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BACKGROUND Children born preterm may be less physically active than children born term because of neurocognitive problems, reduced lung function, and poor physical fitness. We evaluated sports participation of children and adolescents who had been born preterm (

Introduction: Late preterm infants (LPIs) are at greater risk for short- and long-term morbidity compared with term infants. However, little is known about whether breastfeeding can reduce the adve...

The incidence of allergic diseases is increasing, and research on their epidemiology, pathophysiology, and the prevention of onset is urgently needed. The onset of allergic disease begins in infancy with atopic dermatitis and food allergy and develops into allergic asthma and allergic rhinitis in childhood; the process is defined as “atopic march”. Atopic march is caused by multiple immunological pathways, including allergen exposure, environmental pollutants, skin barrier dysfunction, type 2 inflammation, and oxidative stress, which promote the progression of atopic march. Using recent evidence, herein, we explain the involvement of allergic inflammatory conditions and oxidative stress in the process of atopic march, its epidemiology, and methods for prevention of onset.

We examined the association between early childhood exposure to maternal smoking and behavioral issues at 8 years old using a large nationwide population-based longitudinal survey in Japan that began in 2001. We included 46,737 children with information about maternal smoking taken from the 6-month survey. We used logistic regression analysis to examine the hypothesis. Early childhood exposure to maternal smoking increased the risk of behavioral problems related to attention and aggressive or disruptive behavior. The adjusted odds ratios (95% confidence intervals) were 1.37 (1.22-1.54) for inability to wait their turn during play and 1.40 (1.27-1.55) for destroying toys and, compared with children of nonsmoking mothers. Children of mothers who were heavy smokers were more likely to develop behavioral problems than others. Stopping early childhood exposure to maternal exposure can protect children's neurodevelopment.

Aircraft impact analysis is needed for safety assessment of nuclear power plants. One of the items which should be analyzed for aircraft impact is physical damage to a reinforced concrete (RC) building and this can be estimated by numerical simulation. In the simulation, a simulation model which has been validated by some experimental data needs to be established. In 1988, an aircraft impact test using an F4 Phantom fighter was conducted at the Sandia National Laboratories in the US and a lot of important experimental data were measured. The numerical simulation results for this aircraft impact test are also introduced in this paper. The relationship between the thickness and the deceleration of the aircraft model is studied and then the differences in the deceleration between the simulation and test results are discussed. The relationship between the failure strain and the destruction modes of the aircraft and the target in the simulation are also studied, and then the differences between the simulation and test results are discussed as well. Through these parametric simulations, the validations of the aircraft and the target model are demonstrated. In evaluating the physical damage area inside the buildings, or discussing the necessary numbers of RC walls until the impacting aircraft stops, it is important to estimate whether the RC walls are perforated by an impacting aircraft. Besides numerical simulations, some empirical equations to estimate them are reported. One of them is the UKAEA equation. This equation estimates a dynamic punching strength of a RC wall. It is determined whether an impacting aircraft perforates a RC wall by comparing the dynamic punching strength with the dynamic impact load of the aircraft. In this paper, several aircraft impact simulations using the established aircraft model with different RC wall thicknesses are conducted. Dynamic punching strength of these RC walls are measured in each simulation. The obtained values in the simulations are compared with the estimated values by the UKAEA equation. The differences between them are investigated and the reasons of these differences are discussed.

