Economic, cognitive, and social paths of education to health-related behaviors: evidence from a population-based study in Japan

BACKGROUND@#There is substantial evidence on the association between lower education and unhealthy behaviors. However, the mechanism underlying this association remains unclear. This study aimed to examine whether income, health literacy, and social support mediate the association between education and health-related behaviors.@*METHODS@#A questionnaire survey was conducted in metropolitan areas in Japan from 2010 to 2011 among residents aged 25-50 years. Data from 3663 participants were used in this study. Health literacy was measured using the Communicative and Critical Health Literacy scale. Health-related behaviors were current smoking, poor dietary habits, hazardous drinking, and lack of exercise. Poisson regression analyses with robust variance estimators were conducted to examine the associations between education and these health-related behaviors. Multiple mediation analyses were conducted to estimate the magnitudes of the mediating effects of income, health literacy, and social support on these associations.@*RESULTS@#Less educated participants had higher risks of all unhealthy behaviors. Income mediated the associations of education with smoking (6.4%) and exercise (20.0%). Health literacy mediated the associations of education with dietary habits (15.4%) and exercise (16.1%). Social support mediated the associations of education with dietary habits (6.4%) and exercise (7.6%). The education-drinking association was mediated by income in the opposite direction (-10.0%). The proportions of the total effects mediated by income, health literacy, and social support were 9.8% for smoking, 24.0% for dietary habits, -3.0% for drinking, and 43.7% for exercise.@*CONCLUSIONS@#These findings may provide clues for designing effective interventions to reduce educational inequalities in health-related behaviors.

Variations and Factors Associated with the Supply and Utilization of Nursing Home Services in Japan and South Korea / 보건행정학회지

Background@#Few studies have examined the performance of the public long-term care insurance (LTCI) from the perspective of geographic equity. This study investigated regional variations and associated factors in the supply and utilization of nursing home care within and also between Japan and Korea. @*Methods@#A comparative dataset was developed by extracting data from 2013–2015 LTCI statistics yearbooks and Organization for Economic Cooperation and Development regional statistics, as well as other comparable data in Japan and Korea. The unit of analysis was the prefecture in Japan and the province in Korea. We computed variation indices and conducted regression analyses for regional variations within each country and decomposition analyses to examine the variations between the countries. @*Results@#The overall regional supply and use of nursing home care were higher in Japan, but the regional variations in Korea were larger than in Japan. In both countries, the nursing home supply was negatively associated with the proportion of older people with independent living. Nursing home use was also negatively associated with the supply of hospital beds and home care agencies in Korea; the relationship was the opposite in Japan, however. The country-based differences were more likely to be explained by differences in the distributions of the variables included in the analytical model than country-specific characteristics. @*Conclusion@#Regional-level nursing home supply and use were unequal in both countries, and the contributing factors were not the same. Policy efforts are needed to advance regional equality in long-term care (LTC) and collaboration between health and LTC institutions for frail older people, especially in Korea.

How do patients and providers react to different incentives in the Chinese multiple health security systems? / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>China has achieved universal health insurance coverage. This study examined how patients and hospitals react to the different designs of the plans and to monitoring of patients by the local authority in the Chinese multiple health security schemes.</p><p><b>METHODS</b>The sample for analysis consisted of 1006 orthopedic inpatients who were admitted between January and December 2011 at a tertiary teaching hospital located in Beijing. We conducted general linear regression analyses to investigate whether medical expenditure and length of stay differed according to the different incentives.</p><p><b>RESULTS</b>Patients under plans with lower copayment rates consumed significantly more medication compared with those under plans with higher copayment rates. Under plans with an annual ceiling for insurance coverage, patients spent significantly more in the second half of the year than in the first half of the year. The length of stay was shorter among patients when there were government monitoring and a penalty to the hospital service provider.</p><p><b>CONCLUSIONS</b>Our results indicate that the different designs and monitoring of the health security systems in China cause opportunistic behavior by patients and providers. Reformation is necessary to reduce those incentives, and improve equity and efficiency in healthcare use.</p>

