Changing trends in health orientation among older adults: A scoping review

Older people's health condition is not uniform, and the components of their health are interrelated. Concepts regarding the health of older people have emerged and changed over time. However, the transition of concepts and influencing factors are not well examined through research. We have conducted a scoping review of the changes over time in the concept of health for older people and the factors influencing these changes. The public websites of international organizations and academic societies related to older people's health and research paper database were searched, and the extracted data were summarized in a chronological table. Consequently, this study revealed changing trends in health orientation after health had been defined by WHO, namely, successful aging, productive aging, active aging, and healthy aging, and their components, not the concept of health. The emergence and changes of health orientation among older people may have accompanied proposals and measures of international organizations and academic societies developed in response to changes in the demographic structure, and changes in how society perceives and supports older people. With the changing eras that bring about advances in health technology, prolongation of life expectancy, and changes in lifestyles, the needs of older people, society's perceptions of aging and older people, and how to support them will also change. Our findings may provide a valuable basis for understanding aging and older people, reconsidering their health orientation based on the health issues of older people and their significance, and formulating policies for older people in the future. Geriatr Gerontol Int 2024; 24: 5-17.

Spatially heterogeneous associations between the built environment and objective health outcomes in Japanese cities

The built environment is a structural determinant of health. Here we reveal spatially heterogeneous associations of built environment indicators with objective health outcomes (morbidity) by combining a random forest (RF) approach and a multiscale geographically weighted (MGWR) regression method. Using data from six Japanese cities, we found that the ratio of morbidity has obvious spatial agglomerations. The mixed land-use diversity with 1000 m buffer, distance to hospital, proportion of park area with 300 m buffer, and house price with 2000 m buffer, negatively affect health outcomes at all locations. For most locations, high PM2.5 or high floor area ratio with 2000 m buffer are linked to a high ratio of morbidity. Our findings support the use of such data for long-term urban and health planning. We expect our study to be a starting point for further research on spatially heterogeneous associations of the built environment with comprehensive health outcomes.

Development, reliability, and validity of a self-assessment scale for dementia care management

BACKGROUND

This study aimed to develop a self-assessment scale for care management of people with dementia and examine its reliability and validity.

METHODS

Based on Bloom's Taxonomy, previous research, and experts' opinions on dementia and care management, a scale consisting of 18 items was developed to assess care managers' attitudes, knowledge, and skills in their management of people with dementia. To examine the scale's reliability and validity, data were collected from 638 care managers. Construct validity using exploratory factor analysis, known-group validity, and internal consistency reliability of the scale were evaluated.

RESULTS

Exploratory factor analysis supported the construct validity with a four-factor model and explained 59.1% of the total variance. Following were the four factors: Factor I 'Person centred care'; Factor II 'Understanding of disease characteristics, treatment and care'; Factor III 'Understanding of people with dementia and care management according to their characteristics'; and Factor IV 'Utilization of local resources surrounding people with dementia'. Regarding the known-group validity, results showed that the group with a qualified chief care manager scored significantly higher than the group without one on Factors I (P = 0.013) and III (P = 0.026). Cronbach's alpha coefficient for the 18 items was 0.928.

CONCLUSIONS

The findings prove that the scale has acceptable reliability and validity, and can help care managers reflect on their practice. Future research is desirable to measure the validation of change in the scale.

Long-term impact of the COVID-19 pandemic on facility- and home-dwelling people with dementia: Perspectives from professionals involved in dementia care

Aim

The present study aimed to investigate the impact of the coronavirus disease 2019 (COVID‐19) pandemic on facility‐ and home‐dwelling people with dementia (PWD).

Methods

This observational study included two anonymous online survey questionnaires to explore the impact of the first wave of the COVID‐19 pandemic in Japan and the long‐term impact during the 2 years from the onset of the pandemic. The participants were medical and long‐term care facilities representatives for older people (945 facilities in the first survey, 686 in the second), and care managers (751 in the first survey, 241 in the second). A χ²‐test was carried out between the two surveys.

Results

For facility‐dwelling PWD, activities that stimulate cognitive and physical functioning increased significantly compared with the first wave of the pandemic (P < 0.05). Also, a decline in cognitive and walking functions and falls increased in the second survey compared with the first (P < 0.01). For home‐dwelling PWD, the broader impact of the pandemic on support for activities of daily living, social interaction and provision of medical care did not mitigate. The high prevalence of cognitive and physical functional decline in the first survey was similar in the second.

Conclusions

The prolonged COVID‐19 pandemic produced changes in the lives of home‐ and facility‐dwelling PWD, with widespread negative consequences for them. Our findings are useful to consider preventive supports to mitigate or avoid functional decline and symptom exacerbation in PWD due to changes in their living environment and the care they receive in the COVID‐19 era. Geriatr Gerontol Int 2022; 22: 832–838.

