Factors influencing healthcare-seeking behaviour among Muslims from Southeast Asian countries (Indonesia and Malaysia) living in Japan: an exploratory qualitative study.

OBJECTIVES: To identify factors influencing healthcare-seeking behaviours and to explore issues with healthcare experiences of Muslims from Southeast Asian countries (Indonesia and Malaysia) living in Japan. DESIGN: Qualitative study. SETTING: Kansai area of Japan (Kyoto, Osaka, Hyogo and Nara prefectures). PARTICIPANTS: Forty-five Muslims in Japan from Southeast Asian countries (Indonesia and Malaysia). METHODS: Semistructured interviews were conducted by trained interviewers who are Muslims living in Japan. Interviews were conducted in Indonesian and Malaysian languages and transcribed and translated into English. The data were thematically analysed. RESULTS: Four themes were identified: (1) trying to comply with the recommendations of Islam, (2) confusion about healthcare system, (3) improvising an informal support system and (4) language barrier problems. CONCLUSION: Muslims in Japan have some issues when obtaining healthcare services mainly because of communication issues besides the conflicts to meet their religious obligations. Education and awareness building for the Muslim patients in Japan as well as Japanese healthcare providers are needed to allow smooth communication between Japanese healthcare providers and Muslim patients in Japan.

Paleogenomics reveals independent and hybrid origins of two morphologically distinct wolf lineages endemic to Japan.

Little is known about the spatiotemporal dynamics of gray wolves in the Pleistocene across low-latitude regions of Eurasia. In Japan, a small-bodied endemic subspecies of Japanese wolves existed and went extinct in the early 1900s. The fossil record indicates that a giant wolf, which reached 70 cm in body height, inhabited Japan during the Pleistocene, but its evolutionary relationship, if any, with the Japanese wolf remains uncertain. Here, to reveal the genetic origin of the Japanese wolf, we analyzed ancient DNA from remains (recovered in Japan) of one Pleistocene wolf that lived 35,000 years ago and one Holocene wolf from 5,000 years ago. The analysis of the mitochondrial DNA revealed that the Pleistocene wolf was not part of the Japanese wolf clade but rather an earlier-diverging lineage. The analysis of the nuclear DNA of the Holocene Japanese wolf revealed that it was an admixture of the Japanese Pleistocene wolf and continental wolf lineages. These findings suggest that the Japanese wolf originated via waves of colonization of multiple Pleistocene wolf populations at 57-35 and 37-14 ka, respectively, followed by interpopulation hybridization.

Ancient DNA reveals multiple origins and migration waves of extinct Japanese brown bear lineages.

Little is known about how mammalian biogeography on islands was affected by sea-level fluctuations. In the Japanese Archipelago, brown bears (Ursus arctos) currently inhabit only Hokkaido, the northern island, but Pleistocene fossils indicate a past distribution throughout Honshu, Japan's largest island. However, the difficulty of recovering ancient DNA from fossils in temperate East Asia has limited our understanding of their evolutionary history. Here, we analysed mitochondrial DNA from a 32 500-year-old brown bear fossil from Honshu. Our results show that this individual belonged to a previously unknown lineage that split approximately 160 Ka from its sister lineage, the southern Hokkaido clade. This divergence time and fossil record suggest that brown bears migrated from the Eurasian continent to Honshu at least twice; the first population was an early-diverging lineage (greater than 340 Ka), and the second migrated via Hokkaido after approximately 160 Ka, during the ice age. Thus, glacial-age sea-level falls might have facilitated migrations of large mammals more frequently than previously thought, which may have had a substantial impact on ecosystem dynamics in these isolated islands.

British and Japanese international retirement migration and creative responses to health and care challenges: a bricolage perspective.

Most research on international retirement migration has focused on the Western context and the motivations and lifestyle choices of migrants when they are healthy. This paper instead explores how British retirees in Spain and Japanese retirees in Malaysia respond to declining health and increasing care needs through bricolage as they begin to 'age in place'. The paper combines qualitative interviews, focus groups and observations collected by the authors from 215 British and Japanese international retirement migrants. We focus on two key types of bricolage behaviour: 'within-system bricolage' undertaken by migrants to help them access and navigate existing health and care systems; and 'added-to-system bricolage' that is enacted to fill gaps in health and care provision. Our analysis suggests that IRMs engage in 'transnational care bricolage' by combining multiple economic, social and legal resources across local and transnational spaces to address their health and care needs.

