Biomedical subjects

Ichiro Kai

Publications and source records attributed to Ichiro Kai.

29 records · Page 2Linked to original sources

PubMed2004

The development of a brief and objective method for evaluating moral sensitivity and reasoning in medical students.

BACKGROUND: Most medical schools in Japan have incorporated mandatory courses on medical ethics. To this date, however, there is no established means of evaluating medical ethics education in Japan. This study looks 1) To develop a brief, objective method of evaluation for moral sensitivity and reasoning; 2) To conduct a test battery for the PIT and the DIT on medical students who are either currently in school or who have recently graduated (residents); 3) To investigate changes in moral sensitivity and reasoning between school years among medical students and residents. METHODS: Questionnaire survey: Two questionnaires were employed, the Problem Identification Test (PIT) for evaluation of moral sensitivity and a portion of the Defining Issues Test (DIT) for moral reasoning. Subjects consisted of 559 medical school students and 272 residents who recently graduated from the same medical school located in an urban area of Japan. RESULTS: PIT results showed an increase in moral sensitivity in 4th and 5th year students followed by a decrease in 6th year students and in residents. No change in moral development stage was observed. However, DIT results described a gradual rising shift in moral decision-making concerning euthanasia between school years. No valid correlation was observed between PIT and DIT questionnaires. CONCLUSION: This study's questionnaire survey, which incorporates both PIT and DIT, could be used as a brief and objective means of evaluating medical students' moral sensitivity and reasoning in Japan.

Attitude of Health Personnel↗

PubMed2004

Effect of preventive home visits for ambulatory housebound elders in Japan: a pilot study.

BACKGROUND AND AIMS: Programs of preventive home visits for ambulatory housebound elders have not yet become established in Japan. The aim of this randomized pilot study was to investigate effects of such visits by public health nurses in Japan. METHODS: A randomized controlled study with 18-month follow-up was conducted in a small Japanese agricultural town. Participants (n=119) were ambulatory housebound elders aged 65 and over, who were able to walk but who went outdoors less than three times a week at baseline survey. They were randomly assigned to intervention (n=59) or control group (n=60). Intervention group subjects received preventive home visits by public health nurses over 18 months (mean home visits=4.3). Control group subjects received usual primary and community care. Activities of daily living (ADLs), functional capacity, self-efficacy for daily activities, self-efficacy for health promotion, depression, and social support were collected via questionnaire at baseline and at the 18-month follow-up point. RESULTS: At follow-up, 81.4% of intervention group subjects were still living at home vs 73.3% of control group subjects (NS). Simple group comparisons following repeated measures (ANCOVA) showed that the intervention group had higher ADL scores than the control group at follow-up (p=0.044). CONCLUSIONS: These pilot results suggest that home visits by public health nurses may be effective in helping to reduce ADL decline among ambulatory housebound elders.

Activities of Daily Living↗

PubMed2004

The effect of aging on functional decline among older Japanese living in a community: a 5-year longitudinal data analysis.

BACKGROUND AND AIMS: Using longitudinal data analyses, we examined the effects of aging on functional decline, based on activities of daily living (ADL) and instrumental activities of daily living (IADL) during a 5-year follow-up among older people living in a community in Japan. METHODS: The baseline survey in July 1988 involved all elderly residents aged 60 or older in Saku City, Nagano, Japan (N=13418). All survivors of this cohort were asked to participate in follow-up surveys conducted in 1989, 1990, 1991, 1992 and 1993. Five items of ADL and five of IADL were measured on each survey. A generalized estimating equations (GEE) analysis was used to examine the effects of aging on the increase of the proportion of subjects with functional dependence. RESULTS: These results indicated that the proportion of subjects who were dependent in ADL increased during the 5-year period by 2.2 times (p<0.001) and the proportion of those who were dependent in either ADL or IADL increased during the same period by 1.8 times (p<0.001). Gender did not appear to be significantly associated with functional decline. CONCLUSIONS: The GEE analysis in this study identified the statistically significant effect of aging on the increase of the proportion of subjects with functional dependence based on ADL and IADL.

Activities of Daily Living↗

PubMed2004

Frequency of going outdoors: a predictor of functional and psychosocial change among ambulatory frail elders living at home.

BACKGROUND: This study investigated the relationship between the frequency of going outdoors among ambulatory frail elders living at home and subsequent functional and psychosocial changes. METHODS: In this 9-month prospective cohort study, data were collected via questionnaire from 112 frail elderly persons living at home and their families. Functional and psychosocial status at baseline and follow-up regarding activities of daily living, functional capacity, depression, self-efficacy for daily activities, self-efficacy for health promotion, and social support, were compared among 3 groups defined by the frequency of going outdoors: 1) more than 4 times a week, 2) 1-3 times a week, 3) less than once a week. At baseline, elders going outdoors more often were less functionally impaired, more socially active, and scored less depressed than elders going outdoors less often. RESULTS: There were significant differences in functional capacity (p=.0201) and intellectual activities (p=.0026) over time according to the frequency of going outdoors, even when controlling for baseline differences, and the scores of those who seldom went outdoors decreased rapidly. There were similar relationships between frequency of going outdoors and changes in self-efficacy for both daily activities (p=.0067) and for health promotion (p=.0245), with participants going outdoors most frequently improving significantly more. CONCLUSIONS: These results suggest that the frequency of going outdoors may be a useful and simple indicator to predict changes in functional capacity, intellectual activity and self-efficacy.

