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ABSTRACT Objective The incidence rates of dementia, mild cognitive impairment, and cancer increase with age, posing challenges to affected individuals and their families. However, there are currently no clear cancer screening guidelines for individuals with cognitive impairment. This study analyzed the impact of carer health literacy on screening behaviors in this population. Methods We conducted a postal follow‐up survey, associated with the National Center for Geriatrics and Gerontology—Life STORIES of People with Dementia, that targeted primary carers to assess their reports regarding patient attendance at regular cancer screenings recommended by the Japanese Ministry of Health, Labor and Welfare, over the preceding 2 years. Screening rates were compared between the memory clinic cohort and the national average, and the influence of carer health literacy level on screening was analyzed. Results Among the 826 total individuals analyzed, the memory clinic cohort exhibited lower breast cancer screening rates, at 11% among female patients aged 65–74 years versus the national average of 32%. Higher health literacy among carers was significantly associated with increased screening. For female patients, carers with high levels of communicative health literacy were more likely to ensure that patients attended screenings for gastric (adjusted odds ratio [AOR], 1.77; 95% confidence interval [CI], 1.03–3.04), colorectal (AOR, 1.70, 95% CI 1.08–2.70), and breast cancers (AOR, 3.08; 95% CI, 1.40–6.76). Among the male patients, high communicative health literacy was associated with increased lung cancer screening attendance (AOR, 1.82; 95% CI, 1.11–2.99). Conclusions Our research highlights a notable gap in cancer screening attendance between individuals with cognitive impairment and the general population, potentially arising from the intricate nature of screening procedures and the extensive burden on carers. More informed decisions and increased screening rates can be achieved through patient‐centric communication strategies that accommodate the cognitive abilities of patients, ensuring the comprehensibility and accessibility of health‐related information.

PurposeThere are few studies in Japan evaluating informational materials about passive smoking prevention with respect to health literacy. This study applied a range of health literacy assessment tools to assess the understandability of public-sector leaflets about passive smoking prevention.MethodsWe collected 26 anti-passive smoking leaflets published online by Japanese prefectural governments. We used three internationally recognized health literacy assessment tools to evaluate their understandability: the Clear Communication Index (CCI), the Suitability Assessment of Materials (SAM), and the Patient Education Materials Assessment Tool (PEMAT, further divided into scales for understandability and actionability).ResultsAlthough none of the assessed materials met the CCI's scoring threshold for “easy to understand,” the highest-scoring leaflet, which received a top-two ranking in three of the four scales (excluding the PEMAT understandability scale), was characterized by its conciseness and its easy-to-understand structure, including the use of checklists and flowcharts to engage reader interest. There was a significant correlation between CCI and SAM, and between SAM and the PEMAT understandability scale. However, the PEMAT actionability scale did not significantly associate with the other assessment scales.ConclusionsThe understandability of written informational materials about passive smoking prevention in Japan could be improved by referring to multiple assessment scales.

Background: In Japan, the doctor-patient relationship has traditionally been characterized by a power imbalance that may contribute to communication gaps. To date, however, the link between patients' health literacy levels and their understanding of doctors' explanations of medical conditions and treatment has yet to be fully examined in Japan. Objective: The purpose of this study was to investigate the association between patients' health literacy level and their understanding of doctors' explanations. Methods: This was a cross-sectional study analyzing data derived from 11,217 questionnaires collected in July 2021 from participants of the Yamagata Study, a community-based cohort study implemented by Yamagata University since 2009. Key Results: The results showed lower health literacy was associated with poorer understanding of physicians' explanations, adjusting for potential confounding factors. In addition to low health literacy, factors associated with lower comprehension were being male, not having a regular family doctor, and having lower self-perceived levels of health and happiness. Conclusions: The results suggest that health care professionals need to communicate with patients according to their health literacy level and ensure they fully understand their medical condition and treatment. Medical providers need to create a better health-literate environment to enable patients and families to make decisions by themselves. [HLRP: Health Literacy Research and Practice. 2024;8(3):e175–e183.]

