In-service training programme for health and social care workers in the Philippines to strengthen interprofessional collaboration in caring for older adults: a mixed-methods study.

BACKGROUND: A growing number of older adults require complex care, but coordination among professionals to provide comprehensive and high-quality care is perceived to be inadequate. Opportunities to gain the knowledge and skills important for interprofessional collaboration in the context of geriatric care are limited, particularly for those already in the workforce. A short-term training programme in interprofessional collaboration for health and social care workers in the Philippines was designed and pilot tested. The programme was devised following a review of the literature about geriatric care education and group interviews about training needs. The objectives of this paper are to introduce the training programme and to evaluate its influence on attitudes and readiness to collaborate among participants using both quantitative and qualitative methodologies. METHODS: A total of 42 community health workers and 40 health institution workers participated in the training in July 2019. Quantitative indicators were used to evaluate attitudes towards and readiness for collaboration before and after the training. Content analysis was performed of responses to open-ended questions asking participants to evaluate the training. A convergent parallel mixed-methods design was applied to determine the patterns of similarities or differences between the quantitative and qualitative data. RESULTS: Significant improvements were seen in scores on the Attitudes Towards Health Care Teams Scale among community health (P < 0.001) and health institution (P < 0.001) staff after the training. Scenario-based case studies allowed participants to work in groups to practise collaboration across professional and institutional boundaries; the case studies fostered greater collaboration and continuity of care. Exposure to other professionals during the training led to a deeper understanding of current practices among health and social care workers. Use of the scenario-based case studies followed by task-based discussion in groups was successful in engaging care professionals to provide patient-centred care. CONCLUSIONS: This pilot test of in-service training in interprofessional collaboration in geriatric care improved community and health institution workers' attitudes towards such collaboration. A 3-day training attended by health and social care workers from diverse healthcare settings resulted in recommendations to enhance collaboration when caring for older adults in their current work settings.

Improving Community Health Workers' Attitudes toward Collaborative Practice in the Care of Older Adults: An In-Service Training Intervention Trial in the Philippines.

The objective of this study was to evaluate the efficacy of an in-service, short-term training program in improving the attitudes toward, and readiness and activities for collaboration among community health workers (CHWs) in a primary care setting in the Philippines. A randomized controlled trial was adopted dividing participants into an intervention (n = 42) and a control group (n = 39). Attitudes toward, and readiness and activities for collaboration were measured using three standardized scales before and at 6 months after the training. A significant difference (p < 0.001) was observed in the Attitudes Toward Health Care Teams Scale (ATHCTS) scores between pre- and post-test in the intervention (6.3 ± 8.3 [Mean ± SD]) and control groups (0.7 ± 8.2). Multivariate linear regression analysis showed an independent positive association between the intervention and greater improvement in the ATHCTS score (Coefficient ß = 6.17; 95% CI = 0.82, 11.53; p = 0.03) at follow-up, after adjustment for age, years in current occupation, and social support role of participants. The results demonstrated the efficacy of the intervention for improving the attitudes of CHWs toward collaborative practice in the care of older adults.

Association of sleep with emotional and behavioral problems among abused children and adolescents admitted to residential care facilities in Japan.

BACKGROUND: The psychological care of abused children in the child protection system is an urgent issue in Japan. Child abuse has a serious impact on children's emotion and behavior, but there is virtually no evidence about how child abuse affects sleep, which is closely related to behavioral and emotional control. In this study, we sought to identify sleep habits and suspected sleep disorders among abused children and adolescents admitted to residential care facilities in Japan and to investigate their association with emotional and behavioral problems. METHODS: The study targeted 273 abused children and adolescents (age range: 4 to 15 years) who had been admitted to a residential care facility in Japan. They were assessed by physicians and other personnel at facilities with expertise in childcare and abuse. Respondents completed a brief sleep questionnaire on the incidence of problematic sleep habits and suspected sleep disorders as well as a questionnaire on emotional and behavioral issues. RESULTS: Approximately 40% of the abused children and adolescents had some sleep-related symptoms at bedtime and waking, and 19% had suspected sleep disorder. Abused children with emotional and behavioral problems had a significantly higher incidence of suspected sleep disorders than abused children without such problems, and this incidence was particularly high among those with antisocial behavior and depressive behavior. Our predictive model also showed that antisocial behavior and depressive behavior were significant predictors of suspected sleep disorders. CONCLUSION: Careful assessment and appropriate therapeutic intervention for sleep disorders are required in abused children and adolescents with emotional and behavioral problems.

