Changes in Health-related Quality of Life Among Impoverished Persons in the Free/Low-Cost Medical Care Program in Japan: Evidence From a Prospective Cohort Study.

BACKGROUND: The Free/Low-Cost Medical Care Program (FLCMC) can subsidize the payment (exempt/lower) in designated institutions in Japan. Given that poverty is a multidimensional concept including social isolation, the FLCMC applicants may need social support over and above financial aid to improve their quality of life. However, there was no data to discuss what services should be provided and to whom. Hence, we aimed to describe the changes in health-related quality of life scores among users of the FLCMC, with respect to their socioeconomic backgrounds. METHODS: This cohort study included patients who newly used FLCMC from July 2018 to April 2019. We used patients' social work records, obtained at baseline, and self-report questionnaires on the Medical Outcomes Study 8 Items Short Form Health Survey (SF-8), measured both at baseline and 6 months after the application. We used the change in physical and mental health component summary scores (PCS-8 and MCS-8, respectively) as outcome variables. RESULTS: Multiple linear regression analyses, adjusting for age, sex, healthcare institute, and baseline PCS-8 and MCS-8, showed that lower income was associated with an increase in PCS-8 (coef. -0.09; 95% CI, -0.15 to, -0.03) and MCS-8 (coef. -0.04; 95% CI, -0.11, to 0.03). Living alone (versus living with someone) was potentially associated with a decrease in both PCS-8 (coef. -1.58; 95% CI, -7.26 to 4.09) and MCS-8 (coef. -3.62; 95% CI, -9.19 to 1.95). CONCLUSION: Among patients using FLCMC, those who live alone may need additional support. Further study testing the generalizability of the findings is required.

Changes in health-related quality of life scores among low-income patients on social welfare programs in Japan during the COVID-19 pandemic: a single-center repeated cross-sectional study.

BACKGROUND: Low-income is one of the well-established determinants of people's health and health-related behavior, including susceptibility to the coronavirus disease 2019 (COVID-19) infection. Two social welfare services are available in Japan to support financial and medical care among low-income patients: Public Assistance (PA), which provide both minimum income and medical costs; and Free/Low-Cost Medical Care (FLCMC), wherein only medical costs were covered. In this study, changes in Health-Related Quality of Life (HRQOL) scores of low-income patients on PA and FLCMC, before and after COVID-19 pandemic, were described and compared against those that are not utilizing the said services (comparison group) to evaluate the contribution of social welfare services in protecting the HRQOL of the beneficiaries during the pandemic. METHODS: We used repeated cross-sectional data of adult beneficiaries of FLCMC and PA, as well as those without social welfare services, who regularly visit the Kamigyo clinic in Kyoto, Japan. We collected the data from 2018 and 2021 using a questionnaire on patients' socioeconomic attributes and the Japanese version of Medical Outcomes Study 12-Item Short Form Health Survey (SF-12). The Japanese version of SF-12 can calculate the three components scores: physical health component summary (PCS), the mental health component summary (MCS), and the role-social component summary (RCS), which can be transformed to a 0-100 range scale with a mean of 50 and standard deviation of 10. RESULTS: Data of 200 and 174 beneficiaries in 2018 and 2021, respectively, were analyzed. Low-income patients on social welfare services had lower PCS, and RCS than the comparison group in both years. Multiple linear regression analyses with cluster-adjusted standard error estimator showed that the decline in MCS was significantly higher among FLCMC beneficiaries than in those without welfare services (Beta: -4.71, 95% Confidence Interval [CI]: -5.79 to -3.63, p < 0.01), and a decline in MCS among PA recipients was also observed (Beta: -4.27, 95% CI: -6.67 to -1.87 p = 0.02). CONCLUSIONS: Low-income beneficiaries of social welfare may have experienced mental health deterioration during the COVID-19 pandemic. To maintain healthy lives during the pandemic, additional support on mental health for low-income recipients of social welfare services may be required.

[Health-related QOL and Life Background of Outpatients Using Free/Low-Cost Medical Care Program].

OBJECTIVES: We investigated the quality of life (QOL) of patients using the Free/Low-Cost Medical Care Program, which is a system that enables people in financial difficulities to receive treatment free of charge or at a low cost. We also investigated the background charateristics and lifestyle of the patients. METHODS: The subjects were 226 outpatients who used the Free/Low-Cost Medical Care Program (use group) and 226 outpatients who did not use the program (non-use group). The method was an anonymous cross-sectional servey by mail. The survey items included basic attributes, health-related QOL (HRQOL), feeling of being poor, lifestyle diseases, lifestyle, and connection with the community. RESULTS: The number of respondants with valid responses was 97 in the use group and 85 in the non-use group. Among the basic attributes, there were a significant differense between the use group and the non-use group in the family structure, type of work, household income, and educational background. The HRQOL scores of the physical and social summary components were significantly lower in the use group than in the non-use group. The HRQOL scores of mental summary component were higher than the national standard HRQOL score in both the use and non-use groups. CONCLUSIONS: In this study, it was considered that old age affected the HRQOL scores of the physical and social components. It was considered from the HRQOL scores of the mental aspect that the use of the Free/Low-Cost Medical Care Program might have contributed to mental stability a certain to extent.

Role of the Frontal Cortex in Standing Postural Sway Tasks While Dual-Tasking: A Functional Near-Infrared Spectroscopy Study Examining Working Memory Capacity.

Posture control during a dual-task involves changing the distribution of attention resources between the cognitive and motor tasks and involves the frontal cortex working memory (WM). The present study aimed to better understand the impact of frontal lobe activity and WM capacity in postural control during a dual-task. High and low WM-span groups were compared using their reading span test scores. High and low WM capacity were compared based on cognitive and balance performance and hemoglobin oxygenation (oxyHb) levels during standing during single (S-S), standing during dual (S-D), one leg standing during single (O-S), and one leg standing during dual (O-D) tasks. For sway pass length, significant difference in only the O-D task was observed between both groups. oxyHb levels were markedly increased in the right dorsolateral prefrontal cortex and supplementary motor area in the high-span group during a dual-task. Therefore, WM capacity influenced the allocation of attentional resources and motor performance.

Brain activity and the perception of self-agency while viewing a video of hand grasping: a functional near-infrared spectroscopy study.

Self-agency is the recognition of one's own movement and plays a vital role in purposeful, voluntary movement. A sense of self-agency can be elicited in individuals who view their own simple finger movements as they are projected onto a screen and aligned with their actual hand position. Here, we examined whether individuals perceived self-agency when they viewed a video of a hand grasping a wooden cylinder and whether the perception of self-agency correlated with simultaneous changes in oxy-hemoglobin in the parietal or the prefrontal cortical areas. All participants reported the perception of self-agency, which was correlated with oxy-hemoglobin increases in the right prefrontal area. We conclude that self-agency also relates to hand-held objects displayed on video.

Brain activity and the perception of self-agency while viewing a video of tool manipulation: a functional near-infrared spectroscopy study.

Self-agency is the recognition of one's own movement and plays a vital role in purposeful, voluntary movement. Self-agency can occur in individuals who view their own finger movements as they are projected onto a screen and aligned with their actual hand position. Self-agency can also occur when tools are assimilated into the body schema. Here, we examined whether participants perceived self-agency when they viewed a video of a tool that they manipulated and whether the perception of self-agency correlated with simultaneous changes in oxyhemoglobin in the parietal or prefrontal cortical areas. All participants reported the perception of self-agency, which was correlated with oxyhemoglobin increases in the right inferior prefrontal area. We conclude that self-agency also relates to hand-held tools displayed by video.