Nobuyuki Ashida

Types of infectious outbreaks and their impact in elderly care facilities: a review of the literature.

BACKGROUNDninfectious outbreaks in long-term care facilities (LTCFs) tend to have a significant impact on infection rates and mortality rates of the residents.nnnOBJECTIVESnthis review aimed to update the information on pathogens identified in such outbreaks and to try to explore indicators that reflect the impact of outbreaks among residents and health care workers (HCWs).nnnMETHODSnMEDLINE (1966-2008) was used to identify outbreaks using the following thesaurus terms: Cross-Infection, Disease Outbreaks, Urinary-Tract Infections and Blood-Borne Pathogens. Elderly care facilities were identified with the following thesaurus terms: Long-Term Care, Assisted-Living Facilities, Homes for the Aged and Nursing Homes. Age category was limited using Aged.nnnRESULTSnthirty-seven pathogens were associated with 206 outbreaks. The largest number of reported outbreaks by a single pathogen involved the influenza virus, followed by noroviruses. Among residents, the highest median attack rate for respiratory infection outbreaks was caused by Chlamydia pneumoniae (46%), followed by respiratory syncytial virus (40%). In gastrointestinal tract infection outbreaks, high median attack rates were caused by Clostridium perfringens (48%) and noroviruses (45%). Outbreaks with high median case fatality rates were caused by Group A Streptococci (50%) and Streptococcus pneumoniae (44%). High median attack rates for HCWs were caused by C. pneumoniae (41%), noroviruses (42%) and scabies (36%).nnnCONCLUSIONna variety of infectious agents were identified as the cause of outbreaks in the elderly and HCWs in LTCFs. Attack rates and case fatality rates are useful indicators for setting priorities for education and prevention of the outbreaks.

Feasibility study of the integrated circuit tag monitoring system for dementia residents in Japan.

Videotaping, direct observation, and biomechanical devices have been used to measure the wandering behavior of institutionalized people with dementia and to identify patterns of movement. Owing to technical limitations, the variability in movement patterns or the distance traveled could not be examined. The present study examined the feasibility of an integrated circuit tag monitoring system to monitor the movement patterns of Japanese dementia residents. This system generated the following data: the frequency of detection by each receiver, the duration of stay in each location, the cumulative distance walked per day, and the graphic display of the movement pattern. This new system offers objective measurements of ambulation in time and space, which can be used to characterize demented patients and to evaluate the effects of treatment and care.

Environmental Control Interventions for Frontotemporal Dementia With Reversed Sleep—Wake Cycles

Background: This study aimed to evaluate the effectiveness of environmental control interventions using an integrated chip tag monitoring system for a frontotemporal dementia (FTD) patient. Method: The subject was a male FTD patient (Pick type) with reversed sleep—wake cycles. For a 2-week period, the doors to all patients rooms in the unit were kept open as a form of environmental control, and in the following 2 weeks, all doors were kept closed (intervention A). To increase his activity levels, a staff walked with him for 2 weeks (intervention B), while all the doors to patients rooms in the unit were kept closed. Result: In intervention A, daytime ambulation increased, whereas nighttime ambulation decreased significantly. During intervention B, nighttime ambulation increased significantly. Conclusion: Environmental controls seem to be effective for restoring sleep—wake cycles in even an advanced-stage FTD patient, whereas exercise program by the staff aggravated the problem.

Temporal Patterns of Movements in Institutionalized Elderly With Dementia During 12 Consecutive Days of Observation in Seoul, Korea:

Background: The availability of increasingly sophisticated technology has meant that ambulation can be measured with precision over an extended period. Methods: An integrated circuit tag-monitoring system was set up to measure the distance moved in a dementia care unit in Korea in 2006. Various indicators were developed to measure temporal patterns of ambulation over time, such as the median distance moved per hour and the percentage of hours moved. Results: 12 consecutive days of movement data were available for 8 subjects. The mean age of the subjects was 76 ± 5.3 years. The median distance walked per day ranged from 206 to 976 m, and the percentage of hours with movement ranged from 28% to 81%. The changes in the activity level during daytime, evening, and nighttime also differed among the 8 subjects. Discussion: The indicators developed appeared to differentiate temporal patterns of movement in demented persons.