Introduction/Objective: In Asia, 42% of young children suffer from iron deficiency anemia. Children have an increased requirement for iron intake because of growth and physical activity. Education plays an important role in anemia prevention and in ensuring children are aware of appropriate iron intake and the iron content of different foods. As a tool for this purpose, we adapted the adult version of the Revised Iron Intake Scale (RIIS) to create the Child and Adolescent Version of the Iron Intake Scale (CIIS), using illustrations to help children recognize the foods listed in the CIIS. We aimed to evaluate the validity and reliability of this new scale. Methods: We conducted a cross-sectional study using a self-administered questionnaire to examine the criterion-related validity of the CIIS. We used Spearman’s rank correlation coefficient to compare iron intake estimated by the CIIS with that calculated by the Brief-type Diet History Questionnaire (BDHQ-15y), which assesses respondents’ dietary habits over the past month and is standardized among Japanese children. The survey was repeated twice to examine reliability. Results: We found a moderate positive correlation for iron intake between the CIIS and BDHQ-15y, with a correlation coefficient of .52 (n = 258, P

Older patients with loneliness are connected to others through their social network ties and are, therefore, more likely to be influenced by their family environment. We define collateral care as involving the family members of patients suffering from loneliness. This research letter determines what physicians and nurses should be aware of in the families of older patients to manage their health care. A cross-sectional study in Japan was conducted on patients aged 65 years or older together with their accompanying family members, aged 18 years or older. Patient loneliness was assessed using the 3-item version of the UCLA (University of California, Los Angeles) Loneliness Scale (Japanese). The sample comprised 50 pairs of patients and their families. Family income inadequacy was significantly associated with patient loneliness ( P = .021). Our data reveal the family's financial instability contributes to patients’ loneliness. In addition to traditional forms of direct care, physicians and nurses need to be willing to manage the loneliness of older patients by attempting to provide collateral care, considering family circumstances.

Abstract Aim This study aimed to develop a patient‐centred handbook that integrates information on lifestyle modifications and psychological support strategies for individuals with mild cognitive impairment (MCI). This article provides a comprehensive record of the development process. Methods We adopted a participatory research model for the methodology, which comprised five phases and involved an interdisciplinary team specializing in dementia and health literacy. Data were initially collected via interviews conducted among patients with MCI (n = 5) and their families (n = 5). Given the study's preliminary nature, depth and richness of the qualitative data were the key concerns for determining the sample size, rather than broad generalizability. We ensured the inclusion of diverse experiences and perspectives by facilitating the creation of patient questions (PQs) that merged scientific evidence with patient perspectives. To enhance the handbook's accessibility and utility, we continuously evaluated the same using patient interviews, health literacy tool assessments and team discussions. This comprehensive approach harmonized scientific knowledge and patient experience, leading to the development of a personalized MCI management guide. Results The handbook comprises nine domains, encompassing 38 selected PQs: MCI, lifestyle, lifestyle‐related diseases, exercise, nutrition, social participation, cognitive training, psychological care and family support. The health literacy handbook was evaluated based on Clear Communication Index scores. The results revealed that 73.7% of the PQs were deemed difficult prerevision, whereas only 5.3% remained challenging postrevision. The formative evaluation underscored the need for more detailed explanations prerevision, whereas postrevision comments focused primarily on editorial suggestions. Conclusion The inclusion of patients' perspectives right from the outset ensured that the handbook met their specific needs. The final version, which reflects all stakeholders' inputs, is now slated for imminent publication. Patient or Public Contribution Patients and the public participated extensively throughout the project, from initial interviews to material evaluation and refinement.

We conducted a secondary analysis of the data derived from a cross-sectional survey among parents of school-age children in Japan. The present study explored variables associated with parents’ satisfaction with the local parenting environment. Multivariable logistic regression was used by entering parental satisfaction as a dependent variable and basic and parenting-related items as independent variables. A total of 2218 respondents were stratified by self-determined financial circumstances. A higher proportion of respondents stated low satisfaction with the local parenting environment and support schemes among the financially struggling group (50.4%) than among the non-struggling group (33.8%). Among the financially struggling group, the variables significantly associated with low satisfaction were a lack of parenting support (adjusted odds ratio [aOR] = 1.612) and being unable to use after-school children’s clubs (aOR = 1.747). Our exploratory analysis suggests that after-school children’s clubs can be expected to play a role in widening social networks and community connectedness among parents struggling financially. This role should be reflected in municipal welfare policy.

