural themes and that they feel deeply and cry when something touches them emotionally. They love experiencing these emotions more than simple low grade primary school level materials. Therefore, in the present study, we studied whether emotional therapy for patients with AD by retired high school teachers improved cognitive function. The present emotional therapy consists of thematic stories of various areas cited from well-written books. The participants do not feel emotions when the story is not well-written even if the story is famous enough for the older people to recognize. Therefore, the teachers have to select themes in the well-written books to bring emotions to the teachers themselves. The present emotional therapy does not simply remind patients of events that happened to them like in reminiscence therapy, but allows them to feel emotions elicited by thematic stories. We performed a randomized, prospective, parallel group trial with emotional therapy for patients with AD. Participants were recruited from Tomizawa Hospital, a long-term care facility in Sendai, Japan. Patients eligible for this study had a diagnosis of mild-to-moderate AD, were aged 65 years and older, had MMSE scores within the range of 8–23 and no evidence of stroke or obstructive pulmonary disease. Mini-Mental State Examination and Barthel Index were assessed by nurses who had not been involved in the present study. The diagnosis of probable AD was made according to the National Institute of Neurological and Communicative Disorders and Stroke/ Alzheimer’s Disease and Related Disorders Association criteria with no clinical or laboratory evidence of cause other than AD for dementia. Brain magnetic resonance imaging was obtained in all patients within 3 months prior to the study enrollment to exclude patients with possible or probable vascular dementia and other neurodegenerative dementias. Patients were excluded if they had psychiatric disorders such as schizophrenia, depression, behavioral problems, or drug or alcohol abuse. We screened 52 stable patients prescribed with standard medicines without cholinesterase inhibitors for more than 4 months and randomly selected (by a randomization table) for either emotional therapy or usual care without emotional therapy. Usual care included games, painting pictures, simple gymnastics, watching TV, and so on. Six patients selected for emotional therapy refused to receive emotional therapy. Finally, 46 were entered into the study of usual care plus emotional therapy (n = 15; aged 78 1 4 years [mean 1 standard deviation {SD}]; women : men, 10:5) or usual care without emotional therapy (n = 31; 79 1 4 years [mean 1 SD]; women : men, 22:9). Emotional therapy was performed in Tomizawa Hospital, Sendai, Japan, by retired high school teachers (women of 65 and 68 years Geriatr Gerontol Int 2008; 8: 303–306

Personal home made digital video disk for patients with behavioral psychological symptoms of dementia

Behavioral and psychological symptoms of dementia (BPSD) are one of the most difficult targets for care in geriatrics. Patients with BPSD can be hardly cared for at home and this is one of the main reasons for them to be institutionalized. Antipsychotics have been used in these cases but these drugs have been known to cause adverse events such as extrapyramidal symptoms, falls and aspiration pneumonia. Ballard et al. reported an increased long-term risk of mortality in patients with BPSD who are prescribed antipsychotic medication. These adverse events further highlight the need to search for less harmful alternatives for the long-term care of patients with BPSD. We searched for devices other than neuroleptics to care for patients with BPSD. BPSD was subsided by using lavender aroma therapy very quickly and this treatment was effective for a long period. Foot care using green tea paste and massage subsided BPSD. Those more interesting and favorite sensory inputs like odor and somatic sensors might overcome BPSD. In most nursing homes, television watching is one of the amusements for residents. However, most residents with dementia are not interested in television watching. In the present study, we provide a special meaning to television watching in the residents by editing a personal home-made digital video disk (DVD), which screened favorite pictures for patients and greetings from families including grandchildren and studied whether watching a home-made DVD subsided BPSD or not. Home-made DVDs were edited from various sources of pictures; home video pictures, families including grandsons and granddaughters, favorite singers of the patients and others, taken by the families and the favorite pictures of the patients in an album. Several versions of 10–15-min home-made DVDs were edited automatically using a computer (VGN-AW50 DB/H; Sony, Tokyo, Japan) and recorded on a DVD. Various scenes of mountains, the sea, colored leaves, sightseeing places and others were prepared on a commercially available DVD of 10–15 min in length. Favorite singer’s songs such as Miss Hibari Misora were commercially prepared. These DVDs were displayed on a 40-inch television (KDL-40VI; Sony). We randomly assigned patients with BPSD into two groups. One was treated with a home-made DVD and another group was not. All patients were recruited from the long-term care at Sendai Tomizawa Hospital, Sendai, Japan. The diagnosis of dementia was made according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria. The physical condition of all patients had been stable for the past 3 months. At baseline, physical and neurological examinations, and brain computed tomography (CT) scans, as well as Mini-Mental State Examination (MMSE) to assess cognitive function and the Barthel Index for activities of daily living (ADL: higher scores indicate better performance) were examined. BPSD was assessed and evaluated using the Neuropsychiatric Inventory (NPI: lower scores indicate better performance). Patients with dementia of either Alzheimer’s disease or vascular dementia or a combination of both were involved. MMSE scores were less than 20 and concomitant BPSD with a NPI score were more than 6 on delusion, hallucination, violent behavior or apathy subscales. We excluded patients if they had a major medical illness such as neoplastic disease, acute inflammation, or any other diseases that would prevent completion of this study. Twenty-eight patients with moderate to severe dementia (11 men and 17 women; mean 1 standard deviation [SD], 81 1 11 years; MMSE 9 1 6) were investigated. Written informed consent was obtained from participants or their families following a detailed explanation of the study. Tiapride hydrochloride (25 mg), a Geriatr Gerontol Int 2010; 10: 272–274

A change of osteocalcin (OC) and tartrate resistant acid phosphatase 5b (TRACP-5b) with the menstrual cycle.

