Seungwon Jeong

Sex/Gender and Socioeconomic Differences in the Predictive Ability of Self-Rated Health for Mortality

Background Studies have reported that the predictive ability of self-rated health (SRH) for mortality varies by sex/gender and socioeconomic group. The purpose of this study is to evaluate this relationship in Japan and explore the potential reasons for differences between the groups. Methodology/Principal Findings The analyses in the study were based on the Aichi Gerontological Evaluation Studys (AGES) 2003 Cohort Study in Chita Peninsula, Japan, which followed the four-year survival status of 14,668 community-dwelling people who were at least 65 years old at the start of the study. We first examined sex/gender and education-level differences in association with fair/poor SRH. We then estimated the sex/gender- and education-specific hazard ratios (HRs) of mortality associated with lower SRH using Cox models. Control variables, including health behaviors (smoking and drinking), symptoms of depression, and chronic co-morbid conditions, were added to sequential regression models. The results showed men and women reported a similar prevalence of lower SRH. However, lower SRH was a stronger predictor of mortality in men (HR = 2.44 [95% confidence interval (CI): 2.14–2.80]) than in women (HR = 1.88 [95% CI: 1.44–2.47]; p for sex/gender interaction = 0.018). The sex/gender difference in the predictive ability of SRH was progressively attenuated with the additional introduction of other co-morbid conditions. The predictive ability among individuals with high school education (HR = 2.39 [95% CI: 1.74–3.30]) was similar to that among individuals with less than a high school education (HR = 2.14 [95% CI: 1.83–2.50]; p for education interaction = 0.549). Conclusions The sex/gender difference in the predictive ability of SRH for mortality among this elderly Japanese population may be explained by male/female differences in what goes into an individuals assessment of their SRH, with males apparently weighting depressive symptoms more than females.

Effects of nutritional supplements on muscle mass and activities of daily living in elderly rehabilitation patients with decreased muscle mass: A randomized controlled trial

ObjectiveTo investigate the effects of nutritional intervention with resistance training on skeletal muscle mass in elderly patients with disabilities in a convalescent rehabilitation setting.DesignA randomized controlled trial. (UMIN Clinical Trials Registry ID: UMIN000006238).SettingA rehabilitation hospital.Participants39 elderly patients with decreased skeletal muscle mass in an inpatient convalescence rehabilitation unit.InterventionsA combination of resistance training plus nutritional supplementation (R/N group) or resistance training alone (R group). The training and supplementation were conducted essentially from the patient’s admission to discharge (2–6 months).Outcome MeasuresThe patients were evaluated at the time of admission and at the end of the intervention for skeletal muscle mass (calf circumference [CC] as a primary outcome, and arm circumference [AC]), hand grip strength (HG), Mini-Nutritional Assessment-Short Form (MNA®-SF) score, serum albumin level (Alb), body mass index (BMI), and activities of daily living (ADL) as represented by the Barthel Index (BI) score.ResultsSignificant treatment effects were seen for CC, AC, BI, Alb in the R/N group compared to the R group. A mean treatment effect of 3.2 (95%CI: 2.0–4.4) was seen in CC, 1.4 (95%CI: 0.8–2.1) was seen in AC, 11.2 (95%CI: 0.5–21.8) was seen in BI, 0.3 (95%CI: 0.1–0.5) was seen in Alb.ConclusionThe results of this study suggest that nutritional intervention added to resistance training during convalescent rehabilitation may improve skeletal muscle mass and activities of daily living.

An evaluation of the quality of post-stroke rehabilitation in Japan

Correspondence: seungwon Jeong nihon Fukushi University, nagoya, Japan, 4600012 email k-jeong@n-fukushi.ac.jp Context and objectives: This study was to assess the differences in rehabilitation outcomes between the different facilities in Japan, and to determine if there was any variation in patients’ functional recovery at hospital discharge across the different facilities. Methods: This study focused on patients in recovery in the rehabilitation ward using the data of 680 patients from 12 hospitals after adjusting for triage at admission obtained from the Rehabilitation Patient Databank in Japan (issued in September, 2009) and compared the therapeutic results of each hospital. We estimate the expected value of levels of activities of daily living (ADL) at discharge for rehabilitation patients using regression analysis. Furthermore, we show the distribution of the expected improvement levels in ADL by hospitals. Findings: At the time of admission, there were no differences among hospitals in their patients’ characters. However, outcomes differed widely among the hospitals. The differences in the participation of physicians registered as rehabilitation specialists, conference execution rate, amount of exercise per day, self-exercise without a therapist, and exercise in wards, were statistically significant differences between hospitals. Conclusion: Due to the assessments for health care quality and the publication of results it is expected that health care providers will put in voluntary effort to improve their future health care services. Further studies should analyze the characteristics of high-performing hospitals.