The Vanguard of Community-based Integrated Care in Japan: The Effect of a Rural Town on National Policy.

INTRODUCTION: Japan has the largest percentage of elderly people in the world. In 2012 the government implemented a community-based integrated care system which provides seamless community healthcare resources for elderly people with chronic diseases and disabilities. METHODS: This paper describes the challenges of establishing a community-based integrated care system in 1974 in Mitsugi, a rural town of Japan. This system has influenced the government and become the model for the nationwide system. RESULTS: In the 1970s, Mitsugi's aging population was growing faster than Japan's, but elder care was fragmented among a variety of service sections. A community-based integrated care system evolved because of the small but aging population size and the initiative of some local leaders of medical care and politics. After the system took effect, the proportion of bedridden people and medical care costs for the elderly dropped in Mitsugi while it continued to rise everywhere else in Japan. Mitsugi's community-based integrated care system is now shaping national policy. CONCLUSION: Mitsugi is in the vanguard of Japan's community-based integrated care system. The case showed the community-based integrated care system can diffuse from rural to urban areas.

Implementation process and challenges for the community-based integrated care system in Japan.

BACKGROUND: Since 10 years ago, Japan has been creating a long-term vision to face its peak in the number of older people that will be reached in 2025 when baby boomers will turn 75 years of age. In 2003, the government set up a study group called "Caring for older people in 2015" which led to a first reform of the Long-Term Care Insurance System in 2006. This study group was the first to suggest the creation of a community-based integrated care system. REFORMS: Three measures were taken in 2006: 'Building an active ageing society: implementation of preventive care services', 'Improve sustainability: revision of the remuneration of facilities providing care' and 'Integration: establishment of a new service system'. These reforms are at the core of the community-based integrated care system. DISCUSSION: The socialization of long-term care that came along with the ageing of the population, and the second shift in Japan towards an increased reliance on the community can provide useful information for other ageing societies. As a super ageing society, the attempts from Japan to develop a rather unique system based on the widely spread concept of integrated care should also become an increasing focus of attention.

Changes in perceived filial obligation norms among coresident family caregivers in Japan.

PURPOSE OF THE STUDY: Japan introduced a nationwide long-term care insurance (LTCI) system in 2000, making long-term care (LTC) a right for older adults regardless of income and family availability. To shed light on its implications for family caregiving, we investigated perceived filial obligation norms among coresident primary family caregivers before and after the policy change. DESIGN AND METHODS: Descriptive and multiple regression analyses were conducted to examine changes in perceived filial obligation norms and its subdimensions (financial, physical, and emotional support), using 2-wave panel survey data of coresident primary family caregivers (N = 611) in 1 city. The baseline survey was conducted in 1999, and a follow-up survey 2 years later. RESULTS: On average, perceived filial obligation norms declined (p < .05). Daughters-in-law had the most significant declines (global and physical: p < .01, emotional: p < .05) among family caregivers. In particular, physical support, which Japan's LTC reform targeted, declined significantly among daughters and daughters-in-law (p < .01). Multiple regression analysis indicated that daughters-in-law had significantly lower perceived filial obligation norms after the policy introduction than sons and daughters (p < .01 and p < .05, respectively), controlling for the baseline filial obligation and situational factors. IMPLICATIONS: Our research indicates declining roles of daughters-in-law in elder care during Japan's LTCI system implementation period. Further international efforts are needed to design and implement longitudinal studies that help promote understanding of the interplay among national LTC policies, social changes, and caregiving norms and behaviors.

Sleep-related problems and use of hypnotics in inpatients of acute hospital wards.