Objective: Medical advances have resulted in increased survival rates of neurologically impaired children who may require mechanical ventilation and subsequent tracheostomy as a surgical airway. However, at present, there is no definite consensus regarding the timing and methods for placement of a surgical airway in a neurologically impaired intubated child who needs to be cared for over a long-term period. We therefore created a flowchart for the selection of a surgical airway for Neurologically Impaired Pediatric Patients (NIPPs). Methods: The flowchart includes information on the patients’ backgrounds, such as intubation period, prognosis related to reversibility, and history of aspiration pneumonia. To evaluate the importance of the flowchart, first we conducted a survey of pediatricians regarding selection of a surgical airway, and we also evaluated the appropriateness of the flowchart among pediatricians and caregivers through questionnaire surveys which include satisfaction with the decision-making process, and postoperative course after discharge. Results: A total of 21 NIPPs with intubation underwent surgery and a total of 24 participants (14 pediatricians and 10 caregivers) completed the survey. The answers regarding the importance of the flowchart showed that eleven pediatricians had experience selecting of surgical airways, nine of whom had had experiences in which they had to make a difficult decision. The answers regarding the appropriateness of the flowchart revealed that all pediatricians and caregivers were satisfied with the decision-making process and postoperative course after discharge using the flowchart. Conclusions: The present study demonstrated the effectiveness of our flowchart for selecting an appropriate surgical airway in NIPP. By referring to our flowchart, pediatricians and caregivers are likely to be able to select an appropriate surgical airway, leading to increased satisfaction with the decision-making process and postoperative course. Level of Evidence: 4.

To investigate school-age children's perspectives on food and nutrition, we pilot tested a method to quantify and analyze crayon drawings collected from students in health education classes at two elementary schools in Fukushima, Japan. Included were 28 students in a mixed class of first and second graders and 26 students in a fourth-grade class. Specific foods, general shapes, and color choices in children's drawings were entered into a spreadsheet and analyzed quantitatively. From first- and second-graders' data, co-occurrence network analysis put meals into three groups: at home, eating out, and lunch boxes. Among fourth graders, co-occurrence network analysis called attention to the cucumber, noteworthy for being a local agricultural product. In addition, students who drew more side dishes also drew more staple foods and main dishes (p = 0.04), used more colors (p = 0.006), and showed satisfaction with their community (p = 0.04). These results suggest that students' understanding of eating was centered on the places where they eat and that they valued regional specialty products. Furthermore, the drawing of side dishes was indicative of a balanced diet, which in turn was associated with higher satisfaction with their community. Our trial indicates that children's drawings can be a useful tool for adults to grasp children's understanding of health-related information in daily living.

Background: Discrepancies between parents’ reports of paternal parenting have been gaining attention, but epidemiological evidence is scarce in Asia. This study aimed to clarify agreement/discrepancy between paternal and maternal recognition of paternal parenting and the association between actual paternal parenting time and background factors. Methods: Data from couples whose children attended 4-month child health check-ups in Fukushima City were analyzed (N = 509). Based on paternal recognition of paternal parenting (PRPP) and maternal recognition of paternal support (MRPS), couples were classified into four groups. Each group’s paternal household work and parenting time were analyzed. Univariable and multivariable analysis were performed to investigate the association between agreement/discrepancy and background factors of children and parents. Results: Frequency of positive agreement (PRPP+ and MRPS+) was 83.9%, whereas negative agreement (PRPP− and MRPS−) was 2.6%. As for discrepancy, PRPP+ and MRPS− was 8.4% and PRPP− and MRPS+ was 5.1%. Fathers’ total median parenting time was 2 (weekdays) and 6 (weekends) hours, and showed significant differences among the four groups. Multivariable analysis revealed that compared to positive agreement, maternal mental health condition and pregnancy intention were significantly associated with the discrepancy PRPP+ and MRPS−, paternal mental health condition and marital satisfaction with the discrepancy PRPP− and MRPS+, and maternal mental health condition with negative agreement. Conclusions: We identified differences in parenting time and mental health characteristics among couples depending on agreement/discrepancy in recognition of paternal parenting. Assessing both parents’ profiles is necessary in clinical practice to promote paternal participation in childcare.

