Reliability and validity of the Japanese version of the World Health Organization-Five Well-Being Index in the context of detecting depression in diabetic patients

Masticatory performance indicates the development of psychological frailty: A 6-year prospective cohort study by the SONIC study group

PURPOSE

Although the association between oral health and physical frailty is well established, psychological frailty has not been investigated. Therefore, this prospective cohort study was conducted to examine the association between masticatory performance and psychological frailty in older community-dwelling Japanese individuals.

METHODS

The participants included 498 older adults who completed baseline and 3- and 6-year follow-up surveys. The World Health Organization-5 (WHO-5) scale and the Japanese version of the Montreal Cognitive Assessment (MoCA-J) were used to evaluate the psychological frailty status of participants. Psychological frailty was defined as a WHO-5 score < 13 and a MoCA-J score < 23. Masticatory performance was evaluated using a scoring method for the test gummy jelly (score: 0-9). A mixed-effects ordinal logit model analysis was used to examine the influence of masticatory performance and number of teeth on the development of psychological frailty while adjusting for relevant factors such as educational level, financial status, living situation, area of residence, history of chronic diseases, and handgrip strength.

RESULTS

A total of 311 participants (62.5%) exhibited psychological robustness at baseline. The rates of development of psychological frailty after 3 and 6 years were 4.2% and 4.5%, respectively. The longitudinal analysis revealed that masticatory performance at baseline was negatively associated with the prevalence of psychological frailty and pre-frailty at follow-up.

CONCLUSIONS

Decreased masticatory performance is associated with the development of psychological frailty in older community-dwelling people of Japanese descent.

Effect of participating in Kayoi-no-ba during the COVID-19 pandemic on frailty 1 year later in older adults

AIM

This study examined the short-term effects of participation in Kayoi-no-ba - community gathering places for residents to contribute to care prevention with the support of volunteers in Japan - on frailty status during the coronavirus disease 2019 (COVID-19) pandemic, based on a 1-year longitudinal study of older adults.

METHODS

Participants (n = 3899) were aged ≥65 years. At baseline, they were classified into four groups, based on their frequency of participation in Kayoi-no-ba before and after the COVID-19 pandemic: the nonparticipation group, the continued participation group, the interrupted participation group and the new participation group. Frailty status, assessed using the modified Kihon Checklist, was the dependent variable. A generalized linear mixed-effects model was used to compare frailty status changes after a 1-year follow up in the four groups.

RESULTS

The frailty prevalence at baseline was 30.8% in the nonparticipation group, and 37.2% in the participation group. The frailty prevalence in the participation group was significantly reduced at the 1-year follow up (-3.9 percentage points [95% CI -7.4, -0.5]), compared with that of the nonparticipation group. In subgroup analyses, the frailty prevalence was reduced at the 1-year follow up in the order of continued participation group (-4.5 percentage points [95% CI -8.9, -0.2]), new participation group (-4.0 percentage points [95% CI -12.9, 5.0]), and interrupted participation group (-2.4 percentage points [95% CI -9.1, 4.3]), compared with the nonparticipation group (P = 0.024 for trend).

CONCLUSIONS

Even during the COVID-19 pandemic, participation in Kayoi-no-ba was effective in preventing/reducing frailty. Thus, avoiding prolonged nonparticipation in Kayoi-no-ba might be important. Geriatr Gerontol Int 2025; 25: 598-605.

Association Between Occupational Participation and Quality of Life in Japanese Older Adults

Positive associations between occupational participation and quality of life (QoL) are known in various populations, but there are few reports in older adults in Japan. To quantify the association between occupational participation in meaningful occupations and QoL among Japanese community-dwelling older adults. A self-administered questionnaire was sent to 626 older adults. QoL was assessed using the World Health Organization (WHO)-five well-being index, and occupational participation in meaningful occupations was measured with the self-administered occupational performance index. The association between occupational participation and QoL was analyzed. Among 367 participants, significant associations were found between occupational participation in meaningful occupations and QoL. In addition, participants with lower QoL exhibited lower levels of occupational participation in occupational control, occupational balance, and satisfaction of performance domains. There is a positive association between occupational participation and QoL among Japanese older adults. Occupational therapists should prioritize occupational participation to support the well-being of older adults.

Effect of Mediterranean diet and physical activity on healthcare professional depression, burnout and professional fulfillment during COVID-19

Objectives. The mental health of healthcare professionals, especially during the COVID-19 pandemic, is a critical concern. This study investigates the prevalence of burnout and professional fulfillment, depression and the relationship between physical activity and adherence to the Mediterranean diet with depression, burnout and professional fulfillment among healthcare professionals. Methods. Data were collected through a web-based survey of 567 healthcare professionals. Logistic regression analysis with age and sex adjustment was employed to analyze the results. Results. The prevalence of depression was 44%, burnout stood at 66% and professional fulfillment was reported at 28%. Adherence to the Mediterranean diet was linked to a reduced risk of depression (odds ratio [OR] 0.63, 95% confidence interval [CI] [0.41, 0.96], p = 0.033) and physical activity was also associated with a lower risk of depression (OR 0.49, 95% CI [0.32, 0.75], p = 0.001). Furthermore, adherence to the Mediterranean diet was associated with a reduced risk of burnout (OR 0.49, 95% CI [0.25, 0.98], p = 0.045). Conclusion. This study highlights the positive impact of physical activity and the Mediterranean diet as lifestyle factors on depression and burnout. These findings have implications for screening, follow-up and timely interventions to support the mental well-being of healthcare professionals.

Linear Association between Frailty as Assessed by the Kihon Checklist and Quality of Life in Community-Dwelling Older Adults: A Cross-Sectional Population-Based Study

BACKGROUND

The need for support focused on frailty and quality of life (QoL) in older adults is increasing. The Kihon Checklist (KCL) is a comprehensive and easy-to-use tool to assess frailty in older adults. Previous studies have shown associations between frailty and QoL; however, few studies have investigated the association between frailty using the KCL and QoL. In this study, the quantitative relationship between the KCL and QoL in community-dwelling older adults was investigated.

METHODS

This cross-sectional study included from participants in the 2017-2019 baseline survey of a cohort study of community-dwelling older adults in Sapporo, Japan. The World Health Organization-Five Well-Being Index (WHO-5) was used to assess QoL. The KCL was used to assess frailty, and the relationship between frailty and QoL was examined using binomial logistic regression analysis and restricted cubic spline models.

RESULTS

Four-hundred participants were included in the analysis. Of the participants, 22.5% had a lower QoL and they were more likely to have frailty than healthy participants (p<0.001). The KCL scores were significantly associated with a lower QoL (p<0.001). Furthermore, the association between the KCL score and QoL was linear, and subscales of activities of daily living, and depressive mood were significantly associated with a lower QoL.

CONCLUSION

The KCL, a comprehensive frailty questionnaire, was associated with a lower QoL in older adults. To maintain QoL in community-dwelling older adults, it is necessary to provide them with appropriate support from the stage before they are identified as frail by the KCL.

Physical, psychological, and social factors related to help-seeking preferences among older adults living in a community

BACKGROUND

Examining the nature of help seeking and related factors among community-dwelling older adults is important to address social problems, such as loneliness and consumer damage. This study aimed to clarify factors related to the help-seeking preferences of community-dwelling older adults.

METHODS

A questionnaire survey was conducted among men and women aged 65 or older in Tokyo, in 2021. Overall, 5,576 respondents agreed to provide personal information. The survey items included a shortened version of the Help-seeking Preference Scale and measures to evaluate basic attributes, physical and mental health, and social relationships, which were predicted to be associated with help-seeking preferences. Multiple regression analysis was used to analyze the participants' desire for and resistance to help.

RESULTS

Multiple regression analysis revealed significant associations between high desire for help and being female, poor financial status, living alone, low subjective health, subjective forgetfulness, low mental health, low frequency of going out, high trust in community, and lack of social support. Significant associations were also found between high resistance to help and old age, low education level, difficult financial status, low mental health, social isolation, and low trust in the community.

CONCLUSIONS

Older adults who are struggling with mental health may have a high desire for help but also a high level of resistance to help, which may discourage them from requesting assistance. This suggests the importance of professionals' outreach. Further, the results indicate the importance of fostering social capital in the community.

The Wako Cohort Study: Design and Profile of Participants at Baseline

BACKGROUND

We launched the Wako Cohort Study in 2023 to identify individual and socio-environmental factors related to the extension of healthy life expectancy and the reduction of health disparities among community-dwelling adults and to develop health promotion and care prevention strategies. This study profile aims to describe the study design and participants' profile at baseline.

METHODS

The Wako Cohort Study is a prospective study of community-dwelling adults aged ≥ 40 years living in Wako City, Saitama Prefecture, Japan. The Wako Cohort Study consists of two surveys: a mail-in survey for persons aged ≥ 40 years and a face-to-face assessment (on-site survey) for those aged ≥ 65 years. The survey items were designed considering the following points: 1) life course perspective (transition from middle to old age in the life course), 2) health indifference, and 3) employment in older age.

RESULTS

A total of 8,824 individuals participated in the mail-in survey (2,395 persons aged 40-64 years and 6,429 aged ≥ 65 years). Of those aged ≥ 65 years who returned the mail survey, 1,004 participated in the subsequent on-site survey. Men aged ≥ 65 years tended to have higher health interests than those aged 40-64 years; however, this was not true for women. In the mail-in survey, 30.4 % of those aged ≥ 65 years were employed.

