Relationship Between Resilience Factors and Caregiving Status of Families of Patients with Amyotrophic Lateral Sclerosis (ALS) in Japan.

PURPOSE: To identify innate and acquired factors leading to amyotrophic lateral sclerosis (ALS) caregivers' resilience, the relationships among these factors, and caregiving situations. DESIGN: Cross-sectional study. METHODS: Questionnaires measuring resilience, caregiver burden, and family functioning were mailed to caregivers of ALS patients in Japan. FINDINGS: The 370 responses showed that increases in both innate and acquired factors were related to having an ALS association membership, while decreases were associated with reduced family function. Increases in innate factors were related to employment and those consenting to ventilators, while decreases were associated with being male and having a sense of the care burden. Decreases in acquired factors were related to the presence of an alternative caregiver. CONCLUSIONS: By identifying the caregiving situation based on innate and acquired factors, we were able to identify the significance and direction of specific caregiving support. CLINICAL EVIDENCE: Community health nurses should focus on improving family function and creating a supportive environment. Further, support for male and non-working caregivers should be strengthened and consultation on the use of respiratory equipment promoted to reduce the caregiving burden.

[Relationship between breakfast consumption and health-related habits among university students in Japan].

Objectives　The aim of the present study was to describe the current state of health-related habits and examine their association with breakfast consumption habits and other health-related habits among university students in Japan.Methods　A cross-sectional survey was conducted with 1,755 third and fourth year university students in 17 academic departments from 14 universities in metropolitan areas or regional cities of Japan using a self-administered questionnaire. The survey included items addressing the participants' demographic characteristics and health-related habits (nutrition and dietary habits, physical activity and exercise, rest, alcohol drinking, smoking, and oral health). The relationships between breakfast consumption and other health-related habits were examined using a multiple logistic regression analysis.Results　Significant gender-dependent differences were found in the students' health-related habits. Logistic regression models found that breakfast consumption habits were positively associated to better nutritional balance, fruit and vegetable consumption, simple exercises for health, physical activity in daily life, enough sleep quantity, sleep quality, not staying up late, lower alcohol consumption, and lesser smoking.Conclusion　The present study elucidated the current state of unhealthy lifestyles among university students. It appeared that students who regularly consume breakfast had healthier behaviors in various other health-related habits. Accordingly, these students' breakfast consumption status could be used as a core indicator for identifying those with high-risk health-related habits and could help identify them as potential targets for support.

Modeling the factors associating with health-related habits among Japanese students.

The aim of the present study was to clarify the structural relationship between health-related habits and psychosocial factors during adolescence/early adulthood. An anonymous, self-administered questionnaire was provided to 1141 third- and fourth-year students at eight academic departments from six universities in regional Japanese cities. Surveys included items addressing participants' demographic characteristics, psychosocial factors (individual-level social capital, self-efficacy, mental health (from health-related quality of life SF-36v2), and sense of coherence (SOC)), and health-related habits. A multiple indicator analysis based on structural equation modeling was conducted to examine the structural relationship between health-related habits and these factors. Valid responses were obtained from 952 participants. The final model demonstrated a high level of goodness of fit. While the path from SOC to health-related habits was significant, those from self-efficacy to health-related habits and from mental health to health-related habits were not significant. The path coefficient from SOC to health-related habits was greater than the path coefficient from background characteristics. In the multiple population comparison that considered gender, a nearly identical model was supported for men and women. Psychosocial factors related to health-related habits were social capital, self-efficacy, mental health, and SOC. Furthermore, it was suggested that SOC functions as an intervening factor for maintaining a healthy lifestyle. It was observed that individual psychosocial factors influence health-related habits more than their background characteristics. Findings highlight that supporting the building of social relationships and social environments is essential to promote a healthy lifestyle among university students.

Disaster preparedness among families of older adults taking oral medications.

