Experiences of Japanese women simultaneously caring for children and older people: An ethnographic study.

Background: Japan has experienced a rapid decline in birth rate and an aging population, coupled with women choosing to delay having children. Family carers are therefore increasingly expected to accept simultaneous responsibilities for both children and parents. This responsibility often falls on women in Japan, but little is known about their views. This study aimed to understand how Japanese women who are simultaneously responsible for caring for children and older people perceive their experiences. Methods: This was an ethnographic study conducted in central Japan. Over a period of 3 years and 5 months, we observed 19 people active in a peer support group for people with both childcare and caregiving responsibilities. We also carried out individual interviews with 14 Japanese women who were raising children and caring for parents or parents-in-law. Results: Five key themes emerged. These were "Accepting both childcare and caregiving as my role," "Inability to fulfill the role of mother," "Being supported by children and grandparents," "Unable to talk to anyone about the pressures of caregiving," and "Realizing that caregiving is not the only way to live." Conclusions: Japanese women who provided care to both children and older people were influenced by traditional Japanese values. However, they had a sense of mission and accepted the role of providing for their families. They felt guilty about not being able to fulfill their role as mothers, and were lonely, with no one to understand or advise them. If the burden of caregiving is concentrated on women, there is an increased risk that their children will become involved in providing some of the care for older people. It may therefore be necessary to develop a support system for female carers, and to increase understanding of the potential harm of placing caregiving responsibility solely on women.

[Characteristics of ethical dilemma and behavior in the support process of older adults and their families among nurses at a community general support center in Japan].

Objectives　This study was aimed at clarifying characteristics of ethical dilemmas and behaviors in the support process of older adults and their families among nurses at community general support centers.Methods　A self-administered questionnaire survey was mailed to 449 nurses at community general support centers in Tokyo. Question items enquired their age, employment license, years of experience as a nurse, the presence of ethics-related organizations, number of cases in which nurses faced difficulties in supporting older adults and their families in decision making over the past year, the ethical dilemmas they experienced and their situations, and ethical behavior in the process of supporting older adults and their families.Results　From the 143 responses (response rate: 31.8%), 135 (valid response rate: 30.1%) nurses were analyzed. Overall, 43.0% and 27.4% of the participants were in their 50s and 40s, respectively. Of these, 77.0% and 23.0% were nurses and public health nurses, respectively. In total, 52 (38.5%) respondents had an ethics-related organization. The average number of cases in which the respondents faced difficulties in supporting older adults and their families in decision making over the past year was 8.3 (standard deviation, 12.5). Of these, the average number of cases in which they faced difficulties in making ethical decisions was 4.1 (standard deviation, 6.0). Regarding the perception of ethical dilemmas, 113 (83.7%) answered "often" or "sometimes." Ethical dilemma situations included "the intentions of the user and family were different, and I had trouble deciding what to respect" 95 (84.1%); "the user's intention was different from my judgment as a professional, and I had trouble deciding what to respect" 64 (56.6%); and "the intention of the user and neighbors were different, and I had trouble deciding what to respect" 56 (49.6%). Ethical behaviors included "I observe the management rules in my organization regarding personal information data" 116 (85.9%); "I provide easy-to-understand explanations appropriate to the user's situation" 115 (85.2%); and "I decide on a support policy with several staff members when self-decision making is difficult due to the user's situation" 113 (83.7%).Conclusion　More than 80% of the nurses perceived ethical dilemmas. Characteristics of the situations were that users and their families, users and professionals, and users and their neighbors had different intentions. Further research should be conducted on ethical issues related to community-based integrated care.

Experience with Support at Workplaces for People with Young Onset Dementia: A Qualitative Evaluation of Being Open about Dementia.

Young-onset dementia (YOD) occurs at <65 years of age. Individuals with YOD experience social and psychological disturbances, including a loss of employment. This economic toll affects them, their families, and their caregivers. Employers have an increasing role in supporting affected employees in remaining employed, an important component of the "fight for their dignity". This study aims to clarify the workplace support experiences of employees with YOD. To assess the experiences of employers with at least one affected employee, we interviewed personnel from eight facilities for qualitative analysis. We identified 5 unique categories and 14 subcategories encompassing the following aspects: confusion at the workplace stemming from the uncertainty of the disease, sensitivity when recommending consultation and diagnosis, creating a system that considers safety and security, building consensus among employers, supporting employees with YOD and their families, and assisting the individual with YOD with activities of daily living. Employers should be open to addressing dementia-related issues in the workplace, including obtaining information from employees' physicians so that appropriate support can be provided. Appropriate support can include work accommodations, needs-based support, and meetings with families to build consensus for continued employment. This information can facilitate the creation of new training materials for employers.

Relationship between Health Counselor Characteristics and Counseling Impact on Individuals at High-Risk for Lifestyle-Related Disease: Sub-Analysis of the J-HARP Cluster-Randomized Controlled Trial.