Background Previous studies showed that preterm birth increased the risk for hospital admissions in infancy and childhood due to some acute diseases. However, the risk of preterm children developing Kawasaki disease remains unknown. In the present study, we investigate whether preterm birth increased the morbidity of Kawasaki disease. Methods We included 36,885 (34,880 term and 2005 preterm) children born in 2010 in Japan. We examined the association between preterm birth and hospitalization due to Kawasaki disease using a large nationwide survey in Japan. Results In log-linear regression models that were adjusted for children's characteristics (sex, singleton birth, and parity), parental characteristics (maternal age, maternal smoking, paternal smoking, maternal education, and paternal income), and residential area, preterm infants were more likely to be hospitalized due to Kawasaki disease (adjusted risk ratio: 1·55, 95% confidence interval: 1.01-2.39). We then examined whether breastfeeding status modified the potential adverse effects of preterm birth on health outcome. Preterm infants with partial breastfeeding or formula feeding had a significantly higher risk of hospitalization due to Kawasaki disease compared with term infants with exclusive breastfeeding. Conclusions Preterm infants were at a high risk for Kawasaki disease, and exclusive breastfeeding might prevent this disease among preterm infants. Impact Previous studies showed that preterm birth increased the risk for hospital admissions in infancy and childhood due to some acute diseases, however, the risk of preterm children developing Kawasaki disease remains unknown. This Japanese large population-based study showed that preterm infants were at a high risk for Kawasaki disease for the first time. Furthermore, this study suggested that exclusively breastfeeding might prevent Kawasaki disease among preterm infants.

The Neotropical coffee leaf miner is a key coffee pest and in the state of Bahia, one of the major coffee-producing states in the country. The insect finds favorable conditions for its development, causing production losses and intensive use of insecticides. Thus, the objective of the study was to analyze aspects of the profile of coffee crops and the management of the leaf miner, including the use of insecticide for the western and highland regions of Bahia. Data were obtained through questionnaires applied to coffee growers and/or production technicians and included information on the total area, area with coffee, and native vegetation, type of cultivation, cultivars, pest monitoring, methods of control and use, insecticide rotation, and doses used. Descriptive statistical analysis, principal component analysis (PCA), and canonical correlations indicated differences between farm size, and areas with coffee and native vegetation. Chemical pest control prevails as a management strategy in all farms. The results are important for managing the coffee leaf miner while providing an overview and diagnosis of insecticide use in coffee production in the state of Bahia. An increase in the application of systemic insecticides took place in recent years, similarly (same active ingredients) among most coffee growers. This fact increases the risk of selecting populations resistant to insecticides, compromising the management of the leaf miner in the regions.

Safety assessment methods for evaluating the effect of an aircraft impacting a reinforced concrete (RC) structure at a nuclear power plant are required. The damage behavior of an RC wall during aircraft impact would be simulated by finite element analysis (FEA). A model for simulating an aircraft and the RC used in the walls of a concrete structure should be established before an impact simulation is conducted. However, many concrete models are usually installed in commercial FEA codes. In this study, concrete models were investigated, and a model that is appropriate for simulating experimental fracture behavior was suggested. Validation of the concrete model was confirmed by conducting simulations of quasi-static and impact loading. The material properties of concrete models were identified from experimental results of previous literature. The applicability of a concrete model for quasi-static loading and impact loading were investigated by comparing the experimental results. First, quasi-static simulation of an RC beam specimen is subjected to a three-point bending load. The load-displacement curve and damage behavior of an RC beam specimen was compared with the experimental result. Next, impact simulations were conducted of a F4 fighter engines (GE-J79) missile impacting into three different wall thicknesses of 900, 1150, and 1600 mm and then compared the damage to the wall in the simulation with the experimental results conducted at Sandia National Laboratory around 1990. The results of simulated load and damage behavior of the RC beam specimen and the damage behavior of the RC walls agreed with the experimental results. The concrete models can be used to simulate the damage behavior on an RC wall subjected to impact loading.