This study aimed to examine factors influencing disaster preparedness among families caring for older adults who take oral medications. Fifty-eight family caregivers completed anonymous self-administered questionnaires. Binomial logistic regression analysis with the storage of the care recipient's medications as the dependent variable revealed that caregivers' disaster-related information-seeking behavior (e.g., considering appropriate methods to collect such information), and recognition of disaster risks in their communities strongly influenced their storage of emergency medication.

Predictors of potentially harmful behaviour by family caregivers towards patients treated for behavioural and psychological symptoms of dementia in Japan.

BACKGROUND: Potentially harmful behaviour (PHB) by caregivers is detrimental to the physical and psychological well-being of care recipients. In Japan, few studies have investigated caregivers' PHB towards dementia patients. This study examined PHB in family caregivers of dementia patients with behavioural and psychological symptoms of dementia (BPSD) and identified factors related to PHB. METHODS: Following primary consultations at an elderly psychiatric patient department, we enrolled 133 pairs of dementia patients and their family caregivers. We assessed PHB using the Japanese version of the modified Conflict Tactics Scale. We defined the presence of PHB as two or more points (PHB frequency of 'sometimes' or more) on at least one indicator of the modified Conflict Tactics Scale. We investigated the prevalence of PHB in relation to the clinical characteristics of the patients and their family caregivers. We evaluated BPSD using the Neuropsychiatric Inventory and caregiver burden using the eight-item Japanese version of the Zarit Caregiver Burden Interview. RESULTS: Of the family caregivers, 48.9% showed PHB. Multivariate analysis identified the following association with PHB: caregiver's Zarit Caregiver Burden Interview total score (odds ratio [OR], 1.09 per unit increase; 95% confidence interval [95%CI], 1.02-1.16), and Neuropsychiatric Inventory scores for patient irritability (OR, 1.22 per unit increase; 95%CI, 1.06-1.40), appetite/eating disorders (OR, 1.41 per unit increase; 95%CI = 1.08-1.84) and daughters-in-law caregivers (OR, 0.17, 95%CI, 0.05-0.57). CONCLUSIONS: Specific BPSD symptoms could contribute to the expression of PHB. In addition to decreasing caregiver burden, more intensive treatment and care strategies are required to manage individual symptoms.

[A Study on the Number of Offices for Home-Visit/Outpatient Day Long-Term Care in Noto Area, Based on Estimated Population - Analysis Using the Geographic Information System].

There has been a noticeable population decline in the Noto area. The Ministry of Land, Infrastructure, Transport and Tourism has determined the population size necessary for the establishment of daily living-related service businesses and, if the population falls below this, there is a possibility of businesses withdrawing from the area. In this research, we examine the number of home visit and daycare businesses established in the Noto area in 2025, using the geographic information system (GIS). The number of sites of businesses established was calculated using data published by the National Institute of Population and Social Security Research, and the Ministry of Land, Infrastructure, Transport and Tourism. Next, I depicted a buffer with a radius of 15 km from the establishment and confirmed the blank area of the service. Under the condition that the placement of sites is 80%, almost all the municipalities have exceeded the number of home visit care facilities and the number of daycare facilities. In the buffer analysis, blank areas were found in the north. To maintain these services, efforts by groups other than profit-oriented organizations are necessary, especially in the north of Noto. Route analysis by GIS and the consideration of population distribution and location of business establishment will be needed.

Nursing care in multifunctional small group homes providing day, visiting and overnight services for older people living at home.

Home care programs for older people have been developed around the world. Nurses are key to these programs. The aim of this study is to explore details of the nursing activities used in group homes to provide a basis for describing effective nursing practices in such facilities. A self-administered questionnaire was sent to 240 randomly selected facilities throughout Japan in 2013. Responses indicated that the activities of nurses in managing the health of older people included determining the need for medical consultations, dealing with emergencies, and making arrangements for the use of flexible care services. Nursing activities were directly related to the percentage of older people in each facility with diagnoses such as dementia or heart disease. Nurses reported low general self-efficacy for some of the more specialized nursing activities they performed. Nursing activities are performed with the aim of supporting older people with high health care needs to continue living at home; are tailored to the characteristics of residents and contribute to the provision of timely health examinations and flexible arrangement of services. Findings indicate that it might be advantageous to increase the nursing staffing at these facilities, to provide care guidelines and training opportunities to increase nurse self-efficacy.