CONCLUSIONS

The Wako Cohort Study is expected to provide new insights into the development of strategies to extend healthy life expectancy and reduce health disparities in Japan.

Mediating role of fruit and vegetable intake and social interaction between oral function and mental health in older adults aged ≥75 years: The SONIC study

PURPOSE

This study aimed to explore the association between oral function and mental health status in older adults and to determine the potential mediating roles of fruit and vegetable intake and social interaction.

METHODS

This cross-sectional study included 478 community-dwelling older adults aged ≥75 years in Japan. Oral functions (occlusal force, masticatory performance, tongue pressure, tongue-lip motor function, and swallowing function), mental health status, dietary assessment, frequency of outings and interactions with others, and the following confounders were evaluated: educational level, financial satisfaction, residential status, comorbidities, and cognitive function. Structural equation modeling was used to assess the following: (a) a basic model, which hypothesized that oral function has a direct effect on mental health status, and (b) a mediation model, which hypothesized that fruit and vegetable intake and social interaction have potential mediating effects on the association between oral function and mental health status.

RESULTS

The basic model revealed a positive direct association between oral function and mental health status (standardized coefficient = 0.10, P = 0.04). Fruit and vegetable intake and social interactions were identified as mediators; however, no direct association with oral function was observed in the mediation model (P = 0.28), indicating that oral function was indirectly associated with mental health status through the mediating effects of fruit and vegetable intake and social interactions.

CONCLUSIONS

Oral function showed a significant association with mental health status in community-dwelling older adults. Fruit and vegetable intake along with social interactions mediate this relationship.

Association of COVID-19-related violence and harassment with visiting nurses' mental health and intention to resign: A cross-sectional study in Japan

BACKGROUND

Prejudice related to the coronavirus disease 2019 (COVID-19) reportedly led to violence against healthcare workers by clients and their families. However, the impact of such violence and harassment on the mental health of visiting nurses during the pandemic remains unclear.

AIM

We aimed to examine the association of violence and harassment against visiting nurses with their mental health and intention to resign during the COVID-19 pandemic.

METHOD

We conducted an anonymous self-administered cross-sectional questionnaire survey to gain insight into the victimization, mental health, and personal resources (i.e., coping profiles and work engagements) among visiting nurses in Osaka. A multiple regression analysis and logistic regression analysis were used to identify associations between COVID-19-related violence and harassment and mental health or the intention to resign. Open-ended question data were assessed using content analysis to describe the details of the violence.

RESULTS

Visiting nurses were victimized by various people, such as clients and their families, residents in communities they visited, their colleagues, and their own neighbors. COVID-19-related violence and harassment was not significantly associated with subjective psychological well-being but was significantly associated with the intention to resign.

CONCLUSION

Visiting nurses experienced a comprehensive range of COVID-19-related violence and harassment during the pandemic, which may have affected their intention to resign. Coping strategies may be a possible way to mitigate the impact of such violence and harassment. During a novel infectious disease outbreak, adopting a new perspective is crucial, and managing mood swings may be helpful as an emotional coping mechanism.

Perspectives of people with schizophrenia on clinical outcome scales and patient-reported outcome measures: a qualitative study

BACKGROUND

Over the past half-century, numerous scales have been designed to quantify outcomes in people with severe mental health disorders. However, little is known about the views of people diagnosed with schizophrenia on individual outcome scales, particularly outside of European countries.

AIM

We conducted a qualitative study to examine the perspectives of people with schizophrenia on multiple scales in Japan.

METHODS

Eleven participants took part in focus group interviews. Five had extensive experience as mental health peer supporters; the others had no such experience. To address potential power imbalances and facilitate dynamic discourse, participants were intentionally divided into two groups on the basis of peer support experience, and two simultaneous two-hour focus group interviews were conducted in separate rooms. The participants reviewed 12 clinical and patient-reported outcome measures and discussed their views on each measure. Interview data for each group were combined prior to analysis and qualitatively analyzed by four researchers using a thematic analysis approach.

RESULTS

The average age of the participants was 42.7 years (SD = 8.3), and six were male. On average, the participants had been living with schizophrenia for 22.2 years (SD = 11.1). After analyzing the interview data, the following five themes were identified, each containing two to seven subthemes: 1) validity and format of the scale construct, 2) factors affecting the accuracy of responses, 3) plain language and familiar words in Japanese culture, 4) psychological impact on the respondents, and 5) containing important items in everyday life.

CONCLUSION

The participants provided both favorable and unfavorable feedback on each scale. When implementing research utilizing clinical outcome scales and patient-reported outcome measures, researchers should exercise caution considering the potential emotional impact on respondents. Furthermore, scale development should take into account the cultural background and psychological burden experienced by the respondents.

The Relationship Between Sleep Health, Sleep Regularity, Optimism, and Well-Being With Self-Rated Health: A Study on Healthcare Professionals

Background and Objective This study investigates the impact of sleep, well-being, and optimism on self-rated health among healthcare professionals in the United Arab Emirates (UAE).Methods A cross-sectional approach was employed, using Pearson correlation and linear regression to analyze the relationship between sleep, well-being, optimism, and self-rated health among health care professioansl in the UAE.Results The age range of the participants was between 20–65 years, and they were predominantly female (68.7%). Significant predictors of self-rated health included well-being (p < 0.001), optimism (p = 0.004), and sleep circadian regularity (p = 0.009), explaining 10% of the variance in self-rated health (R2 = 0.103). Among the participants, 84.1% worked in public hospitals, and 15.9% in private hospitals. Regarding body mass index, 43.9% were of normal weight, 4.8% underweight, 32.4% overweight, and 18.9% obese. Males reported higher well-being and sleep continuity scores than females.Conclusions The study highlights the critical role of sleep health, well-being, and optimism in shaping healthcare professionals’ self-rated health. These results suggest that improving these mental health factors can positively influence healthcare professionals’ self-rated health, potentially enhancing their performance and patient care quality. Further research is needed to identify additional determinants and to establish causal relationships through longitudinal studies.

Effects of brief family psychoeducation on family caregiver burden of people with schizophrenia provided by psychiatric visiting nurses: a cluster randomised controlled trial

BACKGROUND

The purpose of this study was to examine the effects of a brief family psychoeducation (BFP) programme provided by psychiatric visiting nurses on caregiver burden of family caregivers of people with schizophrenia through a cluster randomised controlled trial (cRCT).

METHODS

The study was a two-arm, parallel-group cRCT. Forty-seven psychiatric visiting nurse agencies were randomly allocated to the BFP programme group (intervention group) or treatment as usual group (TAU; control group). Caregivers of people with schizophrenia were recruited by psychiatric visiting nurses using a randomly ordered list. The primary outcome was caregiver burden, measured using the Japanese version of the Zarit Burden Interview. Outcome assessments were conducted at baseline, 1-month follow-up, and 6-month follow-up. Intention-to-treat analysis was conducted to examine the effects of the BFP programme on caregiver burden.

RESULTS

Thirty-four psychiatric visiting nurse agencies and 83 family caregivers of people with schizophrenia participated in the study. The participant attrition rate was less than 20%. Adherence to the program was 100%. Compared with TAU group, the BFP programme group had decreased caregiver burden. However, this improvement was not significant at 1-month follow-up (adjusted mean difference [aMD] = 0.27, 95% CI = - 5.48 to 6.03, p = 0.93, d = 0.01) or 6-month follow-up (aMD = - 2.12, 95% CI = - 7.80 to 3.56, p = 0.45, d = 0.11).

CONCLUSIONS

The BFP programme provided by psychiatric visiting nurses did not achieve significant decreases in caregiver burden. This result may be attributed to the difficulty in continuing the research due to the COVID-19 pandemic, which prevented us from achieving the targeted sample size necessary to meet the statistical power requirements, as well as to the participation of caregivers with relatively low burden. However, the program had the advantage of high adherence to treatment plan. Further studies should be conducted with a larger sample size and a more diverse sample that includes caregivers with a higher care burden.

TRIAL REGISTRATION

The study protocol was registered in the University Hospital Medical Information Network Clinical Trials Registry (UMIN000038044) on 2019/09/18.

Effects of Changes in Frequency of Going Out during the COVID-19 Pandemic on ikigai (Sense of Purpose in Life) and Mental Health in Middle-Aged and Older Adults in Japan

To clarify whether changes in frequency of going out due to the COVID-19 pandemic affect ikigai (sense of purpose in life) and mental health in Japanese middle-aged and older adults. In a questionnaire survey mailed to 16,866 adults aged > 40 years in Japan in September 2020, 7,973 responses were received (response rate, 47.3%) in October 2020. Following exclusions, data from 6,978 individuals (50.6% female, mean age 67.8 ± 12.2 years) were available for analysis. Respondents were categorized based on changes in frequency of going out, reflecting changes in social and/or physical activity, during the pandemic compared with before it: the previously active group went out often before but less often during the pandemic; the remained active group continued going out often; and the inactive group continued not going out often. Whether these changes affected the respondents' ikigai and mental health was investigated. The previously active group had a significantly higher proportion of individuals with decreased ikigai during the pandemic than the other groups. Mental health score decreased in all groups during the pandemic, but more so in the previously active group (-3.21), followed by the inactive and then the remained active groups (-1.45 and -1.28, respectively). Previously active individuals showed the greatest decline in ikigai and mental health among the three groups. These findings suggest that continuing to engage in appropriate physical and social activities, including going out, while following appropriate infection control measures, even under restrictions, can help people maintain ikigai and mental health.

