An mHealth App (eSkinHealth) for Detecting and Managing Skin Diseases in Resource-Limited Settings: Mixed Methods Pilot Study.

BACKGROUND: In sub-Saharan Africa, the disease burden from skin diseases, including skin-related neglected tropical diseases (skin NTDs), is extremely high. These diseases often are overlooked due to limited access to health care stemming from, for example, remote geographical locations and a lack of experts. To address these gaps, we developed a mobile health app, eSkinHealth, which is a field-adapted platform to serve as a portable electronic patient chart and for teledermatology. OBJECTIVE: The purpose of the study is to evaluate the usability and effectiveness of the app in rural Côte d'Ivoire for diagnosing and managing skin NTDs and other skin diseases. METHODS: A 2-arm trial with local health care providers and patients with skin diseases was implemented over a 3-month period. The providers were assigned to an intervention receiving the eSkinHealth app or control with usual care. Four nurses and 8 community health care workers participated in each arm. The training was provided on the use of the app to the intervention arm only, while both arms were trained on skin diseases. For the usability study, we evaluated our approach with the System Usability Scale (SUS) and in-depth interviews. For the effectiveness study, our primary outcome was to evaluate the detection and management of 5 skin NTDs as our targeted diseases, namely, Buruli ulcer, leprosy, lymphatic filariasis, scabies, and yaws, using the eSkinHealth app. Procedures of our methods were reviewed and approved by the institutional review board of the Ministry of Health and by Tulane University. RESULTS: The mean age of our participants (providers) was 40.5 and 42.5 years for the intervention and control arms, respectively, and all were male (n=24). The average SUS scores taken from the intervention arm at baseline, the midpoint (6 weeks), and the end of study (12 weeks) were 72.3 (SD 11.5), 72.3 (SD 12.4), and 86.3 (SD 10.8), respectively. All participants interviewed, including 4 dermatologists and program managers, were satisfied with the app. Especially community health care workers felt empowered by being equipped with the tool. A total of 79 cases of skin NTDs were reported in the intervention arm as compared to 17 cases in the control arm (P=.002). Besides the skin NTDs, more skin diseases and conditions were reported from the control than from the intervention arm (P<.001). However, 100 cases (66%) were not given any particular diagnosis in the control arm and were documented only as a "dermatosis." In the intervention arm, 151 cases (72.9%) were diagnosed within the eSkinHealth platform, and the remaining were diagnosed on-site by dermatologists. CONCLUSIONS: The study provided evidence for the usability and effectiveness of the eSkinHealth app embedded into our surveillance approach to improve the detection and management of skin NTDs and other skin diseases in Côte d'Ivoire and, furthermore, is expected to contribute to knowledge on mobile health approaches in the control of skin diseases in resource-limited settings. TRIAL REGISTRATION: ClinicalTrials.gov NCT05300399; https://clinicaltrials.gov/ct2/show/NCT05300399.

Impact of an Electronic Medical Record-Connected Questionnaire on Efficient Nursing Documentation: Usability and Efficacy Study.

BACKGROUND: Documentation tasks comprise a large percentage of nurses' workloads. Nursing records were partially based on a report from the patient. However, it is not a verbatim transcription of the patient's complaints but a type of medical record. Therefore, to reduce the time spent on nursing documentation, it is necessary to assist in the appropriate conversion or citation of patient reports to professional records. However, few studies have been conducted on systems for capturing patient reports in electronic medical records. In addition, there have been no reports on whether such a system reduces the time spent on nursing documentation. OBJECTIVE: This study aims to develop a patient self-reporting system that appropriately converts data to nursing records and evaluate its effect on reducing the documenting burden for nurses. METHODS: An electronic medical record-connected questionnaire and a preadmission nursing questionnaire were administered. The questionnaire responses entered by the patients were quoted in the patient profile for inpatient assessment in the nursing system. To clarify its efficacy, this study examined whether the use of the electronic questionnaire system saved the nurses' time entering the patient profile admitted between August and December 2022. It also surveyed the usability of the electronic questionnaire between April and December 2022. RESULTS: A total of 3111 (78%) patients reported that they answered the electronic medical questionnaire by themselves. Of them, 2715 (88%) felt it was easy to use and 2604 (85%) were willing to use it again. The electronic questionnaire was used in 1326 of 2425 admission cases (use group). The input time for the patient profile was significantly shorter in the use group than in the no-use group (P<.001). Stratified analyses showed that in the internal medicine wards and in patients with dependent activities of daily living, nurses took 13%-18% (1.3 to 2 minutes) less time to enter patient profiles within the use group (both P<.001), even though there was no difference in the amount of information. By contrast, in the surgical wards and in the patients with independent activities of daily living, there was no difference in the time to entry (P=.50 and P=.20, respectively), but there was a greater amount of information in the use group. CONCLUSIONS: The study developed and implemented a system in which self-reported patient data were captured in the hospital information network and quoted in the nursing system. This system contributes to improving the efficiency of nurses' task recordings.