Bone metabolism markers associated with 4 menstrual cycle phases were evaluated in 14 healthy young females without menstrual disorder. Menstrual cycle phases were confirmed with basal body temperature for 3 months, luteinizing hormone kits, and sexual hormone concentrations of serum. The bone metabolism markers used were osteocalcin (OC), which was measured by immunoradiometric assay (IRMA), and tartrate resistant acid phosphatase 5b (TRACP-5b), which was measured by enzyme immunometric assay (EIA). The highest values of OC and TRACP-5b were observed in the ovulation phase, and TRACP-5b increased significantly when compared with levels in the menstrual phase (p<0.05). Furthermore, the changes in sex-hormone secretion involved in OC and TRACP-5b showed specific patterns during the menstrual cycle. In other words, TRACP-5b levels are influenced by sex hormones produced during the menstrual period and are based on the bone-formation status. Therefore, it is presumed that the TRACP-5b levels during ovulation play a central role in bone formation and bone metabolism.

Diaper with cushion buttock.

Diapers are widely used for fecal and urinary incontinence in self-care-dependent older adults; in particular, treatment of fecal incontinence is difficult for both patients and caregivers. Diapers should be changed as soon as possible after excretion of stools, but it is sometimes difficult for self-care-dependent older patients to let caregivers know when they have excreted. A shortage of caregivers is another limitation to the ideal treatment of fecal incontinence. Stools and/or urine around the perineum for a longer period of time might have many consequences of not only discomfort of patients, but also skin reactions, which exacerbate decubitus and urinary infection. Furthermore, lean buttocks in these partients would accelerate decubitus in the perineum and caudal area. In the present report, we have developed a new type of diaper with a big hole around the perineum. The new diaper is supported by a cushion buttock in order to separate direct contamination of excretion, and to compensate for lean buttocks. A cushion buttock might reduce pressure ulcers around the perineum and caudal area. Figure 1a, shows a round cushion buttock with an outer frame of 32 cm in length × 34 cm in width 6 cm in thickness, and an inner hole of 26 cm in length × 13 cm in width, which is made of a combination of three different sponges for enabling the patients to attach it comfortably to their buttocks for a long time. Both the front and rear of the round buttock are relatively thin (3 cm in thickness) in order to remove pressure for the caudal area. The cushion buttock is compressed to approximately 2 cm in thickness to allow for 50 kg in bodyweight sitting on it. The cushion buttock is covered by a thin waterproof bag, and can be detached with a fastener for laundering (Fig. 1b). The cover of the cushion buttock extends laterally with front arms. Figure 1c show an ordinary paper diaper, except for a hole covered by a bag. The hole is made by cutting longitudinally by 28 cm in the center of the diaper, which is covered by a bag of approximately 500 mL in capacity, which has absorbable paper inside and is waterproof outside. The diaper is adhered to the covered cushion buttock (Fig. 1d). The diaper with the cushion buttock is fixed so the hole of the diaper, which is 24 cm in length × 11 cm in width and 5 cm in depth in the final shape, does not dislodge from the anus (Fig. 1e). The diaper with the cushion buttock is inserted beneath the hips of patients lying down in the supine position, and is rotated laterally and adjusted to the position of the perineum by pulling the diaper from the opposite side of the patient. Dislodgment of the diaper from the anus a few cm in any direction would not cause trouble for excreting feces into the bag. Urine absorbable tissue 12 cm × 30 cm is places at the front of the perineum for frequent urine incontinence. After the diaper is fixed in place, to the patients trousers are put back on and the patient is moved to a chair or to their bed. Distributions of stools in diapers were compared between the new type (diaper with cushion buttock) and ordinary diapers. Stools were excreted using magnesium oxide, lactobacillus bifidus, sennoside or a combination of these medicines. Prescriptions for these constipation medicines were not systematic, and were dependent on the doctor’s choice. Existence of stools was observed after treatment of constipation for 2–5 days using either of laxoberon, teleminsoft or an enema in either a sitting or supine position, during which either the new type or ordinary diaper was used. A total of 25 patients (16 women and 9 men; age 82 ± 7 years, Mini-Mental State Examination 7 ± 5) with severe dementia who were inpatients at Sendai Tomizawa Hospital, a geriatric hospital, were studied. The diagnosis of dementia was made for a total of 25 patients according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria. All patients were bedbound or chairbound, and could eat food by themselves or by the assistance of caregivers. Tiapride hydrochloride (25 mg), a dopamine D1 antagonist, was used as necessary. Patients were randomly assigned to the new type diaper group (n = 12, age 83 ± 8 years) or the control group with the ordinary diaper (n = 13, age 81 ± 7 years) using a random number table. Written informed consent was obtained from participants or their families after a detailed explanation of the study. Stools were observed in approximately 40% of patients during 1 day, and stools were observed in all patients within 5 days. Stools in the new type of diaper were observed in the bag in all patients, except for a little contamination of feces to the periphery of the hole of the diaper, and a small amount of feces around the anus; whereas those in ordinary diaper stools were observed to have feces widely distributed on the ordinary diaper, and feces were observed around the perineum, including the urinary tract entrance in women and/or caudal area. In one patient with diarrhea and another patient, a large amount of feces were spread outside the ordinary diaper, whereas even diarrhea was inside the bag of the new type of diaper in one patient. bs_bs_banner

Toe clearance rehabilitative slipper for fall risk in institutionalized older people

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