findings indicate that increased burden significantly relates to decreased health-related quality of life among stroke caregivers. In addition, the prevalence of depressive symptoms among caregivers was twice that of community dwelling older people. Roughly 52% of caregivers had Geriatric Depression Scale scores that warranted further evaluation. Despite the prevalence of depressive symptoms only one caregiver had received any psychiatric care during their caregiving tenure.

Decades of research have confirmed that being a family caregiver is a stressful role. However, the point at which these stressors constitute a real risk for decreased mental health has not been established. The purpose of the present study was to determine a statistically valid cut-off score for the Zarit Burden Interview (ZBI) in order to identify family caregivers at risk for depression and in need of further assessment and intervention. The ZBI and the Geriatric Depression Scale or the CES-D were administered to three different populations of family caregivers of older adults: stroke caregivers (n=80), chronic obstructive pulmonary disease (COPD) caregivers (n=48), and general disability caregivers (n=70). Using three different statistical methods, a ZBI cut-off score was determined. Next, contingency analysis was used to compare depression scale scores and ZBI cut-offs for the three groups of caregivers. Findings suggest that a cut-off score ranging from 24-26 has significant predictive validity for identifying caregivers at risk for depression. A ZBI cut-off of 24 correctly identified 72% of caregivers with probable depression. The validity of ZBI cut-offs scores warrants further confirmation with larger samples. Valid cut-off scores would enable health care providers to assess family caregivers at risk and provide necessary interventions to improve their quality of life in this important role.

Due to the substantial prevalence of psychiatric disorders found in false-negative subjects, the above cut-off scores were chosen to optimize the potential for true positives. These scores are recommended for alerting physicians and other caregivers as to when more intensive depression evaluation is needed.

The experience of positive emotions is an integral component of quality of life. Research suggests that cognitive deficits in persons with dementia may impede their ability to generate pleasurable moments and hence decrease their positive affect. Therefore, structured recreation activities may have the potential to significantly improve resident affect. However, differences in affect between ordinary time and recreation time are not well known. The present study used previously published structured-observation instruments to measure affect and behaviour among 35 dementia residents at two nursing homes in Japan during ordinary time and during recreation time. A total of 3,854 one-minute observations were coded. Dementia residents expressed happiness over seven times more often during recreation time than during ordinary time. Over 60% of ordinary time was solitary, with 65.72% of all observed affect being 'Null Affect'. A total of 43.75% of residents expressed happiness only during recreation time. In addition 48.9% of all behaviour during 'Ordinary Time' was coded as 'Null Behaviour', which indicated that the resident was sitting and doing nothing. Findings indicate that recreation time is significantly higher in positive affect than ordinary time and that virtually all residents benefited from recreation.

These findings provide support for many of the management-practice improvements taking place in the field, including those implemented in the BJBC demonstration. Follow-up surveys will provide insight into their effectiveness.

This study investigates the frequency of aggressive behaviors in a sample of elderly nursing home residents with dementia in Japan. Behavioral data were collected on 391 residents using the Cohen‐Mansfield Agitation Inventory (CMAI). Data were also gathered on residents' age, sex, and ability to perform self‐care. Another scale was used to code the degree of resistance that each resident manifested during bathing, toileting, dressing and eating. In addition, qualitative data were collected from caregivers regarding their main caregiving problems with dementia residents. Findings show that 45.4% of the sample manifested aggressive behavior during the 2‐week study period. Men were significantly more likely to manifest physically aggressive behavior, but there was no gender difference for verbal aggression. Age had no relationship to aggressive behavior. Residents who were most dependent in self‐care had significantly higher frequencies of aggressive behaviors. Caregivers reported that most aggressive behavior took place during personal care. The majority of caregivers identified verbal agitation rather than physical aggression as their main caregiving problem. This study represents the first time that the CMAI has been translated and used in Japan and the first time empirical data has been collected on the behavior of dementia patients in Japanese nursing homes. Copyright © 2000 John Wiley & Sons, Ltd.

A B S T R A C T Oxidation of the side chain of 5,3-cholestane-3a,7a,12a-triol was studied in a patient with cerebrotendinous xanthomatosis (CTX) and in control subjects, using various subcellular fractions of liver homogenate and a method based on isotope dilution-mass spectrometry.In the control, 5p8-cholestane-3a,7a,12a-triol was converted into 5f3-cholestane-3a,7a,12a,26-tetrol and 3a,7a,12a-trihydroxy-5,8-cholestanoic acid by the mitochondrial fraction, and into 5,8-cholestane-3a,7a,12a,-25-tetrol by the microsomal fraction.In the CTX patient, liver mitochondria were completely devoid of 26-hydroxylase activity. The same mitochondrial fraction catalyzed 25-hydroxylation of vitamin D3.The microsomal fraction of liver of the subject with CTX contained more than 50-fold the normal amount of 5f3-cholestane-3a,7a,12a-triol.The basic metabolic defect in CTX appears to be a lack of the mitochondrial 26-hydroxylase. The excretion in the bile of 5,p-cholestane-3a,7a,12a,25-tetrol and 5f3-cholestane-3a,7a,12a,24a,25-pentol observed in CTX patients may be secondary to the accumulation of the major substrate for the 26-hydroxylase, i.e., 5,8-cholestane-3a,7a,12a-triol, and exposure of this substrate to the normally less active microsomal 25-and 24-hydroxylases. It is concluded that the major pathway in the biosynthesis of cholic acid in human liver involves a mitochondrial C27-steroid 26-hydroxylation.

Objective Recent studies have found that patients with chronic renal failure suffer from depression and other symptoms of decreased mental health. However, little is know about caregiver burden and mental health among patients’ families. In the present study, we examined the relationship in Japan between peritoneal dialysis (PD) patients and caregivers with regard to health-related quality of life (HRQOL) and caregiver burden. Method In March of 2002, we recruited 60 subjects—26 patients on continuous ambulatory peritoneal dialysis (CAPD), and 34 caregivers—from a PD patient support group in southern Japan. We used the Kidney Disease Quality of Life Short Form (KDQOL-SF) and the Medical Outcomes Study Short Form 36 (SF-36) to measure HRQOL. We used the Zarit Burden Interview (ZBI) to measure caregiver burden. Data was also collected on each patient's duration of illness, treatment modality, age, sex, and medical history. All data were collected by mail surveys. Results Mean age of the PD patients was 48.2; mean age of the caregivers was 46.6. Mean caregiver burden on the ZBI was 14.1, which is considerably lower than that reported among caregivers for patients with dementia or stroke. Caregivers and patients both rated their general health and vitality among the lowest of the eight dimensions on the KDQOL-SF. In addition, patients scored lower than a normative population in all dimensions and significantly lower than caregivers in the dimensions of role physical functioning, role emotional functioning, and social functioning. Compared to national normative data for their age group, caregivers scored substantially lower in general health, vitality, and mental health. Conclusions Patients on CAPD are at risk for social role dysfunction, and their caregivers are at risk for decreased mental health. Further research is needed to identify interventions that can improve the HRQOL of CAPD patients and their family caregivers.