Background: This study aimed to investigate the effects of maternal exposure to external radiation on perinatal outcomes among women who experienced the Fukushima Daiichi Nuclear Disaster (FDND) using the Fukushima Health Management Survey (FHMS). Methods: Data from the Pregnancy and Birth Survey and Basic Survey in the FHMS were combined to analyze external maternal radiation exposure following the FDND, and the relationship between radiation dose and perinatal outcomes was analyzed using binomial logistic regression analysis. Missing dose data were supplemented using multiple imputation. Results: A total of 6,875 individuals responded to the survey. Congenital anomalies occurred in 2.9% of patients, low birth weight (LBW) in 7.6%, small for gestation age (SGA;

There are limited studies on the long-term effects of natural/environmental disasters, especially nuclear disasters, on obstetric outcomes. This study aimed to review the results of perinatal outcomes immediately after the Great East Japan Earthquake (GEJE) and the Fukushima Daiichi Nuclear Power Plant accident, as well as their long-term trends over 8 years, in the Fukushima Health Management Survey. The annual population-based Pregnancy and Birth Survey is conducted as part of the Fukushima Health Management Survey. The Fukushima Prefecture government launched it to assess the health conditions of pregnant women and their neonates after the GEJE. The self-reported questionnaire was sent to 115,976 pregnant women by mail from January 2012, with 58,344 women responding to the questionnaire (50.3% response rate). Pregnancy complications, such as gestational hypertension, respiratory diseases, and mental disorders, increased in some women who were pregnant at the time of the earthquake and immediately after the earthquake. However, the direct effects on newborns, such as preterm birth, low birth weight, and congenital anomalies, were not immediately clear after the earthquake. Although there were significant differences in the occurrence of preterm birth and low birth weight among the districts, there was no change in the occurrences of preterm birth, low birth weight, or anomalies in newborns in Fukushima Prefecture from the fiscal year 2011 to the fiscal year 2018. Therefore, the long-term effects of the post-disaster radiation accident on perinatal outcomes are considered to be very small.

With the aim of monitoring the mental and physical health of mothers and children following the Fukushima nuclear accident and providing them with necessary care, we have been conducting an annual survey of expectant and nursing mothers since 2011. The Pregnancy and Birth Survey is a mail-in survey of about 15,000 individuals, with a response rate of approximately 50.0% each year. In addition, because respondents to a survey conducted in the immediate aftermath of the disaster showed a particularly high rate of depression, follow-up surveys have been conducted at 4 years after childbirth. Reviewing the results of surveys from FY 2011 through FY 2018, we found that the prevalence of depressive symptoms among mothers was highest in the survey after childbirth and decreased over time. Data of follow-up surveys showed that the prevalence of depression was lower than immediately after childbirth and then decreased over time. The proportion of mothers with radiation anxiety was higher among respondents in the FY 2011 follow-up than in the FY 2014 follow-up, indicating the prolonged impact of the nuclear accident, especially among those who gave birth immediately after the disaster. Characteristics of mothers who received telephone parenting counseling included first delivery, caesarean section, living in evacuation zones, not being able to receive medical examinations as scheduled, and having radiation anxiety. Continuous care should be provided to mothers who gave birth immediately after the nuclear accident, including routine perinatal care and parenting support, provision of information on radiation, and long-term monitoring of their wellbeing.

Loneliness is a serious social issue in Japan. We aimed to examine the frequency and patient characteristics of Japanese family physicians and nurses overlooking or misjudging patient loneliness. This cross-sectional study involved 470 patients aged 50 years or older who visited two family medicine clinics in Fukushima Prefecture in August 2020. Statistical analysis was performed using the chi-squared test and logistic regression models. Patient loneliness was self-assessed using the University of California’s Los Angeles Loneliness Scale. Family physicians and nurses assessed patient loneliness prior to the consultation by independently reviewing medical records for the previous 6 months. For family physicians, the proportion of misjudging loneliness, in which patients self-assessed as not lonely but were perceived to be lonely, was 20.2%. The proportion overlooking loneliness, in which patients self-assessed as lonely but were perceived not to be lonely, was 20.9%. Similarly for nurses, the proportions of misjudging and overlooking loneliness were 9.6% and 29.8%, respectively. The odds of a family physician overlooking loneliness was significantly higher for unmarried, divorced, or bereaved patients than for married (adjusted odds ratio [aOR]: 1.94; 95% confidence interval [CI]: 1.08–3.50), and for patients not participating in community activities compared with those participating (aOR: 2.10; 95% CI: 1.24–3.54). The odds of a nurse misjudging a patient as lonely was significantly higher for unmarried, divorced, or bereaved patients than for married (aOR: 3.02; 95% CI: 1.24–7.36) and for patients living alone compared with those cohabiting with someone (aOR: 3.61; 95% CI: 1.17–11.17). The odds of a nurse overlooking loneliness was significantly higher for patients who did not participate in community activities (aOR: 1.96; 95% CI: 1.26–3.06). These findings indicate that perceiving patient loneliness based on marital status, living arrangements, and involvement in community activities is difficult for family physicians and nurses in Japan.