Depression and Anxiety Mediate the Relationship between Discrimination and Well-Being in a Sample of Latinx Adults with Type 2 Diabetes: Results from a Dual Mediation Analysis

Latinxs experience greater risk for type 2 diabetes, discrimination, and poor mental health. The pathways linking these factors, however, are not well understood. This study tested whether depression and anxiety mediated the relationship between discrimination and well-being. Bootstrapped mediation tests were conducted using a sample of Latinx adults with type 2 diabetes (n = 121) and regression models adjusted for demographic and health covariates. Depression and anxiety fully and jointly mediated the effect of discrimination on well-being; everyday discrimination was linked to elevated symptoms of depression and anxiety which were, in turn, independently linked to reduced emotional well-being. Moreover, the effect size for the anxiety pathway (β=-0.13) was 60% larger than for depression (β=-0.08). Dual mediation suggests depression, and especially anxiety, may be important targets for interventions seeking to mitigate the deleterious effects of discrimination. Findings have important implications for psychotherapeutic treatments and public health policy.

Development of a short form of the Japanese version of the Caregiver Reaction Assessment (CRA-J-10) among informal caregivers of older adults

AIM

To support informal caregivers, a simple assessment tool capturing the multidimensional nature of caregiving experiences, including negative and positive aspects, is required. We developed a short form of the Japanese version of the Caregiver Reaction Assessment (CRA-J), a multidimensional assessment scale for caregiver experiences.

METHODS

The internet survey involved 934 Japanese informal caregivers aged 20-79 years (mean age = 58.8 years; 50.2% women) who completed questionnaires, including the CRA-J 18 items (CRA-J-18), consisting of five domains, such as impacts on schedule and finances and positive experiences of caregiving. A 10-item short version of the CRA-J (CRA-J-10; 0-50 points), which was prepared by selecting the two items with the highest factor loadings from each domain, was tested for model fit by confirmatory factor analysis (CFA) and was analyzed for correlations with the CRA-J-18, Zarit Burden Interview (ZBI), Positive Aspects of Caregiving Scale (PACS), Patient Health Questionnaire-9 (PHQ-9), and WHO-Five Well-Being Index (WHO-5). The area under the curve (AUC) in the receiver operating characteristic was evaluated as discriminability for depressive symptoms (PHQ-9 ≥ 10 points).

RESULTS

The CFA indicated a good model fit in the CRA-J-10. The CRA-J-10 correlated well with the CRA-J-18 and other variables (CRA-J-18, r = 0.970; ZBI, r = 0.747; PACS, r = -0.467; PHQ-9, r = 0.582; WHO-5, r = -0.588) and showed good discriminant performance for the presence of depressive symptoms (AUC = 0.793, 95% confidence interval = 0.762-0.823).

CONCLUSIONS

The CRA-J-10 allows a simple assessment of caregiver experiences, helping support informal caregivers. Geriatr Gerontol Int 2024; 24: 290-296.

A Community-Based Intervention to Enhance Subjective Well-Being in Older Adults: Study Design and Baseline Participant Profiles

Promoting subjective well-being is a crucial challenge in aging societies. In 2022, we launched a community-based intervention trial (the Chofu-Digital-Choju Movement). This initiative centered on fostering in-person and online social connections to enhance the subjective well-being of older adults. This paper describes the study design and baseline survey. This quasi-experimental study involved community-dwelling older adults aged 65-84 years in Chofu City, Tokyo, Japan. A self-administered questionnaire was distributed to 3742 residents (1681 men and 2061 women), and a baseline survey was conducted in January 2022. We assessed subjective well-being (primary outcome); psychosocial, physical, and dietary factors; and the use of information and communication technology variables (secondary outcomes) among the participants. After the intervention involving online classes, community hubs, and community events, a 2-year follow-up survey will be conducted to evaluate the effects of the intervention, comparing the intervention group (participants) with the control group (non-participants). We received 2503 questionnaires (66.9% response rate); of these, the analysis included 2343 questionnaires (62.6% valid response rate; mean age, 74.4 (standard deviation, 5.4) years; 43.7% male). The mean subjective well-being score was 7.2 (standard deviation, 1.9). This study will contribute to the development of a prototype subjective well-being strategy for older adults.

A chatbot to improve adherence to internet-based cognitive-behavioural therapy among workers with subthreshold depression: a randomised controlled trial

BACKGROUND

Internet-based cognitive-behavioural therapy (iCBT) is effective for subthreshold depression. However, iCBT has problems with adherence, especially when unaccompanied by human guidance. Knowledge on how to enhance adherence to iCBT without human involvement can contribute to improving the effectiveness of iCBT.

OBJECTIVE

This is an implementation study to examine the effect of an automated chatbot to improve the adherence rate of iCBT.

METHODS

We developed a chatbot to increase adherence to an existing iCBT programme, and a randomised controlled trial was conducted with two groups: one group using iCBT plus chatbot (iCBT+chatbot group) and one group not using the chatbot (iCBT group). Participants were full-time employees with subthreshold depression working in Japan (n=149, age mean=41.4 (SD=11.1)). The primary endpoint was the completion rate of the iCBT programme at 8 weeks.

FINDINGS

We analysed data from 142 participants for the primary outcome. The completion rate of the iCBT+chatbot group was 34.8% (24/69, 95% CI 23.5 to 46.0), that of the iCBT group was 19.2% (14/73, 95% CI 10.2 to 28.2), and the risk ratio was 1.81 (95% CI 1.02 to 3.21).

CONCLUSIONS

Combining iCBT with a chatbot increased participants' iCBT completion rate.

CLINICAL IMPLICATIONS

Encouraging messages from the chatbot could improve participation in an iCBT programme. Further studies are needed to investigate whether chatbots can improve adherence to the programme in the long term and to assess their impact on depression, anxiety and well-being.

TRIAL REGISTRATION NUMBER

UMIN000047621.

Measurement Properties and Optimal Cutoff Point of the WHO-5 Among Chinese Healthcare Students

Purpose

The World Health Organization-Five Well-Being Index (WHO-5) is widely used to assess subjective well-being. Nevertheless, measurement invariance and optimal cutoff point of the WHO-5 have not been examined in Chinese samples. We aimed to assess measurement properties of the Chinese version of the WHO-5 (WHO-5-C) among healthcare students.

Patients and Methods

A two-wave longitudinal assessment was conducted among 343 Chinese healthcare students from September to November 2022. Measurement properties of the WHO-5-C were assessed through structural validity using confirmatory factor analysis (CFA), measurement invariance using multigroup CFA (MGCFA) and longitudinal CFA (LCFA), convergent validity using correlation analysis with the Self-Rated Health Questionnaire (SRHQ) and Patient Health Questionnaire-4 (PHQ-4), reliability using internal consistency and test-retest reliability, and optimal cutoff point using receiver operating characteristic (ROC) analysis.

Results

The WHO-5-C demonstrated satisfactory structural validity with comparative fit index (CFI) of 0.968 at baseline and 0.980 at follow-up, and adequate measurement invariance in different sociodemographic variables at baseline (gender, age, major, home location, being only child, monthly household income, part-time job, physical exercise, hobby, frequency of visiting home, and stress coping strategy) (CFI changes [ΔCFI] = -0.009-0.003) and over a week (ΔCFI = -0.006-0.000). The WHO-5-C also had good internal consistency (Cronbach's α = 0.907-0.934; McDonald's ω = 0.908-0.935) and test-retest reliability (intraclass correlation coefficient [ICC] = 0.803). Convergent validity was supported by moderate correlations of the WHO-5-C with the SRHQ and PHQ-4. The optimal cutoff point of the WHO-5-C was found to be 50, with an area under the ROC curve of 0.882 at baseline data, with sensitivity of 0.803 and specificity of 0.762 at follow-up.

Conclusion

The WHO-5-C demonstrated adequate measurement properties, especially concerning cross-sectional and longitudinal measurement invariance, with a recommended optimal cutoff point of ≥ 50 for assessing adequate level of psychological well-being in healthcare students.

Higher oxytocin concentrations occur in subjects who build affiliative relationships with companion robots

Building affiliative relationships with others is important for mental health. Recently, robots have been expected to play a role in improving mental health, but there is little scientific evidence as to whether they can build affiliative relationships with humans. To investigate that, we conducted studies combining behavior, physiology and questionnaires for companion robot Owners and Non-Owners. The results reveal that the steady-state concentration of oxytocin, a hormone related to affiliative relationships, was significantly higher in Owners than in Non-Owners. In addition, the Owners showed more behaviors indicative of intimacy than the Non-Owners. These results suggest that humans can build affiliative relationships with robots. Fifteen minutes of contact with the robot decreased the concentration of cortisol in both groups, suggesting that even a brief contact can contribute to improving mental health. Therefore, relationships between humans and robots may be one option to improve mental health and enhance well-being.

Association between prior-night sleep and next-day fatigue in older adults: a daily diary study

BACKGROUND

Fatigue is known as an element of frailty. Sleep problems (e.g., short sleep duration and low sleep quality) can increase fatigue, but the day-to-day relationship between sleep and fatigue has not been studied well in older adults. Using a daily diary method, this study examined the within- and between-person associations between sleep and fatigue in older adults.