Factors Related to Evacuation Intentions of Power-Dependent Home Care Patients in Japan.

This study investigated factors affecting disaster preparedness and evacuation intentions among home-care patients dependent on electrical power for life support. Health professionals interviewed 53 home-care patients using the Kanazawa and Kochi Disaster Preparedness Checklist. About half of the participants requiring continuous artificial ventilation or aspiration indicated that they would not or could not evacuate following a disaster-even though their lives could be at risk. The availability of emergency medical equipment for use during a power outage was positively associated with the desire to evacuate. Our results indicate the need for improved systems to assist power-dependent home-care patients.

Preparedness for Protecting the Health of Community-Dwelling Vulnerable Elderly People in Eastern and Western Japan in the Event of Natural Disasters.

We clarified the preparedness necessary to protect the health of community-dwelling vulnerable elderly people following natural disasters. We collected data from 304 community general support centres throughout Japan. We found the following in particular to be challenging: availability of disaster-preparedness manuals; disaster countermeasures and management systems; creation of lists of people requiring assistance following a disaster; evacuation support systems; development of plans for health management following disasters; provision of disaster-preparedness guidance and training; disaster-preparedness systems in the community; disaster information management; the preparedness of older people themselves in requiring support; and support from other community residents.

Illuminance, Subjective Sleep Quality, and Psychosomatic Health in Elderly Individuals Requiring Care: A Survey of Japan's Hokuriku Region in Winter.

We measured the illuminance exposure for 3 days in winter of a convenience sample of 44 elderly people certified as requiring support in Japan's Hokuriku region. We calculated the illuminance ratio per minute during activity and while in bed and analyzed the relationship between illuminance, subjective sleep quality, and psychosomatic health. There was a significant negative correlation between illuminance and 15-item Geriatric Depression Scale scores. Multiple regression analysis indicated that depression scores were significantly related to age, level of required support, and illuminance. The findings suggest that environments without light and dark cycles increase depression scores in frail elderly people.

Relationship between the degree of property damage and changes in red blood cells, hematocrit, and hemoglobin among victims of the Noto Peninsula Earthquake.

OBJECTIVES: The aim of this study was to assess the impact of the Noto Peninsula Earthquake on various hematologic parameters. We studied the relationships between the degree of property damage and changes in red blood cells (RBCs), hemoglobin (Hb), and hematocrit (Ht) among residents before and after the March 2007 Noto Peninsula Earthquake. METHODS: A total of 5,563 residents of Wajima City who were not receiving oral treatment for anemia and who had received basic health screenings for fiscal years (FYs) 2006 and 2007, before and after the earthquake. We analyzed changes in their RBCs, Hb, and Ht levels by gender, age, body mass index (BMI), level of property damage, and evaluation standards. RESULTS: RBCs, Hb, and Ht for FY2007 showed a trend of decreasing values compared to FY2006 in both male and female subjects. RBCs and Hb significantly decreased in females aged between 65 and 74 years who experienced total property damage, and Ht significantly increased for those younger than 65 years who experienced the same level of damage. In addition, significant differences by degree of property damage and FY2007/FY2006 ratio were seen only among subjects with a BMI ratio <1. Furthermore, we found a significant relationship between reduction of RBCs or Hb and increasing age in females; however, no significant relationship to property damage was found. No significant relationships were found for males. CONCLUSIONS: A significant association between property damage and changes in RBCs, Hb, and Ht was not found in this population of residents who experienced the Noto Peninsula Earthquake.

Differences in home-based family caregiving appraisal for caregivers of the elderly in rural and urban Japanese communities.

This quantitative study aimed to determine the differences between rural and urban residencies related to home-based appraisal (including care burden and positive appraisal) for Japanese primary family caregivers of the elderly with extensive care needs. The study examined a sample of 196 caregivers (106 rural, 90 urban), and stepwise multiple regression analysis was performed. Resident location was significantly associated with care burden, and each factor associated with the appraisal, especially care burden, differed between rural and urban areas. The social and physical environment is thus a necessary consideration to support family caregivers and the elderly requiring home-based care.

