Identifying Factors of Obesity in Papua New Guinea: A Descriptive Study

Obesity and overweight are complex phenomena due to causes and consequences as these are the predisposing factors for developing lifestyle-related diseases. In the recent times, obesity and chronic diseases are being taken very seriously than ever before. Once upon a time, obesity was considered as a problem only in developed countries, now it is of a serious concern in low- and middle-income countries. In Papua New Guinea (PNG), a few studies have been conducted on obesity-related issues. However, there is not enough data on obesity to clearly understand about the leading contributing factors. Our research group designed this study to assess the influencing factors of obesity and as well as to identify the principal cause. It is a descriptive study, used structured and semi-structured interview and survey questionnaire. This study was conducted in the capital city of PNG, Port Moresby, and recruited 87 adults aged 30 - 50 years. According to interview and analysis findings, the contributing factors of obesity are less physical movement, unhealthy diet, lifestyle, cultural value system, low education and social system. Government strategies and initiatives are not strong enough to educate and motivate the community people. This study suggests developing an effective coordination among all stakeholders to ensure quality education and increase awareness to prevent obesity and its complications. The standard health policies and strategies are also recommended at the local, national and international level with strong commitment.

Characteristics of Patients with Decreased Cognitive Function Undergoing Treatment for Acute Exacerbation of Chronic Heart Failure—Basic Survey for Standardization of Nursing to Prevent Discontinuation of Treatment

The purpose of this study is to clarify the characteristics of patients with decreased cognitive function undergoing treatment for acute exacerbation phase of chronic heart failure as a basic survey with a view to the standardization of nursing to prevent discontinuation of treatment of patients with declining cognitive function in the acute exacerbation phase of chronic heart failure. As the first stage of the research, using the interview guide created based on the background of discontinuation of treatment and symptomatic monitoring from 33 target literature sources, seven certified chronic heart failure nurses and 15 certified dementia nurses were given semi-structured interviews. Data obtained from the interviews was analyzed by qualitative induction. As a result, we obtained opinions/views on 8 situations namely, “cognitive function at hospitalization”, “characteristics at hospitalization, “characteristics when receiving examinations, procedures or treatment”, “characteristics of course of treatment”, “characteristics related to difficulties in grasping the symptoms of chronic heart failure and indices of deterioration”, “characteristics when using diuretics”, “characteristics concerning compliance with dietary restrictions” and “support required for discharge from hospital” concerning patients with declining cognitive function. In the future, it is necessary to prepare nursing protocols incorporating these contents for standardization of nursing.

Development of the Irrational Belief Test for Nurses (IBTN): Examination of Reliability and Validity

[Purpose]: The purpose of this study is to develop irrational belief test for nurses, and to examine reliability and validity. [Method]: In study 1, The Irrational belief test for nurses was developed based JIBT-20 (mori et al., 1994) of previous studies. And for the nurse (N = 96, 5 male, 91 female), carried out preliminary investigation, created the provisional version of the Irrational belief test for nurses, and examined factor structure and internal consistency. In study 2, for the nurse (N = 541, 21 male, 520 female) examined validity based on JIBT-20 (Japanese Irrational Belief Test), MBI (Maslach Burnout Inventory), ATQ-R Japanese version (Automatic Thoughts Questionnare-Revised), and for the nurse (N = 91, 3 male, 88 female) examined a test-retest reliability four weeks afterward before long. [Result]: As a result of the explanatory factor analysis by a maximum likelihood estimation and promax rotation, 28-item 7 factors were extracted and was named a “patient belief”, “self-expectation”, “avoidance”, “self-inhibition”, “Ethical blame”, “helplessness”, and “dependence”. Moreover, as a result of conducting confirmation factor analysis, the hypothetical model obtained by explanatory factor analysis fitted (GFI = 0.89, AGFI = 0.86). About the reliability of the measure, a Cronbach’s alpha coefficient is 0.68 - 0.82, and a test-retest reliability is 0.64 and reliability is affirmed. About construct validity was checked correlation with JIBT-20, and about criterion validity was checked the correlation with MBI and ATQ-R Japanese-translation version. [Conclusion]: It is suggested that reliability and validity are verified and the irrational belief test for nurses is a useful measure. The developed test can be used to measure the irrational belief in the context of burnout in nurses.