In the original publication [...]

ObjectivesThis study aimed to fill the gap between Vietnamese diabetic patients' needs and care through a qualitative study asking about their experiences with diabetes and quality of care.MethodsInterviews with five diabetic patients were conducted at a tertiary general hospital located in southern Vietnam. The transcribed data were first subjected to quantitative text analysis using KH Coder to identify major categories of frequently used words, followed by a qualitative analysis of selected cases using the Steps for Coding and Theorization (SCAT) method.ResultsThe major categories of frequently used words were chronic health conditions, services, facilities, insurance, patient-doctor communication, and medication. SCAT analysis of three selected cases identified six themes: “Disregarding the disease at the early stage,” “Fear of complications,” “Satisfaction with hospital services and medical staff,” “Insurance-related problems,” “Long waiting times,” and “Communication barriers between patients and doctors.” Patients were satisfied with improved hospital facilities and services; however, the overloading of one hospital led to long waiting times and communication difficulties with doctors. Difficulties with health insurance were also observed, and patients were rather passive in disease management and needed to be empowered through improved communication with doctors and other care providers.ConclusionThese findings from our trial of introducing a qualitative study into service evaluation suggest that listening to patients can help health providers learn their perspectives and be more responsive to their needs.

ObjectivesThis study aimed to determine the main barriers and reasons for non-adherence to preventive measures and treatment for type 2 diabetes mellitus among outpatients in Belarus.MethodsAn anonymous questionnaire survey was conducted with 814 adults aged 18 years and over who visited outpatient health care units and hospitals in Belarus. The questionnaire was developed to analyze the perceived barriers that limit adherence to preventive measures and treatment for type 2 diabetes.ResultsThe proportion of respondents who reported doing daily physical activity was 53.2%, and 46.6% consumed at least 400 grams of fruit and vegetables per day. Among the 42.8% of respondents with a prescribed treatment for type 2 diabetes mellitus, 50.1% sometimes forgot to take their medicine. The specific barriers to treatment most frequently identified by survey respondents were “Financial situation” (23.5% of respondents), and “Fear of side effects” (25.2%). Those for lifestyle instructions were “Insufficient knowledge” (29.3%), “Financial situation” (27.9%), and “Lack of motivation” (21.7%).ConclusionsThe study revealed that the main barriers to adherence were insufficient knowledge of diabetes and its treatment and an underestimation of the role of behavioral risk factors in health, combined with financial difficulties. We recommend that physicians should take a patient-centered approach to raising awareness of behavioral risk factors for type 2 diabetes mellitus, and suggest that the importance of adhering to preventative measures and treatment should be promoted in consultations in Belarus.

Background and Objectives: Zinc is a micronutrient that plays an important role in metabolism, cell growth regulation, and differentiation. Vietnam has many population groups living in poverty. The daily food of Vietnamese people is mainly rice, which contains very little zinc. This cross-sectional study was conducted to determine the prevalence of, and factors related to, zinc deficiency in women of reproductive age.Methods and Study Design: The sample population was non-pregnant women of reproductive age (18–49 years old) who visited Nguyen Tri Phuong Hospital Gynecological Outpatient Clinic. The subjects were interviewed and data on background characteristics, anthropometric measurements, and blood tests (serum zinc concentration, complete blood count, albumin, and ferritin) were collected.Results: The prevalence of zinc deficiency, as defined by the International Zinc Nutrition Consultative Group (IZiNCG), was 85% [61/72; 95% confidence interval (CI) = 74–91%], and the prevalence of severe zinc deficiency was 37% (27/72; 95% CI = 26–50%). There were significant associations of albumin concentration, marital status, and past pregnancy history with severe zinc deficiency.Conclusions: More than three-fourths of Vietnamese women of reproductive age had zinc deficiency at our study site in Ho Chi Minh City. This health issue requires greater attention in order to swiftly promote preventive actions, and further surveillance to confirm our study findings.