The effectiveness of a therapeutic robot, 'Paro', on behavioural and psychological symptoms, medication use, total sleep time and sociability in older adults with dementia: A systematic review and meta-analysis.

OBJECTIVE: To evaluate the effectiveness of a therapeutic robot, 'Paro', on anxiety, agitation, depression, apathy, medication use, total sleep time, and sociability among older adults with dementia. DESIGN: Systematic review and meta-analysis with narrative synthesis. SETTING AND PARTICIPANTS: Older adults aged 60 years and above with any form of dementia in the community, nursing homes, or care facilities. METHODS: A three-step search strategy was conducted by two independent reviewers. Nine databases were searched (January 2003 to November 2022). Randomised controlled, crossover, and cluster trials on Paro for older adults with dementia published in English were included. All relevant trials were screened and assessed for risk of bias. Data were extracted using the Cochrane data collection form. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) was used to assess the quality of evidence. RESULTS: In total, 12 articles involving 1461 participants were included. Results of the meta-analysis showed that Paro had a moderate effect on medication use (SMD: -0.63) and small effect on anxiety (SMD: -0.17), agitation (SMD: -0.27) and depression (SMD: -0.40). However, Paro exhibited negligible effect on total sleep time (SMD: -0.12). The overall quality of evidence for all outcomes were graded as low due to methodological limitations, small sample size, and wide confidence intervals. Narrative synthesis suggested that Paro reduced apathy and increase sociability. CONCLUSION AND IMPLICATIONS: Paro could be a beneficial non-pharmacological approach to improve behavioural and psychological symptoms of dementia, reducing medication use, and increasing sociability for older adults with dementia. However, the results should be interpreted with caution as limited studies were available. Additionally, there were a variety of approaches across the studies (i.e. group and individual interventions, facilitated and non-facilitated) which made it difficult to determine which interventional approach is optimal to produce beneficial effects of Paro. Hence, more rigorous studies with a larger sample size are needed to fully understand the mechanism and effectiveness of Paro in older adults with dementia. The protocol was registered on PROSPERO (CRD42022296504).

Myelin oligodendrocyte glycoprotein antibody-associated disease in a patient with symptoms of aseptic meningitis who achieved spontaneous remission: A case report and review of the literature.

BACKGROUND: A few case reports have described patients with myelin oligodendrocyte glycoprotein antibody (MOG-Ab)-associated demyelinating syndrome who presented with symptoms of aseptic meningitis. All such patients required immunotherapy. We report a patient with MOG-Ab-associated disorder (MOGAD) who presented with symptoms of aseptic meningitis and improved without treatment. CASE: A 13-year-old girl presented with fever, headache, decreased appetite, and neck stiffness. Cerebrospinal fluid (CSF) analysis revealed pleocytosis and magnetic resonance imaging (MRI) showed leptomeningeal enhancement. The patient was diagnosed with aseptic meningitis at admission. However, there were no signs of recovery 4 days after admission (i.e., 8 days after disease onset). Therefore, we performed extensive investigations to identify the cause of the underlying infection and inflammation. On day 14 after admission, the serum MOG-Ab test performed at admission came back positive (1:128) and she was diagnosed with MOGAD. She was discharged on day 18 after admission, because her symptoms, CSF pleocytosis, and MRI findings had improved. About 6 weeks after discharge, MRI revealed hyperintensity without gadolinium enhancement. However, her serum MOG-Ab test was negative. We did follow-ups for 11 months but found no new neurological symptoms. DISCUSSION AND CONCLUSION: To the best of our knowledge, this is the first ever report of a pediatric patient with MOGAD experiencing spontaneous remission with no demyelinating symptoms during an extended follow-up period.