Factors Affecting Employees Work Engagement in Small and Medium-Sized Enterprises

BACKGROUND

Improving the labor productivity of small and medium-sized enterprises (SMEs) is essential because of the aging population and predicted reduction in the labor force. Therefore, it is necessary to ensure that employees are in good health to work for long times. In this regard, the purpose of the study is to investigate the relationship between work engagement (WE) and related variables among SME employees.

METHODS

A cross-sectional study was conducted using the baseline data of the prospective cohort study, which included 377 employees from three SMEs headquartered in Hiroshima Prefecture, Japan.

RESULTS

A multiple regression analysis was performed to see the associations between Utrecht Work Engagement Scale (UWES) scores and other variables. Significant associations were found with job satisfaction, age, health literacy (HL), and quality of sleep (all, p < 0.05). Additionally, there was a statistically significant difference observed in WE, quality of sleep, concern for own body, job satisfaction, and family life satisfaction (all, p < 0.001) with respect to high and low HL levels.

CONCLUSIONS

The results of this study reveal that while implementing health and productivity management in SMEs to increase WE, it is best to concentrate on raising HL, job satisfaction, and sleep quality. To increase generalizability, further research could be conducted with more SMEs companies.

Development of a predictive model using the Kihon Checklist for older adults at risk of needing long‐term care based on cohort data of 19 months

Aim

This study developed a risk scoring tool and examined its applicability using data from the Kihon Checklist cohort dataset for 19 months to predict the transition from no certification for long‐term care to long‐term care level 3 or above.

Methods

Data were collected from 26 357 functionally independent, community‐dwelling older adults in a Japanese city who answered the Checklist in 2014 and were followed for 19 months. Individuals certified for long‐term care during the follow‐up period were classified into three levels depending on their certification status: low, moderate, and high long‐term care levels. Relationships between the Kihon Checklist domains and high long‐term care levels were examined using the logistic regression model. A score chart predicting incidents of high long‐term care levels was created to facilitate its applicability.

Results

As of 2016, 971 participants were certified for long‐term care (3.7%), of which 168 (0.6%), 357 (1.4%), and 446 (1.7%) were certified as high, moderate, and low long‐term care levels, respectively. Variables associated with the certification of high long‐term care level included difficulties in activities of daily living, a decline in locomotor and cognitive function in the Kihon Checklist domains, and age. The score chart was created based on these variables and demonstrated excellent discriminatory ability, with an area under curve of 0.817 (95% confidence interval: 0.785–0.849).

Conclusions

The Kihon Checklist can predict the future development of a high degree of dependency. The score chart we developed can be easily implemented to identify older adults at high risk with reasonable accuracy. Geriatr Gerontol Int 2022; 22: 797–802.

Efficacy of care manager-led support for family caregivers of people with dementia during the COVID-19 pandemic: a randomized controlled study

Background

A prolonged COVID-19 pandemic could exacerbate the risk of infection and undesirable effects associated with infection control measures of older people with dementia (PWD), and the care burden of families. In this study, we examined the efficacy of care manager-led information provision and practical support for families of older PWD who need care, regarding appropriate infection prevention, prevention of deterioration of cognitive and physical functions, and preparedness in cases of infection spread or infection during the pandemic.

Methods

Fifty-three family members (aged ≥20 years) who were primary caregivers living with older PWD using public long-term care services were enrolled in an one-month randomized controlled trial. This duration was set based on behavior modification theory and with consideration of ethical issue that the most vulnerable people not benefiting from the intervention. The intervention group (IG) received care manager-led information provision and practical support, and the control group (CG) received usual care. Care burden (primary outcome) was measured using the Zarit Caregiver Burden Interview, and secondary outcomes were analyzed using Patient Health Questionnaire-9 (PHQ9), the Fear of COVID-19 Scale, and salivary α-amylase activity. Data were collected at baseline and after 1 month. Multiple regression analysis was conducted to examine the efficacy of the intervention. The participants evaluated the care managers’ support.

Results

The participants were randomly divided into IG (n = 27) and CG (n = 26) groups. After the intervention, compared with the CG, there was a decrease in PHQ-9 (β = −.202, p = 0.044) and α-amylase activity in saliva (β = −.265, p = 0.050) in IG. IG also showed an increased fear of COVID-19 after the intervention (β = .261, p = 0.003). With the care managers’ support, 57.2% of the participants felt secure in their daily lives and 53.1% agreed that they were able to practice infection prevention suitable for older PWD.

Conclusions

Our findings suggest that the care manager-led intervention may be useful for families of older PWD to enhance behavioral changes in preventing COVID-19 infection and improve their psychological outcomes in the COVID-19 era.

Trial registration

This study was registered on April 2, 2021 (No. UMIN000043820).

