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1.
Nagoya J Med Sci ; 80(1): 99-107, 2018 02.
Artículo en Inglés | MEDLINE | ID: mdl-29581619

RESUMEN

The number of patients with diabetes is increasing in Japan. Recently, Social capital (SC) has received increasing attention as a factor influencing health conditions. In the US, the relation between SC and diabetes control has been reported, but little attention has been paid to this connection in Japan. Three SC questionnaires, entitled "trust in people in a community," "social support," and "social relationships," were constructed. The subjects were adult patients with type 2 diabetes. Information on diabetic conditions, such as HbA1c, self-attainment of diet (SAD) and exercise (SAE), and complications were collected. The reliability coefficients for the SC questionnaire and factor analysis of SC were conducted. Multiple and logistic regressions were used to identify the influence of SC on diabetes control. Sixty-five patients participated in this study. The questionnaires "social support" and "social relationships" were adopted to measure Cronbach alpha coefficient. Factor analysis extracted the factors "hope to be helped (HH)," "participation in favorite events (PFE)," "sense of belonging (SB)," and "social movement (SM)." HbA1c was positively correlated with HH (P < 0.05). SAD and SAE were negatively correlated with HH (P < 0.05). SAE was positively correlated with PFE (P < 0.05). PFE reduced complication risks (P < 0.05). HH includes amae, which negatively affected self-efficacy that correlates with diabetes control. Therefore, higher HH might cause higher levels of HbA1c. PFE reduces distress and contributes to glucose control. Reduced distress through PFE might prevent complications. HH and PFE were identified as SC that influences diabetes control.


Asunto(s)
Diabetes Mellitus Tipo 2/epidemiología , Capital Social , Anciano , Diabetes Mellitus Tipo 2/sangre , Femenino , Hemoglobina A Glucada/metabolismo , Humanos , Japón/epidemiología , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios
2.
Nagoya J Med Sci ; 79(2): 229-239, 2017 02.
Artículo en Inglés | MEDLINE | ID: mdl-28626258

RESUMEN

Although one of the most important missions of end-of-life education is to ensure proper inter-professional education (IPE), in Japan, end-of-life care IPE has not been given enough attention especially in community settings. This study aims at developing an effective workshop facilitator training program on end-of-life care IPE and acquiring the know-how to set up and efficiently run administrative offices. We first developed a tentative facilitation training program and conducted it in five cities nationwide. The training strategy was as follows: (1) participating in the workshop, (2) attending a lecture on facilitation, (3) conducting a preparatory study, (4) attending one workshop session as a facilitator, and (5) reflecting on one's attitude as a facilitator based on workshop participants' questionnaire, peer-feedback, and video recording. A total of 10 trainees completed the training program. We assessed the level of improvement in the trainees' facilitation skills and the efficacy of the training course using a qualitative approach. This formative study helped us identify several aspects needing improvement, especially in the areas of information technology and social media. Progress in these areas may have a positive impact on the education of community health care professionals whose study hours are limited, helping provide continued facilitation training.


Asunto(s)
Educación , Cuidado Terminal , Adulto , Femenino , Humanos , Estudios Interdisciplinarios , Persona de Mediana Edad
10.
J Rural Med ; 8(2): 222-7, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-25648990

RESUMEN

OBJECTIVE: Multiple studies worldwide have supported the predictive validity of self-rated health (SRH) with regard to disability and mortality among elderly people. Although SRH is an important study topic providing clues to enhance a person's quality of life, there is currently insufficient data on age- and gender-specific differences among factors associated with SRH in Japan, particularly in rural areas. The present study examined the factors associated with SRH of a segment of Japan's rural population by age- and gender-specific analysis. METHODS: We used data from a cohort study of all users who underwent an annual health checkup at a public clinic in a rural area. The study subjects were 155 male and 169 female users from June 2009 to August 2010 who agreed to participate in this study. We divided the study subjects into 4 categories as follows: men aged less than 65, women aged less than 65, men aged 65 and over, and women aged 65 and over. The subjects who responded positively to the SRH-related questions were defined as the high SRH group, and those who responded negatively were defined as the low SRH group. We then compared the data between the high and the low groups in each category. RESULTS: In all four categories, there were statistically significant differences in regular hospital or clinic attendance between the high and low SRH groups. In all four categories, there were no significant differences in eating or exercise habits between the two SRH groups. CONCLUSION: Because regular hospital or clinic attendance by a subject is indicative of the presence of chronic health problems, it is natural for the subject's perception of their own health to be negative. However, rural physicians should provide patients with emotional and psychological support to deal with any health-related concerns positively.

