The Circulatory Dynamics Reactions of Elderly Community Residents during Bathing: Differences Resulting from Immersion Methods and Temperatures / 日本温泉気候物理医学会雑誌

  【Purpose】The number of deaths in the bathtub in the home is increasing year by year, of which about 90% are people over 65 years old. The purpose of this study was to verify the hypothesis that the effect on the circulatory dynamics would be less if one took a half-body bath first and then a whole- body bath after a certain period of time, rather than suddenly taking a whole- body bath.  【Methods】The subjects were ten healthy community elderly men (70.3 ± 4.0 years old). The subjects were bathed at 39°C and 41°C, respectively, with two immersion methods of a 6-min whole body bath and a 3 min whole-body bath after a 3 min half-bath (6 min total). Measured items were systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse (PR), oxygen saturation (SpO2), and forehead skin temperature. The subjective thermal sensation and comfort were also confirmed verbally. Measurements were carried out in the sitting posture before bathing, within 1 min after bathing, after 2 min, 3 min, and 5 min, just after the bath, and 5 min after sitting rest.   【Results】In both SBP (p = .010) and DBP (p = .019), the interaction between bathing conditions and measurement time was significant. SBP was greatly affected by temperature regardless of whether or not stepped immersion was used, and blood pressure decreased immediately after bathing at 41°C. DBP showed a significant decrease during bathing at 41°C compared with the whole-body bath after half-body bathing.  【Discussion】The SBP was markedly decreased immediately after taking a bath at a temperature of 41°C regardless of whether or not the subject was gradually immersed. It is thought that the condition is similar to that of orthostatic hypotension. Furthermore, DBP also showed a decrease of 10 mmHg or more, corresponding to changes during orthostatic hypotension, when bathing only with a whole-body bath at a temperature of 41°C. On the other hand, in the whole-body bath after half-body bathing, the decrease in DBP was less than 10 mmHg even at 41°C.

Rehabilitation services for inpatients with stroke in a provincial hospital in Papua New Guinea: a retrospective observational study

@#Objective: Papua New Guinea (PNG) is the largest of the Pacific Island countries that is facing challenges related to the burden of cerebrovascular disease. There are few reports on rehabilitation services for inpatients with cerebrovascular disease, including stroke. This study aimed to examine the provision of rehabilitation services, physical therapy (PT) and service outcomes in PNG. Methods: A sub analysis of our previous retrospective observational study at a single provincial hospital in PNG was conducted in which patient records of all inpatients (Total group, n = 12,241) and those of inpatients receiving rehabilitation services (PT group, n = 350) were reviewed, and the records of inpatients with cerebrovascular disease were extracted for analysis. For descriptive purposes, demographic data, service provision statistics (length of hospital stay and duration and frequency of PT services provided) and gait function were summarized. Results: The final analysis comprised 50 of 12,241 records in the Total group and 34 of 350 records in the PT group. All of these studied patients suffered a stroke. The dominant age in both groups was ≥40 years. The median length of stay in hospital was 9 days in the Total group. The median frequency and duration of PT services were 4 times and 8.5 days, respectively. Of the 34 inpatients in the PT group, 32 (94%) were discharged with poor gait function defined as ‘dependent or no walking function’. Conclusions: The results implied that stroke patients who were discharged with poor gait function and restarted their life in the community would confront significant barriers and challenges in PNG. This first report, to our knowledge, on rehabilitation services for stroke in PNG may provide a reference point for further clinical research.

Characteristics of inpatients with four major non-communicable diseases receiving rehabilitation services in a Pacific island country, Papua New Guinea: a subanalysis of a retrospective observational study

@#Papua New Guinea (PNG) is one of the Pacific island countries facing a noncommunicable disease (NCD) crisis. Little has been reported about rehabilitation services for them. This study aimed to describe the characteristics of inpatients with the four major NCDs receiving rehabilitation services in PNG: cardiovascular disease (CVD) (divided into cerebrovascular disease and ischaemic heart disease), diabetes, cancer and respiratory disease. We conducted a subanalysis of our previous study. We reviewed the inpatient records of all inpatients (12,241 records, Total group) and those of inpatients receiving rehabilitation services by physical therapy (PT) (350 records, PT group). After extracting the records of patients with NCDs, we investigated the demographic data, diagnostic data and gait function. We calculated the percentages of inpatients’ characteristics and the ratio of the number of inpatients in the PT group to that in the Total group by diagnosis (PT ratio). The final analysis included 442 records in the Total group and 68 records in the PT group. Diagnoses and percentages in the PT group were cerebrovascular disease (65%), diabetes (22%), cancer (9%), respiratory disease (4%) and ischaemic heart disease (0%). The PT ratio was the highest in cerebrovascular disease (0.88), followed by diabetes (0.16) and other diagnosis (≤0.05). The inpatients with cerebrovascular disease and diabetes were more likely to have poor gait function than those with other NCDs. Our findings suggested that the provision of rehabilitation services for inpatients with the four NCDs was limited and biased for specific conditions. For development of rehabilitation services for patients with NCDs in PNG, scaling up the service provision and expanding its scope would be a possible way forward