To investigate the dynamics of body mass index (BMI) and height changes in childhood leading to obesity in adolescents. BMI Z-scores were calculated using the LMS (lambda–mu–sigma) method based on yearly height and weight information (age 1.5–15 years) from a nationwide Japanese birth cohort that started in 2001 (n = 26,711). We delineated the trajectories of BMI and height changes leading to obesity at age 15 years using mixed effect models. Children who became obese at the age of 15 years kept relatively high BMI z-scores through childhood for both genders, and had an increasing trend over time as opposed to the normal weight group, with an increasing slope during puberty. Early adiposity rebound was associated with overweight or obesity at the age of 15 years. Age at peak height velocity (APHV) occurred earlier in the obese/overweight group at age 15 years than in the normal weight group, and occurred later in the underweight group. Obese adolescents experienced early adiposity rebound timing and maintained a serial BMI z-score increase throughout childhood, with a greater slope at puberty. An earlier peak in height gain during puberty may have contributed to the observed patterns of BMI change.

The aim of this study was to investigate the longitudinal relationship between shorter or irregular sleep duration (SD) in early childhood and increased risk of injury at primary school age using data from a nationwide survey in Japan. We categorized SD into seven groups: 6 h, 7 h, 8 h, 9 hrs, 10 or 11 h, &gt, 12 h, and irregular, based on questionnaire responses collected at 5.5 years old. The relationship between SD and incidence of injury at 5.5–nine years of age is shown. In addition, we completed a stratified analysis on children with or without problematic behavior at eight years old. We included 32,044 children, of which 6369 were classified as having an injury and 25,675 as not having an injury. Logistic regression model showed that shorter or irregular SD categories were associated with an increased adjusted odds ratio (aOR) for injuries (6 h: aOR 1.40, 95% confidence interval (CI) 1.19–1.66, 7 h: aOR 1.10, 95% CI, 0.98–1.23, 8 h: aOR 1.13, 95% CI, 1.02–1.26, irregular: aOR 1.26, 95% CI 1.10–1.43). The same tendency was observed with shorter or irregular SD in subgroups with or without behavioral problems. Shorter or irregular sleep habits during early childhood are associated with injury during primary school age.

Dental caries is the most common chronic childhood disease. Recent studies have suggested that dental caries harbor respiratory infections in adults. We investigated the association between dental caries and influenza in children. In this study, 42,812 children aged 2.5 years, 38,540 children aged 5.5 years, and 34,124 children aged 10 years were included in the analysis from the Longitudinal Survey of Newborns in the 21st Century in Japan, which targeted all children born during a certain period in 2001. We used information on dental caries treated at hospitals and clinics in the past year as exposure and influenza as outcome during the observation periods (1.5–2.5, 4.5–5.5, and 9–10 years of age). We performed a log-binomial regression analysis, adjusting for potential confounders, and stratified analysis according to previous dental caries status. The presence of dental caries increased the incidence of influenza in all three target ages compared with the absence of dental caries. The incidence of influenza increased with the presence of current dental caries, regardless of the presence of past dental caries. These associations were observed irrespective of household income. Early detection and treatment of dental caries may reduce the risk of influenza in children.

Background: Although breastfeeding has been well-established as the preferred method for infant nutrition, its prophylactic effects on food allergy remain controversial. Infantile eczema has been linked to food allergy via percutaneous sensitization; however, this relationship has not been considered in previous studies. We aimed to uncover the prophylactic effects of breastfeeding on food allergy, focusing on eczema-mediated percutaneous sensitization. Methods: This retrospective cohort study was based on 46,616 children from the Longitudinal Survey of Newborns in the 21st Century in Japan, begun in 2001. We classified participants into three groups based on infant feeding practices (exclusive breastfeeding, partial breastfeeding including only colostrum, and formula feeding only) and used information from at least one outpatient visit for food allergy during two observation periods (age 6–18 months and age 6–66 months) as health outcomes. We performed log-binomial regression analysis adjusted for potential confounders and stratified analysis according to infantile eczema status. Results: Compared with formula feeding, partial breastfeeding including only colostrum reduced the risk of food allergy only in children with infantile eczema, (RR = 0.66, 95% CI: 0.46, 0.96 for age 6–66 months), whereas exclusive breastfeeding increased this risk in those without infantile eczema (RR = 2.41, 95% CI: 1.40, 4.15, age 6–66 months). The prophylactic effects of breastfeeding on food allergy in the infantile eczema group increased with shorter breastfeeding duration. Conclusions: Our results showed that breastfeeding, especially colostrum, had prophylactic effects on food allergy only among high-risk children with infantile eczema whereas prolonged breastfeeding increased the risk of food allergy. Keywords: Breastfeeding, Cohort, Colostrum, Eczema, Food allergy

