A community-wide intervention to promote physical activity: A five-year quasi-experimental study.

Evidence on the effects of a community-wide intervention (CWI) on population-level physical activity (PA), especially in the long term, is limited. Therefore, we evaluated the five-year effect of CWI on promoting PA through information dissemination, education, and community support primarily targeting older adults, by incorporating Japanese guidelines, in Fujisawa City, from 2013. To assess the effect of the whole-city intervention, we distributed questionnaires in 2013, 2015, and 2018 to three independent random samples of 3,000 community-dwelling adults (aged ≥ 20 years) using a quasi-experimental study design. Three separate samples responded to the survey (41% at baseline, 46% at the two-year mark, and 48% at the five-year follow-up). The primary outcome was change in PA participation. At the five-year follow-up, PA (median: 120 minutes/day) was significantly higher than at baseline (86 minutes/day) and the two-year follow-up (90 minutes/day). The results of the multivariate analysis indicated that PA among older adults-the primary target population of the CWI-increased significantly at the five-year follow-up, compared to those aged 20-64 (mean difference of change between groups: 14.7 minutes/day, P= 0.029). Among older adults, PA was significantly lower in those with poorer perceived economic status than in their more well-off counterparts at the two-year follow-up (P= 0.003); however, there was no significant difference at the five-year follow-up (P= 1.000). There was a positive interaction between group and period (mean difference of change between groups: 40.9 minutes/day, P= 0.001). In conclusion, the five-year CWI targeting older adults, incorporating national guidelines, improved population-level PA.

Intention to undergo dementia screening in primary care settings among community-dwelling older people.

To improve the quality of care for people with dementia, several local governments in Japan have implemented a subsidized system for screening of dementia. This cross-sectional study aimed to identify factors that promote public intention to undergo dementia screening. A postal survey was conducted in a residential area that lies across the two cities which started a subsidized system for dementia screening. Semi-structured questionnaires were distributed to community-dwelling people aged ≥65 years; a total of 2269 persons were included in the analysis. χ2 test and multiple logistic regression analysis were used to identify factors associated with the willingness to undergo dementia screening. Among the people with dementia, only 28% had undergone a screening test for dementia. The participants who were certified of public long-term care need tended to undergo dementia screening. Approximately 67% of the participants were willing to undergo a dementia diagnosis test. Younger age, female sex, perceived poor health status, having a primary care physician, and independent daily activity level were associated with a greater willingness to undergo dementia screening using a subsidized system. Our study showed that majority of people with possible dementia do not undergo dementia screening. However, majority of people were willing to use a subsidized system for dementia screening. Further studies are required to support the benefits of a subsidized dementia screening in primary care settings. J Am Geriatr Soc 68:-, 2020.

Household water insecurity, depression and quality of life among postnatal women living in urban Nepal.

OBJECTIVES: This observational study aimed to assess distress related to the household water supply and to examine the relationship between household water insecurity and psychological health among Nepali postnatal women. METHODS: In total, 300 women consented to participate in the study, of which 267 women were able to participate in a follow-up 1 month after discharge. We developed a household water insecurity scale (HWIS; total score range 0-24 points) by adapting the household food insecurity access scale. RESULTS: The Cronbach's coefficient alpha for the HWIS was moderately acceptable. Psychological health was assessed in terms of postnatal depression and physical health-related quality of life (HRQOL). The median score of the HWIS was 8, and more than 60% of the participants answered that they sometimes or often worried about not having enough water, used only small amounts of water, had a lack of hygiene, and had insufficient time for childrearing. Multiple regression models showed that women with high levels of stress derived from household water insecurity had greater odds of probable depression and lower physical HRQOL scores than did women with low HWIS scores. CONCLUSION: The results suggest that improving water security is necessary to foster maternal psychological health in developing countries.

Comparison of colostrum TGF-ß2 levels between lactating women in Japan and Nepal.

