In Japan terminal medicine for children dying from cancer has not yet been developed nor has a support system for home terminal care and bereaved families been established. We have analyzed our own experiences in these areas and researched the possibilities of establishing support systems.In the 16 years from 1978 to 1993, 56 children with cancer have been treated and have died at Hamamatsu University Hospital. We analyzed the circumstances of their deaths. We interviewed 25 sets of parents about their acceptance of their child's death.Three children ( 5 % ) died unexpectedly during treatment, 27 children (48%) died from the side-effects of intensive treatment, and 26 children (47%) died during terminal care. More children with leukemia and lymphoma died from side-effects than children with solid tumors (P c 0.05). Six out of the 25 familieshad not yet accepted the loss of their child due to regrets associated with the missed opportunity for terminal care. From our experiences with the five children who received terminal care at home, we recognize the need for a support system run by the hospital and conclude the time is ripe for initiating home-based terminal care in Japan.

No abstract

Walking speed as one index of gait ability is an important component of physical fitness among older adults. Walking speed-arterial stiffness relationships have been studied, but whether poor walking speed is associated with higher segment-specific arterial stiffness in older adults is unclear. We thus aimed to examine the relationship between walking speed and segmental arterial stiffness among older community dwellers. This study was a cross-sectional study of 492 older Japanese community dwellers (age range, 65 to 96 years). Heart-brachial PWV (hbPWV), brachial-ankle PWV (baPWV), heart-ankle PWV (haPWV), and cardio-ankle vascular index (CAVI) were used as arterial stiffness indices. Walking speed, strength, flexibility, and cognitive function were also assessed. The participants were categorized into low (Slow), middle (Middle), and high (Fast) tertiles according to walking speed. The CAVI and baPWV were significantly lower in Fast than in Slow. Significant decreasing trends in CAVI and baPWV and a tendency toward decreasing trend in haPWV were observed from Slow to Fast, whereas hbPWV did not significantly differ among tertiles and no trend was evident. The results remained significant after normalizing CAVI and PWVs for multicollinearity of arterial stiffness indices and major confounding factors, such as age, gender, body mass index, blood pressure, cognitive function, and each physical fitness. Therefore, these findings suggest that poor walking speed is associated with higher segment-specific arterial stiffness of the central and lower limbs, but not of upper, in older adult community dwellers.

The numbers of "old-old" and "young-old" adults (age ≥75 y [years] and 65-74 y, respectively) are now about the same, but less is known about the physiological characteristics such as arterial stiffness in old-old adults, especially those aged >85 y. Therefore, the present cross-sectional observational study aimed to determine the characteristics of blood pressure (BP), arterial stiffness, and physical fitness among 559 (male, n = 213; female, n = 346) Japanese community dwellers aged >65 y in Osaka and Kawakami Village, Nara. BP and arterial stiffness were measured in the supine position using a semi-automated device. Physical fitness was assessed by measuring handgrip strength and walking speed, as well as findings of the sit-and-reach and pegboard tests. Values for systolic BP, mean BP, and arterial stiffness were significantly higher in the old-old than young-old community dwellers. Trends in BP and arterial stiffness significantly increased, whereas those of physical fitness significantly decreased with age per decade. This is the first study to show that the physiological characteristics of BP, arterial stiffness, and physical fitness in Japanese community-dwelling older adults over 80 y. These novel findings indicate that community-dwelling older adults, especially nonagenarians, can maintain the longevity characteristics of lower arterial stiffness and higher physical fitness such as handgrip strength.