OBJECTIVE: Although sleep disorders are highly prevalent among patients with physical disorders, only limited information is available about the actual status of sleep-related problems in inpatients of acute hospital wards. We conducted a multicenter cross-sectional observational survey investigating the prevalence of sleep disorders and use of hypnotic-sedative drugs among inpatients of acute wards in 44 general hospitals in Japan. METHOD: Questionnaire-, actigraph- and observation-based sleep evaluations were simultaneously performed in 557 adult inpatients [mean age 72.8 + or - 12.8 (S.D.) years] of acute wards during a one-month period in July 2007. RESULTS: Of the 421 patients with data available, 22.3% had at least one of the following sleep disorders: sleep apnea syndrome, restless legs syndrome, periodic limb movement disorder and nocturnal behavior disorder. Similarly, 62.7% had insomnia, 6.9% had severe daytime sleepiness and 12.8% had other sleep-related symptoms. Only 13.8% were free of any sleep-related problem. Although 33.7% of insomnia patients were taking hypnotic-sedative drugs, 65.2% of them complained of residual insomnia symptoms. CONCLUSION: The findings obtained in this study have revealed the remarkably high prevalence of sleep-related problems experienced by inpatients of acute hospital wards in Japan. Proper diagnosis of sleep disorders should be made among patients with physical disorders.

Service and support needs of Australian carers supporting a family member with disability at home.

BACKGROUND: As part of an international, multicentre project, the service and support needs of Australian family carers were investigated. METHOD: A sample of 1,390, 448 family carers completed a self-report survey, including an adaptation of the Family Needs Survey (FNS) and several open-ended questions. A mixed method design was used, employing quantitative and qualitative analyses. RESULTS: On the FNS the most frequently endorsed items were those relating to the need for information about services and, in particular, future, out-of-home accommodation. Similarly, the need for respite services was endorsed by over 80% of respondents. Comments indicated that access to and the quality of respite, day support, and therapy programs were a priority. CONCLUSIONS: Participants expressed the need for greater access to information. Access to appropriate respite options, together with quality day support and therapy services, remain a priority for family carers.

Collective synchronization as a method of learning and generalization from sparse data.

We propose a method for extracting general features from multivariate data using a network of phase oscillators subject to an analogue of the Kuramoto model for collective synchronization. In this method, the natural frequencies of the oscillators are extended to vector quantities to which multivariate data are assigned. The common frequency vectors of the groups of partially synchronized oscillators are interpreted to be the template vectors representing the general features of the data set. We show that the proposed method becomes equivalent to the self-organizing map algorithm devised by Kohonen when the governing equations are linearized about their solutions of partial synchronization. As a case study to test the utility of our method, we applied it to care-needs-certification data in the Japanese public long-term care insurance program, and found major general patterns in the health status of the elderly needing nursing care.

Japan's universal long-term care system reform of 2005: containing costs and realizing a vision.

Japan implemented a mandatory social long-term care insurance (LTCI) system in 2000, making long-term care services a universal entitlement for every senior. Although this system has grown rapidly, reflecting its popularity among seniors and their families, it faces several challenges, including skyrocketing costs. This article describes the recent reform initiated by the Japanese government to simultaneously contain costs and realize a long-term vision of creating a community-based, prevention-oriented long-term care system. The reform involves introduction of two major elements: "hotel" and meal charges for nursing home residents and new preventive benefits. They were intended to reduce economic incentives for institutionalization, dampen provider-induced demand, and prevent seniors from being dependent by intervening while their need levels are still low. The ongoing LTCI reform should be critically evaluated against the government's policy intentions as well as its effect on seniors, their families, and society. The story of this reform is instructive for other countries striving to develop coherent, politically acceptable long-term care policies.

Use of alcohol and hypnotic medication as aids to sleep among the Japanese general population.