Changes in hospital performance after implementation of pay-for-performance in Japan

Correspondence: Seungwon Jeong Center for Well-being and Society, 5–22–35, Chiyoda, Nakaku, Nagoya 460–0012, Japan Tel +81 52 242 3075 Fax +81 52 242 3076 Email k-jeong@n-fukushi.ac.jp Background: The purpose of this study was to evaluate the effect of pay-for-performance (P4P) in hospitals in Japan, and to determine if any improvement occurred in the Functional Independence Measure (FIMTM) score at the time of discharge from hospital, the return home rate, and whether there was any intentional selection by hospitals of patients expected to have greater recovery. Methods: We used the data produced by the Rehabilitation Patients DataBank of Japan (February 2011, for 903 patients and 26 hospitals), and identified patient characteristics and processes (by t-test and Chi-square test), change in FIM score on discharge from hospital (by regression analysis), and change in return home rate (by logistic regression analysis) before and after the implementation of P4P. Results: Given the high FIM scores at admission and discharge after P4P was introduced, as well as the high return home rate, the possibility of an intentional increase in the number of patients whose conditions would be easily improved could not be excluded, although this could not be construed as the definite result of a patient screening practice. In addition, following the implementation of P4P, there was improvement in the process by which health care delivery was provided, but neither the FIM gain nor the return home rate was significantly higher after P4P was introduced. A similar result was obtained when the data were analyzed only by hospital cases for the entire period before and after P4P implementation. Conclusion: No effect of P4P implementation on FIM at discharge or the return home rate was observed in this study. In the future, continuous monitoring of changes after implementation of P4P and detailed analysis of the possibility of deliberate patient screening will be needed. A more indepth examination of the indicators and incentive criteria currently in use is recommended.

The Effect of Additional Training on Motor Outcomes at Discharge from Recovery Phase Rehabilitation Wards: A Survey from Multi-Center Stroke Data Bank in Japan

Objectives The purpose of the present study was to examine the potential benefits of additional training in patients admitted to recovery phase rehabilitation ward using the data bank of post-stroke patient registry. Subjects and Methods Subjects were 2507 inpatients admitted to recovery phase rehabilitation wards between November 2004 and November 2010. Participants were retrospectively divided into four groups based upon chart review; patients who received no additional rehabilitation, patients who were added with self-initiated off hours training, patients who were added with off hours training by ward staff, patients who received both self-initiated training and training by ward staff. Parameters for assessing outcomes included length of stay, motor/cognitive subscales of functional independent measures (FIM) and motor benefit of FIM calculated by subtracting the score at admission from that at discharge. Results Participants were stratified into three groups depending on the motor FIM at admission (≦28, 29∼56, 57≦) for comparison. Regarding outcome variables, significant inter-group differences were observed in all items examined within the subgroup who scored 28 or less and between 29 and 56. Meanwhile no such trends were observed in the group who scored 57 or more compared with those who scored less. In a decision tree created based upon Exhaustive Chi-squared Automatic Interaction Detection method, variables chosen were the motor FIM at admission (the first node) additional training (the second node), the cognitive FIM at admission(the third node). Conclusions Overall the results suggest that additional training can compensate for the shortage of regular rehabilitation implemented in recovery phase rehabilitation ward, thus may contribute to improved outcomes assessed by motor FIM at discharge.

Effects of a Self-Exercise Program on Activities of Daily Living in Patients After Acute Stroke: A Propensity Score Analysis Based on the Japan Association of Rehabilitation Database