The Circulatory Dynamics Reactions of Elderly Community Residents during Bathing: Differences Resulting from Immersion Methods and Temperatures / 日本温泉気候物理医学会雑誌

  【Purpose】The number of deaths in the bathtub in the home is increasing year by year, of which about 90% are people over 65 years old. The purpose of this study was to verify the hypothesis that the effect on the circulatory dynamics would be less if one took a half-body bath first and then a whole- body bath after a certain period of time, rather than suddenly taking a whole- body bath.  【Methods】The subjects were ten healthy community elderly men (70.3 ± 4.0 years old). The subjects were bathed at 39°C and 41°C, respectively, with two immersion methods of a 6-min whole body bath and a 3 min whole-body bath after a 3 min half-bath (6 min total). Measured items were systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse (PR), oxygen saturation (SpO2), and forehead skin temperature. The subjective thermal sensation and comfort were also confirmed verbally. Measurements were carried out in the sitting posture before bathing, within 1 min after bathing, after 2 min, 3 min, and 5 min, just after the bath, and 5 min after sitting rest.   【Results】In both SBP (p = .010) and DBP (p = .019), the interaction between bathing conditions and measurement time was significant. SBP was greatly affected by temperature regardless of whether or not stepped immersion was used, and blood pressure decreased immediately after bathing at 41°C. DBP showed a significant decrease during bathing at 41°C compared with the whole-body bath after half-body bathing.  【Discussion】The SBP was markedly decreased immediately after taking a bath at a temperature of 41°C regardless of whether or not the subject was gradually immersed. It is thought that the condition is similar to that of orthostatic hypotension. Furthermore, DBP also showed a decrease of 10 mmHg or more, corresponding to changes during orthostatic hypotension, when bathing only with a whole-body bath at a temperature of 41°C. On the other hand, in the whole-body bath after half-body bathing, the decrease in DBP was less than 10 mmHg even at 41°C.

Development of a Social Capital Index for Good Health in Rural Residents / 日本農村医学会雑誌

　　This study sought to develop a social capital index that can contribute to good health in rural communities. A questionnaire was mailed to 7,114 residents of Village A aged 20 years and over in June 2016. A total of 1,327 questionnaires were returned; 4 unfilled forms were eliminated from the analysis and the remaining 1,323 were used to develop a rural community social capital index comprising 4 concepts and 16 items. The goodness of fit of the model was satisfactory, and comparison with other scales confirmed its validity. The model is also associated with the outcomes of self-evaluation of health, sleep status, elderly life competence, frequency of social outings, and Global Deterioration Scale score of 5, thus confirming its criterion-related validity. The reliability of the index was also good with a Cronbach's α value ≥ 0.80 for each concept and all 16 indices. The rural community social capital index developed in this study will help establish healthy communities. Studies of other rural areas are anticipated to accumulate research outcomes.

Qualitative Analysis of Potential Health Benefits of Social Capital in Rural Community - Based on Data Obtained Through Group Interviews with Old People / 日本農村医学会雑誌

　　This study was conducted to identify regional characteristics of salubrious aspects of social capital in a rural community. For this purpose, group interviews took place with three groups, each consisting of six to nine people aged 65 and older in Village A and what those interviewees said with reference to social capital were analyzed qualitatively and descriptively. A total of 610 views were extracted and organized into 141 codes, from which 20 codes that seemed to characterize the rural community in general were sampled and were divided into four categories and eight subcategories. The four categories were made up of “communing with nature,” “maintaining a relationship of trust among community members,” “regarding social norms highly,” and “encouraging social intercourse among individuals and families, and networking.” Thebenefits of social capital in the village to the health showed characteristics of Japanese rural communities - close links among community members who have communed with nature. There were plenty of indications showing a solidarity type of social capital based on a shared territorial bond strengthened in the milieu of a rural community where people had kept cultivating lands from generation to generation. There were also indications that a growing number of people had become aware of the need to strengthen networking from the viewpoint of a bridge type of social capital. The present study has afford us useful hints for maintaining the health of the aged in rural areas as well as for building a community very pleasant to live in.