Promoting Cultural Change Towards Dementia Friendly Communities: A Multi-level Intervention in Japan

Abstract BackgroundEffective strategies to develop dementia-friendly communities (DFCs) are needed in aging societies. We aimed to propose a strategy to develop DFCs from a Japanese perspective and to evaluate an intervention program that adopted the strategy.MethodsThis study implemented a multi-level intervention that emphasized nurturing community social capital in a large apartment complex in the Tokyo metropolitan area in 2017. We offered an inclusive café that was open for extended hours as a place to socialize and a center for activities that included monthly public lectures. Individual consultation on daily life issues was also available for free at the café. Postal surveys were sent out to all older residents aged 70 years and older in 2016 and 2019. With a one-group pre-test and post-test design, we assessed changes in the proportion of older residents who had social interaction with friends and those who were confident about living in the community, even if they were living with dementia.ResultsTotals of 2,633 and 2,696 residents completed the pre and post-intervention surveys, respectively. The mean age of the pre-intervention respondents was 77.4 years; 45.7% lived alone and 7.7% reported living with impaired cognitive function. The proportion of men who had regular social interaction and were confident about living in their community with dementia increased significantly from 38.8–44.5% (p=0.008) and from 34.1–38.3% (p=0.045), respectively. Similar significant increases were observed in the subgroup of men living with impaired cognitive function, but not in the same subgroup for women.ConclusionsThe intervention benefitted male residents who were less likely to be involved in the community’s web of social networks at baseline. A strategy to create DFCs that emphasizes nurturing community social capital can form a foundation for DFCs.Trial registrationThis study was retrospectively registered in the University hospital Medical Information Network (UMIN) Clinical Trial Registry (registry number: UMIN000038193, date of registration: Oct 3, 2019).

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Investigation of the Clinical Significance and Pathological Features of Lanthanum Deposition in the Gastric Mucosa

10.21203/rs.3.rs-30322/v1 ◽

2020 ◽

Author(s):

Shinya Nishida ◽

Kazuhiro Ota ◽

Kimiaki Hattori ◽

Taro Iwatsubo ◽

Yuichi Kojima ◽

...

Keyword(s):

Gastric Mucosa ◽

Total Dose ◽

Clinical Significance ◽

Medical Information ◽

University Hospital ◽

Clinical Trial Registry ◽

Background Factors ◽

Biopsy Specimens ◽

Significant Difference ◽

Histiocytic Infiltration

Abstract Background: There are often specific endoscopic findings caused by deposition of lanthanum (La) in the gastric mucosa of patients taking lanthanum carbonate (LaC), a novel phosphate binder for patients on hemodialysis. We conducted a retrospective study to investigate the clinical significance of Ladeposition in the gastric mucosa, and the association between endoscopic features and histologic findings in the same population.Methods:We compared background factors in patients taking LaC with and without Ladeposition in their gastroscopic biopsy specimen. We also investigated the relationship between gastric endoscopic biopsy specimens with Ladeposition and the concurrent endoscopic images.Results:There was a significant difference in the total dose of LaC between the La-positive and La-negative groups(990 g [180–3150 g] vs. 480 g [225–1328 g]; p=0.013). In 27 biopsy specimens with specific whitish mucosa, 10 showed mild histiocytic infiltration and 17 showed strong infiltration. In contrast, among 24 specimens with non-whitishmucosa, five showed no histiocytic infiltration, 10 showed mild infiltration, and nine showed strong infiltration. There was a significant relationship between endoscopic features and the degree of histiocytic infiltration (p=0.026).Conclusions: We demonstrated that Ladeposition in the gastric mucosa depended on the total dose of LaC and was not affected by background factors. The specific endoscopic features of Ladeposition are associated with the infiltration of histiocytes, which represents the body’s normal response to foreign bodies.The protocol was registered in the University Hospital Medical Information Network Clinical Trial Registry (UMIN000038929).