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-03371-2.

Long-term effectiveness of a disease management program to prevent diabetic nephropathy: a propensity score matching analysis using administrative data in Japan

BACKGROUND

Existing reviews indicated that disease management for patients with diabetes may be effective in achieving better health outcomes with less resource utilization in the short term. However, the long-term results were inconsistent because of the heterogeneous nature of the study designs. In the present study, we evaluated the 5-year follow-up results of a local disease management program focused on diabetic nephropathy prevention under the universal public health insurance scheme in Japan.

METHODS

Patients diagnosed with type 2 diabetes who had stage 3 or 4 diabetic kidney disease and were aged between 20 and 75 years were invited to join a disease management program to support self-management and receive a recommended treatment protocol between 2011 and 2013. Follow-up data were collected from an electronic claims database for the public insurance scheme. Considering the non-random selection process, we prepared two control groups matched by estimated propensity scores to compare the incidence of diabetes-related complications, death, and resource utilization.

RESULTS

The treatment group was more likely to receive clinical management in accordance with the guideline-recommended medication. After propensity score matching, the treatment group had lower incidence of diabetic nephropathy and emergency care use than the control group selected from a beneficiary pool mainly under primary care. Comparisons between the treatment group and the control group with more selected clinical conditions did not show differences in the incidence rate and resource utilization.

CONCLUSIONS

The present results demonstrated limited effectiveness of the program for reducing complication incidence and resource utilization during the 5-year follow-up. Further research on the long-term effectiveness of co-management by primary care physicians, subspecialists in endocrinology and nephrology, and nurse educators is required for effective management of diabetes-related nephropathy.

Characteristics of early-career nurse researchers negatively impacted during the COVID-19 pandemic: a cross-sectional study

OBJECTIVES

This study aimed to identify typical patterns and determinants of early-career nurse researchers (ECNRs: age ≤45 years) who reported that their research activities were negatively impacted during the COVID-19 pandemic, using a data mining methodology. To gain a deeper understanding of the characteristics of these ECNRs, we compared them with the characteristics of senior nurse researchers (SNRs: age ≥46 years).

DESIGN

A cross-sectional study.

PARTICIPANTS

1532 nurse researchers.

DATA COLLECTION AND ANALYSIS

We conducted an anonymous online questionnaire survey that assessed individual and professional attributes of nurse researchers and their experiences from April to June 2020. We analysed the association between the impact on research activities and the individual and professional attributes using cross-tabulation, and employed the chi-square automatic interaction detection technique to perform population segmentation.

RESULTS

We found that difficulties in research management, an increased burden of student education and organisational management, and organisational management position were relatively important factors for determining the negative impact of COVID-19 on the research activities of ECNRs (p<0.05). For both ECNRs and SNRs, the most relevant determinant of disrupted research activities was 'difficulties in research management' (χ²=34.7 and 126.5, respectively, p<0.001 for both). However, only ECNRs yielded 'position in organisational management' and was extracted only for ECNRs (χ²=7.0, p=0.008).

CONCLUSIONS

Difficulties in research management and an increased burden of student education and organisational management had an unfavourable impact on the research activities of ECNRs. To ensure quality of nursing care and nursing science development during and after the COVID-19 era, it is important to support ECNRs in their nursing research activities and career development. Our findings could contribute to the prioritisation of interventions and policymaking for ECNRs who are particularly at risk of being negatively affected by the pandemic.

Factors That Facilitate Discussion and Documentation of End-of-Life Care among Community-Dwelling Older Adults: A Cross-Sectional Study

We aimed to clarify the regional cultural characteristics in areas with different death rates at home, and to identify factors that influence the discussion and documentation of end-of-life care (EOLC) among community-dwelling older adults. This study was a cross-sectional study using a self-administered questionnaire survey, and participants were Japanese older adults. A chi-square test and multiple regression analysis were conducted. Among the 227 respondents, 143 were analyzed. There were no statistical differences by area. Participants who had intentions to discuss EOLC tended to discuss EOLC with their families and family doctors and tended to create documents to show their wills on EOLC (p < 0.05). The following factors that influence the intentions to discuss EOLC were extracted: experience in providing EOLC; information on EOLC; having religious and spiritual beliefs, and not avoiding the subject of death as part of beliefs related to life and death. These results indicate that beliefs and intentions regarding EOLC may be similar across Japan. Moreover, our findings suggest that to increase the interest of older adults on EOLC, it is important to provide opportunities for older adults to share and discuss information about EOLC with healthcare professionals and others who have experience providing EOLC.

Undergraduate nursing students' learning experiences of a telehealth clinical practice program during the COVID-19 pandemic: A qualitative study

BACKGROUND

Against the backdrop of the COVID-19 pandemic, nurse education institutions are required to create innovative and diverse educational methods to ensure the continued learning of undergraduate nursing students. We developed a telehealth clinical practice program to address this challenge.

