Could high continuity of care (COC) have a negative impact on subjective health of hypertensive patients? A Japanese perspective.

BACKGROUND: Cardiovascular diseases, such as stroke and ischemic heart disease attributable to hypertension, are major causes of premature death in Japan and worldwide. Nevertheless, a low rate of blood pressure control among hypertensive patients has been observed in most countries. No previous studies have explored the effectiveness of physician visits among hypertensive patients in Japan. METHODS: To quantify the effects of persistence in physician visits among hypertensive patients, we evaluated the causal effect of physician visits on the health of hypertensive patients. We used 16 waves of nationally representative longitudinal data drawn from the Longitudinal Survey of Middle-aged and Elderly Persons in Japan (2005-2020). To examine the causal effect of physician visits on patients' health outcomes, we used inverse probability treatment weights and doubly robust estimation and obtained the estimates of the average treatment effects on the treated (ATETs). RESULTS: Covariates were well balanced among patients who had physician visits during the past two consecutive years (N = 67,210; 64.9% among hypertensive patients). The estimated ATETs suggest that three consecutive years of physician visits had a negative impact on poor subjective health. Furthermore, patients without habitual exercise tended to not continue physician visits and perceived poor subjective health. CONCLUSIONS: Although the impact of frequent physician visits on blood pressure stability remains uncertain, regular appointments every 30 days can be effective for individuals with hypertension, particularly if they receive continuous instruction from their family physician. Because it is important for physicians to strengthen hypertensive patients' blood pressure control, promoting consecutive physician visits to hypertensive patients with diabetes, lower educational attainment, or smoking habits is needed.

The Impact of the COVID-19 Pandemic on Physician Visits in Japan.

Background: Emerging from the coronavirus disease 2019 (COVID-19) scenario, fears of social distancing and contagion have led to a decline in the number of physician visits in Japan, placing severe financial strain on most hospitals and clinics. In this context, this study examined the impact of the spread of COVID-19 on the utilization of outpatient services. Methods: This study used monthly data drawn from the monthly statistics report of the social insurance medical fee payment fund in Japan and estimated fixed-effects models. Results: The results showed that the decline in the number of physician visits because of the first state of emergency declaration in Japan was greater than that caused by COVID-19's spread during the same period. However, there was a decline in the impact of the declaration over time. After the second state of emergency declaration, the decline in the number of physician visits caused by the spread reduced by almost half. The nationwide preschool closure under the declaration of the first state of emergency also adversely impacted the number of physician visits. The reduced healthcare per capita costs of preschool children were greater among prefectures taking specific precautions. The results showed non-negligible regional differences in physician visits of preschool children during the sample period. Conclusions: The findings imply that we should not overestimate the negative impacts of the state of emergency declaration without lockdown on physician visits. To restore the number of physician visits to its pre-pandemic level, it is crucial to facilitate a smooth transition of COVID-19 patients between hospitals and an effective compensation program for hospitals with COVID-19 patients.

Valuation of health losses of women with multiple roles using a well-being valuation approach: Evidence from Japan.

Unpaid housework among married working couples is largely done by women in Japan, causing health losses due to work-to-family conflict. However, monetary values for the poor health condition of working mothers with multiple roles have not been explored. The purpose of this study is to examine the impacts of health conditions on life satisfaction (LS) among middle-aged Japanese men and women and attach a monetary value to self-assessed poor health (SAPH). The well-being valuation approach applied monetary values to health losses among middle-aged working persons, using a total of 6,779 married workers drawn from a nationwide 6 wave (2007, 2009, 2011-2014) longitudinal data from the Japanese Life Course Panel Survey of Middle-aged Persons. Female workers having multiple roles as employees and housewives, who spent at least 35 hours per week on market work are defined as women with multiple roles. LS was used as a proxy of individuals' subjective well-being. Considering the endogeneity between SAPH and LS, I used the two-stage residual inclusion approach with generalized residuals. Major findings are (1) health losses of women with multiple roles were 1.47 times of the equivalent household income; larger than those of men with multiple roles, and (2) health losses of women with multiple roles can be reduced by around 9.5% of the equivalent household income if the spouse shares the housework by engaging in frequent cleaning of the house. Taking health losses of women with multiple roles into consideration, middle-aged men should reconsider the allocation of work attributable to the attitudes toward gender roles.

Assessing recurrence of depression using a zero-inflated negative binomial model: A secondary analysis of lifelog data.