METHODS

The study recruited 56 Japanese community dwellers (age: 82-86 years; female: 37.5%). Participants responded to a daily diary questionnaire at the end of each day. Over seven days, time in bed and satisfaction were measured after waking up, whereas fatigue was assessed before going to bed. We included person-level covariates (demographic factors, and physical and mental health) and day-level covariates (time in study, and positive and negative emotions). Multilevel models were estimated to examine within- and between-person associations.

RESULTS

At the within-person level, on days following short and long time in bed and days following low levels of sleep satisfaction, individuals felt higher levels of fatigue compared with usual days. At the between-person level, no statistically significant differences in fatigue were observed between individuals with long and short time in bed.

CONCLUSIONS

The findings suggest that prior-day sleep is associated with next-day fatigue in older adults. Long and short sleep duration and low sleep quality can lead to fatigue. Considering that sleep is a modifiable health behavior, appropriate management of sleep behavior may reduce fatigue.

Validation of Chinese version of the 5-item WHO well-being index in type 2 diabetes mellitus patients

BACKGROUND

For better disease management and improved prognosis, early identification of co-morbid depression in diabetic patients is warranted. the WHO-5 well-being index (WHO-5) has been used to screen for depression in diabetic patients, and its Chinese version (WHO-5-C) has been validated. However, its psychometric properties remain to be further validated in the type 2 diabetes patient population. The aim of our study was to examine the reliability and validity of the WHO-5-C in patients with type 2 diabetes mellitus.

METHODS

The cross-sectional study was conducted on 200 patients from July 2014 to March 2015. All patients should complete the WHO-5-C, the Patient Health Questionnaire-9 (PHQ-9), the 20-item Problem Areas in Diabetes Scale (PAID-20), the Mini International Neuropsychiatric Interview (M.I.N.I), and Hamilton Rating Scale for Depression (HAM-D). Internal consistency of WHO-5 was revealed by Cronbach's alpha, and constructive validity by confirmatory factor analysis (CFA). Relationship with PHQ-9, HAM-D, and PAID-20 was examined for concurrent validity, and ROC analysis was performed for criterion validity.

RESULTS

The WHO-5-C presented satisfactory reliability (Cronbach's alpha = 0.88). CFA confirmed the unidimensional factor structure of WHO-5-C. The WHO-5-C had significant negative correlation with HAM-D (r = -0.610), PHQ-9 (r = -0.694) and PAID-20 (r = -0.466), confirming good concurrent validity. Using M.I.N.I as the gold standard, the cut-off value of WHO-5-C was 42, with a sensitivity of 0.83 and specificity of 0.75.

CONCLUSION

The WHO-5-C holds satisfactory reliability and validity that is suitable for depression screening in type 2 diabetes patients as a short and convenient instrument.

Effect of interpersonal conflicts and the moderating effect of the dispositional need to belong on binge eating

The dispositional need to belong (dNTB) is a stable desire to connect with others and belong to groups. Recently, it has been stated that dNTB can alter immediate post-interpersonal conflict behavior. Interpersonal conflict stress is one of the triggers of binge eating. An individual's vulnerability to binge eating in response to interpersonal conflicts before it becomes a disorder has not been investigated from the perspective of the interaction between interpersonal conflict and dNTB. We conducted two studies examining the relationships between interpersonal conflicts and dNTB and the frequency of binge eating behavior in daily life. Conflicting predictions have been made about whether people with a high dNTB eat more after interpersonal conflict than those with a low dNTB. In Study 1, 199 university students answered the survey concerning their dNTB and frequency of interpersonal conflict and binge eating. The results revealed that higher dNTB is associated with more frequent binge eating when individuals face interpersonal conflict. In Study 2, 416 adults throughout Japan participated in the same survey; the results replicated those from Study 1. For exploratory purposes, mental health and other eating behaviors (restrained, emotional, and external eating) were measured in Studies 1 and 2, respectively. However, the moderation effects of dNTB on these eating behaviors were not observed. Previous studies suggested that individuals with a low dNTB ate more in response to social exclusion. This might be due to an immediate interpersonal stress reaction to social exclusion. Conversely, this study's results implicate that the modulation effects of dNTB on excessive eating habits are different from those immediately following interpersonal conflict.

Screening for anxiety and depression in clinical practice: translating scores from World Health Organization-5/Anxiety Symptom Scale-2/Major Depression Inventory-2 to Hospital Anxiety and Depression Scale

AIMS

The aim of this study was to evaluate if a combination of World Health Organization-5 (WHO-5), Anxiety Symptom Scale-2 (ASS-2), and Major Depression Inventory-2 (MDI-2) can replace the Hospital Anxiety and Depression Scale (HADS) as screening tool for anxiety and depression in cardiac patients across diagnoses and whether it is feasible to generate crosswalks (translation tables) for use in clinical practice.

METHODS AND RESULTS

We used data from the Danish 'Life with a heart disease' survey, in which 10 000 patients with a hospital contact and discharge diagnosis of ischaemic heart disease, heart failure, heart valve disease, or atrial fibrillation in 2018 were invited. Potential participants received an electronic questionnaire including 51 questions on health, well-being, and evaluation of the health care system. Crosswalks between WHO-5/ASS-2 and HADS anxiety dimension (HADS-A) and between WHO-5/MDI-2 and HADS depression dimension (HADS-D) were generated and tested using item response theory (IRT). A total of 4346 patients responded to HADS, WHO-5, ASS-2, and MDI-2. Model fit of the bi-factor IRT models illustrated appropriateness of a bi-factor structure and thus of essential uni-dimensionality [root mean square error of approximation (RMSEA) (P value) range 0.000-0.053 (0.0099-0.7529) for anxiety and 0.033-0.061 (0.0168-0.2233) for depression]. A combination of WHO-5 and ASS-2 measured the same trait as HADS-A, and a combination of WHO-5 and MDI-2 measured the same trait as HADS-D. Consequently, crosswalks (translation tables) were generated.

CONCLUSIONS

Our study shows that it is feasible to use crosswalks between HADS-A and WHO-5/ASS-2 and HADS-D and WHO-5/MDI-2 for screening cardiac patients across diagnoses for anxiety and depression in clinical practice.

The multicultural conceptualisation of well-being : The role of culture and circumstance in operationalising well-being in South Africa: A mixed-methods approach

BACKGROUND

Exploring and understanding indicators of better life outcomes have remained popular among social and health researchers. However, the subjective approach to measuring well-being has raised questions on the appropriateness of standard measures of well-being in multicultural settings. The current study examines generalised well-being and its dependence on the implicit understanding of individual culture and circumstances.

METHODS

A mixed-method approach with a cross-sectional design and focus group discussions was adopted. Fifteen focus group discussions with 66 participants were conducted in four provinces of South Africa. Descriptive statistics, correlations, regression analysis and analysis of variance were computed for quantitative data. The focus group discussions were analysed using a content analysis approach. The recorded focus group discussions were transcribed using the intelligent verbatim technique. Data analysis was done stepwise using open, axial, and selective coding techniques.

RESULTS

Quantitative analysis showed a strong and significant association between quality of life and income and a moderate association with educational attainment. The open coding technique for qualitative data confirmed 11 different subconstructs of well-being, mentioned 403 times during the 15 focus group discussions. Furthermore, well-being indicators varied based on participants' racial identity.

CONCLUSIONS

The findings confirm personal circumstance and culture as significant for interpreting results from well-being research. Furthermore, it supports Maslow's Hierarchy of Needs, highlighting the movement from deficiency needs to growth needs after deficiency needs are met. Research must adopt a more sociological approach to improve the accuracy and implementibility of findings when using standardised measures of well-being.

Effect of Continuous Ingestion of Bifidobacteria and Dietary Fiber on Improvement in Cognitive Function: A Randomized, Double-Blind, Placebo-Controlled Trial

Bifidobacterium animalis subsp. lactis GCL2505 has been shown to have some positive effects on health, including improved defecation frequency and reduced visceral fat. These effects are thought to be due to GCL2505's unique ability to reach the intestine in a viable form and proliferate after a single intake. This leads to an increased number of intestinal bifidobacteria. This randomized, double-blind, placebo-controlled, parallel-group study was conducted to confirm that intake of GCL2505 and inulin (a prebiotic) improve cognitive function (n = 80). Participants consumed test drinks containing 1 × 1010 colony-forming units of GCL2505 per 100 g and 2.0 g of inulin per 100 g for 12 weeks. The change in cognitive function assessment scores was set as the primary endpoint. There were significant improvements in scores in the neurocognitive index domain, which is an assessment of overall cognitive function, in addition to overall attention, cognitive flexibility, and executive function domains. The intervention significantly increased the number of fecal bifidobacteria and affected the levels of several inflammatory markers. These results suggest that intake of GCL2505 and inulin improves cognitive function by improving the intestinal environment and alleviating inflammation.

Ownership of dogs and cats leads to higher levels of well-being and general trust through family involvement in late adolescence

Introduction

Late adolescence is a crucial period during which individuals connect with new communities. Furthermore, their mental health has lasting effects on their overall well-being. Involvement with family and the local community plays a significant role in shaping adolescents' personalities and well-being. Additionally, pets, such as dogs and cats, function as social catalysts and increase interactions with family and the local community. We hypothesized that pet ownership would increase involvement with family and the local community and thereby impact adolescents' personalities and well-being.