OBJECTIVE: The present study was conducted to clarify the prevalence of the use of alcohol and hypnotic medication as sleep aids, and associated factors, in the general population in Japan. METHODS: The survey was conducted in June 2000, using self-administered questionnaires, targeting a population that was selected randomly from among 300 communities throughout Japan. A total of 18,205 responses indicating alcohol use and 16,804 responses indicating hypnotic medication use were analyzed. RESULTS: The prevalence of alcohol use as a sleep aid one or more times per week was 48.3% among men and 18.3% among women. The prevalence of the use of hypnotic medication one or more times per week was 4.3% among men and 5.9% among women. The prevalence of alcohol used as a sleep aid increased gradually for men and women up to age 55-59 years and 40-44 years, respectively, and then declined with increasing age thereafter. The prevalence of the use of hypnotic medication among both men and women showed a trend toward a gradual increase with age. The use of alcohol as a sleep aid was associated with "difficulty maintaining sleep," but no such problem was associated with the use of hypnotic medication. CONCLUSIONS: Alcohol is a more popular sleep aid than hypnotic medication. The factors associated with the use of alcohol and of hypnotic medication are different.

Prevalence of smoking and associated factors among pregnant women in Japan.

OBJECTIVE: This study was conducted to estimate the prevalence of smoking among pregnant women living in Japan and to analyze the factors associated with their smoking behavior. METHOD: Five hundred institutions with maternity services were randomly sampled from a list of the Japan Association of Obstetricians and Gynecologists. Of these institutions, 260 participated in the survey which was conducted in February 2002. Using a self-reported anonymous questionnaire, a survey on smoking behavior, drinking behavior and sleep status was conducted on pregnant women. Chi-square tests and logistic regression analyses were used to examine the factors associated with their smoking behavior. RESULTS: Data were obtained from a total of 16,414 pregnant women. The prevalence of smoking during pregnancy was 9.9% [95% confidence interval (CI) 9.4%, 10.4%]. The quit rate of smoking among pregnant woman was 61.9% [95% CI 60.4%, 63.4%]. The odds ratios for smoking during pregnancy were significantly higher in women with relatively young age, less schooling, multiparous, exposure to passive smoking, short sleep duration and in women who drank. CONCLUSION: Smoking among pregnant women remains an important public health problem in Japan. It is necessary to promote antismoking measures based on the results of this study.

The effects of caregiving resources on the incidence of depression over one year in family caregivers of disabled elderly.

The purpose of the study was to investigate the over-time effects of physical, psychological and social resources on the incidence of depression in family caregivers of the disabled elderly. Data were collected twice at a one-year interval from 1,141 primary caregivers of a disabled older person in an urban area of Japan using a self-reported questionnaire survey. The questionnaire included physical health as an indicator of physical resources, caregiving satisfaction and intention to care as indicators of psychological resources, and instrumental and emotional support network and formal home care service utilization as indicators of social resources. The mental health outcome measure was the General Health Questionnaire 12-item version (GHQ-12). Complete data on 235 non-depressed female caregivers were separated into 3 groups according to the relationship type (wife, daughter and daughter-in-law) and analyzed separately. Multivariate logistic regression models controlling for duration of caregiving, care-recipient's gender, ADL dependency and behavioral problems demonstrated that significant predictors of depression were caregiving satisfaction and intention to care in wives, caregiving satisfaction in daughters, and physical health and emotional support network in daughters-in-law. Noteworthy, intention to care increased the risk of depression in wives, while decreasing the risk of depression in daughters-in-law. The findings indicate that the effects of caregivers' resources on mental health may differ by relationship type.

Data synchronization in a network of coupled phase oscillators.

We devised a new method of data mining for a large-scale database. In the method, a network of locally coupled phase oscillators subject to Kuramoto's model substitutes for given multivariate data to generate major features through phase locking of the oscillators, i.e., phase transition of the data set. We applied the method to the national database of care needs certification for the Japanese public long-term care insurance program, and found three major patterns in the aging process of the frail elderly. This work revealed the latent utility of Kuramoto's model for data processing.

[Research related to the status of "collaboration" among municipal public health nurses in Japan].