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Reduction of fatigue and anger-hostility by the oral administration of 5-aminolevulinic acid phosphate: a randomized, double-blind, placebo-controlled, parallel study

Scientific Reports ◽

10.1038/s41598-020-72763-4 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Fumiko Higashikawa ◽

Keishi Kanno ◽

Akiko Ogata ◽

Masanori Sugiyama

Keyword(s):

Placebo Group ◽

Oral Administration ◽

Medical Information ◽

Aminolevulinic Acid ◽

Negative Mood ◽

University Hospital ◽

Physical Fatigue ◽

Post Intervention ◽

Double Blind ◽

T Score

Abstract Although large populations feel fatigue, the standardized medicinal therapy is currently absent. In this study, we determined whether 5-aminolevulinic acid (5-ALA) supplementation alleviates the feeling of fatigue in healthy subjects who feel chronic physical tiredness. Males and females between ages of 20 and 64 who felt physical fatigue on a daily basis, with a visual analogue scale (VAS) for fatigue ≥ 40 mm, a T-score of Fatigue-Inertia in the Profile of Mood States—Second Edition—Adult (POMS2-A) ≥ 50, and a T-score of Vigor-Activity in POMS2-A ≤ 60 were recruited. Seventy eligible participants were randomly assigned to either a 5-ALA or a placebo group. During the 8 weeks of consumption, the subjects completed VAS questionnaires for fatigue and POMS2-A at 4-week intervals. The VAS values for overall feeling of fatigue and feeling of work-related fatigue, and the Anger-Hostility subscale of POMS2-A were decreased by 5-ALA with significant time × group interaction effects (p = 0.040, 0.020, and 0.045, respectively). Besides, the 5-ALA group showed significant differences in Fatigue-Inertia, Depression-Dejection and Total Mood Disturbance scores, when compared between pre- and post-intervention, while the placebo group did not. In conclusion, the oral administration of 5-ALA improves fatigue and negative mood in subjects who constantly feel physical fatigue. This clinical trial was registered with University hospital Medical Information Network Clinical Trials Registry (UMIN-CTR) as UMIN000031528 on 2/3/2018.

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Videoconference-Based Cognitive Behavioral Therapy in Symptomatic Panic Disorder Following Primary Pharmacotherapy: Randomized, Assessor-Blinded, Controlled Trial (Preprint)

10.2196/preprints.28732 ◽

2021 ◽

Author(s):

Yoichi Seki ◽

Ryo Takemura ◽

Chihiro Sutoh ◽

Remi Noguchi ◽

Yoko Okamoto ◽

...

Keyword(s):

Panic Disorder ◽

Cognitive Behavioral Therapy ◽

Medical Information ◽

Behavioral Therapy ◽

Controlled Trial ◽

Standard Of Care ◽

Cognitive Behavioral ◽

University Hospital ◽

Open Label ◽

Post Intervention

BACKGROUND Background: Given the difficulty in accessing cognitive behavioral therapy, pharmacotherapy remains the standard of care for panic disorder (PD). OBJECTIVE Objectives: This study aimed to determine the effectiveness of videoconference-based cognitive behavioral therapy (VCBT) for patients who remain symptomatic after primary pharmacotherapy as an adjunct to usual care (UC) when compared with UC alone. METHODS Methods: This prospective, randomized, open-label endpoint trial enrolled 30 patients with PD who did not respond to primary pharmacotherapy, including antidepressants and anxiolytics, after ≥8 weeks of therapy, who underwent VCBT (n=15) or UC (n=15) between November 2017 and March 2020 at Chiba University Hospital in Chiba, Japan. They were evaluated at screening, week 0 (baseline), week 8 (mid-intervention), and week 16 (post-intervention). The primary outcome was the change in the PD Severity Scale (PDSS) score at week 16 from baseline. RESULTS Results: After 16 weeks, the adjusted mean changes in the PDSS score from baseline were −7.92 and 0.75 in the VCBT and UC groups, respectively, with a between-group difference of −8.67 (95% CI: −11.80 to −5.54, P<.0001). A higher proportion of patients in the VCBT group responded to treatment (≥40% reduction in the PDSS score at week 16) and experienced remission (PDSS score <8 points at week 8) than those in the UC group (P<.0001). CONCLUSIONS Conclusions: Our results suggest that VCBT is an effective treatment adjunct to UC in patients with PD who remain symptomatic following primary pharmacotherapy and improves PD symptoms in these patients. CLINICALTRIAL Trial Registration: University Hospital Medical Information Network Clinical Trials Registry UMIN000029987; https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000034247.