Methods

Therefore, this study investigated whether owning dogs or cats was related to well-being through increased involvement with family and local community members in late adolescence. Data were collected via a questionnaire administered to high school and university students. The questionnaire included questions on basic information about adolescents and their families, pet ownership experience, family and local community involvement, well-being, cultural estrangement inventory, and general trust.

Results

Structural equation modeling revealed that adolescent women who owned dogs or cats had higher well-being and general trust through their involvement with their families. Although previous research reported that men who had experienced pet ownership in childhood were more sociable in old age, the effect of pet ownership on men was not observed in this study.

Discussion

During late adolescence, when individuals experience many connections with new communities, the effects of pets may temporarily decrease. Therefore, future cohort studies should examine the effects of pets on each age group.

Emodiversity evaluation of remote workers through health monitoring based on intra-day emotion sampling

Introduction

In recent years, the widespread shift from on-site to remote work has led to a decline in employees' mental health. Consequently, this transition to remote work poses several challenges for both employees and employers. To address these challenges, there is an urgent need for techniques to detect declining mental health in employees' daily lives. Emotion-based health assessment, which examines emotional diversity (emodiversity) experienced in daily life, is a possible solution. However, the feasibility of emodiversity remains unclear, especially from the perspectives of its applicability to remote workers and countries other than Europe and the United States. This study investigated the association between subjective mental health decline and emotional factors, such as emodiversity, as well as physical conditions, in remote workers in Japan.

Method

To explore this association, we conducted a consecutive 14-day prospective observational experiment on 18 Japanese remote workers. This experiment comprised pre-and post-questionnaire surveys, physiological sensing, daytime emotion self-reports, and subjective health reports at end-of-day. In daytime emotion self-reports, we introduced smartphone-based experience sampling (also known as ecological momentary assessment), which is suitable for collecting context-dependent self-reports precisely in a recall bias-less manner. For 17 eligible participants (mean ± SD, 39.1 ± 9.1 years), we evaluated whether and how the psycho-physical characteristics, including emodiversity, changed on subjective mental health-declined experimental days after analyzing descriptive statistics.

Results

Approximately half of the experimental days (46.3 ± 18.9%) were conducted under remote work conditions. Our analysis showed that physical and emotional indices significantly decreased on mental health-declined days. Especially on high anxiety and depressive days, we found that emodiversity indicators significantly decreased (global emodiversity on anxiety conditions, 0.409 ± 0.173 vs. 0.366 ± 0.143, p = 0.041), and positive emotional experiences were significantly suppressed (61.5 ± 7.7 vs. 55.5 ± 6.4, p < 0.001).

Discussion

Our results indicated that the concept of emodiversity can be applicable even to Japanese remote workers, whose cultural background differs from that of individuals in Europe and the United States. Emodiversity showed significant associations with emotion dysregulation-related mental health deterioration, suggesting the potential of emodiversity as useful indicators in managing such mental health deterioration among remote workers.

Effects of the COVID-19 Pandemic on the Behavioural Tendencies of Cats and Dogs in Japan

Physical and mental effects stemming from COVID-19 have impacted not only people's lives but also the lives of their pets, which in recent years are often seen as members of the family. This study aimed to explore the impact of the COVID-19 pandemic in Japan on pets and their owners. Participants reported changes in physical activity and mental health, as well as working conditions and frequency of interaction with pets, before and after behavioural restrictions due to the COVID-19 pandemic. We also asked about their pets' behaviours using the Feline Behavioural Assessment and Research Questionnaire (Fe-BARQ) and the Canine Behavioural Assessment and Research Questionnaire (C-BARQ). This study showed that most cat and dog owners spent more time at home due to the COVID-19 behavioural restrictions and that the frequency of contact interaction with their pets increased. However, this study showed higher stress-related behaviours (e.g., cats: excessive grooming; dogs: aggression towards owners) among pets whose owners increased contact interaction. Furthermore, owners' low mental health was correlated with high stress-related behaviours (e.g., touch sensitivity) in pets. The results of this study indicate that the lockdown caused by the COVID-19 pandemic in Japan may have affected not only the lives of owners but also the interaction between owners and their pets, and consequently their pets' behaviours. Therefore, there is also concern that changes in lifestyle patterns caused by pandemics could form a negative feedback loop between the health status of both owners and their pets.

Effects of egg yolk choline intake on cognitive functions and plasma choline levels in healthy middle-aged and older Japanese: a randomized double-blinded placebo-controlled parallel-group study

BACKGROUND

Choline, as a neurotransmitter acetylcholine precursor, is reportedly associated with cognitive function. Although there are several cohort and animal studies on choline-containing foods and cognitive function, only a few interventional studies were reported. Egg yolk is a rich source of different choline-containing chemical forms, such as phosphatidylcholine (PC), lysophosphatidylcholine (LPC), and α-glycerophosphocholine (α-GPC). This study aimed to investigate the effect of consuming 300 mg of egg yolk choline per day on cognitive function of Japanese adults.

METHODS

A 12-week, randomized, double-blind, placebo-controlled, parallel-group study was conducted in 41 middle-aged and elderly males and females (43.9% female) aged ≥ 60 years and ≤ 80 years without dementia. Participants were randomly assigned to placebo and choline groups. The choline group received a supplement containing egg yolk choline (300 mg/day), and the placebo group received an egg yolk supplement free from choline for 12 weeks. Assessments of Cognitrax, Trail Making Tests (TMT) part A and B, the MOS 36-Item Short-Form Health Survey (SF-36), the Simplified Japanese Version of the WHO-Five Well-Being Index (WHO-5), and plasma choline levels were performed before and 6 and 12 weeks after supplement intake. In the present study, 19 subjects (9 in the placebo group and 10 in the choline group) were excluded due to the violation of the discontinuation criteria or participant compliance, and 41 subjects were analyzed.

RESULTS

The change amount of verbal memory scores and verbal memory test-correct hit (delay) was significantly higher in the choline group than in the placebo group at baseline-6 and baseline-12 weeks. The plasma free choline level was significantly higher in the choline group compared with the placebo group at 6 weeks. Conversely, the choline group showed significantly lower Cognitrax processing speed scores, symbol digit coding testing correct responses, and SF-36 physical quality of life summary scores compared to the placebo group at 6 weeks.

CONCLUSIONS

The results suggested that continued 300 mg/day intake of egg yolk choline improved verbal memory, which is a part of cognitive functions. To confirm the observed effects of egg yolk choline, more well-designed and large-scale studies are warranted.

TRIAL REGISTRATION

Study protocols were pre-registered in the Clinical Trials Registration System (UMIN-CTR) (UMIN 000045050).

Relationship between occlusal force and psychological frailty in Japanese community-dwelling older adults: The Septuagenarians, Octogenarians, Nonagenarians Investigation with Centenarians study

BACKGROUND

Frailty increases the risk of negative health-related events, such as falls, disability, hospitalizations, and death. Although the association between oral health and physical frailty is well established, the relationship between oral health and psychological frailty has not yet been investigated. Therefore, we conducted a cross-sectional study to examine the association between maximal occlusal force and psychological frailty in Japanese community-dwelling older adults.

METHODS

Psychological frailty was defined as a World Health Organization-5 scale (WHO-5) score of <13, cognitive and functional status was defined as a Japanese version of the Montreal Cognitive Assessment (MoCA-J) score of <23, and psychological robustness was defined as a WHO-5 score of ≥13 and a MoCA-J score of ≥23. We used a cross-sectional study design to measure maximal occlusal force in 1810 participants, and examined the following factors relevant to psychological frailty: educational level, financial status, living situation, history of chronic diseases, handgrip strength, and instrumental activities of daily living. We used propensity score matching to match the psychological frailty and psychological robustness groups according to demographic and confounding factors. This process, resulted in 344 participants, of whom 172 were in the psychological frailty group and 172 were in the psychological robustness group. In the matched cohort, differences between groups with and without psychological frailty were compared using generalized estimating equations for maximal occlusal force after adjusting for the number of teeth.

RESULTS

After controlling for potential confounding factors of frailty, the psychological frailty group showed lower maximal occlusal force compared with the psychological robustness group (unstandardized regression coefficients = -72.7, 95% confidence interval: -126.3 to -19.1).

CONCLUSIONS

Maximal occlusal force was associated with a reduced prevalence of psychological frailty among Japanese community-dwelling older adults participating in our study.

Assessing late-life anxiety in Japanese older adults: psychometric evaluation of the Japanese version of the Geriatric Anxiety Scale

BACKGROUND

This study developed a Japanese version of the Geriatric Anxiety Scale (GAS-J) and its short form (GAS-10-J) to evaluate anxiety in Japanese older adults and assess its psychometric properties using a cross-sectional design.

METHODS

A total of 331 community-dwelling older adult participants (208 men, 116 women, seven unknowns; mean age = 73.47 ± 5.17 years, range = 60-88 years) recruited from two Silver Human Resources Centres in the Kanto region, Japan, answered a set of self-report questionnaires. Of these respondents, 120 participated in a follow-up survey to evaluate test-retest reliability.

RESULTS

Confirmatory factor analysis suggested that, as with the original GAS, the GAS-J had a three-factor structure and the GAS-10-J had a unifactor structure with high standardised factor loadings. Test-retest correlations and internal consistency analyses indicated that these scales were reliable. Correlations between the GAS-J/GAS-10-J with the Geriatric Anxiety Inventory, Generalised Anxiety Disorder-7, Geriatric Depression Scale-15, World Health Organization-Five Well-Being Index, and Kihon Checklist were mostly consistent with our hypotheses, thereby supporting the construct validity of the GAS-J/GAS-10-J.