Early diagnosis and treatment are necessary to prevent lifestyle-related diseases among high-risk individuals. This study aimed to examine the impact of counselor characteristics on clinic visits among individuals at high risk for lifestyle-related diseases. A total of 8975 patients aged 40 to 74 years with lifestyle-related comorbidities, who underwent an annual health checkup and received health counseling, were included in this study. Data intervention timing, mode of counseling, number of counseling sessions, and explanation methods were collected. We assessed the impact of counselor characteristics, including profession (public health nurse, clinical nurse, and nutritionist), age, and years of counseling experience, on counseling outcomes. The probability ratios (95% confidence intervals) of clinic visits were 1.22 (1.11-1.35) for public health nurses and 1.04 (0.90-1.20) for nurses compared with nutritionists. After adjustment for participant and counselor characteristics and initial timing, mode, and number of counseling sessions, the corresponding probability ratios (95% confidence intervals) were 1.16 (1.05-1.29) and 1.12 (0.95-1.31), respectively. Counselor age and years of experience did not influence clinic visits of the target population. Public health nurses were more effective in increasing clinic visits among the target population owing to their profession-specific knowledge, skills, and experience.

Work-related experiences of people living with young-onset dementia in Japan.

Dementia that occurs before age 65 years is defined as young-onset dementia (YOD). YOD develops during the prime of a person's working life and has a major impact on not only work but life in general. Therefore, Japan is promoting measures to support work and social participation, taking into account the characteristics of people living with YOD. Given the rarity of YOD, few studies have examined the difficulties faced by people living with YOD during this life stage or the kinds of support they require. We believe that studying these difficulties and support requirements will contribute to prolonging the careers of people living with YOD and to providing them support during social, emotional and economic crises. This qualitative study aims to clarify the experiences of working-age Japanese people living with YOD to examine, from their perspective, possibilities for employment support. For this study, people living with YOD who were currently working were recruited by snowball sampling. This study was conducted in Japan between September 2018 and February 2019. A semi-structured interview was conducted, and the contents were transcribed and analysed using Colaizzi's qualitative methodology. Four categories were derived: (a) crisis from continuing to work, (b) seeking support, (c) overcoming challenges to work and (d) reaffirming a sense of purpose by resuming work and social participation. Participants were able to continue working and socialising by letting others know about their illness and seeking support. In the process of reaffirming a sense of purpose by resuming work and social participation, participants continued working or transitioned to socially active lives after leaving their job thanks to the support of work colleagues and medical and healthcare/welfare professionals who understand YOD. The results indicate a need for awareness raising in the workplace to promote understanding of such professional support and its significance.

Decreased serum testosterone levels associated with 17ß-hydroxysteroid dehydrogenase activity in 7-year-old children from a dioxin-exposed area of Vietnam.

Since 2008, we have conducted epidemiological cohort studies on the relationship between dioxin exposure and disruption with children in the area sprayed with defoliants during the Vietnam War. In a long-term survey of children through the age of five, we observed androgen disruption due to decreased dehydroepiandrosterone (DHEA) and testosterone levels. In this study of 7-year-old, we separately elucidated androgen disruption for boys and girls, and discussed with respect to hormone disruption with sex differences on the steroid hormone biosynthesis process. This follow-up was conducted with 96 mother-child pairs in Vietnam (hotspot area: 45, non-sprayed area: 51). We took a questionnaire, the physical measurement and assayed 7 steroid hormones in their serum by LC-MS/MS. We examined the relationship between the hormone levels in the serum and dioxin levels in the maternal breast milk. The results showed that the serum DHEA level in the 7-year-old children in the hotspot recovered to levels in the non-sprayed area. The testosterone level of 66.5 pg/mL for boys in the non-sprayed area was 1.5 times the girls level of 44.6 pg/mL, a male-dominant effect. The testosterone level in boys and girls from the hotspot were significantly lower than in the non-sprayed area with no sex difference. The 17ß-hydroxysteroid dehydrogenase (17ß-HSD) activity was significantly higher in boys than in the girls from the non-sprayed area, but was significantly lower in the hotspot boys than in the non-sprayed area boys. Both the testosterone level and 17ß-HSD activity in the boys were inversely correlated with the TEQ total PCDD/Fs in the maternal breast milk. These results indicated that dioxin delayed the expression of the testosterone level and 17ß-HSD activity with growth in the 7-year-old boys. The serum DHEA in the 7-year-old children recovered to the levels of the children in the non-sprayed area.

[Workplace preparedness and recognition of the continued employment of employees with early onset dementia].

OBJECTIVES: This study aimed to clarify workplace recognition regarding working continuation of employees with early onset dementia. METHODS: An anonymous self-administrated questionnaire was emailed to a prefecture consisting of 1,293 workplaces with 50 or more employees. Survey items assessed demographics, workplace regulations supporting employees, coworker acceptance of employees with early onset dementia, and recognition and dealing with employees with early onset dementia. The possibility of employees with early onset dementia continuing work was compared for demographics, workplace regulations supporting employees, and cooperation in the workplace. RESULTS: Responses were received from 375 workplaces, and 273 valid responses were analyzed. In total, 133 workplaces (48.7%) answered that there was a high possibility of continuing employment for employees with early onset dementia and 135 workplaces (49.5%) were aware of early onset dementia. Less than 10% of workplaces reported examination of managing employees with early onset dementia, implementation/planning of training and information dissemination to managers or employees. Factors related to the possibility of continuing employment were number of employees (< 100, p = .015, odds ratio = 2.02), workplace regulations supporting employees with early onset dementia (p = .011, odds ratio = 2.22), and workplace coordination with occupational health staff (p = .004, odds ratio = 2.16). CONCLUSIONS: There is a general need for training and information regarding early onset dementia in the workplace. For smaller companies, external advice and support in providing systems suitable to each workplace is necessary.