Does Smartphone Use Make Older Adults Feel Younger? A Cross-Sectional Online Survey during the COVID-19 Pandemic.

Subjective age (i.e., how old one feels) has been found to be a biopsychosocial marker of aging. This study examined the associations between subjective age and the frequency of information and communication technology (ICT) usage by older adults. Data were collected via an online survey conducted in 2020 during the COVID-19 pandemic. The study analyzed responses from participants aged 65 to 89 (M = 71.9, SD = 3.9) who resided in Japan (N = 1631, 52.8% female). Subjective age was indexed by asking participants to specify in years how old they felt. Proportional discrepancy scores (PDS) were calculated to indicate younger or older subjective age and were used as an independent variable. Participants were asked about the frequency of computer, smartphone, flip phone, tablet, and social networking service (SNS) use. Two-thirds of the participants (63.6%) reported feeling younger than their actual age. Nearly 90% reported using computers for more than 2-3 days a week, while 64.3% reported smartphone use, 22.9% reported flip phone use, and 36.6% reported SNS use. Logistic regression analyses revealed that a lower PDS (i.e., feeling younger) was associated with a significantly higher frequency of smartphone use (OR: 0.77; 95% CI: 0.60, 0.98) after adjusting for potential confounders. No such association was found for computer, flip phone, tablet, or SNS use. Our study found that feeling younger was associated with a higher frequency of smartphone use. The daily use of smartphones may have helped older adults stay in touch with family and friends and obtain the information that they needed, which may have contributed to better psychological well-being outcomes, especially during the COVID-19 pandemic.

Identification of mild cognitive impairment subtypes predicting conversion to Alzheimer's disease using multimodal data.

Mild cognitive impairment (MCI) is a high-risk condition for conversion to Alzheimer's disease (AD) dementia. However, individuals with MCI show heterogeneous patterns of pathology and conversion to AD dementia. Thus, detailed subtyping of MCI subjects and accurate prediction of the patients in whom MCI will convert to AD dementia is critical for identifying at-risk populations and the underlying biological features. To this end, we developed a model that simultaneously subtypes MCI subjects and predicts conversion to AD and performed an analysis of the underlying biological characteristics of each subtype. In particular, a heterogeneous mixture learning (HML) method was used to build a decision tree-based model based on multimodal data, including cerebrospinal fluid (CSF) biomarker data, structural magnetic resonance imaging (MRI) data, APOE genotype data, and age at examination. The HML model showed an average F1 score of 0.721, which was comparable to the random forest method and had significantly more predictive accuracy than the CART method. The HML-generated decision tree was also used to classify-five subtypes of MCI. Each MCI subtype was characterized in terms of the degree of abnormality in CSF biomarkers, brain atrophy, and cognitive decline. The five subtypes of MCI were further categorized into three groups: one subtype with low conversion rates (similar to cognitively normal subjects); three subtypes with moderate conversion rates; and one subtype with high conversion rates (similar to AD dementia patients). The subtypes with moderate conversion rates were subsequently separated into a group with CSF biomarker abnormalities and a group with brain atrophy. The subtypes identified in this study exhibited varying MCI-to-AD conversion rates and differing biological profiles.

The Early Detection and Case Management of Skin Diseases With an mHealth App (eSkinHealth): Protocol for a Mixed Methods Pilot Study in Côte d'Ivoire.