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Effect of Corneal Cross-linking on Endothelial Cell Density and Morphology in the Peripheral Cornea.

10.21203/rs.2.23100/v1 ◽

2020 ◽

Author(s):

Hiroyasu Goukon ◽

Kazutaka Kamiya ◽

Masahide Takahashi ◽

Nobuyuki Shoji

Keyword(s):

Endothelial Cell ◽

Cell Density ◽

Medical Information ◽

Endothelial Cell Density ◽

University Hospital ◽

Rank Test ◽

Cross Linking ◽

Clinical Trial Registry ◽

Peripheral Cornea ◽

Peripheral Regions

Abstract BACKGROUND: To compare the endothelial cell density and morphology in the peripheral cornea before and after corneal cross-linking (CXL).METHODS: This study evaluated twenty eyes of 20 patients who were treated with standard CXL for progressive keratoconus. Preoperatively and 3 months postoperatively, we compared the corneal endothelial cell density (ECD), the coefficient of variation in cell size (CV), and the percentage of hexagonal cells (HEX), in the peripheral regions of the cornea, using a non-contact specular microscope (EM-3000, Tomey). RESULTS: All keratoconic eyes in this series were measurable in the peripheral regions. No significant differences were found in the peripheral ECD preoperatively and 3 months postoperatively at each point (Wilcoxon signed-rank test, superior, p=0.14, nasal superior, p=0.16, temporal superior, p= 0.35, inferior, p=0.27, nasal inferior, p=0.24, temporal inferior, p=0.10). The mean percentage of the ECD loss was 2.3%, 1.6%, 1.5%, 2.4%, 1.1%, and 2.2%, respectively. No significant differences in the peripheral CV or HEX were found preoperatively and 3 months postoperatively at each point.CONCLUSIONS: Standard CXL does not cause significant changes in endothelial cell density, polymegethism, or polymorphism, in the peripheral regions of the cornea. It is suggested that CXL is a less invasive surgical approach for progressive keratoconus, even in terms of peripheral endothelial cells.TRIAL REGISTRATION: University Hospital Medical Information Network Clinical Trial Registry (000031162).

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Effects of Daily Matcha and Caffeine Intake on Mild Acute Psychological Stress-Related Cognitive Function in Middle-Aged and Older Adults: A Randomized Placebo-Controlled Study

Nutrients ◽

10.3390/nu13051700 ◽

2021 ◽

Vol 13 (5) ◽

pp. 1700

Author(s):

Yoshitake Baba ◽

Shun Inagaki ◽

Sae Nakagawa ◽

Makoto Kobayashi ◽

Toshiyuki Kaneko ◽

...

Keyword(s):

Older Adults ◽

Single Dose ◽

Cognitive Function ◽

Psychological Stress ◽

Medical Information ◽

Acute Stress ◽

Amino Acid Content ◽

University Hospital ◽

Controlled Study ◽

Caffeine Intake

Matcha, a type of green tea, has a higher amino acid content than other types of tea. We previously examined the ability of matcha to improve cognitive function in older adults and determined that continuous matcha intake improves attention and executive function. This study aimed to compare the effects of matcha and caffeine and clarify the differences between these effects. The study was registered at the University Hospital Medical Information Network (UMIN000036578). The effect of single and continuous intake was compared, and the usefulness of continuous intake was evaluated under the stress condition. The Uchida–Kraepelin test (UKT) was used to induce mild acute stress, and the Cognitrax was used to evaluate cognitive function. A single dose of caffeine improved attentional function during or after stress loading. The reduced reaction time in the Cognitrax, observed following a single dose of matcha, was likely due to caffeine. The matcha group showed an increase in the amount of work after continuous intake, whereas the caffeine group only showed an increase in the amount of work for the UKT after a single dose. Ingesting matcha with caffeine improves both attention and work performance when suffering from psychological stress compared with caffeine alone.

