Aim:The aim of this study was to investigate the factors related to readmission to a ward for dementia patients with special attention to sex-related issues. Methods:We reviewed the data of 326 patients who were hospitalized in a ward for dementia patients between 1 April 2000 and 31 March 2008, and followed up for 24 months after discharge. For univariate and multivariate analyses, patients were divided into: (i) patients who were not readmitted to our ward within 24 months (control); (ii) patients who were readmitted to our ward within 3 months (early readmission); and (iii) patients readmitted within 4 to 24 months (late readmission). Results: Factors related to readmission differedbetween sexes as well as between the early and late stage. A small number of cohabitants and outcome (hospital) were factors related to early readmission in men, while outcome (hospital) and long stay in the ward were related to early readmission in women. High physical function, care distress and short stay in the ward were the factors related to late readmission in women. Conclusions:Most patients who were transferred to another hospital were readmitted within 3 months. Some women were readmitted in the late stage. They had relatively high cognitive and physical functions and most of their caregivers had care distress. The causes of readmission were not due to a decline in cognitive function. It is important to prevent complications in dementia patients and to establish a caregiving system for dementia patients that decreases the burden on caregivers in order to reduce the rate of readmission.Key words: factors, sex difference, outcome, readmission, ward for dementia patients. I N A PREVIOUS study, we investigated the distress of family members caring for dementia patients and the effect of sex differences among care recipients.1 In a second study, we identified predictors that influenced the outcome after discharge from a ward for dementia patients. In the hospital group, the incidence of complications was high for each sex. In men, the activities of daily living (ADL) score predicted the outcome between the group returning home for care and the institutionalized group. In women, the revised version of Hasegawa's Dementia Scale (HDS-R) score, caregiver, and number of cohabitants influenced the outcome. In women, it was supposed that the predictors of outcome were mainly related to the system under which they received care.2 In a third study, it was observed that there were sex differences among predictors of the length of stay. However, it was difficult to predict the length of stay on admission. Retrospectively, the length of stay was determined by physical and psychological conditions in men. In women, it was supposed that the caregiver's desire to provide care at home reduced the length of stay. However, complication was a common predictor of extension of stay in both sexes. 3 *Correspondence: Toshiyuki Ono, MD, PhD, Department of Psychiatry, Tsuruga Onsen Hospital, 41-1-5 Yoshiko, Tsuruga, Fukui 914-0024, Japan. Email: tur...

Background: In our previous studies, we found both gender differences among care recipients and predictors that influenced outcomes after discharge from a ward for demented elderly. Here, we investigate predictors that influence the length of stay for each sex. Methods:We studied the data of 390 patients with dementia who were hospitalized in a ward for demented elderly between 1 April 2000 and 31 March 2008, and treated until 31 March 2009. The patients were divided into groups classified by gender. We analyzed the gender differences of characteristics and evaluated the predictors that influenced the length of stay in the ward for demented elderly using Cox's proportional hazards model. A model using the initial scores of the Revised Hasegawa Dementia Scale (HDS-R), Assessment Scale for Symptoms of Dementia (ASSD) and Nishimura's activity of daily living scale (N-ADL), which were examined on admission, was named Model 1. In Model 1, we checked the effect of each patient's characteristics, except for complications and destinations, on their length of stay. Model 2 used the final scores of HDS-R, ASSD and N-ADL including complications and destinations. Results: There was a clear gender difference in the length of stay. The length of stay of women was longer than that of men. It was difficult to predict the length of stay in Model 1. Age was the only predictor in women and no predictor was identified in men. In Model 2, complications and the final HDS-R and N-ADL scores were predictors of the length of stay in men. Age, complications and destinations were predictors of the length of stay in women. Conclusions: It was observed that there were gender differences among predictors of the length of stay. However, it was difficult to predict the length of stay on admission. Retrospectively, the length of stay was determined by physical and psychological conditions, not by the social variables in men. In women, it was supposed that the caregiver's wish to give care at home reduced the length of stay. Besides, complication was a common predictor of the extension of stay in each sex. We have to decrease the number of complications as much as possible to reduce the length of stay.

Background: In a previous study, we found gender differences among care recipients and suggested that elderly women living alone have difficulty receiving care from their families. We investigated the gender differences among predictors which influenced outcomes after discharge from a ward for treatment of demented elderly with severe psychotic symptoms. Methods: We enrolled the data of 325 patients with dementia who were hospitalized between 1 April 2000 and 31 March 2007, and discharged by 31 March 2008. Two hundred and ninety-four patients were divided into men and women. We checked the gender differences of their characteristics. After that, they were subdivided into three groups to analyze the effect of each patient's characteristics and care situation on their outcomes: (i) given home care (home); (ii) became institutionalized (institution); and (iii) transferred to another hospital (hospital). Results: In the hospital groups, the incidence of complications was high for each sex. The differences between the institution group and home group were shown by N-ADL score in men. In contrast, the predictors in women were the HDS-R score, the number of cohabitants and the caregiver. Conclusions: It was observed that there were gender differences among outcome predictors. The outcomes of demented patients were predicted by both complications and condition on admission. Most women did not return to their homes because of the situation in which they received care. It is necessary to establish a clear system for providing care for the demented elderly, especially for women.

Peritoneal fibrosis (PF) is a severe complication of peritoneal dialysis, but there are few effective therapies for it. Recent studies have revealed a new biological function of trehalose as an autophagy inducer. Thus far, there are few reports regarding the therapeutic effects of trehalose on fibrotic diseases. Therefore, we examined whether trehalose has anti-fibrotic effects on PF. PF was induced by intraperitoneal injection of chlorhexidine gluconate (CG). CG challenges induced the increase of peritoneal thickness, ColIα 1 mRNA expression and hydroxyproline content, all of which were significantly attenuated by trehalose. In addition, CG challenges induced a marked peritoneal accumulation of α-SMA + myofibroblasts that was reduced by trehalose. The number of Wt1 + α-SMA + cells in the peritoneum increased following CG challenges, suggesting that a part of α-SMA + myofibroblasts were derived from peritoneal mesothelial cells (PMCs). The number of Wt1 + α-SMA + cells was also suppressed by trehalose. Additionally, trehalose attenuated the increase of α-SMA and ColIα 1 mRNA expression induced by TGF-β 1 through Snail protein degradation, which was dependent on autophagy in PMCs. These results suggest that trehalose might be a novel therapeutic agent for PF through the induction of autophagy and the suppression of mesothelial-to-mesenchymal transition in PMCs. Organ fibrosis is a common pathway that finally results in organ failure. Disease-related injuries are responsible for triggering fibrogenic responses. Fibrosis is a short-term adaptive response for wound healing, but prolonged injuries progress and lead to the overproduction of extracellular matrix (ECM). The dynamic deposition of ECM promotes progression to organ fibrosis and ultimately to organ failure 1. Peritoneal fibrosis (PF) is a serious complication for patients undergoing peritoneal dialysis (PD) 2 , which is a life-sustaining therapy for patients with end-stage renal disease worldwide, which accounts for 11% of the overall dialysis population 3. Dialysis solution is hyperosmotic and hyperglycemic, and can induce consecutive peritoneal injuries, thus inducing the progression of peritoneal fibrosis 4. The development of PF causes encapsulating peritoneal sclerosis, which is a lethal complication of PD and an important problem that makes long-term PD difficult 2,5,6. However, the precise molecular mechanisms for the development of PF need to be clarified to establish therapeutic strategies.

It is better to control behavioral and psychological symptoms in order to improve the utilities of day care for dementia patients. The caregiving environment of dementia patients might be associated with the length of day care attendance.