Healthcare Providers' Perceptions on the Timing of Initial Advance Care Planning Discussions in Japan: a Mixed-Methods Study.

BACKGROUND: Most adult patients are willing to discuss advance care planning before the onset of any illness. There might be differences in preferences for timing when it comes to initiating advance care planning discussions by healthcare providers with patients. OBJECTIVE: To identify healthcare providers' willingness to initiate advance care planning discussions in Japan. DESIGN: A mixed-methods questionnaire comprising three case scenarios based on three different illness trajectories. PARTICIPANTS: The study participants were physicians and nurses employed in four community hospitals in Japan. MAIN MEASURES: Percentages of physicians' and nurses' willingness to initiate advance care planning discussions at four stages of patients' illness trajectory were quantitatively determined, and perceptions on preferred timing were qualitatively identified. KEY RESULTS: From 108 physician and 123 nurse respondents (response rate: 99%), 291 physician and 362 nurse responses about three case scenarios were obtained. Overall, 51.2% of physicians and 65.5% of nurses (p < 0.001) accepted discussion before illness. Less than one-third of physicians considered advance care planning a "wise precaution," while about two-thirds of nurses did. Additionally, more than half of both physicians and nurses preferred to postpone advance care planning until the patient's imminent death. CONCLUSIONS: Physicians are less willing than nurses to begin advance care planning discussions before patients' health has deteriorated though most prefer to wait until the patients are close to death. Healthcare providers' attitudes toward advance care planning will need to be addressed to improve rates of completion in Japan.

How Psychosocial Factors Contribute to Japanese Older Adults' Initiation of Advance Care Planning Discussions: A Qualitative Study.

Objectives: This study aimed to reveal the features of older adults' advance care planning (ACP) discussions by identifying psychosocial factors related to their discussions in Japan, where people value family-centered decision making. Methods: A qualitative study using in-depth interviews was conducted with 39 participants (aged ≥65 years) recruited from the outpatient department of a community hospital in Fukushima, Japan. Data were analyzed using the grounded theory approach. Results: Through experiences of family caregiving, participants became aware of their own feelings about the end of life. Equal relationship with family members was important for lowering the threshold for having discussions. Some participants and their families in the same generation reached agreements on ACP; however, they were willing to yield to children's decision making despite these discussions. Discussions: These findings provide insights into the psychosocial factors in relation to ACP discussions and support for the role of ACP discussions in the family-centered decision-making culture.

Investigation of the key factors that influence the girls to enter into child marriage: A meta-synthesis of qualitative evidence.

In this study, we synthesized findings from qualitative studies to identify the key factors that influence child marriage. We used a meta-ethnographic approach coupled with thematic synthesis. We searched literature from nine databases, which were in English language, covering areas in public health, psychology, and social science between 2008 and 2018. Twelve studies were included in the synthesis. We identified six main themes: human insecurity and conflict; legal issues; family values and circumstances; religious beliefs; individual circumstances, beliefs, and knowledge; and social norms. Our findings highlight the impact of human insecurity and conflict, as well as legal issues. In spite of global progress scaling up legislation against child marriage, the legal framework is insufficiently enforced in many settings. Most of the included studies were from the Middle East, Africa, and South Asia. Studies from other parts of the world such as Latin America and Southeast Asia, which have the highest rates of child marriage, are needed.

Patients' preferences and factors influencing initial advance care planning discussions' timing: A cross-cultural mixed-methods study.

