Mikiya Sato

Factors associated with the use of home-visit nursing services covered by the long-term care insurance in rural Japan: a cross-sectional study

BackgroundIn Japan, there is a large increase in the number of elderly persons who potentially need home-visit nursing services (VNS). However, the number of persons using the VNS has increased only little in comparison to the number of individuals who use home social services, which are also covered by the Long-Term Care Insurance (LTCI) system. This cross-sectional study investigated the predictors of the VNS used under the LTCI system in Japan.MethodsWe used 1,580 claim data from all the users of community-based services and 1,574 interview survey data collected in 2001 from the six municipal bodies in Japan. After we merged the two datasets, 1,276 users of community-based services under the LTCI were analyzed. Multiple logistic regression models stratified by care needs levels were used for analysis.ResultsOnly 8.3% of the study subjects were VNS users. Even among study participants within the higher care-needs level, only 22.0% were VNS users. In the lower care level group, people with a higher care level (OR: 3.50, 95% CI: 1.50–8.93), those whose condition needed long term care due to respiratory or heart disease (OR: 4.31, 95% CI: 1.88–89.20), those whose period of needing care was two years or more (OR: 2.01, 95% CI: 1.14–3.48), those whose service plan was created by a medical care management agency (OR: 2.39, 95% CI: 1.31–4.33), those living with family (OR: 1.86, 95% CI: 1.00–3.42), and those who use home-help services (OR: 2.12, 95% CI: 1.17–3.83) were more likely to use the VNS. In the higher care level group, individuals with higher care level (OR: 3.63, 95% CI: 1.56–8.66), those with higher income (OR: 3.79, 95% CI: 1.01–14.25), and those who had regular hospital visits before entering the LTCI (OR: 2.36, 95% CI: 1.11–5.38) were more likely to use the VNS.ConclusionsOur results suggested that VNS use is limited due to management by non-medical care management agencies, due to no caregivers being around or a low income household. The findings of this study provide valuable insight for LTCI policy makers: the present provision of VNS should be reconsidered.

Developing a measure of communicative and critical health literacy: a pilot study of Japanese office workers

With the increase in media reports and rapid diffusion of the Internet, the skills in finding and utilizing health information (health literacy; HL) are becoming important in maintaining and promoting health. This study aimed to examine the psychometric properties of a brief measure to assess major components of communicative and critical HL among Japanese office workers, in order to consider its applicability to health promotion at workplace. The participants were 190 male office workers at a Japanese company. A self-administered questionnaire was distributed at the annual health checkup, in which HL, health-related behaviors and coping with job stress were asked. Also, the number of somatic symptoms reported by the worker was counted out of the eight symptoms in the health checkup questionnaire. The higher HL group was more likely to have regular eating patterns and exercise weekly, and tended to be a never smoker. In coping with job stress, those with higher HL were more likely to actively solve the problems or seek support from others, whereas those with lower HL were more likely to be resigned to the situation. Further, lower HL group reported significantly greater number of somatic symptoms than higher HL group. These findings were generally as hypothesized, supporting the validity of the HL scale among office workers. Further research on HL is needed to explore the extent and impact of HL on health outcomes.

Adverse environmental health effects of ultra-low relative humidity indoor air.

Adverse Environmental Health Effects of Ultra‐low Relative Humidity Indoor Air: Mikiya Sato, et al. Department of Hygiene and Public Health, Teikyo University School of Medicine—In Japan, relative humidity (RH) shows the lowest achievement rate among the various general air quality standards for work environment. It has been mainly contributed by airtight design of modern buildings and occurrence of dry outdoor air in winter. Furthermore, an ultra‐dry air environment of nearly 0% RH is often required in sophisticated industries. In order to assess the adverse health effects of the ultra‐dry air environment, using a self‐reported questionnaire, we have undertaken a study of over 200 employees of a high‐tech device developing laboratory having a room at 2.5% RH (ultra‐dry room). Those who worked in the ultra‐dry room were identified and the prevalence of symptoms was compared with the other workers. Analysis was performed by Wilcoxons test and Fishers exact test. In the ultra‐dry room, all the twelve workers covered their skin with long‐sleeve clothes, paper caps, paper masks and latex gloves. They reported skin symptoms more often (p<0.05) than the other workers (N=143). The prevalence of atopic dermatitis was also higher in the exposed workers (p<0.05). The complaints of workers in the ultra‐dry environment were similar to preceding reports concerning moderately dry environmental exposures. The current precautions to protect the workers from the adverse effects of ultra low RH appear to be insufficient, indicating that additional measures such as selection of appropriate clothing to mere skin coverage should be considered.

The Association of the Reporting of Somatic Symptoms with Job Stress and Active Coping among Japanese White-collar Workers

The Association of the Reporting of Somatic Symptoms with Job Stress and Active Coping among Japanese White‐collar Workers: Kyoko Nomura, et al. Department of Hygiene and Public Health, Teikyo University School of Medicine—To assess the associations between job stress and somatic symptoms and to investigate the effect of individual coping on these associations. In July 2006, a cross‐sectional study was conducted during a periodic health check‐up of 185 Japanese male office workers (21–66 yr old) at a Japanese company. Job stress was measured by job demand, control, and strain (=job demand/control) based on the Job Content Questionnaire (JCQ). Major somatic symptoms studied were headache, dizziness, shoulder stiffness, back pain, shortness of breath, abdominal pain, general fatigue, sleep disturbance, and skin itching. Five kinds of coping were measured using the Job Stress Scale: active coping, escape, support seeking, reconciliation, and emotional suppression. Comorbidities of hypertension, diabetes, obesity, depression, and anxiety were also evaluated. The most frequently cited somatic symptom was general fatigue (66%), followed by shoulder stiffness (63%) and sleep disturbance (53%). Of the five kinds of coping, only “active coping” was significantly and negatively associated with the number of somatic symptoms. The generalized linear models showed that the number of somatic symptoms increased as job strain index (p=0.001) and job demand (p=0.001) became higher, and decreased as active coping (p=0.018) increased, after adjusting for age and comorbidities. There was no statistical interaction among active coping, the number of somatic symptoms, and the three JCQ scales. Reporting somatic symptoms may be a simple indicator of job stress, and active coping could be used to alleviate somatization induced by job stress.