Aircraft impact analysis is needed for a safety assessment of nuclear power plants. One of the contents which should be analysed for aircraft impact is physical damage of a concrete building and this can be estimated by a numerical simulation. In order to conduct aircraft impact analysis, simulation model which validated by some experimental data needs to be established. In 1990s, impact test using actual F4 Phantom fighter was conducted at Sandia national laboratory in U.S. and a lot of important experimental data were measured. In this paper, the numerical simulation results for this F4 Phantom impact test are introduced. The relationship between the thickness of the shell of the F4 Phantom simulation model and the deceleration of this model is indicated and the differences of the deceleration between simulation and test results are discussed. In addition, the relationship between fracture strain of the shell of the F4 Phantom simulation model and the destruction mode of this model in simulation is indicated and the differences between the destruction mode of the F4 Phantom between simulation and test results are discussed. In order to evaluate the physical damage area after the aircraft impact, it is necessary to estimate the aircraft velocity after it perforates the outer concrete wall and to calculate the decrease of the kinematic energy of the aircraft by this perforation. In this paper, several aircraft impact simulations with different concrete wall thickness are conducted and the reduction in kinematic energies of an aircraft by a perforation is estimated. Using these simulation results, the necessary numbers of concrete walls until the impacting aircraft stops is discussed.

When Salvadore Cammarano was adapting Walter Scott’s The Bride of Lammermoor (1819) for Donizetti’s new opera, Lucia di Lammermoor (1835), the librettist removed several characters. The most striking deletion was that of Lucy’s mother, Lady Ashton, who in the novel seems to be a prime mover in the narrative, alongside the character of Lucy herself. This paper first discusses Lady Ashton’s absence in relation to general theories of ‘opera-as-adaptation’, and contrasts Donizetti’s opera with earlier stage works based on the same novel. Central to the dramaturgical analysis here is the notion of ‘presence-through-absence’: Lady Ashton’s influence is present in spite of her bodily absence; Lucy’s ‘angelic’ personality masks darker aspects not directly acknowledged; and the silent presence of the ghostly girl killed by an ancestor of Lucy’s lover Ravenswood turns Lucia into what we might call (borrowing from Derrida) a “corporeal ghost”. Indeed the metaphysics of presence/absence, conceived in Derridean terms, has a great deal to do with this opera, and offers a hermeneutics window into its effects and layers of activity.

To avoid the stress encountered during oral drug administration, we implanted chronically a catheter into the stomach, and recorded electroencephalogram (EEG) and electromyogram, in freely moving rats to evaluate their sleep–wake pattern. Rats with catheters in their stomach did not exhibit any changes in sleep–wake profiles in terms of sleep amount, number of episodes and EEG power spectra. When administered through the catheter, caffeine (6 mg/kg) statistically increased wakefulness, as compared with the vehicle control. However, when given orally by hand restraint and gavage, it caused no increase in wakefulness, owing to the masking effect of this method, which caused increased wakefulness when saline was used by handling animals. These results indicate that oral administration through a chronic stomach catheter is a useful way for evaluating wake-promoting components.