BACKGROUND: Maternal milk-borne transforming growth factor (TGF-ß plays a potential role in the development of the mucosal immune system in infants. However, it remains unclear what factors determine TGF-ß levels in breast milk. We hypothesized that microbial pressures during pregnancy might affect the expression levels of TGF-ß in colostrum. OBJECTIVE: This study compared TGF-ß2 levels in colostrum of lactating women living in Japan and Nepal with contrasting hygiene statuses. Additionally, we identified environmental and intrinsic factors influencing TGF-ß levels in colostrum. METHODS: Breast milk samples and structured questionnaires were collected from 80 women living in Japan and 208 women living in Nepal. A robust regression model was used to identify factors associated with colostral TGF-ß levels. RESULTS: Analysis using the Mann-Whitney U test showed that TGF-ß levels were significantly higher in Japanese women than in Nepalese women. Japanese women who consumed animal milk daily during pregnancy and had atopic dermatitis expressed lower levels of TGF-ß in colostrum, as compared to Japanese women who did not. Among Nepalese women, large family size and higher birth order were associated with lower TGF-ß levels and women who gave birth to infants with low birth weight had higher expression of TGF-ß levels in milk than women who gave birth to infants with normal birth weight. CONCLUSION: The results suggest that induction of TGF-ß levels in colostrum depends on differences in the ethnicity of lactating women. Consumption of animal protein and parturition characteristics may affect TGF-ß levels in breast milk, and may explain differences in these levels in breast milk between countries.

Dementia diagnostic and treatment services in the Western Pacific: challenges, preparedness and opportunities in the face of amyloid-targeting therapies.

Here we first review the limited available literature addressing the current landscape of specialist assessment services for dementia and cognitive decline and the preparedness for new amyloid-targeting therapies for Alzheimer's disease across the Western Pacific region. Considering the scarcity of literature, as national representatives of Western Pacific nations we were then guided by the World Health Organization's Global Action Plan on Dementia to provide country-specific reviews. As a whole, we highlight that the existing diverse socioeconomic and cultural landscape across the region poses unique challenges, including varying access to services and marked differences among countries in their preparedness for upcoming amyloid-targeting therapies for Alzheimer's disease. Therefore, there is an urgent call for intergovernmental collaboration and investment across the Western Pacific to ensure that for all nations, citizens living with dementia and cognitive decline have access to effective and equitable methods of diagnosis, treatment and care.

Barriers and catalysts of nutrition literacy among elderly Japanese people.

Improving skills for accessing and utilizing diet/nutrition information is important for preventing non-communicable diseases and frailty among elderly people. With the rapidly increasing number of elderly people in the world, promoting nutrition literacy among them is a pivotal health policy for maintaining and promoting health. This article describes the barriers and catalysts of nutrition literacy among elderly Japanese people (aged ≥75 years). A cross-sectional analysis of the responses to a questionnaire administered to 678 study participants (men = 347, women = 331) was conducted. Logistic regression analysis revealed that more men had limited nutrition literacy than did women. After stratification by gender, the limited nutrition literacy group was associated with cognitive difficulty in men and women, visual impairment in men and hearing impairment in women. Lower education level and economic status were associated with limited nutrition literacy among women. Adjusted odds ratios (ORs) controlling for age, education level and economic status, as well as cognitive, visual and hearing function, indicated that informational support [OR = 5.59, 95% confidence interval (95% CI) = 1.28-24.49] and diet/nutrition information obtained from friends of the participants (OR = 2.16, 95% CI = 1.11-4.20) were both associated with adequate nutrition literacy among men, whereas diet/nutrition information from health professionals (OR = 3.96, 95% CI = 1.97-7.95) had a significant relation with adequate nutrition literacy among women. Moreover, in the adequate nutrition literacy group, men were more likely to be overweight (OR = 2.17, 95% CI = 1.20-3.91). These findings suggested that cognitive and sensory functions should be taken into account when diet information is provided to older adults. Enhancement of social networks is also a key point in improving nutrition literacy. An effective intervention to improve nutrition literacy in elderly people, particular old men, warrants further investigation.

Depressive symptoms and past lifestyle among Japanese elderly people.