Development and Validation of an Interprofessional Collaboration Scale for Home Health Care for the Frail Elderly.

PURPOSE: The purpose of this study was to develop an interprofessional collaboration (IPC) scale for home health care for frail elderly. METHODS: The first items of the IPC scale included collaboration members' attitudes, awareness, motivation, team strength, communication, relationships, information, care recipients' interests, effects, development, utilization of social resources, contributions to the community, and crisis management. The subjects were 512 care managers who work in home care support offices across Japan. They manage interprofessional collaboration in home health care for frail elderly who need care at 65 years old and above. The scale's construct validity, internal consistency, the validity of known groups, concurrent validity, and test-retest reliability (193 subjects) were examined. RESULTS: The final IPC scale's items consisted of four factors (37 items): the strength of interprofessional teams (16), the management of collaborative systems (7), effects of collaboration (8), and communication (6). Four factors explained 58.6% of the total explained variance. The modified model fit of the scale achieved acceptable levels. The Cronbach's α coefficient for all items was .97. The sum of communication factor in the cities/wards group was lower than those in the towns/villages group. There were differences between the sum and each factor with different levels of ease to collaborate. The intraclass correlation coefficient for all items in the first and second assessments was .875. CONCLUSIONS: The validity and reliability of the IPC scale have been verified. This scale can be used to assess the IPC for home health care for frail elderly.

Factors related to preparedness for emergency hemodialysis in the event of a natural disaster.

ABSTRACT: This study aimed to explore patients' preparedness for emergency hemodialysis in the event of a natural disaster and to determine the factors affecting such preparedness.A cross-sectional study was conducted in undergoing hemodialysis at dialysis facilities in Sapporo, Hokkaido. The participants were a cohort of 256 outpatients aged 20 years or older, 186 (72.7%) were male, and the average age was 61.9 ±â€Š10.9 years. The participants were divided into those who had prepared for emergency dialysis treatment and those who had not. Cross tabulations were performed on the 2 groups using the following participant attributes: preparedness for dialysis during a disaster, knowledge of how to protect themselves during a disaster, and intention to dialyze and evacuate during a disaster, followed by binomial logistic regression analysis.Of the 256 study patients, 184 (71.9%) were not prepared for dialysis treatment. In logistic regression models, patients who were not prepared for dialysis treatment were found to have higher odds of being employed (odds ratio (OR): 2.469; 95% confidence interval (CI): 1.205-5.058), not being aware of disaster information acquisition methods in the event of a disaster (OR: 4.580, 95%; CI: 2.048-10.241), did not receive explanations on proper disaster response from dialysis facility staff (OR: 2.557, 95%; CI: 1.319-4.954), and believing that their family away from home would not be concerned about them (OR: 2.021; 95% CI: 1.062-3.847).Disaster preparedness in patients undergoing dialysis remain inadequate. Dialysis facilities need to strengthen their explanations of disaster response, particularly with regard to working, middle-aged people.

Factors promoting sense of coherence among university students in urban areas of Japan: individual-level social capital, self-efficacy, and mental health.