Activities of Daily Living↗

PubMed2004

[Nursing home directors' attitude toward medical decision-making and medical care for elderly people with dementia].

Medical decision-making involving elderly people with dementia often troubles care providers in Japan. Meanwhile, little attention has been paid to the routine medical care of nondementia illnesses in such patients. To understand the current situation surrounding the issue, we conducted a postal survey with nursing home directors across the nation. A self-administered questionnaire was sent to 1,117 randomly selected nursing homes, one third of all such facilities in Japan, and 502 (44.9%) responded. Of the respondents, 291 (58.0%) said more than a half of their residents have difficulties in daily life because of dementia. Less than 20% of the facilities said that they routinely confirm residents' preferences in writing when they are admitted concerning each of the following items; terminal care, medical information disclosure, leaving a will, funerals and application for the guardian system. 206 (41.0%) facilities have difficulties in finding a hospital for the elderly with dementia when necessary. The Mann-Whitney U test showed no significant relation between facilities' characteristics and their difficulties in finding a hospital that would admit demented patients. At present, a number of nursing homes confirm their residents' preferences only some time after they are admitted. However, the way of confirming seems inappropriate under the circumstances in which more than a majority of residents have difficulties in daily life due to dementia. Though more than a half of nursing homes have difficulties in finding a hospital that would admit dementia patients, no significant relation was found between the difficulties and the facility-hospital relation. The problem seems to lie in the acceptance mechanism of hospitals.

Aged↗

PubMed2004

[What kind of family makes a case difficult? Public health nurses' views on home care for the frail elderly].

OBJECTIVE: Public health nurses (PHNs) played the major role in providing care management for the frail elderly before the Long-term Care Insurance started in 2000. Although the role of care management has now shifted to care managers, PHNs are still consulted by such care managers, service providers and families of the elderly about long-term home care. The purpose of this study was to explore the factors that make a case difficult to deal with from PHNs' viewpoint. This study focuses on the factors related to family living in the same household (living-together family). SUBJECTS AND METHODS: The informants of this study were seven PHNs who worked for a city with a population of 67,000 (proportion of elderly in the whole population is 19%) in Nagano Prefecture. First, a focus group interview (about 90 minutes) with the six PHNs was conducted to extract an outline of difficult cases. Next, semi-structured interviews (about 60 minutes each) with five PHNs were conducted to obtain detailed information on difficult cases. The interviews were tape-recorded and transcribed verbatim. KJ analysis was conducted by defining characteristics, finding similar factors, and grouping these together to form categories. RESULTS: Categories of family related problems emerged for each of two major categories: family characteristics and care related problems. Firstly, existing family characteristics, including the existence of mental or psychological disorders, low motivation towards providing long-term care, conflictual familial relationships, objections to having service providers in the home, and economic difficulties contribute to problems in providing long-term care with living-together families. These characteristics can lead to a second set of problems, relating to the actual provision of care by the living-together family to frail elderly patients. These care related problems include including insufficient care, rejection of formal care services, and deviation from care directives, including to the point of physical mistreatment. CONCLUSION: This study points to the need for care providers to consider the living-together family's background and the potential for the phenomena, indicated in this study, to negatively impact on the provision of care for the frail elderly.

Aged↗

PubMed2004

Influence of self efficacy for health promotion on functional decline of elderly living in a rural community in Japan.

OBJECTIVE: To clarify whether self efficacy for health promotion is associated with functional ability among elderly inhabitants of a rural community in Japan. METHODS: The research was a longitudinal study of inhabitants aged 65 and over in a community in Nagano, Japan, who completed a questionnaire at the baseline in 1998 and at follow-up in 1999. The questionnaire included 1) Self Efficacy Scale for Health Promotion measuring the belief in task performance on health, 2) health behavior, 3) a functional ability scale consisting of instrumental activities of daily living, effectance, and social role (Tokyo Metropolitan Institute of Gerontology Index of Competence: TMIG Scale), and 4) demographic factors such as age and sex. RESULTS: At the baseline, 477 subjects completed the questionnaire by themselves and achieved full marks on the TMIG Scale. Of these, 457 responded again 12 months later. Low self efficacy for health promotion at baseline was a significant correlate for functional decline during the 12-month period. CONCLUSION: Self efficacy for health promotion is a predictive factor for functional ability and can be important as an intervention target for elderly people.

Activities of Daily Living↗

PubMed2004

Factors affecting attitudes toward care of elderly mothers.

