[Anxiety-related factors among elder-care facility employees regarding admission of tuberculosis patients after inpatient-treatment completion].

Objective　Tuberculosis (TB) patients are discharged after confirming their non-infective status. However, elder-care facilities often refuse to admit discharged TB patients. As no study has investigated anxiety among elder-care facility employees, we aimed to identify anxiety-associated factors among elder-care facility employees regarding the post-discharge admission of TB patients who have completed inpatient treatment.Methods　Among the 74 elder-care facilities under the jurisdiction of the Ibaraki Public Health Center in Osaka, Japan, (we excludes facilities that provided only daycare services), and invited all 3,213 employees of the remaining 70 facilities to participate in this questionnaire-based survey. Copies of an anonymous, self-administered questionnaire were mailed to the manager of each facility and were further distributed among employees. Responses were initially collected individually and subsequently directly collected from each facility by a public health nurse at the center. The questionnaire items included: the presence/absence of anxiety, resistance, and/or a feeling of difficulty about admitting TB patients who had completed inpatient treatment ("anxiety"), age, sex, occupation, years of work, total experience caring for TB patients, and knowledge of TB. The correlation between the presence/absence of anxiety and each item was analyzed using the chi-square test.Results　Completed questionnaires were obtained from 1,950 employees (response rate, 60.7%), of which 1,290 without missing data for relevant items were analyzed. Anxiety was present in 987 (76.5%) respondents. A significantly higher proportion of anxiety was observed in relation to the occupation (care workers and helpers), experience of caring for TB patients (respondents without such experience), and among employees who incorrectly answered questions on knowledge of TB, such as the infectiveness of TB patients after discharge, their management, and the risk of developing TB following infection.Conclusion　The study identified anxiety-associated factors among employees of elder-care facilities about admitting TB patients who had completed inpatient treatment for TB. Therefore, anxiety-mitigating environments may need to be established for such employees to facilitate the admission of discharged TB patients and their smooth return of patients to their pre-TB lives.

[Seasonal changes in blood pressure and related factors among older patients receiving home medical care].

AIM: We investigated seasonal variations in blood pressure (BP) and factors related to these variations among older patients receiving home medical care. METHOD: A total 57 patients ≥ 65 years old receiving home medical care who participated in the Osaka Home Care REgistry study (OHCARE), a prospective cohort study, were included. We investigated the seasonal patient characteristics and variations in the BP. In addition, to determine the influence of seasonal variations in the systolic blood pressure (SBP) on the occurrence of clinical events (hospitalization, falls and death), we classified patients into larger- and smaller- change groups based on the median seasonal variations in SBP. RESULT: About 60% of subjects were very frail or bedridden. The mean BP was higher in winter than in summer (124.7±11/69.5±7 vs.120.5±12/66.9±8 mmHg) (P< 0.01). On comparing the characteristics of the two groups with larger and smaller changes in the SBP, the group with large BP changes had a significantly lower BP in summer than the group with small BP changes. In addition, the incidence of "hospitalization" was significantly higher in the group with large BP changes than in the group with small BP changes (P = 0.03). CONCLUSION: The present study revealed that there were seasonal changes in the BP in older patients receiving home medical care. It was also suggested that seasonal changes in the BP might be associated with the risk of hospitalization events. Given these BP variations, doctors and visiting nurses should be alert for systemic abnormalities, especially in frail patients receinving home medical care.

Associations of blood pressure levels with clinical events in older patients receiving home medical care.

Some studies reported that excessive blood pressure (BP) control was not appropriate for older people, especially from the viewpoint of quality of life and maintaining sufficient blood flow for tissue perfusion. However, the lower limit of the target BP is still unclear, and there has not yet been a sufficient consensus. Therefore, we investigated the associations of BP levels with clinical events in older patients ~85 years old receiving home medical care. A total of 144 patients were included, who were followed for longer than 3 months in the Osaka Home Care Registry study, a prospective cohort study targeting older patients receiving home medical care in Japan. BP levels were divided into lower and higher groups based on the average systolic blood pressure (SBP). The main outcomes were clinical events, including hospitalizations, falls, and deaths during follow-up. As a result, the hospitalization rate in the SBP below 124 mmHg group was significantly higher than that in the SBP over 124 mmHg group. When comparing the clinical events between the two groups only in participants with hypertension, the same results were obtained. Furthermore, in Cox proportional hazards regression models adjusted by age, sex, and current diseases, the SBP below 124 mmHg group showed a significantly higher rate of required hospitalization (hazard ratio: 7.25, 95% confidence interval: 1.79-29.45). Thus, in older and very frail patients requiring home medical care, an SBP level below 124 mmHg could be a predictive marker of clinical events leading to hospitalization.