Competency model for public health nurses working on tobacco control in local governments in Japan: A qualitative study.

AIM: In Japan, public health nurses play a major role in tobacco control at the local government level. However, the competencies required are not clear. This study aimed to identify competencies of public health nurses working on local tobacco control in Japan. METHODS: Twelve expert public health nurses from nine local governments in Japan participated in semi-structured interviews using the Behavioral Event Interview. Data analysis used the Iceberg Model and qualitative descriptive methods. RESULTS: The competencies of the public health nurses were driven by three "motives": strong motivation to pioneer and change tobacco control; unwavering determination to remove barriers to tobacco control; and strong drive to achieve tobacco control. Public health nurses also showed three "attitudes": a partnership-oriented stance to delivering tobacco control; enthusiasm for evidence-based goals; and commitment to developing expertise and roles. These underpinned eight "skills": advocating to raise awareness of the need for tobacco control; positioning tobacco control as a policy issue based on regional and social situations; creating an organizational system for tobacco control; pioneering opportunities for intervention and delivering effective and locally appropriate activities; evaluating and improving the quality of tobacco control measures; developing and establishing community-based measures for tobacco-free communities; expanding activities by strategically collaborating with stakeholders; and coordinating and negotiating to avoid conflicts. CONCLUSIONS: Public health nurses who promote tobacco control share characteristics, despite barriers such as resistance inside and outside the organization. In the future, these could be used as indicators of the competency of public health nurses working on local tobacco control.

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.

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.

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.

Examination of the relationship between the working conditions of young workers and the content of the meals they buy at convenience stores.

The aim of this study was to investigate the relationship between the working conditions of young workers and the meals they buy at convenience stores, and to consider the prevention of obesity. The subjects of this study were 284 workers under 29 yr of age employed at a transportation company in Ishikawa prefecture. Questionnaires were sent to participants, and 193 valid responses were obtained. Working types, night duty and working time were correlated with convenience store patronage, although working situations were not obviously associated with the content of meal selection at convenience stores. The study results revealed a tendency for the proportion of the fat in meals to be greater than 25% for the majority of working situations. It was also shown that foods selected with high frequency contained a high proportion of fat. There results suggest that this situation increases the risk of obesity. In addition, the more days per week convenience stores were patronized, the greater the number of participants felt "The need to improve meals." Therefore, we believe it is essential that young workers consider the prevention of obesity by observing nutritional information when selecting foods. An environment in which such information is easy to obtain at convenience stores should be arranged.

Difficulties experienced by care managers who are care workers managing elder abuse cases in the Japanese long-term care insurance system.

The purpose of the present study is to describe the difficulties perceived by care managers in Japan when managing care in cases of abuse of elderly people in the home. Participants (n = 21) were female care managers who had handled an abuse case while working for an in-home care management service provider. Participants had a mean of 4.3 +/- 0.7 years of experience as a care manager. Interview data were collected from 2004 to 2005 and analysed according to the grounded theory approach. Seven categories and one core category of difficulties were extracted from the data. The core category was 'tacit control of care management by the abusive caregiver'. The other categories were as follows: the terrible situation of the people abused cannot be ignored; the long-term care insurance service is the only support for abused people; the abusive caregiver has the authority to cancel the contract; concerns that intervention might increase abuse; prioritising how to deal with the abuser rather than the abused is unavoidable; the abusive caregiver deciding the needs of the individual requiring care; and creating a care plan that is acceptable to the caregiver. Therefore, the present results suggest the necessity of not only treating the role of care managers as an important position within the care system that deals with elder abuse, but also highlight the need to establish a system that supports care managers in order to promote appropriate care management.

Randomised controlled trial to evaluate a new double-layer air-cell overlay for elderly patients requiring head elevation.

A clinical investigation was conducted concerning the effects of a newly designed double-layer air-cell overlay in preventing the onset of pressure ulcers for patients with a Braden scale score of < or = 16, and who require a head-elevated position of 45 degrees or higher. A randomised controlled trial was undertaken involving 82 patients from a general hospital ward using one of the following three support surfaces: a double-layer air-cell overlay, a single-layer air-cell overlay or a standard hospital mattress. A significantly lower percentage of patients using the double-layer air-cell overlay developed pressure ulcers (3.4%) compared to 19.2% and 37.0% for those patients using the single-layer air-cell overlay and standard mattress respectively. Based on these findings, a double-layer air-cell overlay should be more effective in preventing the onset of pressure ulcers than either a single-layer air-cell overlay or a standard hospital mattress for subjects requiring head elevation.