36-Month Follow-Up Study of Post-Intervention Chronic Heart Failure Patients

Aim: Although numerous studies of disease management and case management of chronic heart failure (CHF) have been carried out, length of effectiveness after program commencement has not been examined, so we examined a follow-up study at 36 months after program commencement. Methods: Participants went for follow-up visits to one Japanese clinic which specializes in internal cardiovascular medicine and they were given diagnoses of CHF. 104 outpatients participated in this study and randomized control trial was implemented. An educational program was implemented for 6 months. The data were collected at baseline, 3, 6, 9, 12 months from both intervention and control groups and at 24 and 36 months from the intervention group. Results: There was significant improvement in New York Heart Association (NYHA) in the intervention group between baseline and 36 months. Improvement in weight monitoring and activities or exercise in the intervention group continued up to 36 months. Meanwhile, sodium restricted diets and quitting smoking and/or drinking depended on individual preference and it was difficult to make improvements in these areas. Conclusions: The educational program showed promise in preventing CHF outpatients from deteriorating significantly on a long-term basis as self-monitoring of activity and weight continued significantly and there were no participants with CHF who deteriorated in the intervention group at 36 months after program commencement, although the program aimed only to provide illness and self-management knowledge. On the other hand, future work will need to compare participants in this program to a control group over an extended period of time with consideration for relieving the burden of the control group.

Analysis of the Incidence of Hepatitis B and Hepatitis C and Association with Socio-Economic Factors in Various Regions in China

The incidence of liver cancer in China accounts for more than half of the world, and the majority of them is caused by hepatitis B and hepatitis C. China is known as a great contributor to hepatitis. The Chinese government has implemented a series of preventive measures to solve this problem, especially the policy of free hepatitis B vaccination for newborn babies and effectively reduced the incidence of hepatitis. The incidence of infectious diseases is often related to socio-economic factors. Therefore, we used data on the incidence of hepatitis B and C and socioeconomic factors to analyze and find out the relationship among them in various regions. There were high incidence areas and low incidence areas in China, and the high incidence area of hepatitis B was also the high incidence area of hepatitis C. Especially in Xinjiang, the highest incidence of hepatitis B and hepatitis C was observed at the same time. The incidence of hepatitis B and hepatitis C was more affected by regional economic factors. The economic factors in low incidence areas of hepatitis were better than those in high incidence areas. There was a negative correlation between economic factors and the incidence of hepatitis. In conclusion, in economically developed areas, the government has invested more money and resources in public health and people’s health awareness in comparison to underdeveloped areas. In the future, various preventive strategies should be carried out according to the background of different regions.

The Effect of the Group Cognitive Behavior Therapy in a Nurse’s Burnout and Intention to Resign

Purpose: The purpose of the present study was to decrease burnout and intention to resign by practicing cognitive behavioral approach to nurses of the 3 years nursing clinical experience. Methods: Nurses (N = 180) who worked at acute-care hospitals and whose clinical experience was 3 years were requested. Nurses (n = 95, male 5, female 90) who were able to do participation at all the sessions were objects. The program was created and carried out for a nurse’s burnout with reference to cognitive behavior therapy. Evaluation of intervention was asked to complete a questionnaire that measured burnout (MBI), job stressors (NJSS), automatic thoughts (the shorter version of Japanese version ATQ-R), Irrational Belief Test for Nurses (IBTN), coping measure and whether or not they had an intention to resign. Measurement was performed 3 times of a baseline, after the end of session and follow-up. Analysis of covariance which adjusted the baseline level was performed. Result: According to the results, “helplessness”, “positive thinking” and “personal accomplishment” were significant (p < 0.01). According to the results of Friedman test, significant difference was observed in “emotional exhaustion” in the group with low degree of irrational belief (p < 0.10 ) and in the group with high degree (p < 0.05). With regard to the intention to leave the job, “wants to continue working as a nurse” was significant in the group in 3 months after intervention (p < 0.05). Conclusion: It is suggested that cognitive behavioral approach appears to be effective for reducing nurse’s burnout or intention to resign in nurses of the 3 years nursing clinical experience.

Healthcare Needs of the Elderly People over 85 Years Living Alone on the Island Area in Japan: A Descriptive Study

Background: Japan has the highest aging people accounting 33.8 million with the rate of 26.7% in 2015. Although, public long-term care insurance services support people age 40 years and above, most of the users are 85 years and over due to their more vulnerability for getting sick. This study describes the physical, mental and social status of the elderly people aged 85 years and over, who were living alone at home. Method: A cross-sectional study was conducted between November 2016 and March 2017 in the island of Kure city, Hiroshima, Japan. A structured questionnaire and scales were used for data collection and documentation of physical measurements. Descriptive analysis was used. Result: A total of 190 subjects were participated, and the data were analyzed. The age range of the subjects was 85 to 98 years, and 68.4% of them were 85 to 89 years old. Male and female ratio was 21.6% vs 78.4%. Subjects of 17.4% continued their occupation at the time of the study period and most of them involved in agricultural work (93.9%). A certain percentage of the subjects had abnormal physical, mental and social difficulties and need additional support from family, friends, relatives, and community. Conclusion: Early detection and intervention such as disease management, nutritional support, and human support are required. The findings suggested policy makers to predict the burden and provide necessary care for these elderly people. It is necessary to aware family, friends, relatives, community and government supporting staff to provide information on correct recognition and usages of long-term care insurance services for these elder people.

