[A consideration of the support for terminal care at the private skilled nursing home].

The increase in the number of residents in elderly care facilities has developed into a growing demand for home-based terminal care rather than treatments at medical institutions. Like many others, the Active Life Toyonaka (private skilled nursing home) has received more requests from its residents for adequate terminal care. It is unfortunate, however, that quite a few residents are obliged to be hospitalized for medical reasons that result in death. The purpose of our study is to determine what a terminal care should be like in a private skilled nursing home. The study has been conducted with the focuse on the successful case of a 90-year-old male resident diagnosed as having prostate cancer with bone metastasis. Our study has concluded that the crucial factors for a better terminal care should go as follows: (1) Having good coordination with medical institutions, (2) Reporting every change in residents' condition and administering an immediate treatment for alleviating pains of the residents, (3) Providing the residents with comfortable life of less restraint on activities in home-based care, (4) Sharing the same information among the staff of all divisions who is in charge of residents (doctors, nurses, caregivers, etc.) and (5) Establishing relationships of mutual trust with residents and their families. Nurses, especially, need to play important roles as coordinators among all the personnel concerned.

Concentrations and compositions of organochlorine contaminants in sediments, soils, crustaceans, fishes and birds collected from Lake Tai, Hangzhou Bay and Shanghai city region, China.

Contamination by persistent organochlorines (OCs), such as DDTs, hexachlorocyclohexane isomers (HCHs), chlordane compounds (CHLs), hexachlorobenzene (HCB) and polychlorinated biphenyls (PCBs) were examined in sediments, soils, fishes, crustaceans, birds, and aquaculture feed from Lake Tai, Hangzhou Bay, and in the vicinity of Shanghai city in China during 2000 and 2001. OCs were detected in all samples analyzed, and DDT and its metabolites were the predominant contaminants in most sediments, soils and biota. Concentrations of p,p'-DDT and ratio of p,p'-DDT to SigmaDDTs were significantly higher in marine fishes than those in freshwater fishes. While the use of DDTs has been officially banned in China since 1983, these results indicate a recent input of technical DDTs into the marine environment around Hangzhou Bay. Comparison of organochlorine concentrations in fishes collected from Lake Tai and Hangzhou Bay suggests the presence of local sources of HCHs, chlordanes and PCBs at Lake Tai. Higher proportions of penta- and hexa-PCB congeners in fishes at Lake Tai may suggest the use of highly chlorinated PCB product, such as PCB(5), around this lake. To our knowledge, this is a first comprehensive study to examine the present status of organochlorine contamination in various environmental media, such as sediments, soils and wildlife, in China.