<b>Successful Treatment of Post-influenza Chronic Fatigue Syndrome </b><b>with Kampo Medicine : a Case Report</b> / 日本東洋医学雑誌

A main symptom of chronic fatigue syndrome (CFS) is fatigue which continues for more than 6 months and does not improve with rest, leading to a marked decrease in quality of life. Other problems include fever, sleep disorder, and headache. Etiologically, a preceding viral infection, immunological disorder, and changes in the central nervous system, especially in hippocampus have been reported. However, the precise pathogenesis of CFS has not been elucidated, and neither diagnostic markers nor effective treatments have yet to be discovered. Here, we report a case of CFS, successfully treated with Kampo medicines.<br>The patient was a 16-year-old high school student, who had received medical therapy for one year under the diagnosis of CFS. His chief complaint was a continuing fever and strong malaise after influenza infection. At his visit to our outpatient clinic, we confirmed that his symptoms met the criteria for CFS. A combination treatment with Kampo medicine (sanoshashinto) and duloxetine improved his malaise and fatigue in 4 weeks, but fever and anorexia remained. The addition of hochuekkito to the combination dramatically ameliorated his symptoms. This case suggests that Kampo medicines would contribute to the effective treatment of CFS, which is refractory to Western medicines.

The association of the number of comorbidities and complications with length of stay, hospital mortality and LOS high outlier, based on administrative data

<p><b>OBJECTIVES</b>With greater concern for efficient resource allocation and profiling of medical care, a case-mix classification was applied for the per-diem payment system in Japan. Many questions remain, one of which is the role of comorbidity and complication (CC) in grouping logic. We examined the association of the number of CC with the length of hospital stay (LOS) and hospital mortality as well as the proportion of LOS high outliers in 19 major diagnostic categories (MDCs).</p><p><b>METHODS</b>This study was a secondary data analysis embedded in a government research project, including anonymous claims and clinical data during a 4-month period from July 2002. Every 19 MDC, LOS, hospital mortality or proportion of LOS high outliers was compared by the number of CC and presence of any procedures.</p><p><b>RESULTS</b>From 82 special function hospitals, 241,268 patients were enrolled in this study. Among all patients, 50.5% were identified without any CCs, 32.4% with one or two, 13.4% with three or four, and 3.7% with over five CCs. The overall mean LOS was 22.15 days and hospital mortality 26.05 cases per 1,000 admissions. In any MDC, LOS and the proportion of outliers increased as the number of CC rose. The mortality rate increased prominently in the respiratory system and the hematology system.</p><p><b>CONCLUSIONS</b>This study demonstrated that the occurrence of more CC caused longer LOS and higher mortality in some major disease categories. Further study will clarify the association of the weighted CC with resource use through controlling procedures specific for MDC.</p>

Effect of Acupuncture on Leukocyte and Lymphocyte Subpopulation in Human Peripheral Blood. Quantitative discussion / 日本温泉気候物理医学会雑誌

To evaluate the effects of acupuncture on the immune system, the leukocyte, monocytes, lymphocyte and lymphocyte surface markers, CD2, CD4, CD8, CD11b, CD16, CD19 and CD56 in the peripheral blood of seventeen healthy volunteers were counted. The leukocyte above CD⁺ cell counts significantly increased after acupuncture. The results indicate that acupuncture may regulate the immune system and can increase the activity of cellular and humoral immunity and NK cell.<br>According to the percentage of lymphocytes or granulocytes, volunteers were divided into two types, those with more than 70% of granulocyte were recognized as G type and those with more than 40% of lymphocyte were divided into L type. Interestingly, before and after the treatment of acupuncture, the number of granulocytes and lymphocytes had a negative relationships. Namely we found an increase in the lymphocytes as well as a decrease in the granulocytes in the G type. On the other hand in the L type, we found an increase in the granulocytes and a decrease in the lymphocytes. Therefore we suggest that acupuncture can enhance the activity that maintains the balance of the immune function.