First-principles study of nanometer-sharp domain walls in ferromagnetic Fe monolayers under in-plane strain.

We investigated a nanometer-sharp magnetic domain wall (DW) structure in a free-standing Fe(110) monolayer and studied the crucial role of in-plane strain using fully unconstrained noncollinear ab initio spin-density-functional theory calculations within the generalized gradient approximation. The DW width is calculated to be 0.86 nm. A precise vector-field description of the magnetization density revealed that a noncollinear character in the DW was spatially confined between atoms, whereas a collinear and high magnetization density was localized around each atom. In the rapid rotation of magnetic moments in the DW, we found an electron rearrangement from the d(zx) and d(x(2)-y(2)) states to the d(xy), d(yz) and d(z(2)) states due to a shift of band structures. Applied tensile and compressive in-plane strains both bring about narrower DWs in the monolayer except when the strain is small. The strain dependence of the DW width is discussed in terms of both exchange interaction and magnetocrystalline anisotropy.

[Compliance and knowledge about prescribed medication among elderly home-care recipients by method of providing medications].

After long-term care insurance commenced in April 2000, various types of in-home care began, including delivery of prescriptions medicines to the elderly. However, the effects of in-home care workers on patient drug compliance are unclear as yet. In this study, we examined the characteristics of the care workers who delivered prescription medicines to the elderly, and analyzed the effects on patient drug compliance and knowledge about medication. The subjects included 163 homecare recipients aged 60 and older, who were taking more than one prescribed drug, who ranked worse than J-2 who were physically disabled, and cognitively normal. The rate of good compliance was 71.1% when pharmacists provided the prescribed drugs and counseled the patients at home, which rate was significantly higher than that of self-supply by the patient (35.0%), caregiver supply (44.7%), and home-helper supply (0.0%). The difference in compliance may be explained by the possibility that when caregivers and home-helpers provided prescribed medications, thorough and accurate information about the drugs were not clearly imparted to the elderly, whereas when pharmacists provided prescribed medications, a pharmacological examination was performed and thorough and accurate information was communicated to the elderly. In the group counseled by pharmacists, knowledge about the effects and purpose of medication positively correlated with drug compliance. However, in the group provided drugs by caregivers, knowledge about the effects and purpose of medication inversely correlated with drug compliance. These findings suggested that the elderly in the latter group chose, to some degree, not to comply. Many elderly people had difficulty getting to hospital, and 23.1% of the patients in this study had not consulted the doctor for more than 2 months. Our data suggest that drugs provided by pharmacists and the availability of pharmacist counseling play an important role in preventing drug noncompliance and in making home care more effective, and also suggest that it is important for pharmacists to cooperate with other care workers, including a care-manager, and to provide written information on prescription medicine to caregivers and home-helpers as well as to elderly patients.

Is cognitive impairment a risk factor for poor compliance among Japanese elderly in the community?

OBJECTIVE: The association between cognitive impairment and compliance with prescribed medications was investigated among functionally independent Japanese elderly in the community. SUBJECTS: The subjects of this study were 220 elderly persons aged 60 years and over, who lived in the community. All participants were taking a regimen of one or more prescribed drugs. We included elderly with mild to moderate cognitive impairment. Medication use was observed by pharmacist-conducted interviews during home visits. Compliance was estimated by the pill count method. The Mini-Mental State Examination (MMSE) was used to estimate cognitive function. RESULTS: The mean age (SD) of the subjects was 75.7 (6.9) years. Of the subjects, 58 (26.4%) were cognitively impaired (MMSE < or = 23), and 76 (34.6%) exhibited poor compliance (rate of compliance< 80%). Poor compliance was associated with the subjects who had a lower education level, had lower MMSE scores, had concern about taking drugs, who intentionally self-selected (intentional noncompliance) prescribed drugs, had a poor relationship with a physician, who did not have one dose package, and those who did not use a medical calendar. In multiple logistic regression analyses, intentional noncompliance (OR 19.65, 95%, CI 9.22-41.92; OR, odds ratio; CI, confidence interval), cognitive impairment (MMSE < or = 23; OR 2.94, 95%, CI 1.32-6.58), and a poor relationship with a physician (OR 6.24. 95%, CI 1.55-25.20) were independent predictors of poor compliance for elderly in the community. CONCLUSION: We found that cognitive impairment was one of the predictors for poor compliance among the elderly who are functionally independent in the community. Intentional noncompliance was the strongest predictor for poor compliance, which was influenced by the relationship between patient and physician. Physicians should establish good communication with their elderly patients and provide some support to compensate for cognitive impairment.

Compliance and medication knowledge among elderly Japanese home-care recipients.

OBJECTIVES: To investigate the risk factors for noncompliance in elderly home-care recipients; and to evaluate to what extent regular home visits and drug counseling by a pharmacist contribute to compliance. SUBJECTS: One hundred and sixty-three elderly home-care recipients aged 62 years and over took part in this study. All subjects were cognitively normal, and taking a regimen of one or more prescribed drugs. Medication use was observed by pharmacist-conducted interviews during home visits. Compliance was estimated by comparing prescribed regimens with medications actually being taken at home. RESULTS: The mean age with (SD) of the subjects was 78.7 (8.3) years. Eighteen per cent were regularly counseled by a pharmacist about medication. Poor compliance with prescribed medications was associated with subjects aged 80 years and over, who were administering their own medication, consuming less than three meals a day, did not have one dose packages, and who were not receiving pharmacist counseling. In multiple logistic regression analyses, frequency of meals (OR 5.99; 95% CI 1.25-28.79), pharmacist counseling (OR 5.32; 95% CI 2.00-14.20), and age (OR 0.96; 95% CI 0.92-1.00) were independent predictors of good compliance for home-care recipients with physical disabilities. Compliance correlated inversely with knowledge of drug names, and drug purposes in the uncounseled group. Compliance, however, positively correlated with knowledge of drug purposes in the counseled group. CONCLUSION: In this study, compliance among elderly Japanese home-care recipients was found to be associated with receiving pharmacist counseling, frequency of meals, and age.

[Lifestyle, mental health, and awareness of health among Japanese bus drivers].

To examine lifestyle, mental health and awareness of health, a self-administered questionnaire survey was performed among 751 employees of a bus company in a rural city of Japan. From 597 (79.5%) respondents, we analyzed 130 male bus drivers and age-matched 130 male clerks. The questionnaire included eleven questions about lifestyle and mental health, three questions about awareness of health, and questions on personal concern about specific parts of the body or diseases, and health information they needed. Answers for lifestyle and mental health were classified into the categories of "good" or "not good" practices recommended by Breslow and Morimoto. The results were as follows; 1) Over 80 percent of subjects of both groups had good awareness of health, but bus drivers had significantly worse lifestyle with regard to nutritional intake (p < 0.05), daily walking (p < 0.001), sports (p < 0.05), and sleeping hours (p < 0.001). 2) Bus drivers had significantly greater prevalence of concern about their cardiovascular system, esophagus and gastrointestinal system, and joints and bones than clerks (p < 0.05). 3) Bus drivers had a significantly greater need for information about nutritional intake (p < 0.001), and methods for prevention of diseases (p < 0.01). From these results, the discrepancy between awareness of health and lifestyle seen in this study, especially in food intake, walking time, sports participation, and sleep, may have resulted from the bus driver's characteristics of job, for example, long and irregular working hours. Therefore, effective guidance on health and lifestyle changes to restore balance and improve their lifestyle.