BACKGROUND: Although advance care planning discussions are increasingly accepted worldwide, their ideal timing is uncertain and cultural factors may pertain. AIM: To evaluate timing and factors affecting initiation of advance care planning discussions for adult patients in Japan and Taiwan. DESIGN: Mixed-methods questionnaire survey to quantitatively determine percentages of patients willing to initiate advance care planning discussions at four stages of illness trajectory ranging from healthy to undeniably ill, and to identify qualitative perceptions underlying preferred timing. SETTING/PARTICIPANTS: Patients aged 40-75 years visiting outpatient departments at four Japanese and two Taiwanese hospitals were randomly recruited. RESULTS: Overall (of 700 respondents), 72% (of 365) in Japan and 84% (of 335) in Taiwan (p < 0.001) accepted discussion before illness. In Japan, factors associated with willingness before illness were younger age and rejection of life-sustaining treatments; in Taiwan, older age, stronger social support, and rejection of life-sustaining treatments. Four main categories of attitudes were extracted: the most common welcomed discussion as a wise precaution, responses in this first category outnumbered preference for postponement of discussion until imminent end of life, acceptance of the universal inevitability of death, and preference for discussion at healthcare providers' initiative. CONCLUSION: The majority of patients are willing to begin discussion before their health is severely compromised; about one out of five patients are unwilling to begin until clearly facing death. To promote advance care planning, healthcare providers must be mindful of patients' preferences and factors associated with acceptance and reluctance to initiate advance care planning.

Why girls get married early in Sarawak, Malaysia - an exploratory qualitative study.

BACKGROUND: Child marriage, a marriage that involves someone under the age of 18 years, is a long-standing social issue in Sarawak state, Malaysia. The state has taken several measures to improve situations of inequity for women who get married early; however, the practice is still a common part of the tradition and culture. The aim of this study was to explore the factors leading to child marriage in Sarawak state, Malaysia. METHODS: This was an exploratory qualitative study conducted via semi-structured interviews with twenty-two women who were married when they were younger than 18 years old in Kuching, Sarawak, Malaysia. Participants were recruited through purposive and convenient sampling with the use of data from a reproductive health clinic and recruitment in villages. Thematic analysis was used for data analysis. RESULTS: Four overarching themes were identified: health risk behaviour, family poverty, early marriage as fate, and family disharmony. CONCLUSIONS: In-depth understanding of the unique factors leading to child marriage locally will facilitate the introduction of new approaches to interventions to eradicate child marriage in Sarawak state, Malaysia.

Conceptualization of a good end-of-life experience with dementia in Japan: a qualitative study.

OBJECTIVES: To conceptualize a "good end of life" for people with dementia from the perspectives of bereaved family caregivers in Japan. DESIGN AND PARTICIPANTS: A qualitative study using in-depth, semi-structured interviews focused on the family caregivers' perceptions of their loved one's experiences. Family caregivers who had lost their relatives with dementia more than six months previously were recruited using maximum variation sampling by cultural subpopulation. A thematic analysis was conducted. RESULTS: From 30 interviews held, four main themes emerged. A good end of life for people with dementia means experiencing a "Peaceful Death" while "Maintaining Personhood" at a "Preferred Place" allowing for feelings of "Life Satisfaction." A "Preferred Place" emerged as a basic requirement to achieving a good end of life according to the three other themes, in particular, "Maintaining Personhood." However, the interviewees experienced difficulties in ensuring that their loved ones stayed at a "Preferred Place." CONCLUSIONS: Despite different cultural backgrounds, perceptions of a good end of life with dementia were remarkably similar between Japan and Western countries. However, recent societal changes in family structures and long-term care access in Japan may explain the theme of a comfortable place taking a central position. We suggest that these themes be considered and translated into care goals. They could supplement established end-of-life care goals for quality of life in dementia, which aim to maximize functioning and increase comfort. TRIAL REGISTRATION NUMBER: Ethics Committee of the Graduate School and Faculty of Medicine, Kyoto University (R0808-2).

Qualitative and Quantitative Analysis of Posttreatment Strategy After Endoscopic Resection for Patients with T1 Colorectal Cancer at High Risk of Lymph Node Metastasis.