BACKGROUND: There is a high prevalence of skin diseases sub-Saharan Africa, including skin neglected tropical diseases (NTDs) that could lead to lifelong disabilities and deformities if not diagnosed and treated early. To achieve early detection and early treatment of these skin diseases, we developed a mobile health app, eSkinHealth. OBJECTIVE: This paper outlines a protocol for evaluating the effect of our eSkinHealth app in the early detection and effective management of skin diseases in Côte d'Ivoire. METHODS: A mixed methods pilot trial will be conducted in Côte d'Ivoire and will consist of 3 phases: (1) the development and improvement of the eSkinHealth app, (2) a pilot trial to evaluate the usability of the eSkinHealth app for local medical staff in Côte d'Ivoire, and (3) a pilot trial to evaluate the effectiveness of early detection and case management of targeted skin NTDs (Buruli ulcer, leprosy, yaws, and lymphatic filariasis) with the eSkinHealth app in Côte d'Ivoire. The pilot study will be implemented as a 2-arm trial with local health care providers and patients with skin NTDs over a 3-month follow-up period. The local health care providers will be assigned to an intervention group receiving the eSkinHealth app to be used in their daily practices or a control group. Training will be provided on the use and implementation of the app and the diagnostic pipeline to the intervention group only, while both groups will receive training on skin diseases. Our primary outcome is to evaluate the early detection and effective management of skin diseases using the eSkinHealth app in Côte d'Ivoire by the number of cases diagnosed and managed. Additionally, we will evaluate the eSkinHealth app with validated questionnaires and in-depth interviews. Procedures of our methods have been reviewed and approved by the Institutional Review Board of the Ministry of Health, Côte d'Ivoire and by Tulane University in 2021. RESULTS: This study was funded in 2021. We started the enrollment of patients in February 2022, and data collection is currently underway. We expect the first results to be submitted for publication in 2023. CONCLUSIONS: Our eSkinHealth app is a field-adapted platform that could provide both direct diagnostic and management assistance to health workers in remote settings. The study will provide evidence for the usability and the effectiveness of the eSkinHealth app to improve the early detection and case management of skin NTDs in Côte d'Ivoire and, furthermore, is expected to contribute to knowledge on mobile health approaches in the control of skin NTDs. TRIAL REGISTRATION: ClinicalTrials.gov NCT05300399; https://clinicaltrials.gov/ct2/show/study/NCT05300399. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/39867.

Evaluation of the Usability of a Mobile Application on Neglected Skin Diseases in Côte d'Ivoire: A Pilot Study.

This study investigated the usability of a mobile phone-based system, "eSkinHealth", for healthcare providers in Côte d'Ivoire. The eSkinHealth can be used both online and offline to address the poor Internet connectivity of these rural settings. Data recorded in the mobile application were synchronized with an online database, and specialists in Abidjan, Côte d'Ivoire and in Japan advised local healthcare providers on difficult cases. In this pilot study, 21 healthcare providers used the eSkinHealth and completed questionnaires assessing the usability. The average score of a system usability scale for eSkinHealth was 84.2 (SD 11.7), which can be interpreted as excellent. The average registration for patient information (e.g., name, sex, age, area of residence) was 8.6 (SD 15.5). Further studies with more targeted areas and participants are needed to evaluate the usability of eSkinHealth in rural Côte d'Ivoire.

Factors Related to Acceptance to Use Care Technologies for Bathing Among Middle-Aged Adults: A Cross-Sectional Study.

A dearth of evidence remains regarding the acceptance of care technologies by middle-aged adults that will need long-term care in the future. Therefore, we identified the factors associated with the acceptance of care technologies for bathing among middle-aged adults in Japan. Of the 1937 participants, 1553 participants were willing to receive bathing assistance from care technologies. The factors positively related to the acceptance of care technologies were female sex and higher educational levels.

Comparison of the Mental Burden on Nursing Care Providers With and Without Mat-Type Sleep State Sensors at a Nursing Home in Tokyo, Japan: Quasi-Experimental Study.

BACKGROUND: Increasing need for nursing care has led to the increased burden on formal caregivers, with those in nursing homes having to deal with exhausting labor. Although research activities on the use of internet of things devices to support nursing care for older adults exist, there is limited evidence on the effectiveness of these interventions among formal caregivers in nursing homes. OBJECTIVE: This study aims to investigate whether mat-type sleep state sensors for supporting nursing care can reduce the mental burden of formal caregivers in a nursing home. METHODS: This was a quasi-experimental study at a nursing home in Tokyo, Japan. The study participants were formal caregivers who cared for residents in private rooms on the fourth and fifth floors of the nursing home. In the intervention group, formal caregivers took care of residents who used sleep state sensors on the fourth floor of the nursing home. The sleep state sensors were mat types and designed to detect body motion such as the frequency of toss and turning and to measure heartbeat and respiration. One sensor was placed on a bed in a private room. When body motion is detected, the information is instantly displayed on a monitor at a staff station. In addition, the mental condition of the formal caregivers was measured using a validated self-reported outcome measure-the Profile of Mood States (POMS), Short-Form, 2nd edition. Formal caregivers in both groups received the POMS at baseline, midpoint (week 4), and endpoint (week 8) to identify changes in these domains. The primary outcome was the difference in total mood disturbance (TMD) of the POMS at baseline and week 8. RESULTS: Of the 22 eligible formal caregivers, 12 (intervention group) utilized sleep state sensors for 8 weeks. The remaining 10 formal caregivers (control group) provided nursing care as usual. As for the primary outcome of the difference between TMD at baseline and week 8, TMD in the intervention group improved by -3.67 versus 4.70 in the control group, resulting in a mean difference of -8.37 (95% CI -32.02 to 15.29; P=.48) in favor of the intervention. CONCLUSIONS: The present 8-week study showed that sleep state sensing for elderly residents might not be associated with reduced mental burdens on formal caregivers in nursing homes.