OBJECTIVES

We explored the students' learning experiences of our telehealth clinical practice program by qualitatively analyzing student reports.

METHODS

The participants were fourth-year undergraduate students who had taken the telehealth clinical practice program at Hiroshima University. Data were collected as reports from the participants during clinical practice and analyzed using thematic analysis.

RESULTS

Of the 59 students who completed the practical training, 26 agreed to participate in the study (consent rate: 44.1%). Sixteen themes emerged from the analysis as the students' learning experiences, and were classified into four thematic categories: (1) recognition of continued self-improvement required to become a nurse and development of a sense of ethics, (2) improvement of knowledge and practical skills in chronic care nursing, (3) acquisition of telehealth skills, and (4) learning through modeling and teamwork, and improvement of self-efficacy. Interacting with persons through telehealth provided an opportunity to learn directly about persons' lives and their experiences of illness, and helped participants develop a sense of responsibility and ethical nursing.

CONCLUSIONS

Our study findings indicate that undergraduate nursing students perceived that their attitude, knowledge and skill acquisition improved through this program. We believe that telehealth can have a place as a teaching strategy and this telehealth clinical practice program can be further enhanced the learning effects by combining it with face-to-face training and multidisciplinary education in the future.

Person-centered dementia care during COVID-19: a qualitative case study of impact on and collaborations between caregivers

Background

Little is known about the actual impact of COVID-19 on caregivers of older people with dementia and resultant collaborations among them to provide continued person-centered care while undertaking infection control measures. In this study, we explored the impact of providing dementia care during COVID-19 on caregivers involved in dementia care.

Methods

This is an exploratory qualitative case study. The participants were family members living with older people with dementia, care managers, and the medical and long-term care facility staff. Data were collected from 46 caregivers via face-to-face and semi-structured interviews and analyzed using thematic analysis.

Results

The interviews identified 22 themes related to the impact of COVID-19 on different positions of the caregivers involved in dementia care and their collaboration, and we categorized them into six categories. The core themes were “re-acknowledgement of care priorities” and “rebuilding of relationships.” When caregivers’ perceptions were aligned in the decision-making processes regarding care priorities, “reaffirmation of trust” and “strengthening of intimate relationships” emerged as positive changes in their relationships. Furthermore, the differences in the ability of each caregiver to access and select correct and appropriate information about COVID-19, and the extent of infection spread in the region were related to “anxiety during COVID-19 pandemic” and caused a “gap in perception” regarding infection control.

Conclusions

The present study clarified that the process of aligning the perceptions of caregivers to the objectives and priorities of care for older people with dementia during COVID-19 pandemic strengthened the relationships among caregivers. The findings of this study are useful for caregivers involved in person-centered dementia care.

Experts' perception of support for people with dementia and their families during the COVID-19 pandemic

Aim

This study aimed to explore the perceptions of dementia experts on support for people with dementia (PWD) and their families, considering PWD's vulnerability regarding COVID‐19 prevention.

Methods

A collaborative qualitative study was conducted, involving Hiroshima University, the Japan Geriatrics Society, the Japan Society for Dementia Research, and the Japanese Psychogeriatric Society. An anonymous, self‐reported questionnaire survey was sent to dementia experts from 456 medical centers for dementia in Japan. The responses were categorized in a qualitative inductive manner.

Results

A total of 214 experts from 119 centers responded (facility recovery rate: 26.1%). Four core themes emerged from the data analysis. Of these themes, three were related to support for infection prevention and related issues and response to infection: (i) support for continuation of daily life while preventing infection; (ii) support to mitigate the unfavorable effects of infection prevention measures; and (iii) decision‐making support and treatment for infected PWD. The remaining theme, (iv) community building for PWD living together, was extracted as a basis for facilitating themes (i) to (iii). Furthermore, in each theme, the roles of medical and long‐term care facilities, administration, and the need for community collaboration were identified.

Conclusions

Dementia experts strongly felt the need not only for short‐term support to prevent the spread of infection to PWD and their families during the pandemic, but also for long‐term support to enable them to maintain their daily lives and mitigate the impact of infection prevention measures. Geriatr Gerontol Int 2022; 22: 26–31.

Can a sleep disorder intervention-embedded self-management programme contribute to improve management of diabetes? A pilot single-arm pretest and post-test study

OBJECTIVE

To investigate the efficacy and feasibility of a self-management programme incorporating a sleep intervention for improving diabetes outcomes.

DESIGN

A single-arm pre-test and post-test study was conducted within a community setting in Hiroshima, Japan.

PARTICIPANTS

Participants were aged 52-74 years and diagnosed with type 2 diabetic nephropathy stages 1-3.