BACKGROUND: Although endoscopic resection is increasingly performed to treat submucosal invasive colorectal cancer (T1CRC), approximately 10% are at risk of lymph node metastasis. The Japanese Society for Cancer of the Colon and Rectum guideline indicates that the following risk factors should be considered when deciding whether to perform additional surgical resection with lymph node dissection: depth of T1 invasion, lymphovascular invasion, poor histological grade, and budding grade 2/3. However, there is little information about the prognosis of T1CRC patients, or factors to consider when deciding subsequent treatment of high-risk T1CRC. METHODS: This retrospective mixed method study was conducted using electronic medical records at Kyoto University Hospital between February 2005 and February 2015. Participants were T1CRC patients at risk of lymph node metastasis with at least one of the above four risk factors. They were assigned either careful follow-up (FU) or additional surgery (AS) through shared decision-making. To identify factors affecting decision-making in the FU group, we performed qualitative content analysis of electronic medical records. The prognosis of the groups was compared using the Kaplan-Meier method and the log-rank test. RESULTS: Of 161 T1CRC patients, 18 were included in the FU group and 19 in the AS group. The median follow-up time was 39.5 (range 23-126) months for the FU group and 62 (range 22-141) months for the AS group. Factors considered in selecting FU were advanced age, comorbidities, the sole presence of the "depth" risk factor, and lower rectal cancer. For AS, the risk factors cited in the guideline were considered. There was one recurrent case in each group during the research period. There were no significant differences in overall survival, cause-specific survival, or recurrence-free survival between the groups. CONCLUSIONS: Age, comorbidities, and lower-rectal cancer location were considered in deciding posttreatment strategy among high-risk T1CRC patients, alongside with positive vertical margin, depth, lymphovascular invasion, poor histologic grade, and budding. During the research period, there was no prognostic difference between the FU and AS groups.

In-depth examination of issues surrounding the reasons for child marriage in Kelantan, Malaysia: a qualitative study.

OBJECTIVE: To examine individual, familial, community and societal issues surrounding the reasons for child marriage in Kelantan, Malaysia. DESIGN: Qualitative study by means of semistructured interviews with women and key informants, using social-ecological model as a conceptual framework. SETTING: Interviews were conducted in Kota Bharu district, Kelantan, a northeast state in Peninsular Malaysia. PARTICIPANTS: Eighteen women of reproductive age (18 to 44 years old) that experienced their first marriage below the age of 18, as well as five key informants, consisting of a government officer, a community leader, an officer from religious department and two mothers. The women were recruited from a reproductive health clinic. The key informants who had specialised knowledge related to child marriage were selectively chosen. RESULTS: Three themes emerged that aligned with the social-ecological model: immaturity in decision-making, family poverty and religious and cultural norms. CONCLUSIONS: The findings imply that sex education and awareness-building activities regarding the consequences of child marriage must be implemented to eradicate child marriage in Malaysia. Such implementation must be coordinated as a team-based approach involving experts in such fields as law, religion, psychology, social-welfare and public health. In order to increase the awareness of child marriage consequences, the target for awareness must extend not only to the adolescent girls and their families, but also to the community and society at large by clearly communicating the negative consequences of and addressing the drivers for child marriage.

Stable Iodine Distribution Among Children After the 2011 Fukushima Nuclear Disaster in Japan: An Observational Study.

CONTEXT: Intake of stable iodine helps prevent childhood thyroid cancer in nuclear emergencies, but there is limited case information. OBJECTIVE: We identified the intake rate and the factors associated with no intake among children who did not take stable iodine after the Fukushima disaster. DESIGN: Retrospective observational study. SETTING: Data were obtained from thyroid cancer screenings performed from August through November 2017. PARTICIPANTS: Children in Miharu Town, Fukushima, Japan. INTERVENTION: No intervention. MAIN OUTCOME MEASURES: We performed multilevel logistic regression analysis at the regional and individual levels. We qualitatively examined the reasons for no intake of stable iodine based on closed- and open-ended questions. RESULTS: The rate of distribution was 94.9%, but the intake rate was only 63.5%. Intake was lower in those aged 0 to 2 years compared with those aged ≥3 years (OR, 0.21; 95% CI, 0.11 to 0.36). Parents' intake was positively associated with their children's intake (OR, 61.0; 95% CI, 37.9 to 102.9). The variance partition coefficient for regions was 0.021, suggesting that the intake of stable iodine was more likely affected by individual than by regional factors. Closed-ended questions showed that the main reason for avoiding intake was concern about safety. Open-ended questions for other reasons revealed issues related to the distribution method, information about the effects and adverse effects of iodine, and instructions for iodine intake. There were no symptomatic adverse effects claimed to the town. CONCLUSIONS: The distribution and consumption of stable iodine occurred in Miharu Town after the Fukushima disaster. To prepare for future nuclear emergencies, it is important to explain to both children and parents the need for intake of stable iodine, particularly among young children.