OBJECTIVE: Sense of coherence (SOC) is a concept that helps to explain the relation between personal intentionality as psychosocial factors and health-related behaviors. Thus, it is essential to enhance SOC when encouraging a healthy lifestyle. However, the factors that promote SOC have not been fully investigated among university students. The objective of this study was to clarify the general resistance resources (GRRs) that may promote the development of the SOC among university students. Therefore, we examined the relationship between SOC and social capital (SC), self-efficacy, and mental health. METHODS: Participants included 443 students from nine academic departments at eight universities in the Kanto or Kinki metropolitan areas of Japan. Participants completed an anonymous questionnaire. Individual-level cognitive and structural SC, generalized self-efficacy, mental health inventory (from SF-36v2), and SOC were measured. Confirmatory factor analysis using structural equation modeling was conducted to verify the factor structure of the SOC-13 scale. Stepwise multiple regression analysis and two-way layout analysis of variance were performed with SOC as the dependent variable. RESULTS: The factor structure of SOC indicated the optimal model fit in the second-order three-factor model of the 12 items. SOC was predicted by five variables: age, cognitive SC, structural SC, mental health, and self-efficacy. For students from urban areas, SOC was predicted by the interaction between cognitive and structural SC. CONCLUSION: SOC was significantly related to cognitive SC, structural SC, and self-efficacy as well as mental health in university students from urban areas. Furthermore, the combination of higher-level cognitive SC and higher-level structural SC exerted an inhibitory influence on SOC among students who previously and currently live in urban areas. Therefore, the findings indicated that both cognitive and structural SC as well as self-efficacy may act as GRRs that promote the development of SOC, and similarly, good mental health may promote a strong SOC.

Factors influencing practices among ward nurses that support ongoing independent community living after discharge: a cross-sectional study.

Background:It is not clear which personal factors and experiences affect ward nurses' practice in supporting patients to return home after discharge. Aims: To explore the practices among ward nurses that help them support patients to continue to live independently in the community; and the influence on these of personal experience of providing home care, approaches to discharge planning, and understanding about patients after discharge. Design: Cross-sectional study. Methods: The study included 178 ward nurses in three hospitals. We used a t-test to analyze differences in ward nursing practices focusing on community living by nurses' characteristics, experience in providing home-based care, discharge planning approaches, and understanding of patient situations after discharge, and a stepwise multi-regression analysis with ward nursing practices focusing on community living as the dependent variable. Results: Respondents included 167 female and 11 male nurses, with 34.8% in their 40s. Their mean length of nursing experience was 14.2 ± 9.8 years. Only 45.5% of the ward nurses recognized that discharge planning should commence on admission. The most common area of ward nursing practice focusing on community living was educating patients and their families. Cooperation with community healthcare workers was seen least frequently. The highest rate of contribution was observed in a model including recognition of the importance of discharge planning, number of conferences attended with community care service providers, experience of caring for a family member, and length of nursing experience (Adjusted R2 = 0.301). Impact statement: Improved ward nursing practice can help nurses to focus on enabling ongoing independent community living. Conclusions: Nurses were most focused on educating patients and their families to help them to manage after discharge. Recognizing the importance of discharge planning, holding conferences with community care service providers, and experience in caring for a family member affected ward nursing practice supporting community living.

Effects of maintaining web-based diaries by caregivers on adherence to care regimens in preschoolers with asthma.

BACKGROUND: The objective of this pilot study was to assess the effects of maintaining web-based diaries by the caregivers of preschoolers with asthma on the adherence to asthma care regimens, the recognition of asthma symptoms, and their perceived levels of parenting stress, quality of life, and family functioning. DESIGN AND METHODS: The caregivers of preschoolers with asthma completed a 4-week web-based diary and received weekly emails that depicted their children's asthma symptoms. We compared asthma symptoms from before and after the intervention. We analyzed demographic data, such as the caregivers' age and education, and assessment scores from the Japanese Pediatric Asthma Control program (JPAC), Adherence with Asthma Management for Caregivers of Preschoolers (AAMCP), General Functioning subscale of the Family Assessment Device (GF-FAD), Parenting Stress Index Short Form (PSI-SF), and Quality of Life assessment scale for Caregivers of Asthmatic Children 24 (QOLCA-24). RESULTS: A total of 45 participants were included in the analyses. The mean scores depicting asthma control were significantly improved postintervention (pre: 12.29 ± 2.65; post: 13.02 ± 2.01; t = -2.15, p = .037). Mean AAMCP scores postintervention (52.13 ± 6.25) were significantly greater than before (49.78 ± 7.20; t = -3.07; p = .004). PRACTICE IMPLICATIONS: Adherence to asthma care and the recognition of asthma symptoms improved following the use of a web-based diary, making it a potential cost-effective intervention for asthma patients and their families.