INTERVENTIONS

Participants received self-management education from nurses for 6 months. First, the nurses assessed their sleep conditions using insomnia scales and a sleep metre. Then, the participants learnt self-management to increase their physical activity and improve their sleep condition. They also implemented diet therapy and medication adherence.

OUTCOME MEASURES

Physiological indicators, subjective and objective indicators of sleep quality, self-management indicators, quality of life (QOL) and feasibility were evaluated. To confirm the efficacy of intervention, Freidman tests, analysis of variance, Wilcoxon signed-rank test and t-test were performed. Pearson's correlations were analysed between activities and sleep condition.

RESULTS

Of the 26 enrolled participants, 24 completed the programme and were analysed. Among them, 15 participants (62.5%) had sleep disorders caused by multiple factors, such as an inappropriate lifestyle and physical factors that interfere with good sleep. Although insomnia scales did not change for the sleep disorders, their subjective health status improved. Regarding indicators related to diabetes management, lifestyles improved significantly. Haemoglobin A1c, body mass index, systolic blood pressure, non-high-density lipoprotein-cholesterol and QOL also improved. All participants except one were satisfied with the programme. However, use of the sleep metre and nurses' consultation about sleep disturbance were not well evaluated.

CONCLUSIONS

This programme was effective in improving diabetes status, lifestyle and behaviour changes. However, its effect on sleep condition was limited because of its complexity. A simple and novel approach is needed to strengthen the motivation for sleep behaviour change and to increase programme efficacy and feasibility.

TRIAL REGISTRATION NUMBER

UMIN000025906.

The Effectiveness of Telenursing for Self-Management Education on Cardiometabolic Conditions: A Pilot Project on a Remote Island of Ōsakikamijima, Japan

Introduction:

Providing self-management education for residents with cardiometabolic conditions in remote islands is a challenge due to the shortage of primary care practitioners (PCPs), specialist physicians, and nurses. Therefore, we applied telenursing with lifestyle-related chronic diseases in remote island residents in Japan. This project aimed to improve the self-management behavior, cardiometabolic indicators, self-efficacy, and quality of life (QoL) of residents with cardiometabolic risks.

Methods:

We chose Ōsakikamijima Island, Hiroshima Prefecture, Japan, which is designated under the Remote Islands Development Act. The project was conducted from 2013 to 2014. The residents aged over 40 and under 75 years old, selected from the annual specific health check-up examination and from PCPs for screening cardiometabolic risks (urinary protein, glycohemoglobin A1c, systolic and diastolic blood pressure (BP), Low-density lipoprotein cholesterol, High-density lipoprotein cholesterol, and triglyceride) were included. The effectiveness of telenursing for self-management education was 6-month-long with a 6-month follow-up and evaluated by a single-group pre-and post-test design. Face-to-face health education was applied at the initial interview followed by telenursing (biweekly telephone calls till third-month, and a monthly telephone call during the fourth and fifth-month) by the trained nurses outside the island. To enhance participants’ self-monitoring health behavior changes, the nurses used motivational interviewing and behavior change techniques based on the transtheoretical model.

Results:

A total of 130 residents, 42 agreed to participate, 41 finished the 6-month program, and 33 completed the 12-month follow-up. Most of their behavior changes like self-management behaviors, cardiometabolic indicators, and self-efficacy at 6-month were improved significantly except QoL. Among the 12-month study periods, self-management behaviors, body mass index, systolic BP, diastolic BP, and self-efficacy (sense of control), (all P < .05) showed significant improvement.

Conclusion:

This study results indicated that telenursing might be effective to improve the lifestyles-related behaviors in chronic diseases on the remote island of Ōsakikamijima, Japan.

Understanding the process for developing sleep disorders among Japanese workers: a qualitative study

Background: Sleep disorders have an enormous impact on occupational health and are counterproductive from an economic perspective. However, the processes of causing sleep disorders from psychosocial aspects have not yet been known. The purpose of this study was to describe how sleep disorders develop among workers with respect to different psychosocial conditions.

Methods: A conventional qualitative content analysis was conducted with a semi-structured interview among twenty-seven workers (14 males and 13 females) who were diagnosed with sleep disorders or had a self-reported history of sleep difficulties. Study participants were recruited from a specialized clinic and communities using snowball sampling. This paper adhered to the Standards for Reporting Qualitative Research (SRQR) checklist.

Results: The results showed that there were four steps involved in the sleep disorders development process. Firstly, participants with sleep disorders developed ‘early warning signs’ with 11 categories of triggers; secondly, ‘aggravating factors’ on top of these early warning signs; thirdly, workers tried to ‘cope with’ their sleep disorders in the ways they thought would be effective. Finally, when coping failed to improve the quality of sleep, it led to the onset of sleep disorders.