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Effectiveness of a virtual-reality anti-stigma application to reduce the stigma of depression: a randomized controlled trial (Preprint)

10.2196/preprints.28072 ◽

2021 ◽

Author(s):

Wey Guan Lem ◽

Ayako Kohyama-Koganeya ◽

Toki Saito ◽

Hiroshi Oyama

Keyword(s):

Virtual Reality ◽

Medical Information ◽

Intervention Group ◽

University Hospital ◽

Control Group ◽

Public Stigma ◽

Control Groups ◽

Post Intervention ◽

Significant Difference ◽

And Control

BACKGROUND Public stigma against depression contributes to low employment rates among individuals with depression and self-stigmatization of people with depression. Contact-based educational (CBE) interventions, either using in-person contact or video-based contact, have been shown to reduce stigma against mental illness effectively. In-person contacts can stimulate empathy in participants but are challenging to arrange, while video-based contact is cost-effective but encounters difficulty stimulating empathy towards the patient. In this paper, we examined the usefulness of the virtual-reality anti-stigma (VRAS) application to reduce public stigma. OBJECTIVE To develop and evaluate a VRAS application that could provide CBE intervention without using real patients. METHODS Sixteen medical students were recruited and randomized 1:1 to intervention and control groups. Participants in the intervention group (VRAS group) used the VRAS application, while those in the control group watched video material on depression. Participants' depression stigma score was assessed using the Depression Stigma Scale (DSS) and Attitudinal Social Distance (ASD), both pre-and post-intervention. The feasibility of both the VRAS application and video, and the utility of the VRAS application was also evaluated post-intervention. RESULTS Feasibility score was significantly higher in the intervention group (mean 5.63, SD 0.74) than in the control group (mean 3.88, SD 1.73; P=.03). This result indicates that the VRAS application promoted an understanding of stigma in participants. However, no significant differences were apparent between the intervention and control groups for DSS (intervention: mean 35.13, SD 5.30; control: mean 35.38, SD 4.50; P=.92) or ASD (intervention: mean 12.25, SD 3.33; control: mean 11.25, SD 1.91; P=.92). Stigma scores tended to decrease, but the stigma-reducing effects of the VRAS application were not statistically significant for either DSS (pre: mean 33.00, SD 4.44; post: mean 35.13, SD 5.30; P=.12) or ASD (pre: mean 13.25, SD 3.92; post: mean 12.25, SD 3.33; P=.12). CONCLUSIONS No significant differences in mean DSS or ASD were seen between VRAS and control groups. However, one item in the feasibility score showed a significant difference, and feedback comments suggested that VRAS was effective in educating about the stigma of depression. CLINICALTRIAL University hospital Medical Information Network Clinical Trials Registry (UMIN-CTR) UMIN000043020; https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000049109

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Impact of the Clinical Trials Act on noncommercial clinical research in Japan: An interrupted time-series analysis

10.1101/2021.01.29.21250729 ◽

2021 ◽

Author(s):

Ikuyo Tsutsumi ◽

Yusuke Tsutsumi ◽

Chikashi Yoshida ◽

Takuya Komeno ◽

Yuichi Imanaka

Keyword(s):