11.
J Rural Med ; 8(2): 193-7, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-25649330

RESUMEN

OBJECTIVE: Japan introduced a new metabolic syndrome (MetS) screening and intervention program. However, the specific benefits of the program have not yet been identified. The aim of our study was to highlight the role of the program in reducing risks related to MetS in a Japanese rural area. METHODS: We used data from a prospective observational cohort study of all users who underwent an annual health checkup at a public clinic in a rural area. The subjects of the present study were all users aged 40-74 years who participated in the MetS program between January and September 2010. We ultimately analyzed a total of 413 subjects followed up 12 months after enrolment. The subjects were divided into two groups based on the need for educational support: support and non-support. In each group, we compared the subjects' MetS conditions at baseline and 12 months later. RESULTS: Thus, 88 subjects out of 413 were assigned to the support group. Among the support group subjects, there were no significant changes in glycemic metabolism, lipid metabolism, blood pressure and accumulation of visceral fat between the baseline and follow-up checkups. Among the non-support group subjects, there were no significant changes in glycemic metabolism, lipid metabolism and blood pressure between the baseline and follow-up checkups, but there were significant changes for the worse in accumulation of visceral fat with time. CONCLUSION: Unfortunately, the metabolic conditions of the rural subjects who participated in a new MetS screening and intervention program did not improve with time. Our findings underscore the importance of developing educational intervention programs to encourage the general population to modify their lifestyle and acquire healthier habits.

12.
Healthcare (Basel) ; 1(1): 53-63, 2013 Sep 12.
Artículo en Inglés | MEDLINE | ID: mdl-27429130

RESUMEN

Preventive care for frail older adults includes providing tailor-made diet information suited to their health conditions. The present study aims to explore the current situation and challenges of home nutrition advice for Japanese frail older adults using qualitative data from a ten-person group discussion among care managers. As the results of our analysis, nine themes were identified: (1) Homebound older adults develop poor eating habits; meals turn into a lonely and unpleasant experience; (2) With age, people's eating and drinking patterns tend to deteriorate; (3) Many older adults and their family know little about food management according to condition and medication; (4) Many older adults do not understand the importance of maintaining a proper diet; (5) Many homebound older adults do not worry about oral hygiene and swallowing ability; (6) Some older adults are at high risk for food safety problems; (7) Only a limited range of boil-in-the-bag meal options are available for older adults; (8) Many older adults feel unduly confident in their own nutrition management skills; and (9) For many family caregivers, nutrition management is a burden. We conclude that the provision of tailor-made information by skilled dietitians and high-quality home-delivered meal service are essential for the successful nutrition management of the older adults.

15.
Nihon Ronen Igakkai Zasshi ; 49(4): 387-92, 2012.
Artículo en Japonés | MEDLINE | ID: mdl-23269022

RESUMEN

AIM: To clarify the opinions of members of the Japan Geriatric Society regarding the revised version of their Position Statement on terminal medicine and care in elderly patients. METHODS: A self-report questionnaire was sent to special honorary members, emeritus academic staff, and officers and delegates of the Japan Geriatrics Society (789 people). The questions were: 1) Do you agree with the Position Statement as revised by the Ethics Committee of the Japan Geriatric Society or not? 2) Do you have any ideas about any specific item and its' content or necessary revisions and if so, what are they? 3) Are there any headings or items that should be added to the Q&A section and if so, what are they? RESULTS: The response rate was 28.5% (225/789). Of these, 91.6% agreed with the revised version of the Position Statement. More than 80% of respondents had no suggested revisions. Suggested items that should be added to the Q&A were: advanced directives or advanced care plans, legal interpretation on the withholding of life-support treatments including hemodialysis, the establishment of a guardian system, and legal interpretation of the decisions made by the Ethics Committee. CONCLUSION: Although most respondents agreed with the revised version of the Position Statement, some issues remain to be discussed, including the relationship of patient autonomy with the optimal benefits for those in terminal-stage disease, the decision-making systems regarding the introduction and withholding of life-support treatments such as artificial nutrition, artificial ventilation, and hemodialysis.


Asunto(s)
Cuidado Terminal , Anciano , Geriatría , Humanos , Japón , Rol , Sociedades Médicas
20.
J Rural Med ; 7(2): 59-64, 2012.
Artículo en Inglés | MEDLINE | ID: mdl-25649740

RESUMEN

OBJECTIVE: The aim of the present study was to clarify the signs and symptoms of impending death in end-of-life senile dementia from the point of view of formal caregivers in rural areas. Patient/Materials and Methods: We used qualitative data based on retrospective analyses. The data was gathered following a workshop on end-of-life care of the elderly with dementia attended by formal caregivers that was held in Iga City, Mie Prefecture, Japan, in September 2011. There was a total of 29 workshop participants. The workshop products were created in the first session of the workshop entitled "Signs of death." During the session, we used the brainstorming method, and participants took turns stating at least two signs, symptoms or premonitions of death. In the end, there were 93 cards in total displaying signs of impending death observed in the end stage of dementia. These 93 entries were then classified into clear categories. RESULTS: The categories defined were breathing disorder, consciousness decline, vital power decline, reduced oral intake, feces disorder, calm and peaceful character, blood pressure decline, change in skin color, patient odor, edema, preagonal vital power, body temperature decline, bedsore/wound deterioration, body weight reduction, cyanosis, and oliguria. The most frequently cited symptoms fell in the breathing disorder category (12 cards), followed by consciousness decline (9 cards), vital power decline (9 cards), reduced oral intake (6 cards), and feces disorder (6 cards). Also frequently mentioned were symptoms falling in the calm and peaceful character, patient odor and preagonal vital power categories. CONCLUSION: The results show that formal caregivers in rural areas identified breathing disorder as a top indicator of impending death in end-of-life senile dementia cases. The results also highlight some other characteristic signs of impending death, such as preagonal vital power and calm and peaceful character. This research could help develop formal caregivers' observational skills in the end-of-life care settings.

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