Conclusion: The development of sleep disorders and triggers of psychosocial factors were revealed. An occupational health nurse can bring these findings in practice for preventing worker’s sleep disorders.

Awareness Development and Usage of Mobile Health Technology Among Individuals With Hypertension in a Rural Community of Bangladesh: Randomized Controlled Trial

Background

Hypertension (HTN) is a major modifiable risk factor and the leading cause of premature deaths globally. The lack of awareness and knowledge have been identified as risk factors in low- and middle-income countries including Bangladesh. Recently, the use of mobile phone SMS text messaging is found to have an important positive impact on HTN management.

Objective

The study aimed to develop awareness and knowledge in order to enhance lifestyle behavior changes among individuals with HTN in a rural community of Bangladesh by using health education and mobile health (mHealth) technology (SMS text messaging).

Methods

A prospective randomized 5-month intervention, open-label (1:1), parallel-group trial was implemented among the individuals with HTN aged 35 years or older. Both men and women were included. Between August 2018 and July 2019, we enrolled 420 participants, selected from a tertiary level health facility and through door-to-door visits by community health workers. After block randomization, they were assigned to either the intervention group (received SMS text messaging and health education; n=209) or the control group (received only health education; n=211). The primary outcome was the evaluation of self-reported behavior changes (salt intake, fruits and vegetables intake, physical activity, and blood pressure [BP], and body weight monitoring behaviors). The secondary outcomes were measurements of actual salt intake and dietary salt excretion, blood glucose level, BP values, and quality of life (QOL).

Results

During the study period, a total of 8 participants were dropped, and the completion rate was 98.0% (412/420). The adherence rates were significantly higher (9%) among the control group regarding salt intake (P=.04) and physical activity behaviors (P<.03), and little differences were observed in other behaviors. In primary outcome, the focused behavior, salt intake less than 6 g/day, showed significant chronological improvement in both groups (P<.001). The fruits intake behavior steadily improved in both groups (P<.001). Participants in both groups had a custom of vegetables intake everyday/week. Physical activity suddenly increased and continued until the study end (P<.001 in both groups). Both BP and body weight monitoring status increased from baseline to 1 month but decreased afterward (P<.001). In case of secondary outcomes, significant chronological changes were observed in food salt concentration and urinary salinity between the groups (P=.01). The mean systolic BP and diastolic BP significantly chronologically decreased in both groups (systolic BP, P=.04; diastolic BP, P=.02.P<.05). All of these supported self-reported behavior changes. For the QOL, both groups showed significant improvement over the study periods (P<.001).

Conclusions

Based on these results, we suggest that face-to-face health education requires integration of home health care provision and more relevant and timely interactive SMS text messages to increase the effectiveness of the intervention. Besides, community awareness can be created to encourage “low-salt culture” and educate family members.

Trial Registration

Bangladesh Medical Research Council (BMRC) 06025072017; ClinicalTrials.gov NCT03614104; https://clinicaltrials.gov/ct2/show/NCT03614104 and UMIN-CTR R000033736; https://tinyurl.com/y48yfcoo

International Registered Report Identifier (IRRID)

RR2-10.2196/15523

A Health Guidance App to Improve Motivation, Adherence to Lifestyle Changes and Indicators of Metabolic Disturbances among Japanese Civil Servants

We investigated whether an Information and Communication Technology (ICT) application (app) motivated to increase adherence to lifestyle changes, and to improve indicators of metabolic disturbances among Japanese civil servants. A non-randomized, open-label, parallel-group study was conducted with 102 participants aged 20–65 years undergoing a health check during 2016–2017, having overweight and/or elevated glucose concentration. Among them, 63 participants chose Specific Health Guidance (SHG) and ongoing support incorporating the use of an app (ICT group) and 39 individuals chose only SHG (control group). Fifty from the ICT group and 38 from the control group completed the study. After completing the 6-month program, the control group showed a significant decrease in body mass index (p = 0.008), male waist circumference (p < 0.001), systolic blood pressure (BP) (p = 0.005), diastolic BP (p < 0.001), and glycated hemoglobin (HbA1c) (p < 0.001), and increase in high-density lipoprotein (HDL) cholesterol (p = 0.008). However, the ICT group showed a significant decrease in male waist circumference (p < 0.001), diastolic BP (p = 0.003), and HbA1c (p < 0.001), and increase in HDL cholesterol (p = 0.032). The magnitude of change for most indicators tended to be highest for ICT participants (used the app ≥5 times/month). Both groups reported raised awareness on BP and weight. The app use program did not have a major impact after the observation period. Proper action requires frequent use of the app to enhance best results.