Clinical Trial ◽

Time Series ◽

Clinical Trials ◽

Clinical Studies ◽

Medical Information ◽

Interrupted Time Series ◽

University Hospital ◽

Trial Registry ◽

Clinical Trial Registry ◽

The Impact

AbstractBackgroundThe number of new noncommercial clinical studies conducted in Japan declined within the first year of the implementation of the Clinical Trials Act (CTA) on April 1, 2018. This study aimed to examine the impact of the CTA’s enforcement on the number of new noncommercial clinical studies registered in the Japanese Clinical Trial Registry.MethodsAn interrupted time-series design was used in the analysis, which was conducted for the period of April 2015 to March 2019. We collected data for trials registered in the Clinical Trial Registry, managed by the University Hospital Medical Information Network.ResultsIn total, 35,811 studies were registered in the registry; of these, 16,455 fulfilled the eligibility criteria. The difference in the trend of monthly number of new trials after CTA enforcement decreased significantly by 15.0 trials (95% CI, −18.7 to −11.3), and the level decreased by 40.8 (95% CI, −68.2 to −13.3) from the pre-enforcement to the post-enforcement period. Multigroup analyses indicated that the act exerted a significant effect on the trend of new clinical trials, particularly those with smaller sample sizes, interventional study designs, and nonprofit funding sponsors.ConclusionsThe number of Japanese noncommercial clinical studies declined significantly following implementation of the CTA. It is necessary to establish a system to promote clinical studies in Japan while ensuring transparency and safety.

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Intervention on knowledge and perception of hand hygiene among healthcare workers

European Journal of Public Health ◽

10.1093/eurpub/ckz186.364 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

A Ben Cheikh ◽

S Ben Fredj ◽

S Bhiri ◽

H Ghali ◽

S Khefacha ◽

...

Keyword(s):

Hand Hygiene ◽

Healthcare Workers ◽

Intervention Program ◽

Developed Countries ◽

Effective Procedure ◽

University Hospital ◽

Effective Intervention ◽

Post Intervention ◽

Before And After ◽

Hygiene Compliance

Abstract Background Many studies conducted in healthcare settings with limited resources reported healthcare associated infections (HAIs) rates higher than in developed countries. Hand hygiene is considered as the most effective procedure for reducing infection in a wide variety of settings. The aim of this study was to assess the effectiveness of an intervention program to improve knowledge and perception of hand hygiene among healthcare workers (HCWs). Methods We conducted a prospective before-and-after study design in university hospital Sahloul, Sousse, Tunisia, from January 2015 to December 2016. The same questionnaire, constructed by the WHO was distributed and collected at HCWs’ workplace. Results A total of 149 and 146 HCWs were enrolled, respectively at pre and post intervention. The majority was nursed women aged between 20 and 35 in pre intervention, whereas in post intervention the majority where physicians. Globally, our results showed tendencies toward improvement, but only two items were significant: the HW is the appropriate technique after injury (73.5% vs 86.8%; p = 0.006) and the hands of HCWs are the lead vehicle of HAIs (65.1% vs 83.6%; p = 0.01). On the other hand, judging by the HCWs’ responses, the probably most effective intervention to enhance hand hygiene compliance was that an alcohol-based hand-rub is available at each point of patient care. In contrast, empowering patients to remind HCWs to perform hand hygiene was mostly rated to be the least effective intervention both in pre and post intervention. Conclusions Our intervention to positively influence hand hygiene knowledge was unfortunately less effective than we had hoped it would be, which suggests a HCWs’ reluctance to attend the training program. Key messages Hand hygiene is considered as the most effective procedure for reducing nosocomial infection. the intervention to positively influence hand hygiene knowledge was effective.

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Investigation of the clinical significance and pathological features of lanthanum deposition in the gastric mucosa

10.21203/rs.3.rs-30322/v2 ◽

2020 ◽

Author(s):

Shinya Nishida ◽

Kazuhiro Ota ◽

Kimiaki Hattori ◽

Taro Iwatsubo ◽

Shimpei Kawaguchi ◽

...