Effectiveness of technology-based interventions on psychological morbidities, quality of life for informal caregivers of stroke survivors: A systematic review and meta-analysis.

AIMS: To evaluate the effectiveness of technology-based interventions in reducing psychological morbidities such as depressive symptomology, anxiety, burden and improving quality of life and self-efficacy in informal caregivers of stroke survivors. DESIGN: A systematic review and meta-analysis. DATA SOURCES: An extensive search was systematically undertaken at CENTRAL, PubMed, Embase, Scopus, CINHAL, Web of Science and PsycInfo until January 2021. Grey literature and dissertations were searched in Google Scholar, ProQuest & Scholarbank@NUS. Studies involving registered trials were retrieved from Clinicaltrials.gov and CENTRAL, respectively. REVIEW METHODS: Two reviewers independently screened the trials, conducted quality appraisal and extracted the data. Quality of the studies included in the review was assessed using Cochrane Risk of bias tool. Meta-analysis was conducted using RevMan 5.4. Narrative synthesis was performed for studies where results could not be pooled statistically. The results were reported abiding Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS: This review included 15 trials with a total of 1276 informal caregivers of stroke survivors. Eleven trials were included in the meta-analysis. Subgroup analyses revealed that technology-based interventions with structured educational programs were statistically significant in reducing depressive symptoms (d = -0.27, 95% CI [-0.49 to -0.05], p = .02). Technology-based interventions with structured educational programs <3-month revealed significant effects (d = -0.31, 95% CI [-0.49 to -0.13], p = .0009). Results of narrative synthesis reported technology-based intervention with face-to-face training minimized depressive symptoms of informal caregivers. Notably, there were no statistically significant effects on anxiety, burden, quality of life and self-efficacy outcomes. CONCLUSION: Technology-based interventions had beneficial effects in alleviating depressive symptoms among informal caregivers. IMPACT: Technology-based interventions serve as a support mechanism for informal caregivers of stroke survivors who face time-constrains. Further high-quality randomized controlled trials are warranted to elucidate sustainability, optimal format and dosage of intervention.

[Evaluation of Skeletal Muscle Mass and Functions during Perioperative Period of Colorectal Cancer Patients].

Sarcopenia is a syndrome characterized by progressive and generalized loss of skeletal muscle mass, loss of muscle strength and/or reduced physical performance. Sarcopenia has repeatedly been reported as a strong predictor of both short- and long-term outcomes following surgical treatment for colorectal cancer. In this study, 86 primary colorectal cancer cases who received surgery at our hospital were examined. To evaluate which factor amongst muscle volume, muscle strength or physical performance would be important to avoid sarcopenia after surgery, we examined objective values of muscle volume, muscle strength and physical performance respectively. We also divided patients into groups by their ages or procedures of surgeries, then compared and analyzed within those groups. The results showed that most patients tended to lose their muscle volume of their legs and their physical performance after their surgeries. We also found patients who were equal or older than 75-year-old and patients who received open surgeries tended to lose their muscle volume or physical performance after their surgeries. These groups of patients have a potential risk to turn sarcopenia after surgeries. It would be important to observe each of 3 factors such as skeletal muscle volume, muscle strength and physical performance to evaluate precisely their condition of sarcopenia. Tailor-made peri-operative rehabilitation programs, especially for elderly patients or patients who received open surgeries, would be a possible solution to avoid sarcopenia after surgery for colorectal cancer.