Health Resource Utilization and Comorbidities in Patients with Mental Disorders: Analysis Based on Health Insurance Claim Data

The number of patients with mental disorders is increasing all over the world and they have a high prevalence of physical complications. To analyze and compare the cost of mental disorders with the total medical costs such as mental disorders and physical disorders, we analyzed the cost that patients with mental disorders incurred. We investigated the distribution of medical costs and the characteristics of diseases by using the health insurance claims of people in City A, Japan from March 2013 to February 2014. The subjects had one or more of 4 mental disorders: schizophrenia, alcohol related disorders, bipolar disorder, and depressive episode. As a result, the total number of patients who met inclusion criteria per year was 7403 (6522 outpatients and 881 inpatients). It was revealed that the hospitalization rate of patients with mental disorders increased with age, and many inpatients stayed in hospital for a long time. Also, it was revealed that many patients with mental disorders were in complicated condition with more than one mental or physical disorders and incurred medical costs for these comorbidities. In conclusion, this analysis indicated that many patients with mental disorders switch from attending the outpatient department to hospitalization as they become older. Further, they incurred a lot of medical expenses for complication management. To improve their QOL, comprehensive assessment of their mental/ physical health, self-management education, coordination of services, and support for decision making regarding treatment are necessary.

Effects of progressive muscular relaxation and stretching exercises combination on blood pressure among farmers in rural areas of Indonesia:a randomized study

Objective:Maintaining blood pressure(BP)could improve the quality of life among farmers in agricultural health.The study aims to evaluate the effects of progressive muscular relaxation and stretching exercises(SEs)for BP in farmer subjects in rural areas.Methods:A randomized controlled design was applied for this study.We performed a method,which is the combination of progressive muscle relaxation(PMR)and SEs for participants(30 in the control group and 60 in the intervention group).The intervention group self-practiced PMR and SEs through a video that providing instructions for 15 min.PMR practiced before going to sleeping in the night,and SEs practiced before going to farms in the morning per day for 3-months.Wilcoxon signed-rank test was performed to measure the difference between systolic blood pressure(SBP)and diastolic blood pressure(DBP)as one pre-and post-test comparison of baseline and 3 months data in control and intervention groups.Results:There were no significant differences between SBP and DBP pre-and post-test in control group(P>0.050).Meanwhile,there were significant differences in reducing SBP(M=126.67;SD=18.07;95%CI=120-147.5 mmHg)and DBP(M=80.67;SD=6.91;95%CI=80-90 mmHg)pre-and post-test combination of PMR and SEs in intervention group(P<0.001).After 3-months of follow-up data,number type SBP and DBP still remained at the same levels of baseline and 3-month data in control group.While,there was an increased number of normal and prehypertension for SBP and DBP(10%vs.10%and 20%vs.31.6%)and reduced of hypertension stage I for SBP and DBP(30%vs.41.6%).Conclusions:This pilot study demonstrated effectively to reduce SBP and DBP among farmers using the combination of PMR and SEs in the agricultural health setting.

Effects of a Revised Moderate Drinking Program for Enhancing Behavior Modification in the Workplace for Heavy Drinkers: A Randomized Controlled Trial in Japan

This study examined the effects of the Hizen Alcoholism Prevention Program (HAPPY) and the revised version of HAPPY (HAPPY Plus), and also compared the two programs to determine whether the HAPPY Plus achieved better outcomes for heavy drinkers in the workplace. The HAPPY Plus designed to strengthen participants’ recruitment, perception of threat, stress management, behavior modification by self-monitoring using a calendar-based diary, and to prevent dropout by telephone and e-mail follow-up by a trained nurse. Participants were men and women who consumed at least 20 g and 10 g of alcohol daily, respectively, and had not been diagnosed with alcohol dependence. A group intervention, 3-month randomized controlled trial was conducted. The control and intervention groups received the HAPPY and HAPPY Plus, respectively. The primary endpoint was average daily alcohol consumption. The Alcohol Use Disorders Identification Test (AUDIT), weight, body mass index, blood pressure, liver function, goal achievement rate, self-efficacy, and self-esteem were also measured. Out of 88 recruited employees, 83 (intervention group: 40;control group: 43) completed the study (completion rates were 100% and 93.4% respectively). As a result, average daily alcohol consumption decreased significantly in both groups (p < 0.001), but did not differ between groups. Even though behavior change rate was higher, and self-efficacy and confidence increased in the intervention group, AUDIT decreased in both groups but was significant only in the control group. Physiological indicators in the intervention group improved, but were not significant between the groups. Against the program revision, this study did not prove superiority of HAPPY Plus to the HAPPY regarding the indicators. However, better behavior modification and lower dropout were observed in the HAPPY Plus. Therefore, after further improvement is made, this group intervention program is applied to the workplace.

