ABSTRACT
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.
ABSTRACT
OBJECTIVE: The objectives of this study were to clarify changes in antimüllerian hormone (AMH) concentrations during the menopausal transition and to determine whether AMH may serve as a marker to predict the onset of menopause. METHODS: Blood samples were collected annually for 6 years from 595 women living in Iwaki, Japan. We selected 44 women according to strict criteria: those older than 40 years at first participation; those who had their regular menstruation; those whose menstrual cycle had changed from regular to irregular or those who met the final menstrual period; and those who did not take medication that may affect the menstrual cycle. Serum AMH concentrations were determined by the newly developed AMH Gen II assay kit. Stage of the menopausal transition was defined according to the Stages of Reproductive Aging Workshop. RESULTS: Among the 44 women who participated in the study, 29 experienced menopause during the study (group A), whereas the remainder developed irregular menstrual cycles (group B). AMH was consistently found to be undetectable for 3 years before menopause, suggesting that AMH is a sensitive marker for predicting the onset of menopause. In addition, serum AMH was detectable at low levels in women from group B until menstrual cycles became irregular, suggesting that AMH serves as a marker for diagnosing the menopausal transition. CONCLUSIONS: When AMH levels fall below detectable levels, women at the menopausal transition will progress to menopause within 3 years.