CONCLUSIONS

The findings indicate that the GAS-J and GAS-10-J have robust psychometric properties for assessing late-life anxiety in Japanese older adults. Further GAS-J studies are required for clinical groups.

Effects of community-based frailty-preventing intervention on all-cause and cause-specific functional disability in older adults living in rural Japan: A propensity score analysis

Preventing frailty is crucial in aging societies. We examined the effectiveness of a community-based frailty-prevention program for delaying the onset of functional disability among community-dwelling older adults. From 2014 to 2019, 48 community-based frailty prevention classes (FPC, 60 min/session, once a week), comprising resistance exercise and nutritional or psychosocial programs, were established in Yabu City, Japan. We conducted a baseline survey in 2012 and followed up with participants for up to 6.8 years (4.8 years from establishing the first FPC). We analyzed data from 3350 older people. The primary and secondary outcomes were the onset of functional disability and cause-specific functional disability (including dementia and cardiovascular and orthopedic diseases), respectively. In addition to crude Cox proportional hazard regression, inverse probability of treatment weighting (IPTW) and propensity score matching (PSM; 918 nonparticipants and 459 participants) were used to adjust for confounders. Participants were more likely to be female and have a healthy lifestyle than nonparticipants. During the follow-up, 690 individuals developed a functional disability. The hazard ratio of incident functional disability in the participants was significantly lower than that in nonparticipants in the IPTW (hazard ratio 0.53, 95% confidential interval 0.38-0.75) and PSM (0.52, 0.37-0.71) analyses. In age-stratified analysis, significant associations were observed only in the ≥75-year-old subgroup. In a cause-specific analysis, participation significantly and consistently reduced incident functional disability caused by dementia (IPTW 0.47, 0.25-0.86; PSM 0.45, 0.25-0.83). Community-based FPC may be effective for preventing functional disability, especially caused by dementia, in this population.

Patient-tailored transcranial direct current stimulation to improve stroke rehabilitation: study protocol of a randomized sham-controlled trial

BACKGROUND

Many patients do not fully regain motor function after ischemic stroke. Transcranial direct current stimulation (TDCS) targeting the motor cortex may improve motor outcome as an add-on intervention to physical rehabilitation. However, beneficial effects on motor function vary largely among patients within and across TDCS trials. In addition to a large heterogeneity of study designs, this variability may be caused by the fact that TDCS was given as a one-size-fits-all protocol without accounting for anatomical differences between subjects. The efficacy and consistency of TDCS might be improved by a patient-tailored design that ensures precise targeting of a physiologically relevant area with an appropriate current strength.

METHODS

In a randomized, double-blinded, sham-controlled trial, patients with subacute ischemic stroke and residual upper-extremity paresis will receive two times 20 min of focal TDCS of ipsilesional primary motor hand area (M1-HAND) during supervised rehabilitation training three times weekly for 4 weeks. Anticipated 60 patients will be randomly assigned to active or sham TDCS of ipsilesional M1-HAND, using a central anode and four equidistant cathodes. The placement of the electrode grid on the scalp and current strength at each cathode will be personalized based on individual electrical field models to induce an electrical current of 0.2 V/m in the cortical target region resulting in current strengths between 1 and 4 mA. Primary endpoint will be the difference in change of Fugl-Meyer Assessment of Upper Extremity (FMA-UE) score between active TDCS and sham at the end of the intervention. Exploratory endpoints will include UE-FMA at 12 weeks. Effects of TDCS on motor network connectivity and interhemispheric inhibition will be assessed with functional MRI and transcranial magnetic stimulation.

DISCUSSION

The study will show the feasibility and test the efficacy of personalized, multi-electrode anodal TDCS of M1-HAND in patients with subacute stroke patients with upper-extremity paresis. Concurrent multimodal brain mapping will shed light into the mechanisms of action of therapeutic personalized TDCS of M1-HAND. Together, the results from this trial may inform future personalized TDCS studies in patients with focal neurological deficits after stroke.

Building a City with Low Noise Pollution: Exploring the Mental Health Effect Thresholds of Spatiotemporal Environmental Noise Exposure and Urban Planning Solution

Urban noise pollution and health hazards have become serious social problems and challenges. Noise prevention and control is the most cost-effective health strategy. However, in urban planning and noise control, reliable evidence is still lacking on individual spatiotemporal environmental noise exposure and its mental health effects. This study used real-time noise exposure data and GPS trackers from 142 volunteers aged 18 to 60 years in Guangzhou, and further analyzed the differences in environmental noise exposure and its mental health impact thresholds under individual spatiotemporal behavior. The results showed that the noise exposure of residents under daily activities has obvious differences in time, space and place. Regarding the threshold relationship between noise exposure and mental health, noise exposure at night, work, personal affairs, travel and sleep activities, as well as at home and work had a threshold effect on residents' mental health. Noise thresholds were 60 dB, 60 dB, and about 34 dB at night, during work or at a workplace, and while sleeping, respectively. The optimal sound environment for personal affairs, traveling, and at home was around 50 dB, 55-70 dB, and 45 dB, respectively. The environmental noise exposure assessment and mental health impact threshold analysis based on the spatial and temporal activities of individuals will provide important reference for government management departments in planning and policy formulation.

Antecedents and Outcomes of Work Engagement among Psychiatric Nurses in Japan

While previous studies have examined antecedents and outcomes of work engagement among general nurses, studies among psychiatric nurses remain limited. This study aimed to explore the antecedents (i.e., job crafting and nursing practice environment) and outcomes (i.e., strength-oriented care attitudes, mental health, and turnover intention) of work engagement among psychiatric nurses in Japan. This cross-sectional study included 309 nurses from three psychiatric hospitals in Japan (valid response rate: 60.4%). Data collection using the self-administered questionnaire took place from July to August 2021. We performed Structural Equation Modeling to examine the directional relationships among variables. Job crafting (β = 0.57, p < 0.01) and nursing practice environment (β = 0.23, p = 0.01) exhibited positive effects on work engagement. Work engagement had positive effects on strength-oriented care attitudes (β = 0.15, p = 0.04) and mental health (β = 0.37, p < 0.01) as well as negative effects on intention to resign from their profession as a nurse (β = -0.17, p = 0.01). Job crafting and a healthier nursing practice environment could help enhance work engagement. Higher work engagement could contribute to improving strength-oriented care attitudes, mental health, and intention to resign from their profession as a nurse.

High-intensity training in patients with lacunar stroke: A one-year follow-up

OBJECTIVES

Physical inactivity is a major risk factor for stroke. It is a challenge for patients to initiate and adhere to regular exercise post-stroke. Early initiation of home-based high-intensity interval training (HIIT) may engage patients in physical activity, improve cardiorespiratory fitness, and reduce risk of recurrent stroke.

MATERIALS AND METHODS

Post-intervention follow-up of patients with lacunar stroke, randomized to three-months HIIT including weekly motivational calls, or usual care. At follow-up (six- and 12-months post-stroke), we investigated changes in cardiorespiratory fitness, physical activity, fatigue, depression, mental well-being, stress, cognition, cardiovascular function, and recurrent stroke.

RESULTS

We included 71 patients of whom 59 patients (mean age: 63.9 ± 8.8 years) completed six- and 12-month follow-up. No change was detected in cardiorespiratory fitness between groups from baseline to 12-months follow-up. At six months, vigorous-intensity activity (median hours/week [interquartile range]) was maintained in the intervention group (baseline, 0[0;2]; post-intervention, 2[0;3]; six-month, 2[0;4]) and increased in the usual care group (baseline, 0[0;1]; post-intervention, 1[0;2]; six-month, 1[0;3]), with no difference between groups. Vigorous-intensity activity declined to baseline levels at 12-months in both groups. Secondary outcomes improved from baseline to 12-months with no significant differences between groups. Similar rate of recurrent stroke (n=3) occurred in each group with a three-month delay in the intervention group.

CONCLUSIONS

Early initiated HIIT did not increase long-term cardiorespiratory fitness, but increased time spent doing vigorous-intensity activities post-stroke. Decline to baseline activity level at 12 months warrants identification of motivators to initiate and sustain physical activity post-stroke.