The cerebrospinal fluid (CSF) plays an important role in homeostasis of the brain. We previously demonstrated that major CSF proteins such as lipocalin-type prostaglandin D2 synthase (L-PGDS) and transferrin (Tf) that are biosynthesized in the brain could be biomarkers of altered CSF production. Here we report that the levels of these brain-derived CSF proteins correlated well with each other across various neurodegenerative diseases, including Alzheimer’s disease (AD). In addition, protein levels tended to be increased in the CSF samples of AD patients compared with the other diseases. Patients at memory clinics were classified into three categories, consisting of AD (n = 61), mild cognitive impairment (MCI) (n = 42), and cognitively normal (CN) (n = 23), with MMSE scores of 20.4 ± 4.2, 26.9 ± 1.7, and 29.0 ± 1.6, respectively. In each category, CSF protein levels were highly correlated with each other. In CN subjects, increased CSF protein levels correlated well with those of AD markers, including amyloid-β and tau protein, whereas in MCI and AD subjects, correlations declined with AD markers except p-tau. Future follow-up on each clinical subject may provide a clue that the CSF proteins would be AD-related biomarkers.

Background/Aim: Hypertension occurs frequently in patients taking pazopanib. Therefore, this study aimed to clarify the predictive factors for pazopanib-induced hypertension. Patients and Methods: In total, 47 patients who started pazopanib treatment for renal cell carcinoma or soft tissue sarcoma during hospitalization at Kurume University Hospital from November 2012 to February 2020 were included in the study. Patient background factors associated with pazopanib-induced hypertension were analyzed using a logistic regression model. Subsequently, a time-dependent receiver operating characteristic (ROC) analysis was performed to evaluate changes in the predictive performance of predictors of pazopanib-induced hypertension over time. Results: Logistic regression analysis showed that total bilirubin (t-bil) and sex are predictors of pazopanibinduced hypertension, along with systolic blood pressure (SBP) before pazopanib introduction. Additionally, evaluation of area under the curve (AUC) changes over time during the first 20 days of pazopanib treatment using time-dependent ROC showed that the AUC tended to be higher in the first half for SBP and in the second half for t-bil. Moreover, models including these two factors (SBP+t-bil and SBP+tbil+ sex) maintained a higher AUC from the early to late stages of the treatment period. Conclusion: Total bilirubin and sex can serve as predictors of pazopanib-induced hypertension. Total bilirubin may contribute to the prediction of the development of hypertension after day 5. [ABSTRACT FROM AUTHOR]

Background and Objectives: To examine the reliability and validity of the Japanese version of the Dutch Eating Behavior Questionnaire (DEBQ-J) for patients with mental illness, and to determine the characteristics of eating behavior among these patients when compared with healthy controls. Methods and Study Design: In May 2018, 120 outpatients with mental illness and 132 healthy controls were surveyed. First, exploratory factor analysis was conducted on the DEBQ-J statement responses for both patients and healthy controls. Next, reliability coefficients were calculated for the eating behavior scale scores (emotional, restrained, and external eating) extracted from the factor analysis. The association between BMI and eating behavior was examined using Student's t-test and Pearson's correlation coefficient. Results: The DEBQ-J had a similar factor structure to that of the original DEBQ for healthy controls, with a cumulative contribution of 52.4% for the three factors, and alpha coefficients ranging from 0.87 to 0.91. For patients, factor analysis showed that four statements classified as emotional eating items in the original DEBQ were recategorized as external eating items, and the percentage of patients with obesity (BMI=25) was 57.5%, compared with only 25.4% among the healthy controls. The patients with obesity tended to score higher on the external eating scale than did those with BMI<25. Conclusions: Patients tended to blur the distinction between emotional feelings of mental irritability or anxiety and feelings in response to external stimuli. Monitoring of the DEBQ-J external eating score and appropriate intervention among patients living with mental illness may help to prevent obesity. [ABSTRACT FROM AUTHOR]