Sitagliptin significantly improves some lipid parameters while having a comparable effect on blood glucose to nateglinide. A large-scale prospective study of sitagliptin therapy is warranted.

Within the set of fluoro-gold-labeled neurons, 10% were positive for GAP43 in sham-operated animals, 22% positive in the TNF-deficient NP group, and 38% positive in the wild-type NP group. These intergroup differences in the percentage of GAP43-positive neurons were statistically significant (sham vs. TNF-deficient NP group: P = 0.009; TNF-deficient NP group vs wild-type NP group: P = 0.026). CONCLUSION.: The percentage of fluoro-gold-labeled GAP43-immunoreactive neurons significantly increased after injections of NP harvested from both mouse types. Furthermore, the percentage of GAP43-immunoreactive neurons was significantly higher in mice receiving wild-type NP compared with mice receiving TNF-deficient NP. These findings suggest that TNF-alpha acts as an inducer of axonal growth into degenerated discs, as evidenced by decreased GAP-43 immunoreactivity in mice receiving TNF-deficient NP injections and even lower GAP-43 immunoreactivity in control mice receiving NP-free fluoro-gold injections.

Aim This study aimed to examine the validity of the care‐needs levels classified in Japan's long‐term care insurance system (LTCI‐CNLs) when compared with patients’ self‐perceived functioning, disability and physical performance among patients receiving home medical care. Methods This was a multicenter cross‐sectional study in Japan. Patients who were receiving continuous home medical care and who could respond to the questionnaire were enrolled in this study. In addition to the LTCI‐CNLs, the 12‐item version of the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) and the SARC‐F were used to measure functioning, disability and physical performance (sarcopenia). In addition, correlations and associations of the LTCI‐CNLs with the WHODAS 2.0 and SARC‐F were analyzed using Spearman correlations and linear mixed models. Results Data from 181 patients were included in the analyses. The LTCI‐CNLs varied, ranging from support level 1 (5.5%) to care‐needs level 5 (10.5%), with care‐needs level 2 being the most prevalent (24.9%). Moderate correlations of the LTCI‐CNLs with the WHODAS 2.0 and SARC‐F were found (ρ = 0.58 and 0.44, respectively). Although WHODAS 2.0 and SARC‐F scores varied within each LTCI‐CNL, predicted WHODAS 2.0 and SARC‐F scores increased as LTCI‐CNL increased. Dementia was not associated with WHODAS 2.0 or SARC‐F. Conclusions The LTCI‐CNLs was associated with self‐reported functioning, disability and physical performance among home medical care patients. Future studies can use the LTCI‐CNLs as an outcome variable for specific care approaches or as a proxy covariate for casemix status. Geriatr Gerontol Int 2021; 21: 229–237.

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Background Spiritual care should be included in home medical care for patients with limited life expectancy. However, the effect of shortened life expectancy on patients` quality of life (QOL) and hopes is poorly understood. Methods This multicenter cross-sectional study involved 29 home medical care centers in Japan. Exposures were life expectancy (≥ one year / ≥ six months to < one year / < six months) as assessed by home medical care physicians. The outcomes were QOL in home medical care measured via the Quality-of-Life Scale for Elderly Patients Receiving Professional Home Care (QOL-HC), the domain scores of health-related hope (″health,″ ″role and connectedness,″ and ″something to live for″), and decrease in life functioning measured using the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0). Linear mixed models were fitted for analyses, with the facilities treated as clusters. Results Shorter life expectancy was associated with higher WHODAS 2.0 scores and significantly lower ″something to live for″ scores (< six months vs. ≥ one year). In contrast, ″role and connectedness″ scores did not change remarkably with decreased life expectancy, whereas QOL-HC scores were significantly higher with shorter life expectancy. Conclusion Home medical care physicians who engage in spiritual care should facilitate thoughtful dialogue with their patients by recognizing declines in life functions and hope for fulfillment, which are associated with short life expectancy.