Developing the nursing practice environment scale for home health care: A trial study in Japan.

AIM: To develop the nursing practice environment scale in home health care (NPES-HHC), which measures the attractiveness of nursing practice environments in Japan. DESIGN: Cross-sectional study. METHODS: The answers of 1,050 mail surveys conducted for nurses at 421 home-visit nursing agencies in Japan were analysed. Exploratory and confirmatory factor analyses of the NPES-HHC's candidate items were performed. Relationships between the newly developed NPES-HHC and participants' intention to remain at the workplace, job satisfaction and quality of care were also tested. RESULTS: A seven-dimensional model with 37 items was obtained by exploratory factor analysis (Cronbach's alpha: 0.77-0.92). Confirmatory factor analysis supported this model. NPES-HHC scores had significant positive relations with participants' intention to remain at the workplace, job satisfaction and quality of care (p < .01). The NPES-HHC is a reliable and valid instrument to assess the attractiveness of the practice environment for home-visit nursing agencies.

Outcomes of a financial incentive scheme for dementia care by dementia specialist teams in acute-care hospitals: A difference-in-differences analysis of a nationwide retrospective cohort study in Japan.

OBJECTIVES: The quality of care for dementia in acute-care settings has been criticised. In 2016, the Japanese universal health insurance system introduced a financial incentive scheme for dementia care by dementia specialist teams in acute-care hospitals. This study aimed to investigate the effectiveness of this financial incentive scheme on short-term outcomes (in-hospital mortality and 30-day readmission). DESIGN AND METHODS: Using a Japanese nationwide inpatient database, we identified older adult patients with moderate-to-severe dementia admitted for pneumonia, heart failure, cerebral infarction, urinary tract infection, intracranial injury or hip fracture from April 2014 to March 2018. We selected 180 propensity score-matched pairs of hospitals that adopted (n = 180 of 185) and that did not adopt (n = 180 of 744) the financial incentive scheme. We then conducted a patient-level difference-in-differences analysis. In a sensitivity analysis, we restricted the postintervention group to patients who actually received dementia care. RESULTS: There was no association between a hospital's adoption of the incentive scheme and in-hospital mortality (adjusted odds ratio [aOR]: 0.97; 95% confidence interval [CI]: 0.88-1.06; p = 0.48) or 30-day readmission (aOR: 1.04; 95% CI: 0.95-1.14; p = 0.37). Only 29% of patients in hospitals adopting the scheme actually received dementia care. The sensitivity analysis showed that receiving dementia care was associated with decreased in-hospital mortality. CONCLUSIONS: The financial incentive scheme to enhance dementia care by dementia specialist teams in Japan may not be working effectively, but the results do suggest that individual dementia care was associated with decreased in-hospital mortality.

Comparison of progression of care-need levels among long-term care recipients with and without advanced care management in a rural municipality of Japan: A population-based observational study.

BACKGROUND: Little is known about the association between advanced care management and patient outcomes in home settings. In 2009, the Japanese government introduced a financial incentive scheme for advanced care management by long-term care agencies with at least one advanced care manager. However, it remains unclear whether advanced care management in rural areas is associated with improved outcomes for recipients. OBJECTIVE: To compare the progression of care-need levels among long-term care recipients in home settings with and without advanced care management. DESIGN: A population-based observational study. SETTING: A rural municipality in Japan. PARTICIPANTS: Recipients of long-term care (n = 2005). METHODS: We used individual-level secondary data provided from a rural municipal government that was collected as part of the Survey of Long-Term Care Benefit Expenditures and medical care claim records between April 2012 and March 2017. We linked these two databases using unique identifiers. The inclusion criteria for study subjects were that they: (1) were aged ≥65 years; (2) were newly certified as care-need level 1, 2, or 3; and (3) used long-term care insurance services in home settings from April 2012 through March 2017. We excluded individuals using long-term care insurance services for less than six months. Ultimately, we selected 1722 propensity-matched recipients with and without advanced care management, and then conducted Kaplan-Meier survival analyses and a log-rank test. The outcome measure was progression of care-need levels. RESULTS: The proportions of five-year cumulative progression-free survival in the groups with and without advanced care management were 50.3% and 42.2% for recipients of care-need level 1 (p < .01), 34.3% and 32.3% for recipients of care-need level 2 (p < .01), and 22.3% and 24.5% for recipients of care-need level 3 (p > .05), respectively. The progression-free period lasted a median of 12 (interquartile range, 10-24) months for recipients of care-need level 1, 14 (interquartile range, 11-28) months for recipients of care-need level 2, and 12 (interquartile range, 10-24) months for recipients of care-need level 3. CONCLUSIONS: Long-term care recipients with advanced care management in home settings had a higher probability of progression of care-need levels in a rural municipality of Japan. This finding suggests that the governmental policy of providing financial incentive for advanced care management may not be effective in improving the outcome of long-term care recipients in a rural municipality of Japan.