We assessed the surgical indication in obstructive sleep apnea syndrome (OSAS) by comparing cephalometry between a responder group of uvulopalatopharyngoplasty (UPPP) and a nonresponder group. Cephalometric studies were conducted on 43 patients--42 men and one women--who required UPPP and underwent both pre- and postoperative polysomnography, and on 50 non-OSAS patients who formed the control group. Angles and distances were measured based on the Downs-Northwestern method as detailed in the reference cited. The comparison between the OSAS and control groups indicated anterior displacement of the maxilla, and anteroposterior discrepancies of the maxilla and the mandible in OSAS. Significant differences were seen in distance measurements for all values other than the distance from the sella to the nasion. We then compared the 3 groups--responders, nonresponders, and controls. From differences in the Y-axis angle, the Gonial angle, the ANB angle, the distance from the gonion to the menton, and the maximum thickness of the soft palate between responder and control groups, we concluded that the efficacy of UPPP is higher in OSAS patients who have several factors such as micrognathia, anteroposterior discrepancy in the maxillary and mandibular bases, and thick soft palate. We concluded that routinely conducting that cephalometric analysis would be useful for deciding on adopting UPPP.

Recently Coblation Technology has been used to enlarge the pharyngeal space in sleep disordered breathing patients. However, the indications are unclear. In this study, we evaluated Coblation Technology with the epworth sleepiness scale (ESS), visual analogue scale (VAS) for snoring, and apnea hypopnea index (AHI) in 17 sleep-disordered breathing patients. ESS (89%) and VAS (100%) were improved in most cases after surgeries. Of the 17 patients with AHI, 88% had a reduced AHI of more than 50% after Coblation Technology. All of the patients with an AuI under 40 improved remarkably after treatment; however, several patients with an AHI over 40 did not improve as much. Coblation Technology is an effective treatment for sleepiness and snoring in sleep-disordered breathing patients, however, the physician must be careful using it for patients with an AHI above 40.

In an electronics plant, a new one-component naphthalene type epoxy resin was used as an adhesive for reinforcing a circuit board. The resinous part of the adhesive consisted of diglycidyl ether of bisphenol A (DGEBA) and 1,6-bis(2,3-epoxypropoxy)naphthalene type epoxy resins. The hardener was methylhexahydrophthalic anhydride (MHHPA). Of 54 workers, 15 (27.8%) were diagnosed to have work-related dermatitis but were not patch tested. Therefore, it was impossible to determine the specific agent responsible for the worker's symptoms or to distinguish between allergic and irritant contact dermatitis. They worked without protective gloves until they started to develop skin symptoms. The hands were the commonly affected region (13 out of 15 cases). The latent period of dermatitis was very short (mean 2.2 weeks). Of these, 10 cases (66.7%) received medication for dermatitis, and 9 cases (60%) were transferred to other work. The work-related skin symptoms were closely related to the specific tasks, i.e., filling dispensers with the adhesive and manual application of the adhesive to a portion of a circuit board using a dispenser. For occupational hygiene reasons, contact with epoxy resins should be minimized by taking all possible measures into use, including protective gloves. Further studies are required to clarify the allergenicity of 1,6-bis(2,3-epoxypropoxy)naphthalene, since very little is known about the mechanism through which it leads to the symptoms of dermatitis.

O objetivo deste trabalho foi o de avaliar as práticas culturais utilizadas no cultivo da mandioca em 13 municípios da Região Sudoeste da Bahia. Foram aplicados 848 questionários durante o primeiro semestre de 2005. A amostragem foi realizada por município, com coleta de informações sobre variedades utilizadas, origem do material de plantio, época de plantio, método de plantio e espaçamento, consorciação, manejo de plantas daninhas, ocorrência de pragas e doenças e época de colheita. Os dados foram submetidos à análise de frequência simples de ocorrência das alternativas apresentadas nos questionários, usando-se os programas SAEG 9.1 e Excel 2003. O sistema de produção foi caracterizado pela reduzida adoção de tecnologias agronômicas. A maioria dos produtores não usa técnicas como plantio em espaçamento apropriado e regular, predominando o cultivo de variedades tradicionais, colhidas geralmente com 18 a 24 meses após o plantio, feito em sistema de consórcio, predominando o uso do feijão e do milho. The aim of this research was to evaluate cassava crop management practices in thirteen counties of Southwest area of Bahia State. There were used 848 questionnaires during the first semester of 2005. The sampling was taken in each one of counties, with data about utilized varieties, source of the cassava cuttings, planting period, planting method and spacing, intercropping, weed management, pests and diseases control, and harvest time. The data were submitted to simple frequency analysis of the alternatives showed in the questionaires using the SAEG 9.1 and Excel software. The production system was characterized by low adoption of agricultural technologies. Most of the farmers do not use proper and regular plant spacing, prevailing the cultivation of traditional varieties, harvested generally with 18 a 24 months after the planting which is done mainly in intercropping with common bean and maize.