The impact of sleep on ambulatory blood pressure of female caregivers providing home care in Japan: an observational study.

BACKGROUND: Elderly family caregivers are presumed to be susceptible to having various health problems. However, biomedical indicators of health in these caregivers are rarely examined. OBJECTIVE: To examine the effect of sleep quality, measured by hours of sleep and the number of times leaving bed, on various blood pressure parameters in elderly caregivers. DESIGN: Observational study. SETTING: Northern Japan. PARTICIPANTS: Seventy-eight female family caregivers. METHODS: Ambulatory blood pressure was monitored at 30-60-min intervals for a 24-h period. An actigraph was used to determine sleep/wake status. Face-to-face interviews were conducted to obtain home care and demographic information, and self-administered questionnaires were used to collect information on activities in a 24-h period. RESULTS: The mean age of the caregivers was 62.5+/-9.6 years, and the mean hours of sleep were 7.3. Out of 78 caregivers, 19 were on antihypertensive medication. Of the remaining 59, this study found 45.8% to be hypertensive, with the mean maximum systolic pressure exceeding 180mmHg. The hours of sleep at night and for the 24-h period were inversely associated with the mean systolic blood pressure. The majority of caregivers on antihypertensive medication also had high blood pressure. CONCLUSIONS: This study suggests the importance of 24-h ambulatory blood pressure monitoring for elderly caregivers, so as to screen for hypertension as well as to monitor the effectiveness of antihypertensive medication.

Tsunami evacuation simulation using geographic information systems for homecare recipients depending on electric devices.

Tsunamis cause direct damage to property and destroy infrastructure. In addition, power outages can lead to death, especially for patients who rely on medical equipment requiring a power supply. Recently, Nankai Trough Earthquakes have been predicted, and much effort has been put into developing countermeasures in Japan. Kochi City on Shikoku Island is expected to suffer in the event of a large tsunami. The present study identifies individuals living in Kochi who need evacuation assistance and depend on electrical medical devices, simulates evacuation behavior and inundation during a tsunami using a geographic information system (GIS), and considers the usefulness of such a GIS. We asked caregivers, including visiting nurses, to introduce us to homecare recipients who rely on a ventilator, an endotracheal suction device, or other medical devices requiring electric power. We received introductions to 52 homecare recipients. Using a GIS, we plotted the area of predicted inundation and the locations of homecare recipients, nursing stations, and welfare evacuation shelters. We predicted evacuation routes, and then analyzed the time difference between the time required for evacuation and tsunami arrival at a welfare evacuation shelter. To measure the effects of the main parameters, we conducted both one-way and multi-way sensitivity analysis. In the event of a tsunami, eight of the homecare recipients living in the forecasted inundation areas in Kochi may face delayed evacuation. Among homecare recipients facing a high possibility of escape delay, 95.2% lived more than 1,800 m from the nearest welfare evacuation shelter. We found that individual evacuation behavior can be simulated by specifying the residence of a homecare recipient and the evacuation route using a GIS.

A foot-care program to facilitate self-care by the elderly: a non-randomized intervention study.

OBJECTIVE: We aimed to evaluate a foot-care awareness program designed to improve foot morphology, physical functioning, and fall prevention among the community-dwelling elderly. Eleven independent community-dwelling elderly women (aged 61-83 years) were provided with foot-care advice and shown effective foot-care techniques to perform regularly for 6 months, and compared with a control group of 10 elderly women who did not receive any intervention. Measurements of foot form, functional capacity, subjective foot movement, and physical function were taken at baseline and 6-month follow-up. RESULTS: At follow-up, improvements were seen in the intervention group in foot morphology, subjective foot movement, foot pressure, and balance. In the intervention group, 90% of women had maintained or improved foot form and none of them had fallen during the post-intervention period, compared to the control group where 30% improved foot form (p = 0.0075) and four (40%) of them had fallen. Therefore, a foot-care program may have the potential to prevent falls and improve mobility among the elderly. Trial Registration UMIN-CTR No. UMIN000029632. Date of Registration: October 19, 2017.