Acceptance of care technologies to support activities of daily living by middle-aged and older adults in Japan: A cross-sectional study.

Background: Various technologies to provide long-term care have been developed in the last decade due to the shortage of caregivers in Japan. However, care technologies are not widely used in long-term care, and the reasons for the lack of acceptance of care technologies are poorly understood. Objectives: To identify the factors associated with the acceptance of care technologies designed to assist with activities of daily living (i.e., bathing, dressing, toileting, transferring, and eating) among middle-aged and older adults in Japan. Design and Methods: A cross-sectional survey was conducted in August 2020. The target population was middle-aged and older adults (i.e., 40-79 years) in Japan. We used an online questionnaire platform of a research company to target people throughout Japan, and measured the acceptance of care technologies to support the performance of each of five activities of daily living. Multivariable logistic regression models were fitted to identify the associated factors using the bivariate variable "willingness to use care technologies for activities of daily living" as the dependent variable. Results: A total of 3261 eligible respondents were included in the analysis. The factors positively associated with the acceptance of care technologies for transferring, which had the highest level of acceptance, were female sex (adjusted odds ratio=1.25, 95% CI: 1.04-1.52), university or higher education level (1.73, 1.41-2.12), an annual income of 39000 to 58999 USD (1.47, 1.08-2.01) or greater than 99,000 USD (1.88, 1.21-2.94), experience as an informal caregiver (1.25, 1.02-1.54), the use of social networking services a few times per year (1.40, 1.11-1.78) or nearly every day (1.47, 1.19-1.82), and willingness to live in a nursing home when care is needed (1.29, 1.05-1.60). In contrast, aged 70-79 years was negatively associated with the acceptance of care technologies for transferring (0.70, 0.52-0.93). Conclusion: Female sex, university or higher education level, an annual income greater than 99,000 USD, the use of social networking services a few times per year or more often, and willingness to live in a nursing home when care is needed were positively associated with the acceptance of care technologies for multiple activities of daily living. Given that many of the respondents will need care in 5-10 years, the acceptance of care technologies among those who need care will increase. Therefore, governments and developers of care technologies could consider the potential needs of this population group.

Association Between Advanced Care Management and Progression of Care Needs Level in Long-Term Care Recipients: Retrospective Cohort Study.

BACKGROUND: Long-term care insurance systems in Japan started a special senior care program overseen by qualified care managers (also known as advanced care managers). However, the relationship between advanced care management and outcomes in long-term care recipients remains unknown. OBJECTIVE: We aimed to compare the outcome of long-term care recipients using facilities with advanced care management and conventional care management, in terms of care needs level progression. METHODS: We conducted a retrospective cohort study using the Survey of Long-Term Care Benefit Expenditures in Japan. We identified those aged ≥65 years who were newly designated a care need level of 3, and received long-term care services between April 2009 and March 2014 in Tokyo. We compared survival without progression of care needs level between the groups, with and without advanced care management, using the Kaplan-Meier method. Factors affecting the outcomes were determined using a multivariable logistic regression model fitted with a generalized estimating equation. RESULTS: Of 45,330 eligible persons, 12,903 (28.46%) received long-term care based on advanced care management. The average duration of progression-free survival was 17.4 (SD 10.2) months. The proportions of five-year cumulative progression-free survival were 41.2% and 32.8% in those with and without advanced care management, respectively. The group with advanced care management had significantly lower care needs levels (odds ratio 0.77, 95% CI, 0.72-0.82, P<.001). CONCLUSIONS: Advanced care management was significantly associated with improved care needs levels.