Purpose To compare the outcomes of transconjunctival sutureless 23-gauge vitrectomy and conventional 20-gauge vitrectomy 1 year after removal of preretinal membrane. Design Retrospective, consecutive, comparative case series. Methods One hundred consecutive eyes with a preretinal membrane underwent either 23- and 20-gauge vitrectomy. The rate of improvement of the logarithm minimum angle of resolution visual acuity (VA) was calculated by the formula: (various postoperative values − preoperative values) × 100/ (1 year postoperative values − preoperative values). Results No significant differences were found between the groups in the preoperative and postoperative VAs. The VA improvement was higher and the surgically induced corneal astigmatism was lower 1 week postoperatively in the 23-gauge group compared with the 20-gauge group (P = .006 and P = .001, respectively). The flare values in the anterior chamber measured by laser flare meter preoperatively and 1 week postoperatively did not differ between the groups. The surgical time was significantly (P = .023) shorter in the 23-gauge group than in the 20-gauge group. No apparent complications developed in either group. Conclusion Transconjunctival sutureless 23-gauge vitrectomy appears effective for preretinal membrane surgery with an acceptable safety profile. Transconjunctival sutureless 23-gauge vitrectomy may be a treatment option for preretinal membranes.

AIM This study was done to clarify the characteristics of elderly patients with nontuberculous mycobacteriosis. METHODS We investigated the clinical features of 10 patients at an advanced age who had been given diagnosis of nontuberculous mycobacteriosis. RESULTS Mycobacterium avium intracellulare complex (MAC) were detected in all cases. The age of the patients ranged from 65 to 92. Four cases had underlying respiratory diseases (old pulmonary tuberculosis in 3 cases, pulmonary emphysema in 1 case, bronchiectasia in 1 case). Six cases suffered from dementia. The symptoms were relatively nonspecific, such as low grade fever, fatigue, appetite loss in almost all cases in this study. On computed tomography (CT) scans of the chest, mainly small nodular infiltrates were seen. MAC was detected in clinical samples such as sputum, gastric juice and bronchial lavage. The examination of gastric juice was performed in 6 out of the 10 cases. Gastric juice samples were smear-positive for acid-fast bacilli in 5 of 6, and culture-positive for MAC in 5 of 6. The detection of MAC in gastric juice samples was higher than that in sputum samples on admission. CONCLUSION Gastric juice might be useful to differentiate infection from casual isolation of MAC in elderly patients.

The seroprevalence of IgG antibodies to Toxoplasma gondii was assessed in 56 non-hemophiliac human immunodeficiency virus (HIV)-infected adult patients in Japan. Seroprevalence of T. gondii infection was only 5.4%, which is lower than reported for most other countries. Given these results, patients in Japan displaying lesions of the central nervous system and antibodies to T. gondii have a high probability of toxoplasmosis.