PURPOSE: The two main goals of this research were: (1) To clarify the current state of collaboration among municipal public health nurses throughout Japan (referred to collectively as "Public Health Nurses"); and (2) To identify personal factors that separate Public Health Nurses who collaborate frequently from those who do not, and to clarify the characteristics of relevant interventions. The author believes that the results of this study should be valuable in demonstrating specific methodologies related to the ability of Public Health Nurses the ability to execute collaborative activities. OBJECTIVE: Before conducting the main survey, a preliminary survey was performed to determine the affiliate divisions for Public Health Nurses employed by all of the 3,190 municipalities in Japan. Based on this survey, we gained an understanding of factors such as the number of Public Health Nurses and their places of employment. Next, during December 2003 to August 2004, we carried out a questionnaire survey by post to the 21,631 Public Health Nurses in Japan who had been identified through the preliminary survey. METHODS: Survey items included: the Public Health Nurse's gender, age, position, most recent academic history, total years of work, number of years working with the current employer, affiliated division, types of tasks undertaken, status of execution of those tasks, and collaborative activities, as well as specialists institutions and organizations involved in such collaboration. RESULTS: Data were gathered from 13,024 Public Health Nurses, which represents roughly 80% of the Public Health Nurses in Japan. First, regarding collaboration, links with health and medical institutions, health centers, and other government institutions appeared active, but this was not the case for social welfare facilities for the physically or mentally disabled. Furthermore, although the subjects collaborated with Public Health Nurses from other institutions, as well as with government administrators and doctors, there was little collaboration with pharmacists or with mental health and welfare workers. When we analyzed data for individual specialists and specialized institutions, we found that the "collaborating" group had significantly higher scores for collaborative activities than the "not collaborating" group. These scores are believed to reflect actual conditions. When we analyzed the relationships between personal factors for Public Health Nurses and collaborative activity scores, we found that scores tended to be higher for older nurses and for those with more years of experience. Looking at the relationship between details of tasks undertaken and collaborative activity scores we found that the group developing new business or securing budgets to develop new business had significantly higher scores, and that in terms of the execution of day-to-day operations, the Public Health Nurses with higher scores were those undertaking tasks that required new knowledge, or tasks that demanded high-level skills. CONCLUSIONS: Municipal Public Health Nurses often collaborate with specialists or health-related divisions, but they do not collaborate closely with divisions related to welfare services for the physically or mentally disabled. The Public Health Nurses with the highest collaborative activity scores were those scores clearly indicated active collaboration, and whose personal factors included extensive experience in the field. These Public Health Nurses were also involved in tasks that demanded a high level of skill.

Factors associated with exclusive breast-feeding in Japan: for activities to support child-rearing with breast-feeding.

BACKGROUND: Benefits of breast-feeding are not only limited to nutrition and sanitation in developing countries but also extend to cost-saving health care and alleviation of anxiety related to childrearing in developed countries. This study aims to elucidate factors associated with exclusive breast-feeding in Japan and use this information to achieve child-rearing support worldwide by promoting breast-feeding. METHODS: This cross-sectional study used data from a survey conducted by Ministry of Health, Labour and Welfare of the Japanese government, the First Longitudinal Survey of Babies in 21st Century. All subjects were infants (n=53,575) born in Japan in 2001 between January 10 and 17 and between July 10 and 17. According to the data, the exclusive breast-feeding rate in Japan during the first 6 months of life was 21.0%. We examined the factors associated with exclusive breast-feeding using univariate and multivariate logistic regression analyses. RESULTS: Among the factors examined, the adjusted odds ratio (OR) for exclusive breast-feeding was low for late childbearing, low birth weight infants, multiple births, smoking parents, living with grandparents, and feeling burdened by childrearing. The adjusted OR was high for factors that included sufficient childcare leave and consultation about childrearing with the spouse, a birth attendant and/or nurse, and a peer in a child-rearing circle. CONCLUSIONS: Exclusive breast-feeding is associated not only with medical factors but also with social factors. This study clarifies the necessity of social support to reduce the child rearing burden and a political system to promote paternal participation in childrearing and to improve the childcare leave system.

Epidemiological study on passive smoking among Japanese infants and smoking behavior of their respective parents: a nationwide cross-sectional survey.