Increasing Awareness and Use of Mobile Health Technology Among Individuals With Hypertension in a Rural Community of Bangladesh: Protocol for a Randomized Controlled Trial

Background

Hypertension remains one of the foremost noncommunicable diseases that most often lead to cardiovascular diseases and its different complications. The prevalence of hypertension in Bangladesh has been increasing. However, there are very limited studies that have evaluated the impact of health education and awareness development in mitigating the burden of hypertension and its complications in Bangladesh.

Objective

This study aims to increase awareness, enhance knowledge, and change lifestyle behaviors through health education and the use of mobile health (mHealth) technology among individuals with hypertension living in a rural community of Bangladesh.

Methods

A randomized controlled trial is underway in a Mirzapur subdistrict of Bangladesh. This trial compares two groups of individuals with hypertension: The comparison arm receives health education and the intervention arm receives health education and a periodic mobile phone–based text message intervention. The trial duration is 5 months. The primary end point is participants’ actual behavior changes brought about by increased awareness and knowledge.

Results

Enrollment of participants started in August 2018, and collection of follow-up data was completed at the end of July 2019. A total of 420 participants volunteered to participate, and among them, 209 and 211 were randomly allocated to the intervention group and the control group, respectively. Among them, the ratio of males/females was 12.0/88.0 in the intervention group and 16.1/83.9 in the control group. Data cleaning and analyses have been completed and the results have been submitted for publication.

Conclusions

Periodic short education using mHealth technology in addition to face-to-face health education may be an effective method for increasing awareness and knowledge about behavioral changes and maintaining healthy lifestyle behaviors.

Trial Registration

Bangladesh Medical Research Council (BMRC) 06025072017; ClinicalTrials.gov NCT03614104, https://clinicaltrials.gov/ct2/show/NCT03614104; University hospital Medical Information Network (UMIN) R000033736, https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_his_list.cgi?recptno=R000033736

International Registered Report Identifier (IRRID)

DERR1-10.2196/15523

Patterns of elderly people's long-term care risks and determinants: A methodological study in a Japanese city

AIMS

Existing analysis methods about the relationships between the long-term care (LTC) risks and determinants of the elderly often experience issues of independence, linearity and homogeneity. Such methodological issues are particularly problematic when the relationships are complicated, making the prioritization of LTC interventions to groups with different care needs difficult. To overcome these shortcomings, this study made an initial attempt to identify representative patterns of elderly people's LTC risks associated with different determinants, from a methodological perspective.

METHODS

A data mining approach (Exhaustive CHAID) is applied to data collected from 26 357 elderly people in a Japanese city in 2016. It can automatically segment the samples into a tree structure that accommodates nonlinear, heterogeneous and sequential relationships, without caring about issues of independence across determinants.

RESULTS

In total, 16 representative patterns are derived, among which four patterns are considerably riskier (the unhealthy percentage >10.0%), and five are moderately riskier (the unhealthy percentage is 5.0%-10.0%). Age is the most important determinant, followed by locomotor function, cognitive function, homebound, gender and residential location, in that order, which all show heterogeneous associations with the risk patterns.

CONCLUSIONS

The Exhaustive CHAID is suitable to derive scientifically-sound insights into an early screening of risk factors for pre-frail groups and tailor-made preventive LTC interventions for frail groups in a flexible and objective way. Geriatr Gerontol Int 2020; 20: 674-679.

Evaluating the effectiveness and feasibility of nurse-led distant and face-to-face interviews programs for promoting behavioral change and disease management in patients with diabetic nephropathy: a triangulation approach

BACKGROUND

We examined whether telecommunication-device-based distance interviews are inferior to face-to-face interviews in terms of facilitating behavioral changes and disease management in patients with diabetic nephropathy. We also examined the feasibility of a newly designed six-month telenursing program.

METHODS

This study represents a post-hoc analysis of data from a randomized controlled trial, in which we compared the efficacy of remote self-management education with that of direct education for patients with diabetic nephropathy. The participants were 40 company employees, who were randomly divided into two groups. Over 6 months, the intervention group (n = 21) received three distance interviews using a tablet computer. Meanwhile, the control group (n = 19) received three face-to-face interviews. In addition, both groups received biweekly nine telephone calls. A triangulation approach was used. We first compared the two groups in inferiority tests. Then, we analyzed data from semi-structured interviews with all participants and nurses, examining whether trusting relationships and motivation were developed, and the accuracy of the information exchanges. Further, for the intervention group, we also enquired about the overall operability of the telenursing device.

RESULTS

The completion rates for the program were 81.0 and 78.9% for the participants in the intervention and control groups, respectively. Both groups showed similar behavioral changes, and the participants verified the feasibility of the distance interviews. The participants in the intervention group felt that they understood the severity of their diseases and the necessity of self-management, and felt confidence in the nurses. On the other hand, their degree of behavioral change regarding self-monitoring was lower than that shown by the control group.