When studying recurrence of depression, researchers should pay attention to cases where physicians' assessment corresponds to the patients' perception. However, they should also focus on potential signs of recurrence when the recurrence is suspected by the physicians but not the patients (false-negative zeros). Because false negatives can delay diagnosis and treatment, we aimed to investigate "sitting idly" as a predictor influencing no alert sign of recurrence and estimated the counts of recurrence of depression. A smartphone application and a wearable device were used to collect lifelog data from 89 remitted depressive patients over one year. Recurrent depression was defined using the Japanese version of the Kessler Psychological Distress Scale and Patient Health Questionnaire-9 scores. Estimates of the population-averaged parameters indicated that daily hours of sitting idly increased the chances of recurrent depression occurring two to four weeks later. Exposure to daily ultraviolet light reduced depression relapse. Although long sleep was a determinant of zero outcome of the recurrence of depression after two to four weeks, daily hours of sitting idly can negate it. Thus, daily hours of sitting idly could reduce overdispersion of the recurrence of depression, and we could measure recurrent depression accurately by considering changes in sitting idly.

Predicting recurrence of depression using lifelog data: an explanatory feasibility study with a panel VAR approach.

BACKGROUND: Although depression has a high rate of recurrence, no prior studies have established a method that could identify the warning signs of its recurrence. METHODS: We collected digital data consisting of individual activity records such as location or mobility information (lifelog data) from 89 patients who were on maintenance therapy for depression for a year, using a smartphone application and a wearable device. We assessed depression and its recurrence using both the Kessler Psychological Distress Scale (K6) and the Patient Health Questionnaire-9. RESULTS: A panel vector autoregressive analysis indicated that long sleep time was a important risk factor for the recurrence of depression. Long sleep predicted the recurrence of depression after 3 weeks. CONCLUSIONS: The panel vector autoregressive approach can identify the warning signs of depression recurrence; however, the convenient sampling of the present cohort may limit the scope towards drawing a generalised conclusion.

Distinct impacts of high intensity caregiving on caregivers' mental health and continuation of caregiving.

Although high-intensity caregiving has been found to be associated with a greater prevalence of mental health problems, little is known about the specifics of this relationship. This study clarified the burden of informal caregivers quantitatively and provided policy implications for long-term care policies in countries with aging populations. Using data collected from a nationwide five-wave panel survey in Japan, I examined two causal relationships: (1) high-intensity caregiving and mental health of informal caregivers, and (2) high-intensity caregiving and continuation of caregiving. Considering the heterogeneity in high-intensity caregiving among informal caregivers, control function model which allows for heterogeneous treatment effects was used.This study uncovered three major findings. First, hours of caregiving was found to influence the continuation of high-intensity caregiving among non-working informal caregivers and irregular employees. Specifically, caregivers who experienced high-intensity caregiving (20-40 h) tended to continue with it to a greater degree than did caregivers who experienced ultra-high-intensity caregiving (40 h or more). Second, high-intensity caregiving was associated with worse mental health among non-working caregivers, but did not have any effect on the mental health of irregular employees. The control function model revealed that caregivers engaging in high-intensity caregiving who were moderately mentally healthy in the past tended to have serious mental illness currently. Third, non-working caregivers did not tend to continue high-intensity caregiving for more than three years, regardless of co-residential caregiving. This is because current high-intensity caregiving was not associated with the continuation of caregiving when I included high-intensity caregiving provided during the previous period in the regression. Overall, I noted distinct impacts of high-intensity caregiving on the mental health of informal caregivers and that such caregiving is persistent among non-working caregivers who experienced it for at least a year. Supporting non-working intensive caregivers as a public health issue should be considered a priority.

Persistence of physical activity in middle age: a nonlinear dynamic panel approach.

No prior investigation has considered the effects of state dependence and unobserved heterogeneity on the relationship between regular physical activity (RPA) and latent health stock (LHS). Accounting for state dependence corrects the possible overestimation of the impact of socioeconomic factors. We estimated the degree of the state dependence of RPA and LHS among middle-aged Japanese workers. The 5 years' longitudinal data used in this study were taken from the Longitudinal Survey of Middle and Elderly Persons. Individual heterogeneity was found for both RPA and LHS, and the dynamic random-effects probit model provided the best specification. A smoking habit, low educational attainment, longer work hours, and longer commuting time had negative effects on RPA participation. RPA had positive effects on LHS, taking into consideration the possibility of confounding with other lifestyle variables. The degree of state dependence of LHS was positive and significant. Increasing the intensity of RPA had positive effects on LHS and caused individuals with RPA to exhibit greater persistence of LHS compared to individuals without RPA. This result implies that policy interventions that promote RPA, such as smoking cessation, have lasting consequences. We concluded that smoking cessation is an important health policy to increase both the participation in RPA and LHS.