In order to develop an effective preventive intervention for depression, this cross-sectional study aimed to analyze the relationship between past lifestyle, social activity, and depressive symptoms among community-dwelling elderly people in Japan (n = 887). The Geriatric Depression Scale was used for assessing depressive symptoms. The lifestyle of middle-aged people was assessed using a recall report. The prevalence of depressive symptoms among the subjects was 12.9%. Logistic regression analyses showed that physical exercise, daily intake of well-balanced meals and milk products, and the presence of hobbies were related to the absence of depressive symptoms among both men and women. Among men, avoidance of excess salt and fat was related to the absence of depressive symptoms, while among women, moderate alcohol consumption and good relationships with neighbors were related. Physical exercise, dietary education, and promotion of social activities among middle-aged people were recommended for prevention of depressive symptoms.

National dementia supporter programme in Japan.

Due to the growing number of people with dementia worldwide, the role of dementia supporters is becoming increasingly important. In 2005, a national campaign called the Dementia Supporter Caravan was launched in Japan. However, the impact these trainings have on facilitating the work of dementia supporters is not quite understood. This study aimed to assess the challenges faced by dementia supporters in conducting activities for people with dementia. Our results showed that even after a period of six months since the training session, only half of the supporters had commenced new support activities. Future studies should examine the impact activities conducted by dementia supporters have on people with dementia and their family caregivers.

Dementia Literacy and Willingness to Dementia Screening.

The increasing prevalence of delayed and missed diagnoses for dementia constitutes major public concern. In this regard, inadequate knowledge and poor understanding of the condition may create a barrier to timely dementia screening. This cross-sectional study assessed dementia literacy, then identified the association between dementia literacy and willingness to undergo routine dementia screening among community-dwelling older adults in two urban areas of Japan. More specifically, structured questionnaires were distributed to a total of 854 individuals aged ≥ 65 years. A multivariate logistic regression was then used to explore the factors associated with dementia literacy and willingness to undergo routine dementia screening. Results showed that younger respondents and respondents who received dementia information from television/radio and/or paper-based sources were more likely to have high dementia literacy. While less than half of participants were willing to undergo routine dementia screening, those with higher dementia literacy were more willing to do so (albeit, not a statistically significant difference). Although there are pros and cons to routine dementia screening, it is necessary to implement such a system to detect dementia and cognitive impairment. Further, assessments should also attempt to gain information about individual beliefs and understandings related to dementia information.

Public attitudes towards people living with dementia: A cross-sectional study in urban Japan (innovative practice).

Stigma and social isolation are major challenges in building dementia friendly communities. Information is a key factor in improving knowledge and attitudes about dementia. This cross-sectional survey aimed to investigate public attitudes towards people with dementia in an urban community in Japan. Nearly 90% of the participants responded that they were able to have a good relationship with a person with dementia and help such a person if needed. However, around half of the participants would be ashamed of a family member with dementia. A multiple regression model showed that information from television and educational classes was associated with positive attitudes towards people with dementia among older adults. Information from educational classes and the Internet was likewise associated with positive attitudes among the volunteers. Increasing the availability and accessibility of information on dementia may contribute to improving public attitudes towards people with dementia.

Cognition of social capital in older Japanese men and women.

OBJECTIVE. This study explored factors related to cognition of social capital among Japanese older people. METHOD. Using a cross-sectional survey design, data were gathered from 940 people aged over 65 years. Cognition of social capital was compared by gender, and it was regressed on participation in community activities and health behaviors of middle age and current health status. RESULTS. Men had higher cognitive social capital than women (p = .004). Multiple regression analysis shows that men who rested for health during middle age had high cognition of social capital. Cognition of social capital was also related to self-rated health, depression, and cognitive difficulties for both men and women. Daily activity was included among women. DISCUSSION. Participation in community activities and health behaviors during middle age were associated factors for cognition of social capital among the older people, and encouraging cognition of social capital was important for active aging.

Development of an objective water security index and assessment of its association with quality of life in urban areas of developing countries.

