Search

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 six-month-after the application. We used the change in physical and mental health component summary score (PCS-8 and MCS-8) 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). Conclusions Among patients using FLCMC, those who live alone may need additional support. Further study testing the generalizability of the findings is required.

Background: Low-income is one of the well-established determinants of people’s health and health-related behavior including susceptibility to coronavirus disease 2019 (COVID-19) infection. To support financial access to medical care among low-income patients, there are two social welfare services in Japan: Public Assistance (PA) which provide both minimum income and medical costs, and Free/Low-Cost Medical Care (FLCMC) in which only medical costs were covered. The purpose of this study was to describe and compare the changes in Health-Related Quality of Life (HRQOL) scores before and after the COVID-19 pandemic among low-income patients on PA, FLCMC, and the general population, to examine if the social welfare services contributed to protect low-income people’s HRQOL during the pandemic.Methods: We used repeated cross-sectional data obtained from adult patients on FLCMC or PA and 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 about patients’ socioeconomic attributes and Medical Outcomes Study 12-Item Short Form Health Survey (SF-12).Results: We analyzed data of 200 individuals in 2018 and 174 individuals in 2021. Low-income patients on social welfare services had lower physical health component summary (PCS) score, and the role-social component summary (RCS) score than general population in each year. The results of multiple linear regression analyses with robust standard estimator showed that the decline in Mental Component Summary (MCS) score was significantly larger among FLCMC recipients than patients without welfare services (coefficient: -4.71, 95% Confidence Interval: -8.92 to -0.51), while the decline in MCS scores among PA recipients were not significant when compared to the general population.Conclusions: Low-income patients on social welfare services especially on FLCMC experienced the significant decline in MCS scores during COVID-19 pandemic. To maintain mental health of low-income patients on social welfare services in the pandemic, need to be provided with not only social care, but financial livelihood support may also be required.Trial registration: N/A

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.

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.

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.