The Effect of Educational Intervention regarding Advance Care Planning for Advance Directives

This study aimed to examine the effects of empowerment and education intervention to promote Advance Care Planning (ACP) for residents in a highly aged and depopulated region. The study utilized a single-group pre- and post-test design and was conducted in Osakikamijima, Hiroshima, Japan. The researchers and town officials together formed an ACP committee and created an intervention framework. An ACP workshop was held for the participants and a self-administered questionnaire was carried out before, immediately after, and 3 months after the workshop. A total of 125 residents participated in the workshop and 87 of them completed more than 80% of the questionnaire items, whose responses were analyzed as valid responses. The number of participants who completed the AD increased significantly three months after the workshop (p = 0.008). There was a slight increase in the frequency of consultation with the family, but no change was observed in terms of consultation with healthcare providers. The educational intervention in-creased the respondents’ awareness and knowledge of ACP but did not affect the autonomous decision-making process regarding end-of-life care. This strategic process of ACP empowered the residents’ awareness and attitude towards end-of-life care with an increased completion rate of AD. On the other hand, cognitive barriers remained toward communication and decision-making shared with healthcare providers. Insufficient consultation with family members also became evident. Therefore, a new intervention strategy which helps increase communication with healthcare providers needs to be formulated and guidelines for consultation with the family and others need to be prepared.

Assessment of a portfolio as an effective tool to promote self-management among patients with ischemic heart diseases: A preliminary trial

Portfolio has been used as an approach to promoting self-learning in the field of education and its effectiveness was reported in school education. The purpose of this study was to assess effectiveness of portfolio as a tool for educating patients with ischemic heart diseases as self-management behavior in terms of applicability and efficacy. Subjects of this study were seventeen patients who had myocardial infarction or angina. They were assigned to collect information about their themes chosen from diet, exercise, alcohol intake, smoking cessation, and stress management and gathered in files. Thirty minutes face-to-face educational interviews were conducted by a nurse for once per month over three months. Self-management, self-efficacy, and physiological data were evaluated for baseline and 3 months. Two participants dropped within two months (completion rate is 88.2%). The results showed that portfolio was effective as a self-management education tool on patients who were willing to participate, but did not improve physiological data if they did not continuously implement lifestyle change. Moreover it was dangerous when the patients acquired incorrect information on diseases. For these patients, health education by health professionals is required prior to conducting portfolio. Attributes fit for portfolio were assessed. Effectiveness of portfolio related to high self-efficacy and high self-management, but did not relate to living status, having job, educational background, and health locus of control.

Efficacy and Usability of an E-Learning Program for Fostering Qualified Disease Management Nurses

In order to train nurses to perform disease management and telenursing, we developed an e-learning education program, and assessed the efficacy. A single-group pre-test and post-test design was used. Nurses who worked at a medical institution or a disease management company were included, and the duration of the program was set 2 months. We developed the program so that it could grow attitude and improve knowledge and skills in disease management and patient education. Of 55 subjects, 48 who completed the program were analyzed. After the program, subjects increased knowledge and interests in disease management and patient education. Almost of the subjects answered that e-learning was a good learning method. Our program was effective at enhancing subject’s interests in disease management and patient education, and considered to improve their skills in the future.

Development and Evaluation of Disease Management Program and Service Framework for Patients with Chronic Disease

We developed a disease management program and service framework to enhance the self-management skills of patients with chronic diseases for the first time in Japan. In this study, we analyzed the efficacy of this program. A single-group pre-test and post-test design was used. In the program, disease management nurses provided self-management education to patients that were specific for their disease and risk factors in cooperation with their primary physicians. The duration of the program was 6 or 12 months. A total of 1258 patients were enrolled. After excluding discontinued subjects, 987 patients in the diabetes program and 11 patients (except those with diabetic nephropathy) in the chronic kidney disease (CKD) program were analyzed. The diabetic patients showed improvement of HbA1c and blood pressure after intervention, as well as maintaining renal function. CKD patients showed no change of renal function after intervention, but there was improvement of non high density lipoprotein-cholesterol (HDL-c). The patients acquired the ability to detect at an early stage and respond to abnormal symptoms and data, which enabled them to avoid progression of their diseases and emergency hospitalization. The program was effective at preventing disease progression in patients with chronic illnesses and may contribute to the containment of medical costs.