Akiko Shibuya

The relation between health literacy, hypertension knowledge, and blood pressure among middle-aged Japanese adults.

BackgroundWith the growth in the popularity of the Internet, individuals’ skills in finding and applying information about health issues [health literacy (HL)] are affecting their health behaviors. This study aimed to examine functional HL (FHL), critical HL (CHL), and hypertension knowledge (HK) among middle-aged Japanese adults. In addition, to measure health outcomes, we examined the relationship between HL, HK, and blood pressure (BP) level. MethodsThe study included middle-aged participants who received an annual health check-up at an urban clinic in Japan. FHL, CHL, and HK were assessed using structured questionnaires. In addition, BP was obtained from the electronic medical record. ResultsParticipants included 139 women and 181 men with a mean age of 54.4 years (standard deviation=0.69). Individuals with lower reading comprehension scores in FHL were more likely to have a history of hypertension (P=0.003) and diabetes mellitus (P=0.02). Individuals with lower CHL had significantly higher rates of current smoking (P=0.03) and men with lower CHL had a significantly higher waist circumference (P=0.03). There was a significant relationship between sex and HK (P=0.03). Systolic BP in women with higher HL and HK was significantly lower than in men with higher FHL (P<0.001), CHL (P=0.01), and HK (P=0.001). ConclusionLower HL and HK were associated with a poor health status and BP level in middle-aged participants. Further research is needed to examine the role of health management in improving outcomes and to address disparities between individuals with higher and lower HL.

An Approach to Medical Knowledge Sharing in a Hospital Information System Using MCLink

Clinicians often need access to electronic information resources that answer questions that occur in daily clinical practice. This information generally comes from publicly available resources. However, clinicians also need knowledge on institution-specific information (e.g., institution-specific guidelines, choice of drug, choice of laboratory test, information on adverse events, and advice from professional colleagues). This information needs to be available in real time. This study characterizes these needs in order to build a prototype hospital information system (HIS) that can help clinicians get timely answers to questions. We previously designed medical knowledge units called Medical Cells (MCs). We developed a portal server of MCs that can create and store medical information such as institution-specific information. We then developed a prototype HIS that embeds MCs as links (MCLink); these links are based on specific terms (e.g., drug, laboratory test, and disease). This prototype HIS presents clinicians with institution-specific information. The HIS clients (e.g., clinicians, nurses, pharmacists, and laboratory technicians) can also create an MCLink in the HIS using the portal server in the hospital. The prototype HIS allowed efficient sharing and use of institution-specific information to clinicians at the point of care. This study included institution-specific information resources and advice from professional colleagues, both of which might have an important role in supporting good clinical decision making.

The prevalence of mental distress before the Great East Japan Earthquake and the associated impact of an aged society: An ecological study

Various studies have determined that the Great East Japan Earthquake (GEJE) caused mental distress among residents in affected areas. However, previous studies had not considered the prevalence of mental distress before the GEJE, and ignored the impact of an aged society on mental distress. Therefore, we aimed to describe the prevalence of mental distress before the GEJE in Miyagi Prefecture, Japan and elucidate the effect of an aged society on mental distress. We conducted an ecological study, using municipality in Miyagi Prefecture as the study unit. We used the cross-sectional mail survey data conducted in February 2011. We performed a correlation analysis in each of the 39 municipalities in Miyagi Prefecture. The prevalence of serious mental distress was 9.1%. The proportion of the population aged 65 years or older was related to the prevalence of serious mental distress in municipalities with a low proportion of all workers engaged in primary industry and with a high estimated number of inpatients with mental illness. We found that residents in Miyagi Prefecture suffered from poor mental health before the GEJE. Aged society was related to serious mental distress in the areas with advanced industrial structure and more patients with mental illness. We should approach mental health problems in the context of social structure, particularly in an aged society, based on facts about mental distress before the GEJE.

Social determinants affecting the use of complementary and alternative medicine in Japan: An analysis using the conceptual framework of social determinants of health

This study aims to use the conceptual framework of social determinants of health (SDH) to elucidate the social determinants that affect the use of complementary and alternative medicine (CAM) from the perspectives of both intermediary and structural determinants. Data were derived from a survey mailed to 1,500 randomly selected residents (20–69 years old; May–July 2009) of Sendai city in Japan. A generalized linear model was used in the analysis, with CAM use over the past one month as the dependent variable, SDH structural and intermediary determinants as independent variables, and demographic characteristics, indicators of health status, and the evaluation of health or healthcare systems as control variables. The prevalence of CAM usage was 62.1%. The generalized linear model showed that middle subjective social status (OR = 1.47; 95% CI: 1.04–2.07) as structural determinants was significantly associated with CAM usage. Adding the intermediary determinants, the same effect was observed. When demographic characteristics, indicators of health status, and the evaluation of health or healthcare systems were introduced as control variables, the associations of the structural determinants disappeared, revealing that hope (OR = 1.25; 95%CI: 1.04–1.50) as intermediary determinants was associated with the use of CAM. Female sex (OR = 1.47; 95% CI: 1.02–2.12) and health anxiety (OR = 1.68; 95% CI: 1.20–2.34) were associated with CAM usage. We found that intermediary rather than structural determinants were associated with CAM usage. Hope as an intermediary determinant was particularly associated with CAM usage.