Keyword(s):

Gastric Mucosa ◽

Total Dose ◽

Clinical Significance ◽

Medical Information ◽

University Hospital ◽

Clinical Trial Registry ◽

Background Factors ◽

Biopsy Specimens ◽

Significant Difference ◽

Histiocytic Infiltration

Abstract Background: There are often specific endoscopic findings caused by deposition of lanthanum (La) in the gastric mucosa of patients taking lanthanum carbonate (LaC), a novel phosphate binder for patients on hemodialysis. We conducted a retrospective study to investigate the clinical significance of La deposition in the gastric mucosa, and the association between endoscopic features and histologic findings in the same population.Methods: We compared background factors in patients taking LaC with and without La deposition in their gastroscopic biopsy specimen. We also investigated the relationship between gastric endoscopic biopsy specimens with La deposition and the concurrent endoscopic images.Results: There was a significant difference in the total dose of LaC between the La-positive and La-negative groups (990 g [180–3150 g] vs. 480 g [225–1328 g]; p=0.013). In 27 biopsy specimens with specific whitish mucosa, 10 showed mild histiocytic infiltration and 17 showed severe infiltration. In contrast, among 24 specimens with non-whitish mucosa, 5 showed no histiocytic infiltration, 10 showed mild infiltration, and 9 showed severe infiltration. There was a significant relationship between endoscopic features and the degree of histiocytic infiltration (p=0.026).Conclusions: We demonstrated that La deposition in the gastric mucosa depended on the total dose of LaC and was not affected by background factors. The specific endoscopic features of La deposition are associated with the infiltration of histiocytes, which represents the body’s normal response to foreign bodies. The protocol was registered in the University Hospital Medical Information Network Clinical Trial Registry (UMIN000038929).

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Effects of a Group Program to Increase Cognitive Performance Through Cognitively Stimulating Leisure Activities in Healthy Older Subjects

GeroPsych ◽

10.1024/1662-9647/a000035 ◽

2011 ◽

Vol 24 (2) ◽

pp. 83-92 ◽

Cited By ~ 22

Author(s):

Valentina A. Tesky ◽

Christian Thiel ◽

Winfried Banzer ◽

Johannes Pantel

Keyword(s):

Cognitive Function ◽

Cognitive Performance ◽

Older Persons ◽

Intervention Program ◽

Leisure Activities ◽

The Elderly ◽

Cognitive Stimulation ◽

Group Program ◽

Positive Effects ◽

Older Subjects

To investigate the effects of leisure activities on cognitive performance of healthy older subjects, an innovative intervention program was developed. Frequent participation in cognitively stimulating activities (i.e., reading, playing chess, or playing music) is associated with reduced risk of dementia. AKTIVA (active cognitive stimulation – prevention in the elderly) is an intervention program designed to enhance cognitive stimulation in everyday life by increasing cognitive stimulating leisure activities. The present study determines the effects of AKTIVA on cognitive function, mood and attitude toward aging in a sample of older participants from the general population. Several measurement instruments were used including the Alzheimer’s Disease Assessment Scale (ADAS-Cog), the Trail-Making Test (TMT), and the Memory Complaint Questionnaire (MAC-Q). Initially, the sample consisted of 307 older persons (170 female, 72 ± 7 years). The intervention was evaluated with a randomized, controlled pre-post follow-up design. Participants were randomly assigned to one of three conditions: AKTIVA intervention (n = 126), AKTIVA intervention plus nutrition and exercise counseling (n = 84), no-intervention control group (n = 97). The AKTIVA intervention consisted of 8 weekly sessions and two booster sessions after a break of 4 months. Participation in the group program resulted in positive effects on cognitive function and attitude toward aging for subassembly groups. Older persons (≥ 75 years) showed enhanced speed of information processing (by TMT Version A) (F = 4.17*, p < .05); younger participants (< 75 years) showed an improvement in subjective memory decline (by MAC-Q) (F = 2.55*, p < .05). Additionally, AKTIVA enhanced the frequency of activities for leisure activities for subassembly groups. The results of this study suggest that the AKTIVA program can be used to increase cognitively stimulating leisure activities in the elderly. Further research is necessary to identify the long-term effects of this intervention particularly with respect to the prevention of dementia.

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