A Scoping Review of After-Hours House Call Systems and Outcome in Different Countries / 日本プライマリ・ケア連合学会誌

Introduction: We performed a scoping review of after-hours primary care to examine delivery models of after-hours house calls and their use, and conducted outcome evaluation studies of after-hours house calls. Methods: PubMed, Embase, Google Scholar, and Ichuu-shi were used to identify studies published between 2000 and 2021. We selected studies that explained the after-hours house call system or studies that included outcome evaluation. Results: We included 109 studies. The system of after-hours house calls varied in each country. There were one to four research reports on the actual situation of after-hours house calls in each country; however, there were no nationwide reports in Japan. After-hours house calls accounted for the lowest proportion of after-hours care. Only observational studies were found for the impacts of satisfaction and utilization of emergency department services as outcome evaluations for after-hours house-call services. Conclusion: Further research on the after-hours care system is needed, and further discussions based on the results of the study are required.

Weekend and off-hour effects on the incidence of cerebral palsy: contribution of consolidated perinatal care

OBJECTIVE@#This study estimated the effects of weekend and off-hour childbirth and the size of perinatal medical care center on the incidence of cerebral palsy.@*METHODS@#The cases were all children with severe cerebral palsy born in Japan from 2009 to 2012 whose data were stored at the Japan Obstetric Compensation System for Cerebral Palsy database, a nationally representative database. The inclusion criteria were the following: neonates born between January 2009 and December 2012 who had a birth weight of at least 2000 g and gestational age of at least 33 weeks and who had severe disability resulting from cerebral palsy independent of congenital causes or factors during the neonatal period or thereafter. Study participants were restricted to singletons and controls without report of death, scheduled cesarean section, or ambulance transportation. The controls were newborns, randomly selected by year and type of delivery (normal spontaneous delivery without cesarean section and emergency cesarean section) using a 1:10 case to control ratio sampled from the nationwide Japan Society of Obstetrics and Gynecology database.@*RESULTS@#A total of 90 cerebral palsy cases and 900 controls having normal spontaneous delivery without cesarean section were selected, as were 92 cerebral palsy cases and 920 controls with emergent cesarean section. A significantly higher risk for cerebral palsy was found among cases that underwent emergent cesarean section on weekends (odds ratio [OR] 1.72, 95% confidence interval [CI] 1.06-2.81) and during the night shift (OR 2.29, 95% CI 1.30-4.02). No significant risk was found among normal spontaneous deliveries on weekends (OR 1.63, 95% CI 0.97-2.73) or during the quasi-night shift (OR 1.26, 95% CI 0.70-2.27). Regional perinatal care centers showed significantly higher risk for cerebral palsy in both emergent cesarean section (OR 2.35, 95% CI 1.47-3.77) and normal spontaneous delivery (OR 2.92, 95% CI 1.76-4.84).@*CONCLUSION@#Labor on weekends, during the night shift, and at regional perinatal medical care centers was associated with significantly elevated risk for cerebral palsy in emergency cesarean section.

The Association between Continuation of Home Medical Care and Utilization of Other Home Care Services for Older People with Long-term Care Insurance in Japan / 日本プライマリ・ケア連合学会誌

Background: We investigated how individual home care services by nurses, care workers, and therapists at patients' homes are related with the continuation of home medical care service provided by medical doctors.Methods: This research retrospectively analyzed primary insured patients registered with the Japanese long-term care insurance system who had newly started using home medical care service, and whose care level was between 1 and 5 according to national long-term care insurance system claims data. We performed multivariable logistic regression analysis to evaluate patients who used home medical care continuously for >3 months and the utilization of each home care service adjusted for patient age, gender, and care level.Results: A total of 26,590 patients were analyzed. Multivariable analysis revealed that the following home care services were associated with longer continuation of home medical care service compared with home medical care alone: day service (OR, 2.10; 95% CI, 1.98-2.23), home help service (1.91; 1.81-2.01), day care including rehabilitation (1.88; 1.69-2.10), home-visit rehabilitation (1.49; 1.31-1.69), and home-visit nursing (1.23; 1.16-1.31).Conclusions: Our results demonstrated a correlation between utilization of home care services and longer continuation of home medical care from the start. These findings may help medical doctors who provide home medical care service collaborate with other home care services by nurses, care workers, and in-home care therapists.

Emerging Population Ageing Challenges in Africa: A Case of Ethiopia / 国際保健医療

Population ageing is an emerging challenge in Ethiopia whose demographic features indicate slow but steady changes. As of 2010, about 5.1 percent of the Ethiopian population were 60 years old or over whereas 53.1 percent are younger than 15. If current demographic projections for Ethiopia hold, population ageing would accelerate and 10.3 percent of its population, or about 19.4 million people, will join the club of the elderly by 2050.<BR><b>Objective</b><BR>To analyze the trend and possible consequences of population aging in Ethiopia and explore policy options.<BR><b>Method</b><BR>Use date from Demographic and Health Survey and United Nations population estimates and projections to assess the current as well as likely future demographic dynamics in the country.<BR><b>Results</b><BR>Ethiopia is facing daunting demographic growth and population aging challenges without the commensurate financial and infrastructural resources. It is time to pursue policies that jointly address the problems of unsustainable population growth and rapid population aging.

Effect of Maternal Education and Outreach Services on Child Mortality in a Zambian Village / 国際保健医療

<b>Objective</b><br> To examine the effects of the educational status of mothers and outreach services on childhood mortality in a Zambian village<br><b>Methods</b><br> The study design was a cross-sectional descriptive study. A survey was carried out in a village of Zambia in 2007. Five Japanese medical and nursing students interviewed mothers who had children under five years old. A structured questionnaire was used to collect information on social and educational factors and their experience of child deaths. In total, 73 mothers were interviewed, but three subjects were excluded because their records were inadequate. Information on the remaining 70 subjects was analyzed. The relationship between the dependent variable (child death rate per household) and independent variables (mother's characteristics, community circumstances) was examined. In this study, we used “the numbers of babies or young children who had died without defining age by care takers in a household” (child death rate per household) as a measure of child mortality.<br><b>Results</b><br> Of the 70 mothers, 30 were literate (42.9%). 33 mothers received health information from an outreach program and 22 from community health workers (CHWs).<br> The mother's education and the availability of health information from the outreach program were significantly related to lower child death rate per household (p=0.015 and p=0.019 respectively). The relationship between the mother's literacy and child death rate per household also showed an inverse tendency. Mothers with some education who received health information from the outreach program had reduced child death rate per household.<br> After stratification by maternal age (younger or older than 30 years), greater education, literacy and outreach program of the younger mothers were more strongly associated with decreased child death rate per household.<br><b>Conclusions</b><br> Education and community learning are important for the health of children. Maternal educational level and a community-based approach have strong impacts on child survival.