OBJECTIVE To investigate whether self-exercise programs for patients after stroke contribute to improved activities of daily living (ADL) at hospital discharge. DESIGN Retrospective, observational, propensity score (PS)-matched case-control study. SETTING General hospitals. PARTICIPANTS Participants included patients after stroke (N=1560) hospitalized between January 3, 2006, and December 26, 2012, satisfying the following criteria: (1) data on age, sex, duration from stroke to hospital admission, length of stay, FIM score, modified Rankin Scale (mRS) score, Glasgow Coma Scale score, Japan Stroke Scale score, and self-exercise program participation were available; and (2) admitted within 7 days after stroke onset, length of stay was between 7 and 60 days, prestroke mRS score was ≤2, and not discharged because of FIM or mRS exacerbation. A total of 780 PS-matched pairs were selected for each of the self-exercise program and no-self-exercise program groups. INTERVENTION Self-exercise program participation. MAIN OUTCOME MEASURES At discharge, FIM motor score, FIM cognitive score, FIM motor score gain (discharge value - admission value), FIM motor score gain rate (gain/length of stay), a binary variable divided by the median FIM motor score gain rate (high efficiency or no-high efficiency), and mRS score. RESULTS Patients were classified into a self-exercise program (n=780) or a no-self-exercise program (n=780) group. After matching, there were no significant between-group differences, except motor system variables. The receiver operating characteristic curve for PS had an area under the curve value of .71 with a 95% confidence interval of .68 to .73, and the model was believed to have a relatively favorable fit. A logistic regression analysis of PS-matched pairs suggested that the self-exercise program was effective, with an overall odds ratio for ADL (high efficiency or no-high efficiency) of 2.2 (95% confidence ratio, 1.75-2.70). CONCLUSIONS SEPs may contribute to improving ADL.

Prevention of accidental deaths among people with dementia missing in the community in Japan: Letters to the Editor

dystonia and degenerative skeletal changes, as well as loss of postural reflexes. In a recent study, Spagnolo et al. suggested including striatal hand examination in routine practice in Parkinson’s patients, stating a 100% diagnostic specificity. However, the authors could also find a report of basal ganglia infarction leading to striatal toe. In the present case, the authors describe the first report of a striatal hand deformity in a patient who had suffered from tubercular meningitis. We hypothesize that a possible vasculitic infarct in the basal ganglia of the contralateral side could have resulted in the deformity in the present patient. The initial computed tomography imaging of the brain did not show any such abnormality. However, the patient developed the hand deformity later in the disease course. It is quite possible that a low grade central nervous system inflammation was persisting in the patient just like the persisting tubercular osteomyelitis. This may have been responsible for the vasculitic infarct. The case highlights the fact that striatal deformities of the limbs characteristically described in Parkinson’s disease might be observed in other diseases that are no longer rampant in the more developed world populations.

Effects of branched-chain amino acids and vitamin D supplementation on physical function, muscle mass and strength, and nutritional status in sarcopenic older adults undergoing hospital-based rehabilitation: A multicenter randomized controlled trial: BCAA and rehabilitation

To investigate the effects of branched‐chain amino acids and vitamin D supplementation on physical function, muscle strength, muscle mass, and nutritional status in sarcopenic older adults undergoing hospital‐based rehabilitation.

The effects of a self-exercise program on ADL in acute patients following stroke - a propensity score analysis based on the Japan Association of Rehabilitation Database (JARD).

OBJECTIVE To investigate whether self-exercise programs for patients after stroke contribute to improved activities of daily living (ADL) at hospital discharge. DESIGN Retrospective, observational, propensity score (PS)-matched case-control study. SETTING General hospitals. PARTICIPANTS Participants included patients after stroke (N=1560) hospitalized between January 3, 2006, and December 26, 2012, satisfying the following criteria: (1) data on age, sex, duration from stroke to hospital admission, length of stay, FIM score, modified Rankin Scale (mRS) score, Glasgow Coma Scale score, Japan Stroke Scale score, and self-exercise program participation were available; and (2) admitted within 7 days after stroke onset, length of stay was between 7 and 60 days, prestroke mRS score was ≤2, and not discharged because of FIM or mRS exacerbation. A total of 780 PS-matched pairs were selected for each of the self-exercise program and no-self-exercise program groups. INTERVENTION Self-exercise program participation. MAIN OUTCOME MEASURES At discharge, FIM motor score, FIM cognitive score, FIM motor score gain (discharge value - admission value), FIM motor score gain rate (gain/length of stay), a binary variable divided by the median FIM motor score gain rate (high efficiency or no-high efficiency), and mRS score. RESULTS Patients were classified into a self-exercise program (n=780) or a no-self-exercise program (n=780) group. After matching, there were no significant between-group differences, except motor system variables. The receiver operating characteristic curve for PS had an area under the curve value of .71 with a 95% confidence interval of .68 to .73, and the model was believed to have a relatively favorable fit. A logistic regression analysis of PS-matched pairs suggested that the self-exercise program was effective, with an overall odds ratio for ADL (high efficiency or no-high efficiency) of 2.2 (95% confidence ratio, 1.75-2.70). CONCLUSIONS SEPs may contribute to improving ADL.