Issues in healthcare services in Malaysia as experienced by Japanese retirees.

BACKGROUND: Worldwide, international retirement migration is growing in its popularity and Japanese retirees choose Malaysia as their most preferred destination. This study examines the pertinent issues related to healthcare services as experienced by Japanese retirees in this country. METHODS AND RESULTS: From January to March 2015, we conducted focus group discussions with 30 Japanese retirees who live in Kuala Lumpur and Ipoh. Guided by the social-ecological model, we discovered seven pertinent themes: 'language barriers','healthcare decisions', 'medical check-ups','healthcare insurance', 'nursing and palliative care', 'trust and distrust of healthcare services', and 'word-of-mouth information'. DISCUSSION: We identified seven pertinent issues related to healthcare services among Japanese retirees in Malaysia, of which four are especially important. These issues are explained as integrated themes within the social-ecological model. Language barriers prohibit them from having difficulty accessing to healthcare in Malaysia, but lack of will to improve their language skills exist among them. For that reason, they rely heavily on word-of-mouth information when seeking for healthcare. As a consequence, some develop feelings of trust and distrust of healthcare services. In addition, we have identified the needs for provide nursing and palliative care among Japanese retirees in Malaysia. CONCLUSION: Based on the magnitude of the discussion, we concluded that there are four crucial healthcare issues among Japanese retirees; 'language barriers', 'trust and distrust of healthcare services', 'word-of-mouth information' and 'nursing and palliative care'. We propose that further dialogue by healthcare stakeholders should be carried out to improve further the healthcare service provisions for Japanese retirees in Malaysia.

Factors affecting Japanese retirees' healthcare service utilisation in Malaysia: a qualitative study.

OBJECTIVE: While living overseas in another culture, retirees need to adapt to a new environment but often this causes difficulties, particularly among those elderly who require healthcare services. This study examines factors affecting healthcare service utilisation among Japanese retirees in Malaysia. DESIGN: We conducted 6 focus group discussions with Japanese retirees and interviewed 8 relevant medical services providers in-depth. Guided by the Andersen Healthcare Utilisation Model, we managed and analysed the data, using QSR NVivo 10 software and the directed content analysis method. SETTING: We interviewed participants at Japan Clubs and their offices. PARTICIPANTS: 30 Japanese retirees who live in Kuala Lumpur and Ipoh, and 8 medical services providers. RESULTS: We identified health beliefs, medical symptoms and health insurance as the 3 most important themes, respectively, representing the 3 dimensions within the Andersen Healthcare Utilisation Model. Additionally, language barriers, voluntary health repatriation to Japan and psychological support were unique themes that influence healthcare service utilisation among Japanese retirees. CONCLUSIONS: The healthcare service utilisation among Japanese retirees in Malaysia could be partially explained by the Andersen Healthcare Utilisation Model, together with some factors that were unique findings to this study. Healthcare service utilisation among Japanese retirees in Malaysia could be improved by alleviating negative health beliefs through awareness programmes for Japanese retirees about the healthcare systems and cultural aspects of medical care in Malaysia.

Plastic casts and confocal laser scanning microscopy applied to the observation of enamel tubules in the red Kangaroo (Macropus rufus).

Scanning electron microscopy for plastic casts and confocal laser scanning microscopy for Villanueva bone-stained ground sections were used together to observe enamel tubules in red kangaroo molars. Although the tubular structures such as terminals, bends, expansions, splits, divergences and rejoinings in this species were within the variations of marsupial species, their morphological characteristics were demonstrated with extremely clear and persuasive images. Thus, the combined observations of plastic casts by scanning electron microscopy and Villanueva bone-stain sections by confocal laser scanning microscopy were found to be of value for the investigation of enamel tubules and tubular structures in other hard tissues.