OBJECTIVE: In this study, we aimed to examine the factors that affect people's attitudes toward parental care. Previous qualitative studies present several factors that affect the decision of adult children of whether to take care of elderly parents or send them to a nursing home when they become fragile and need daily help. In the present study, we included affection, filial obligation, sekentei (i.e., wanting to keep an appearance of taking care), and other factors presented in previous studies. METHODS: In May 2001, we mailed a questionnaire to females in their 30s who live in an agricultural area of K. City, Saitama Prefecture in Japan. We asked the respondents whether they would take care of their mothers or mothers-in-law, or send the mothers to a nursing home when the mothers need 24-hour care in the near future. RESULTS: Logistic regression analysis revealed that filial obligation and sekentei affected attitude toward care in the case of a mother while affection did in the case of a mother-in-law. DISCUSSION: These results suggest that women who do not have intimate feelings towards their mothers-in-law may choose not be a caregiver. On the other hand, women may take care of their mothers, whatever feelings they have because of the blood-relation. Also it may be that in such a small agricultural area, sekentei affects people's conduct, even if it is a private matter, such as caring an elderly mother.

Adult↗

PubMed2003

Perspectives on advance directives in Japanese society: A population-based questionnaire survey.

BACKGROUND: In Japan, discussion concerning advance directives (ADs) has been on the rise during the past decade. ADs are one method proposed to facilitate the process of communication among patients, families and health care providers regarding the plan of care of a patient who is no longer capable of communicating. In this paper, we report the results of the first in-depth survey on the general population concerning the preferences and use of ADs in Japan. METHOD: A self-administered questionnaire was sent via mail to a stratified random sampling of 560 residents listed in the residential registry of one district of Tokyo, Japan (n = 165,567). Association between correlating factors and specific preferences toward ADs was assessed using contingency table bivariate analysis and multivariate regression model to estimate independent contribution. RESULTS: Of the 560 questionnaires sent out, a total of 425 participants took part in the survey yielding a response rate of 75.9 %. The results of the present study indicate that: 1) the most important components to be addressed are the specifics of medical treatment at the end of life stage and disclosure of diagnosis and prognosis; 2) the majority of participants found it suitable to express their directives by word to family and/or physician and not by written documentation; 3) there is no strong need for legal measures in setting up an AD; 4) it is permissible for family and physician to loosely interpret one's directives; 5) the most suitable proxy is considered to be a family member, relative, or spouse. Multivariate analysis found the following five factors as significantly associated with preferences: 1) awareness regarding living wills, 2) experience with the use of ADs, 3) preferences for end-of-life treatment, 4) preferences for information disclosure, and 5) intentions of creating a will. CONCLUSIONS: Written ADs might be useful in the Japanese setting when the individual either wishes: 1) to not provide a lot of leeway to surrogates and/or caregivers, and/or 2) to ensure his or her directives in the cases of terminal illness, brain death, and pain treatment, as well as regarding information disclosure.

Advance Directives↗

PubMed2003

[Intervention study using a fall prevention program to prevent functional decline of old-old elderly in a rural community].

The purpose of this study was to determine the effects of a fall prevention program for old-old elderly in a rural community in Japan. The subjects were 71 inhabitants aged 75 and over who used community health and welfare services such as day services and social activity classes. They were divided into two groups: 34 in the experimental group, and 37 controls. Physical therapists and care staff instructed the experimental group in fall prevention exercises once per two weeks from December 2000 to March 2001. The control group utilized the usual services without any special instructions. All subjects were evaluated by physical performance tests and a self-administered questionnaire before and after 4 months following the intervention. Collected data were analyzed by two-way ANOVA using intervention and time as independent variables, and physical performance tests as dependent variables. Twenty-three of the experimental group and 26 of the control group completed both baseline and follow-up surveys. There were no significant differences in physical ability between the two groups at the time of the baseline survey. The experimental group showed excellent compliance and participated in all sessions during the intervention period. Interaction effects on body mass index and Timed Up and Go Test were shown to be significant (F = 5.623, P < 0.01: F = 6.541, P < 0.05). There were no changes in terms of other physical and psychological factors. Our results showed specific exercises could improve some aspects of physical performance. Since the group exercise program can be effective for old-old elderly, it might contribute to decreasing falls and prolong independent living.

Accidental Falls↗

PubMedDate not supplied

Functional transitions and active life expectancy for older Japanese living in a community.

We examined functional transitions in both the activities of daily living (ADL), and instrumental activities of daily living (IADL), over a 1-year interval among older Japanese living in a community, then estimated their physically active life expectancy (PALE) and instrumentally active life expectancy (IALE). In 1992, all residents aged 65 or older who lived in Saku City, Nagano, Japan, were followed-up over the 1-year interval. A self-administrated questionnaire, which involved age, sex, five ADL items, and five IADL items, was used for each survey in both 1992 and 1993. Of the baseline cohort (n=10,098), we received 9533 analyzable questionnaires at the follow-up survey in 1993. During the follow-up, 92 and 87% of subjects who were initially independent in ADL and IADL remained independent, respectively. PALE for men and women were estimated to be 16.0 and 18.9 at 65 years of age, respectively. IALE for men and for women were estimated to be 12.8 and 14.6 at the age of 65, respectively. Proportions of the PALE to total life expectancy (TLE) at any age did not greatly differ between men and women; however, men had a slightly larger proportion of IALE to TLE at any given age than women.

Journal Article↗