CONCLUSION

Our findings show that both interview methods are effective for encouraging the adoption of self-management; further, in terms of taking medication and improving the main clinical indicators, we found that the distance method is not inferior to the direct face-to-face method. However, when considering long-term effects, based on the respective degrees of improvement in behavioral change, the direct method seems to be more effective.

TRIAL REGISTRATION

The trial was registered with the University Hospital Medical Information Network clinical trial registry (No. UMIN000026568) on March 15, 2017, retrospectively.

Disease perception and experiences among rural Bangladeshi hypertensive women: A qualitative approach

Background: Hypertension (HTN) is well established as a leading cause of common serious illnesses worldwide. We carried out this qualitative research to understand perception of and experiences related to HTN among rural Bangladeshi hypertensive women. Methods: A total of 74 female hypertensive participants who were diagnosed as HTN were purposively recruited in a rural community in Mirzapur, Bangladesh. A focus group discussion(FGD) was applied to share their perception and experiences. Transcripts were read in an iterative process, and a thematic analysis was performed. This paper is reported followed by COREQ checklist. Results: Three main themes were generated; (i) Perception of HTN based on experiences, (ii)Knowledge of management of HTN, and (iii) Barriers of management of HTN. Under the themes, seven subthemes were identified. The participants only knew about their high blood pressure(HBP) when they had symptoms, and they applied traditional remedies in the rural context to deal with those symptoms. Even though more than half of participants had relevant knowledge of how to manage HTN, but still there were social-cultural and economic barriers and lack of social infrastructure to access healthcare, existed to practice them. Conclusion: Based on our study reports, health education programs at the household and community level could be a potential starting point for any preventive and containment strategy in rural communities of Bangladesh.

Characteristics of heart failure patients incurring high medical costs via matching specific health examination results and medical claim data: a cross-sectional study

OBJECTIVE

We describe the characteristics of patients with high medical costs by matching specific annual medical examination results and medical claim data. Clarifying the relationships between examination items and high medical costs allows the screening of high-risk persons.

DESIGN

A cross-sectional study.

SUBJECTS

Subjects were persons insured by national health insurance in Hiroshima City, Hiroshima Prefecture, from April 2016 to March 2017. To identify true heart failure (HF) patients, the disease name listed in the medical claim data was compared with drugs prescribed for HF, with extraction of only subjects whose comparative data matched.

DATA COLLECTION AND ANALYSIS

The specific health examination includes a questionnaire on areas such as lifestyle habits, anthropometry, blood pressure, blood tests and urine tests. The percentage of the total medical costs related to the medical care of subjects with HF was described using Pareto analysis. For specific health examination items, we compared the high-cost and low-cost groups. The normality and homoscedasticity of each variable was checked and Student's t-tests and χ² tests were applied. Finally, multiple logistic regression analysis was used to detect factors in the health examination items related to high medical costs.

RESULTS

Pareto analysis showed that 80% of all medical costs were paid by 30% of the HF patient population. The fees for cardiovascular surgery accounted for 54% of the total surgical cost, 64% of which included preventable diseases. Levels of creatinine (Cr) and γ-glutamyl transpeptidase (γ-GTP) and a history of smoking were found to be related to high medical costs.

CONCLUSION

Analysis of specific health examination results for HF patients revealed the association between high medical costs, γ-GTP, Cr, and smoking. These results can thus serve as a reference for screening persons at high risk of HF and help prevent the exacerbation of HF.

An Investigation of Factors Influencing High Usage of Medical and Long-Term Care Services in an Aging Society in Japan

Medical and long-term care costs are increasing all over the world. In this study, we investigated the characteristics of groups with high cost of medical and long-term care to define targets for curbing social security costs. As a result, for the population covered by the National Health Insurance, a large portion of medical costs were incurred for mental disorders, malignant neoplasms, and lifestyle-related diseases. For those covered by the Late Elderly Health Insurance System, most medical costs were incurred for lifestyle-related diseases, femoral fractures, neurological diseases, mental disorders, pneumonia, malignant neoplasms, and Alzheimer’s disease. From multiple regression analysis, the hospitalization days, use of advanced medical treatment, outpatient days, and high long-term care level influenced the increased costs. On the other hand, disease characteristics had only a very low effect. These findings suggest that the target population has complex medical and long-term care needs because they have multiple diseases.

Effects of a self-management skills-acquisition program on pre-dialysis patients with diabetic nephropathy

The study was to examine the effects of a six-month educational program aiming acquisition of self-management skills on patients with diabetic nephropathy. One-group, pre- and post-test design was performed. Face-to-face and telephone interviews were conducted by nurses. Thirty participants completed the program. As a result of the program, self-efficacy, self-management ability, and Hb(A1c) improved, and renal function was maintained.