Evaluation of a Novel Wellness Curriculum on Medical Student Wellbeing and Engagement Demonstrates a Need for Student-Driven Wellness Programming

PROBLEM

Medical training is stressful and has well-established implications for student wellbeing. Despite widespread efforts to reduce student burnout through wellness programming in medical schools, there is a paucity of literature examining students' perception of wellness and engagement with these programs. As such, we sought to evaluate: 1) medical students' level of engagement with a multifaceted wellness curriculum, 2) factors students perceived as important to wellbeing, and 3) associations with longitudinal measures of wellbeing and perceived stress. Intervention: A multipronged wellness curriculum was instituted at Mayo Clinic Alix School of Medicine-AZ (MCASOM-AZ) in 2017. This includes mental health services, curriculum-embedded seminars, wellness committee (composed of students, faculty, and administration) driven programming, and student proposed wellness activities that are reviewed and funded by the committee. The authors invited students at our institution to complete questionnaires at three timepoints during the 2018-2019 academic year. Questionnaires asked participants to rank eight factors from least to most important to their overall wellbeing. Participants self-reported their participation in each prong of the wellness curriculum and ranked the impact of each on their overall wellbeing. Their wellbeing and perceived stress were measured at each timepoint using validated psychological instruments. Context: As MCASOM-AZ opened in 2017, the student body at the time of study consisted of first- and second-year medical students. All students had the opportunity to engage with all aspects of the wellness curriculum and participate in this study, however participation was elective and all responses were anonymous. Of the MCASOM-AZ student body comprised of 100 students, 58 consented to participate in the study, 41.4% of which were Year 1 and 58.6% of which were Year 2 students. Participant age and gender were collected and were representative of the larger student body. Impact: Students engaged most with student-initiated wellness. They perceived unscheduled time as most impactful to their overall wellbeing with student-initiated activities as second-most impactful. Students with higher perceived stress were more likely than others to use mental health resources, which otherwise ranked lower in importance. Ranking academic performance as important to wellbeing was associated with higher wellbeing. There was no difference in wellbeing between students who participated in the wellness curriculum and those who did not. However, overall student wellbeing increased over the course of the year while perceived stress decreased. Lessons Learned: Medical school programs may benefit from allowing students to direct or contribute to the design of their own wellness curriculum. Additionally, medical education should work toward creating a more supportive learning environment with improved flexibility in order to better meet students' individual needs without compromising their education. Despite having low utilization rates overall, mental health resources remain an important aspect of student support services as they are used by students under greater amounts of perceived stress than their peers.

Supplemental data for this article is available online at https://doi.org/10.1080/10401334.2021.2004415 .

Age Group Differences in the Association Between Sleep Status and Frailty Among Community-Dwelling Older Adults: The SONIC Study

Objective: We aimed to determine whether the association of sleep status with frailty differs between age groups of older adults. Method: This cross-sectional study was part of the observational Septuagenarians, Octogenarians, Nonagenarians Investigation with Centenarians (SONIC) study. Subjects were community-dwelling older adults in their 70s and 80s. Frailty was evaluated using the Japanese version of the Cardiovascular Health Study criteria (J-CHS). Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep status. Poor sleep quality was defined as a PSQI global score ≥6. Sleep duration was categorized as short (<6 hr), normal (6-8), and long (>8). We performed multivariable logistic regression to investigate the association between sleep status and frailty separately for each age group adjusted for multiple covariates. Results: In those in their 70s, long sleep duration and sleep medication use were independently associated with frailty. In those in their 80s, poor sleep quality was independently associated with frailty. Conclusions: The association between sleep status and frailty was different between age groups. The findings underscore the importance of incorporating the evaluation of sleep quantity and non-pharmacological therapies in those in their 70s and the evaluation of sleep quality in those in their 80s to help prevent the onset of frailty.

Measuring the quality of life of long-term care service users in Japan: a cross-sectional questionnaire study

BACKGROUND

In Japan's super-aging society, the number of long-term care service providers is increasing, and the quality of care is a matter of concern. One aspect of the quality of care is the user's quality of life. The questionnaires EQ-5D and WHO-5 are representative indicators of quality of life. Herein, we aimed to measure the quality of life in long-term care service users in Japan and to clarify the relationship between quality of life and the level of care required.

METHODS

A questionnaire study was conducted in 106 facilities of 22 corporations. In addition to the EQ-5D and WHO-5, sex, age, and the level of care required were assessed by descriptive statistics. Bonferroni's multiple comparison test was used to analyze each quality of life score, and the differences by sex and age were analyzed multiple regression analyses, with each quality of life score as the objective variable.

RESULTS

Of 4647 cases collected, 2830 were analyzed, with no missing data. Both indicators tended to be lower than the general older population. Those scores tended to be higher in females than males (EQ-5D: males, 0.58 ± 0.26; females, 0.60 ± 0.24; P = 0.06 and WHO-5: males, 13.8 ± 5.92; females 14.9 ± 5.70; P < 0.001). In terms of age, those under 65 years old with specific diseases had lower EQ-5D scores than those in other age groups (P < 0.001); however, WHO-5 scores did not differ by age. Multiple regression analysis showed a significant association between the EQ-5D score and level of care required, except for support-required level 1, which tended to worsen as the level of care required increased. Conversely, the WHO-5 score was significantly lower for care need levels 2, 4, and 5.

CONCLUSIONS

The quality of life of long-term care service users was worse than that of the general older population, it tended to be low among males and those under 65 years old with specific diseases. Furthermore, it gradually decreased as the level of care required increased. It is important to monitor users' quality of life as a quality indicator of care, to improve and manage it.

The Kesennuma Study in Miyagi, Japan: Study Design and Baseline Profiles of Participants

BACKGROUND

To clarify the association between psychosocial problems and frailty in the areas affected by the Great East Japan Earthquake, and to develop strategies for preventive long-term care in the community, we launched the Kesennuma Study in 2019. This report describes the study design and the participants' profiles at baseline.

METHODS

The prospective study comprised 9,754 people (4,548 men and 5,206 women) randomly selected from community-dwelling independent adults aged 65 to 84 who were living in Kesennuma City, Miyagi. The baseline survey was conducted in October 2019. It included information on general health, socio-economic status, frailty, lifestyle, psychological factors (eg, personality, depressive moods), and social factors (eg, social isolation, social capital). A follow-up questionnaire survey is planned. Mortality, incident disability, and long-term care insurance certifications will also be collected.

RESULTS

A total of 8,150 questionnaires were returned (83.6% response rate), and 7,845 were included in the analysis (80.4%; mean age 73.6 [standard deviation, 5.5] years; 44.7% male). About 23.5% were considered frail. Regarding psychological and social functions, 42.7% had depressive moods, 29.1% were socially isolated, and only 37.0% participated in social activities at least once a month. However, 82.5% trusted their neighbors.

CONCLUSION

While local ties were strong, low social activity and poor mental health were revealed as issues in the affected area. Focusing on the association between psychological and social factors and frailty, we aim to delay the need for long-term care for as long as possible, through exercise, nutrition, social participation, and improvement of mental health.

A randomized controlled trial of the "positive diary" intervention for family caregivers of people with dementia

PURPOSE

We examined the effectiveness of the "positive diary," in which family caregivers of people with dementia write down three good things that happened with reasons at the end of each day.

DESIGN AND METHODS

In this randomized controlled trial, the intervention group used the "positive diary," while the control group kept a record of each meal for 4 weeks.

FINDINGS

The intervention group showed improvement on several measures of wellbeing including Neuropsychiatric Inventory Questionnaire and Center for Epidemiologic Studies Depression Scale.

PRACTICE IMPLICATIONS

The "positive diary" is a useful self-care tool for caregivers of people with dementia.

Patient-reported outcome measures for assessing health-related quality of life in people with type 2 diabetes: A systematic review

Patient-Reported Outcome Measures (PROMs) are important tools to assess outcomes relevant to patients, with Health-Related Quality Of Life (HRQOL) as an important construct to be measured. Many different HRQOL PROMs are used in the type 2 diabetes field, however a complete overview of these PROMs is currently lacking. We therefore aimed to systematically describe and classify the content of all PROMs that have specifically been developed or validated to measure (aspects of) HRQOL in people with type 2 diabetes. A literature search was performed in PubMed and EMBASE until 31 December 2021. Studies on the development or validation of a PROM measuring HRQOL, or aspects of HRQOL, in people with type 2 diabetes were included. Title and abstract and full-text screening were conducted by two independent researchers and data extraction was performed independently by one of the researchers. Data were extracted on language in which the PROM was developed, target population, construct(s) being measured, names of (sub)scales and number of items per (sub)scale. In addition, all PROMs and subscales were classified according to specific aspects of HRQOL based on the Wilson & Cleary model (symptom status, functional status, general health perceptions) to aid researchers in PROM selection. In total 220 studies were identified that developed or validated PROMs that measure (aspects of) HRQOL in people with type 2 diabetes. Of the 116 unique HRQOL PROMs, 91 (of the subscales) measured symptom status, 60 measured functional status and 26 measured general health perceptions. In addition, 16 of the PROMs (subscales) measured global quality of life. 61 of the 116 PROMs (subscales) also include characteristics of the individual (e.g. aspects of personality, coping) or environment (e.g. social or financial support) and patient-reported experience measures (PREMs, e.g. measure of a patient's perception of their personal experience of the healthcare they have received, e.g. treatment satisfaction), which are not part of the HRQOL construct. Only 9 of the 116 PROMs measure all aspects of HRQOL based on the Wilson & Cleary model. Finally, 8 of the 116 PROMs stating to measure HRQOL, measured no HRQOL construct. In conclusion, a large number of PROMs are available for people with type 2 diabetes, which intend to measure (aspects of) HRQOL. These PROMs measure a large variety of (sub)constructs, which are not all HRQOL constructs, with a small amount of PROMs not measuring HRQOL at all. There is a need for consensus on which aspects of HRQOL should be measured in people with type 2 diabetes and which PROMs to use in research and daily practice. PROSPERO: CRD42017071012. COMET database: http://www.comet-initiative.org/studies/details/956 .

Web-Based Mindfulness-Based Interventions for Well-being: Randomized Comparative Effectiveness Trial

BACKGROUND

Mindfulness can improve overall well-being by training individuals to focus on the present moment without judging their thoughts. However, it is unknown how much mindfulness practice and training are necessary to improve well-being.