Aim There is growing recognition of the need to hold advance care planning discussions. Older adults who have direct interpersonal involvement with dying family members might begin to consider their own end‐of‐life care. This study examined the associations between experiences of being with a dying family member and advance care planning discussions among Japanese older adults. Methods This study examined data from a previous self‐administered questionnaire survey carried out among outpatients aged ≥65 years. All participants were visitors of a community hospital in Japan, with data being collected over a 1‐week period in July 2016. The main exposure was experiences of being with dying family members, while the outcome was advance care planning discussions with the family members and/or their physician. We analyzed the associations between experiences of being with dying family members and advance care planning discussions through log‐binomial regression models adjusted for possible sociodemographic confounders. Results Of the 302 respondents included for analysis, 96 (32%) had experiences of being with dying family members, while 179 (59%) held advance care planning discussions. Respondents with said experiences were more likely to have discussions than those without experiences (fully adjusted prevalence ratio 1.31, 95% confidence interval 1.04–1.65). Subgroup analyses showed no significant interaction effects between experiences of being with dying family members and the covariates. Conclusions Direct interpersonal involvement with dying family members might facilitate advance care planning discussions among Japanese older adults. Our results should help healthcare providers recognize individuals who are unlikely to have discussions. Geriatr Gerontol Int 2021; 21: 197–202.

Background There is a growing need to realize high-quality end-of-life care at home that respects the patient’s wishes. Objective To examine the association between the quality of primary care and advance care planning (ACP) participation among patients receiving home-based medical care. Methods In this multicentre, cross-sectional study, 29 home medical care clinics in Japan were included. Adult Japanese patients receiving home medical care were surveyed to assess their consideration of ACP. The quality of primary care, which reflects patient-centredness, was assessed with the Japanese version of the Primary Care Assessment Tool-Short Form (JPCAT-SF). Information on the clinical conditions that require home medical care was collected from physicians. Results Of the 194 patients surveyed from 29 home medical services, 62 patients (32%) showed signs of ACP participation. Lack of opportunities was the most common reason for not participating in the ACP. In a multivariable-adjusted generalized estimating equation, primary care quality was associated with ACP participation (per 10-point increase, adjusted odds ratio: 1.96, 95% confidence interval: 1.51–2.56). In addition, all domains of the JPCAT-SF were associated with ACP participation. Conclusions Patient-centredness in home medical care facilitates the initiation of ACP participation.

Background: It remains unclear how both the quality of patient-centered care and the patient's illness affect advance care planning (ACP) in primary care settings. Identifying the facilitators and barriers to ACP in primary care settings has become a growing scientific and clinical challenge. Objective: To examine the association between the quality of primary care and ACP preparedness among patients. Additionally, to investigate whether ACP preparedness and the patient's illness are associated with the expression of future treatment preferences. Design: Multicenter cross-sectional study. Participants: Adult Japanese patients receiving home medical care. Main Measures: A survey was run to assess consideration of ACP by patients and expression of future treatment preferences. The quality of primary care, which reflects patient centeredness, was assessed with the Japanese version of the Primary Care Assessment Tool–Short Form. Information on the clinical conditions that required home medical care was collected from physicians. Key Results: Of 194 patients using 29 home medical services, 62 patients (32%) showed signs of ACP preparedness, and 153 patients (78%) expressed their treatment preferences. In a multivariable-adjusted generalized estimating equation, primary care quality was associated with ACP preparedness (per 10-point increase, adjusted OR: 1.96, 95% CI: 1.51–2.56). However, we found insufficient evidence to support that ACP preparedness was associated with a lower incidence of non-expression of treatment preferences (adjusted OR: 1.02, 95% CI 0.49–2.12). In contrast, having cancer was associated with a lower incidence of non-expression of treatment preferences (adjusted OR: 0.12, 95% CI: 0.01–0.995). Conclusions: At a minimum, patient centeredness in home medical care facilitates must ensure the initiation of ACP preparedness. To understand the association between ACP preparedness and expression of treatment preferences, further efforts are warranted to clarify the quality and content of ACP preparedness simultaneously with the patient's illness.