Legionella spp are well recognized as one of the etiologic factor in pneumonia, but it is difficult to distinguish the clinical features of Legionella infection from pneumonia due to other causes. The objective of the present study was to examine the clinical characteristics of community-acquired Legionella pneumonia in elderly patients. We reviewed the clinical, laboratory and radiographic findings in 8 patients diagnosed as having pneumonia caused by Legionella. The diagnosis was confirmed by the presence of urinary antigen, bacterial culture, polymerase chain reaction (PCR) and serum antibody. There were 6 men and 2 women, whose ages ranged from 76 to 85 years. All patients had fever and hypoxia, four patients had respiratory symptoms. The initial chest X-ray findings were varied--consolidation, ground glass opacity, pleural effusion and linear shadow. Urinary antigen was positive in 4 patients, bacterial culture in 2, PCR on the sputum in 3 and serum antibody in 2 patients. As pneumonia caused by Legionella often becomes life-threatening, especially in elderly people, it is imperative to diagnose it at the initial stage. In this study, urinary antigen proved to be the most useful diagnostic means. However, it is important to confirm the diagnosis through plural examinations.

Aims: To investigate the frequency, rate of causes of dementia, and clinical characteristics of early-onset dementia in consecutive patients of a memory clinic. Methods: A total of 668 consecutive demented patients were involved in this study. We examined the distribution of patients’ diagnosis, differences in sex, education, dementia severity and cognitive function at the first visit, and the duration from onset to consultation. We also examined the changes in the proportion of subjects during the research period. Results: There were 185 early-onset patients, 28% of all demented patients. No significant differences were observed between the early-onset and late-onset dementia groups in Clinical Dementia Rating and Mini-Mental State Examination score at the first consultation, but the duration from onset to consultation was significantly longer in the early-onset group. In the early-onset group, the rates of patients with Alzheimer’s disease and dementia with Lewy bodies were relatively low and the rate of patients with frontotemporal lobar degeneration was relatively high. There were no significant differences in the proportion between either demented subjects and nondemented subjects or early-onset dementia patients and late-onset dementia patients during the research period. Conclusion: We conclude that early-onset dementia is not rare and its clinical characteristics and causes are different from late-onset dementia.

Background The increase in the number of people suffering from dementia is of increasing global concern. A survey on the living conditions of the elderly in a Japanese rural community revealed a high prevalence of early dementia and the necessity for interventions not only for the elderly with early dementia but also for their families. Objective To describe the implementation and process evaluation of a programme based on cognitive rehabilitation aimed at empowering the elderly with early dementia and education and counselling programmes aimed at likewise empowering their family caregivers. Design This study used a community health action research model. Participatory action research (PAR) was conducted through a cycle of planning, action, and reflection to identify effective interventions to empower participants with dementia (PsWD) and their caregivers. Setting A rural town in Japan. Participants This project involved 37 community-dwelling elderly with early or mild dementia and 31 family caregivers. Methods A focus group interview was used for assessment. A monthly activity-based programme based on cognitive rehabilitation was developed to improve cognitive function. Three types of data were collected: observational data collected during the activities, written comments from the caregivers, the record of phone interviews and counsellings with caregivers. These data were compiled in chronological order into a portfolio for analysis. To empower family caregivers, educational and counselling programmes were offered. Results The PAR lasted for 5 years and evolved over three cycles: individual, group and community. In the first cycle, the major focus of the intervention was to regain procedural skills for each PWD through a cooking programme. In the second cycle, to increase interactions with family members and with other PsWD, group activities that promoted communication among family members as well as among PsWD were implemented. The collective values and the beliefs of the PsWD's generation were validated by a series of trips to temples and shrines. In the third cycle, community participation was planned and implemented through culturally relevant sequential activities. PsWD demonstrated their expert skills and regained confidence. For family caregivers, the educational programme provided knowledge about dementia and utilization of social resources. Face-to-face and phone counsellings were offered as needed to coach problem-focused coping. These programmes helped to interpret the symptoms of dementia and to reduce the behavioural problems. Conclusions Cognitive rehabilitation theory was useful to restore lost procedural skills and regain confidence for PsWD. This PAR illustrated the importance of interventions for both community dwelling elderly with early dementia and their family caregivers.