OBJECTIVE

The primary aim of this study was to determine whether a standard 8-session web-based mindfulness-based cognitive therapy (MBCT) program, compared with a brief 3-session mindfulness intervention, improved overall participant well-being. In addition, we sought to explore whether the treatment effects differed based on the baseline characteristics of the participants (ie, moderators).

METHODS

Participants were recruited from 17 patient-powered research networks, web-based communities of stakeholders interested in a common research area. Participants were randomized to either a standard 8-session MBCT or a brief 3-session mindfulness training intervention accessed on the web. The participants were followed for 12 weeks. The primary outcome of the study was well-being, as measured by the World Health Organization-Five Well-Being Index. We hypothesized that MBCT would be superior to a brief mindfulness training.

RESULTS

We randomized 4411 participants, 3873 (87.80%) of whom were White and 3547 (80.41%) of female sex assigned at birth. The mean baseline World Health Organization-Five Well-Being Index score was 50.3 (SD 20.7). The average self-reported well-being in each group increased over the intervention period (baseline to 8 weeks; model-based slope for the MBCT group: 0.78, 95% CI 0.63-0.93, and brief mindfulness group: 0.76, 95% CI 0.60-0.91) as well as the full study period (ie, intervention plus follow-up; baseline to 20 weeks; model-based slope for MBCT group: 0.41, 95% CI 0.34-0.48; and brief mindfulness group: 0.33, 95% CI 0.26-0.40). Changes in self-reported well-being were not significantly different between MBCT and brief mindfulness during the intervention period (model-based difference in slopes: -0.02, 95% CI -0.24 to 0.19; P=.80) or during the intervention period plus 12-week follow-up (-0.08, 95% CI -0.18 to 0.02; P=.10). During the intervention period, younger participants (P=.05) and participants who completed a higher percentage of intervention sessions (P=.005) experienced greater improvements in well-being across both interventions, with effects that were stronger for participants in the MBCT condition. Attrition was high (ie, 2142/4411, 48.56%), which is an important limitation of this study.

CONCLUSIONS

Standard MBCT improved well-being but was not superior to a brief mindfulness intervention. This finding suggests that shorter mindfulness programs could yield important benefits across the general population of individuals with various medical conditions. Younger people and participants who completed more intervention sessions reported greater improvements in well-being, an effect that was more pronounced for participants in the MBCT condition. This finding suggests that standard MBCT may be a better choice for younger people as well as treatment-adherent individuals.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03844321; https://clinicaltrials.gov/ct2/show/NCT03844321.

Social prescription for isolated parenting in Japan: Socioeconomic characteristics of mothers with weak social connectivity in their community

The social connection of mothers is important for the sound development of children and the prevention of child maltreatment. Understanding the attributes of mothers at risk of isolation enables community workers to support vulnerable mothers. This cross-sectional study aimed to identify the socioeconomic predictors of isolation risk for mothers and was conducted in Japan between December 2018 and February 2019. The self-administered questionnaire included the Social Connectivity of Mother Scale along with maternal age, marital status, employment status, education, number of children, years of child-rearing experience, whether childcare or kindergarten was used, family structure, years of residence, housing type, family finances, and level of neighbourhood interactions. There were 510 valid responses (51.6%). In the multiple regression analysis, five socioeconomic characteristics were associated with mothers' low social connectivity: the standardised coefficient of the maternal age of 20-24 was -0.12 (p = 0.004), lack of childcare or kindergarten usage, -0.09 (p = 0.032), and poor family finances, -0.09 (p = 0.031); mothers' perception of neighbourhood interactions was found to be poor at -0.29 (p < 0.001). The model did not take into account the effects of family finances, and the scores were low when the highest level of education of the mother was junior high or high school. Mothers' perception of neighbourhood interactions was a significant predictor of isolation risk, along with maternal age, education level, and financial comfort. Our findings give policymakers, community workers, and community leaders an insight into the importance of cultivating interactions among neighbourhood communities.

Sensory hypo- and hypersensitivity in patients with brain tumors

OBJECTIVES

Hyper- and hyposensitivity in multiple modalities have been well-documented in subjects with autistic spectrum disorder (ASD) but not in subjects with acquired brain injury (ABI). The purpose of this study was to determine whether subjects with ABI experience altered sensory processing in multiple sensory modalities, and to examine the relationships between impaired sensory processing and the emotional state.

METHODS AND PROCEDURES

Sixty-eight patients with brain or spinal cord tumors participated in the study. Cognitive ability and emotional function were tested, and subjective changes were evaluated in two directions (hyper- and hyposensitivity) and five modalities (visual, auditory, tactile, olfactory, and gustatory) at two time points (after disease onset and after surgery).

RESULTS

One-fifth of the participants complained of hypersensitivity in the visual domain, and a similar proportion complained of hyposensitivity in the auditory and tactile domains. Additionally, one-third of participants complained of two or more sensory abnormalities after disease onset. A hierarchical regression analysis indicated that auditory and tactile sensory changes predicted a depressive state.

CONCLUSION

In conclusion, multimodal sensory changes occurred in patients with brain tumors, manifesting as hyper- or hyposensitivity. Sensory changes might be related to depressive state, but the results were inconclusive.

Cross-cultural validity of the WHO-5 Well-Being Index and Euthymia Scale: A clinimetric analysis

BACKGROUND

The assessment of psychological well-being and euthymia represents an emerging issue in clinical psychology and psychiatry. Rating scales and indices such as the 5-item version of the World Health Organization Well-Being Index (WHO-5) and the Euthymia Scale (ES) were developed but insufficient attention has been devoted to the evaluation of their cross-cultural validity. This is the first study using Clinimetric Patient-Reported Outcome Measures (CLIPROM) criteria to assess cross-cultural validity and sensitivity of five different versions of the WHO-5 and ES.

METHODS

A multicenter cross-sectional study involving a total of 3762 adult participants from different European (i.e., Italy, Poland, Denmark) and non-European (i.e., China, Japan) countries was conducted. Item Response Theory models (Mokken and Rasch analyses) were applied.

RESULTS

Mokken coefficients of scalability were found to range from 0.42 to 0.84. The majority of the versions of the WHO-5 fitted the Rasch model expectations. Paired t-tests revealed that the Italian and Danish WHO-5 versions were unidimensional. Person Separation Reliability indices showed that the Polish, Danish, and Japanese ES versions could reliably discriminate between subjects with different levels of euthymia.

LIMITATIONS

A convenience sampling was used, thus limiting the generalizability of study findings. In addition, no measures of negative mental health were administered.

CONCLUSIONS

WHO-5 can be used in international studies for cross-cultural comparisons since it covers transcultural components of subjective well-being. Findings also suggest that the ES can be used as a cross-cultural screening tool since it entailed the clinimetric property of sensitivity.

The Preliminary Efficacy of a Program to Facilitate Benefit Finding for People with Mental Illness: A Pilot Randomized Controlled Trial in Japan

Benefit finding is a concept that refers to finding positive changes or benefits through negative experiences from stressful life events. The present study aimed to develop a new intervention program to facilitate benefit finding for people with mental illness and examine its feasibility and preliminary efficacy from pilot data. We hypothesized that participants who joined the group-based intervention program would show progress in benefit finding, personal recovery, and well-being, as well as alleviated psychiatric symptoms and functional impairment, compared to participants in the control group. The participants in the intervention group joined in a new program which focuses on (1) cognitive–behavioral stress management and (2) own experiences, including what was found or realized through their lives since the onset of mental illness. The program used a workbook comprised of eight 90-min sessions, with one held every week. Twenty-four were found eligible and provided informed consent to participate in the study. About 46% were males, and the average age was 42.5 years. Around 63% were diagnosed with schizophrenia. We did not find significant differences over time by groups. However, medium to large effects in each scale or at least one subscale (i.e., benefit finding, personal recovery, subjective well-being, and psychiatric symptoms and functional impairment) were observed. Future studies with more participants from various settings would be necessary to exactingly examine the effectiveness of the intervention program.

The Association between Working Hours Flexibility and Well-Being Prior to and during COVID-19 in South Korea

Objective: This study examined the relationship between the flexibility of work schedule arrangements and well-being among full-time workers prior to and after the coronavirus disease (COVID-19) outbreak in South Korea. Methods: Data from the fifth 2017 and sixth 2020–2021 Korean Working Conditions Survey, including a final sample of 45,137 participants (22,460 males; 22,677 females), were used. Multiple logistic regression was performed to establish the association between schedule arrangement types and the 5-item World Health Organization Well-Being Index. Results: The study found an association between flexible schedule arrangements and good well-being in 2017: “little flexibility” (odds ratio (OR), 1.33; 95% confidence interval (CI), 1.27–1.48), “moderate flexibility” (OR, 1.48; 95% CI, 1.28–1.71), and “high flexibility” (OR, 1.35; 95% CI, 1.06–1.72). During COVID-19, only workers with “high flexibility” were likely to have good well-being (OR, 1.49; 95% CI, 1.18–1.88), while the association between well-being and “low flexibility” (OR, 1.06; 95% CI, 0.96–1.17) and “moderate flexibility” types (OR, 0.66; 95% CI 0.59–0.75) decreased. This study found that flexible working hours may contribute to better well-being among full-time workers. However, the impact of the COVID-19 pandemic on working conditions and employee well-being should be addressed while setting working hours.