A method for supporting at-home fitness exercise guidance and at-home nursing care for the elders, video-based simple measurement system

Penetration of the Internet has paved the way for the interactive video communication at home. Videos, which subjectively show entire views and give comprehensive overviews at a glance, serve as storable media and information contained in such excellently informative media has been increasingly stored as video image databases. Nevertheless, videos also have some disadvantages, for example, watching them takes time because information cannot be summarized, and consolidating videos with other types of information is difficult. Additionally, accurate human body measurement using videos and still images requires special equipment and facilities, making the application of such system to home use difficult. For that reason, we developed the simple video-based measurement system so that joint motion angles, numerical values of physical fitness measurement, time required to make certain motions, and indexes for motion smoothness can be measured using recorded videos. In Japan, home-visit exercise guidance programs and home care services are vigorously offered, but, few methods are available to objectively evaluate effects of such programs and services. When videos shot at individual homes are sent to an analysis center for the measurement by this measurement system, the outcomes provided as feedback give clear views about physical strength improvement and effects of rehabilitation and are expected to encourage elder people and reduce burdens on fitness instructors and nurses.

Automatic Identification of Apnea Through Acoustic Analysis for At-Home Screening

OBJECTIVEnAlthough many studies have analyzed breathing sounds in the diagnosis of obstructive sleep apnea syndrome, the recording of snoring sounds at home is hampered by the various background noises of daily life. Recordings also frequently include talking during sleep, which may infringe the privacy of patients.nnnMATERIALS AND METHODSnA recording system used a bone conduction microphone to record snoring sounds. This microphone reduced background noise. A simple system transmitted recorded breathing sound data for screening at a hospital as envelope data instead of complete sound recordings, thereby decreasing data volume and protecting privacy.nnnRESULTSnIn periods in which blood oxygen levels (SpO₂) were drastically decreased, the probability of apnea as deduced from the envelope curve of breathing sounds was consistent with SpO₂ values.nnnCONCLUSIONSnThis method provides a basis for telemonitoring of sleep apnea syndrome.

Association between activity level and changes in bodyweight in dementia patients

Introduction:u2002 Bodyweight is routinely used as an important health assessment measure in care facilities. Recently, the integrated circuit (IC) tag monitoring system became available for measuring the distance walked by patients with dementia (PsWD) over an extended period. The main objective of the present study was to examine an association between the distance walked and changes in bodyweight in PsWD.

Efficient Health Information Management Systems Using Wireless Communications Technology to Aid Disaster Victims

Japan is an earthquake-prone country, and disasters have a devastating effect on the lives of residents in stricken areas. Shelters can be constructed in order to secure the physical safety of residents, but there are no such provisions for the shock of experiencing a disaster, losing property and friends, and transitioning to an unfamiliar life in a shelter, all of which can lead to mental disorders. Caretakers such as medical doctors and nurses who are dispatched to disaster sites also face difficulties in the disruption of communications and transportation, thus a system able to secure efficient health management in those facilities is also required. This paper proposes a health information management system that utilizes mobile phone cameras and mark-sensing cards to improve recovery conditions in disaster-stricken areas.

Attempts to differentiate the patterns of temporal movements in Alzheimer's disease patients from vascular dementia patients by the integrated circuit tag monitoring system

Department of Clinical Nursing, Division of Health Sciences, Graduate School of Medicine, Osaka University, Osaka, 2Asakayama Hospital, Sakai-city and 3Koshien University, Takarazuka-city, Japan Correspondence: Ms Nanae Segawa, BSN, Department of Clinical Nursing, Division of Health Sciences, Graduate School of Medicine, Osaka University, 1-7 Yamadaoka, Suita, Osaka 565-0871, Japan. Email: sega7a@sahs.med.osaka-u.ac.jp Received 17 December 2007; accepted 24 January 2008.

Communication Network Analysis in Maternity Hospital Bulletin Board System

Recent changes in Japanese social environments consequently dropped total fertility rate, and poor interpersonal relationships in local communities have aggravated the environments for childbirth and child-rearing. Under such circumstances, we introduced a bulletin board system (BBS) to an official web-site of a maternity hospital to set up a community for its patients for communication regarding childbirth and the like. Based on the logs from BBS, we graphed types of communication among its users with to describe topologies. Additionally, we calculated degrees of centralization of entire networks and found the hospital role as the administrator becomes smaller as inter-user communication becomes more brisk. The analysis of contents of respective threads also revealed that main topics shifted from gestational matters to postnatal and child-rearing as communication became more brisk, which indicates those postnatal users are also strongly conscious with gestational and progestational contents and contribute to supporting the entire BBS.