BACKGROUND: Passive smoking is a well-known health hazard for infants. This study was conducted to: (1) estimate the prevalence of passive smoking among Japanese infants and (2) clarify the prevalence of indoor smoking and associating factors among parents having infants. METHODS: Subjects were all 53,575 infants born throughout Japan on January 10-17, 2001 or July 10-17, 2001. When the infants reached 6 months of age, the questionnaires were mailed to the homes. Family members answered questions that included information about the current smoking behavior of the parents. RESULTS: A total of 44,562 questionnaires (83.2%) were analyzed. The prevalence of smoking among the mothers and the fathers were 17.1% and 63.5%. The percentages of mothers and fathers who smoked indoors were 12.1% and 36.2%. The percentage of households where mothers and/or fathers smoked indoors was 37.5%. Multivariate logistic analysis indicated that young age, having a spouse who was a smoker, infants having many siblings, the mother not breast-feeding, and lower annual incomes had significantly higher odds ratios for both the mother's and the father's indoor smoking. CONCLUSIONS: Passive smoking is common among Japanese infants. To protect Japanese infants from passive smoking, further public health measures must be taken.

Prediction of care class by local additive reference to prototypical examples.

The public long-term care insurance program for the elderly in Japan set out in 2000 toward establishing a new system whereby citizens can be assured that they will receive care and be supported by the society as a whole. The insurance program includes computer-aided certification processes to estimate the needs for nursing care for clients. In this work, we show the applicability of an adaptive local nonlinear approximation method associated with the Japanese national database for automatic inference of the care class.

Care-needs certification in the long-term care insurance system of Japan.

The introduction of Japan's long-term care insurance (LTCI) system in April 2000 has made long-term care an explicit and universal entitlement for every Japanese person aged 65 and older based strictly on physical and mental status. At the start of the program, more than two million seniors were expected to apply for services to approximately 3,000 municipal governments, which are the LTCI insurers. The LTCI implementation required a nationally standardized needs-certification system to determine service eligibility objectively, fairly, and efficiently. The current computer-aided initial needs-assessment instrument was developed based on data collected in a large-scale time study of professional caregivers in long-term care institutions. The instrument was subsequently tested and validated by assessing data of 175,129 seniors involved in the national model programs before the start of LTCI. The computer-aided initial assessment (an 85-item questionnaire) is used to assign each applicant to one of seven need levels. The Care Needs Certification Board, a committee of medical and other professionals, reviews the results. Three years after implementation, the LTCI system and its needs-assessment/certification system have been well accepted in Japan. Despite the overall successes, there remain challenges, including area variations, growing demands for services, and the difficulty of keeping the needs certification free of politics. The LTCI computer network that links municipalities and the central government is instrumental in continuously improving the needs-certification system. Future challenges include promoting evidence-based system improvements and building incentives into the system for various constituencies to promote seniors' functional independence.

Excessive daytime sleepiness among the Japanese general population.

BACKGROUND: Excessive daytime sleepiness is one of the principal symptoms of sleep disturbances, and is often associated with serious consequences including traffic and industrial accidents, decreased productivity, and interpersonal problems. However, there are few epidemiologic studies on excessive daytime sleepiness in a large scale sample targeting Japanese general population. METHODS: The survey was performed using a self-administered questionnaire in June 2000, targeting a population randomly selected from among 300 communities throughout Japan. This questionnaire included information about sleep habits and sleep problems. Excessive daytime sleepiness measured according to a question "Do you fall asleep when you must not sleep (for example when you are driving a car)?" RESULTS: A total of 28,714 subjects completed the questionnaire. The prevalence of excessive daytime sleepiness was 2.5% (male=2.8% and female=2.2%). Backward elimination analysis showed that the following were associated with excessive daytime sleepiness: male sex, young age, short sleep duration, subjective insufficient sleep, loss of deep sleep, disagreeable sensations in the legs, interruption of sleep by snoring or dyspnea, and feeling psychological stress. Interruption of sleep by snoring or dyspnea was the strongest associated factor (adjusted odds ratio=2.46, 95% confidence interval=1.76-3.43) of excessive daytime sleepiness. CONCLUSIONS: These results suggest that excessive daytime sleepiness in Japanese is associated with several sleep problems. These findings may be useful in attempts to prevent excessive daytime sleepiness in the general population of Japan.