Blood lead and erythrocyte protoporphyrin levels in association with smoking and personal hygienic behaviour among lead exposed workers

Aims: To investigate the effects of smoking and personal hygienic behaviour on blood lead (BPb) and free erythrocyte protoporphyrin levels (FEP) in lead exposed workers. Methods: Subjects were 105 lead exposed male workers in a battery recycling plant during the years 2000–03. BPb and FEP were measured as part of the ongoing occupational surveillance. Each worker completed a questionnaire for assessment of smoking and four measures of personal hygienic behaviour (glove and mask use, hand and face washing before meals during working hours). Results: Statistically significant decreases in mean BPb and FEP occurred during the three years. The proportion of BPb reduction in the non-smoking workers was significantly higher (mean 24.3%) than in the smoking workers (15.3%). When the workers were classified into three groups (excellent, good, and poor) based on the four personal hygienic behavioural indicators, the greatest decreases of BPb and FEP were observed in the non-smoking workers of the excellent group. Conclusions: The consistent use of protection devices and cleanliness at work appeared to contribute to the lowering of BPb and FEP. Cessation of smoking in the workplace was also of importance.

Benzodiazepine prescription and length of hospital stay at a Japanese university hospital.

BackgroundThe relationship between bed days and benzodiazepine prescription (BDZ) in Western countries is inconclusive, and no hospital-based report has documented this phenomenon in Japan. This study was done to assess the association between bed days and BDZ in a Japanese hospital.Methods21,489 adult patients (55.1% men, mean age 59.9 years old) hospitalized between April, 2005 and December, 2006 were enrolled in the study. Patient age, sex, ICD-10 diagnosis, prescription profile, and days of hospital stay were assessed in 13 non-psychiatric departments using a computer ordering system. Patients prescribed a benzodiazepine during hospitalization were defined as positive.ResultsOf the total sample, 19.9% were allocated to the benzodiazepine (+) group. Female sex and older age were significant factors associated with benzodiazepine prescription. The median number of bed days was 13, and the likelihood of BDZ significantly increased with the number of bed days, even after controlling for the effects of age, gender, and ICD-10 diagnosis. For example, when the analysis was limited to patients with 50 bed days or longer, the percentage of BDZ (32.7%) was equivalent to that of a report from France.ConclusionIrrespective of department or disease, patients prescribed benzodiazepine during their hospital stay tended to have a higher number of bed days in the hospital. The difference in the prevalence of BDZ between this study and previous Western studies might be attributed to the relatively short length of hospital stay in this study. Because BDZs are often reported to be prescribed to hospitalized patients without appropriate documentation for the indications for use, it is important to monitor the rational for prescriptions of benzodiazepine carefully, for both clinical and economical reasons.

Factors that allow elderly individuals to stay at home with their families using the Japanese long‐term care insurance system

This study examined the factors that allow elderly individuals to stay at home continuously by considering the roles of the family caregiver, the use of services and characteristics of the elderly individual.

Predictors of continuity in home care for the elderly under public long-term care insurance in Japan

Background and aims: With the rapid increase in the elderly population, the number of people requiring care is also increasing and the capacity of the family to provide care is decreasing. Because institutionalization costs are high, more research is needed to investigate predictors of preventing institutionalization. The aim of this study was to examine the impact of social engagement and other predictive factors, including disability, household composition, and formal services, on continuity in home care of the elderly. Methods: The study was retrospective longitudinal in design. Data were collected from elderly people living in the community who were certified as eligible for care level 2–5 under Japanese long-term care insurance. Continuity in home care was defined as a participant living at home 1 year after the beginning of the study. Results: Of 244 participants, 200 continued to receive home care (82%). Based on a logistic regression analysis predicting continuity in home care, after controlling for gender, age, initial care level, household composition, and daycare service use, having friends was significantly associated with continuity in home care (odds ratio [OR] 2.42; 95% confidence interval [CI] 1.04–5.65). Participants who lived alone or with a spouse were less likely to continue to receive home care compared with those who lived with others (OR 0.27; 95% CI 0.08–0.87 and OR 0.18; 95% CI 0.06–0.53, respectively). Conclusions: Having friends was a significant predictor of continuity in home care. The promotion of social engagement may be important in preventing institutionalization.

Comparison of public and private care management agencies under public long-term care insurance in Japan: A cross-sectional study

Aim:  Long‐Term Care Insurance (LTCI), which started in April 2000, allowed private business corporations to provide long‐term care services which had been provided by social welfare corporations or public agencies in the previous long‐term care scheme. This study compared differences in care management plans for community‐dwelling frail elderly people between public care management agencies and private care management agencies.

Association between potentially inappropriate medications and anxiety in Japanese older patients

The use of potentially inappropriate medications (PIMs) for older patients is a major public health problem. However, there is little information regarding PIMs in Japanese primary care settings, and the association between psychological problems and PIMs is unknown. The present study was carried out to explore the prevalence of PIMs among older patients in a primary care setting in Tokyo, and to assess the association between PIMs and depression and anxiety.