A composite metric assessing water security's physical dimension at the micro/ community level is lacking but is essential for setting priorities for program and policy implementations. We prepared an objective index (OI) of water security to measure the physical dimension using a model centered on household water-use behavior in developing countries' urban areas. A cross-sectional household survey (n = 1500) with multi-stage cluster design was conducted from December 2015 to February 2016 in the Kathmandu Valley, which has faced long-term, severe water shortage. A structured questionnaire probed socio-demographic characteristics, water sources, frequency and quantity of water use, cost related to water, etc. A 15-item water insecurity scale was used to measure subjective and experiential dimension of water insecurity. The World Health Organization Quality of Life - BREF was used to measure quality of life (QoL). The QoL has been considered as proxy of well-being in this study. The OI measured differential water security within small cities, the utility's service areas for instance, and identified area-specific key dimensions that need improvement. Overall, the OI and its key dimensions can be useful measures to design water-scarcity averting programs and policies, specific to a particular community's needs. The increased OI values were significantly and positively associated with better physical and psychological health and better social relationship domains of QoL suggesting health implications of water security.

Groundwater use and diarrhoea in urban Nepal: novel application of a geostatistical interpolation technique linking environmental and epidemiologic survey data.

Background: Groundwater is a common domestic water source in developing countries, but is persistently contaminated with enteropathogens. However, studies on determinants of diarrhoea have predominantly focused on piped water. This study examines the relationship between groundwater microbial quality and household diarrhoea occurrence (HDO). Methods: Considering it as a proxy of enteropathogens, this study analysed Escherichia coli concentrations in groundwater wells. Ordinary kriging, a geostatistical technique in geographic information systems, was used to interpolate the E. coli concentration to survey points that had secondary survey data (n=942). The relationship between E. coli and HDO using simple and multivariate statistical analyses in SPSS was analysed. Results: A total of 77% of households used groundwater. One-third of households were without piped-water access (PWA), and these households were significantly more likely to use groundwater than those with PWA. Of the 87 households that reported HDO, 77% were groundwater users. Of the groundwater users, the households with HDO consumed groundwater with significantly higher E. coli concentrations than the households without HDO. Of the households without PWA, the increase in the E. coli concentration increased the odds of HDO (adjusted odds ratio=3.15; 95% CI=1.07-9.22). Conclusion: It is suggested that the groundwater microbial quality is a risk factor for HDO and illustrates this by an application of an interpolation technique relevant for developing countries.

Access to improved water and its relationship with diarrhoea in Kathmandu Valley, Nepal: a cross-sectional study.

OBJECTIVE: To assess the associations between diarrhoea and types of water sources, total quantity of water consumed and the quantity of improved water consumed in rapidly growing, highly populated urban areas in developing countries. DESIGN: Cross-sectional analysis using population-representative secondary data obtained from an interview survey conducted by the Asian Development Bank for the 2009 Kathmandu Valley Water Distribution, Sewerage and Urban Development Project. SETTING: Kathmandu Valley, Nepal. PARTICIPANTS: 2282 households. METHODS: A structured questionnaire was used to collect information from households on the quantity and sources of water consumed; health, socioeconomic and demographic status of households; drinking water treatment practices and toilet facilities. RESULTS: Family members of 179 households (7.8%) reported having developed diarrhoea during the previous month. For households in which family members consumed less than 100 L of water per capita per day (L/c/d), which is the minimum quantity recommended by WHO, the risk of contracting diarrhoea doubled (1.56-fold to 2.92-fold). In households that used alternative water sources (such as wells, stone spouts and springs) in addition to improved water (provided by a water management authority), the likelihood of contracting diarrhoea was 1.81-fold higher (95% CI 1.00 to 3.29) than in those that used only improved water. However, access to an improved water source was not associated with a lower risk of developing diarrhoea if optimal quantities of water were not consumed (ie, <100 L/c/d). These results were independent of socioeconomic and demographic variables, daily drinking water treatment practices, toilet facilities and residential areas. CONCLUSIONS: Providing access to a sufficient quantity of water-regardless of the source-may be more important in preventing diarrhoea than supplying a limited quantity of improved water.