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Biomedical subjects

Ichiro Kai

Publications and source records attributed to Ichiro Kai.

At least 19 recordsLinked to original sources
PubMed2007

Health and motivation of elderly relocating to a suburban area in Japan.

In Japan, few studies have investigated the effects of moving residence among the elderly, despite the fact that Japanese elderly will be increasingly required to switch residence in the future. Here, we used representative sampling to examine the characteristics of elderly persons who had moved residence to a Tokyo suburb and compared results with those of non-moving residents of the suburb. Movers aged 65 years old or older who had relocated within the previous 2 years (movers) and residents aged 65 years old or older and had lived in the area longer than 5 years (non-movers) were surveyed by mail in 2004, with a focus on health and psychosocial measures. Compared with non-movers (N=117), movers (N=97) were more depressed, socially isolated, and fulfilled less active social roles among family members. The majority of movers had moved to find affordable housing or to live with or near family. Two factors preceded co-residence with family, namely retirement and imminent loss of functional independence. Our findings suggest that movers require community support to prevent social isolation, dependency and health declines.

Activities of Daily Living↗
PubMed2006

Attitudes and practices of breast cancer consultations regarding sexual issues: a nationwide survey of Japanese surgeons.

PURPOSE: To investigate doctors' current practices and attitudes and correlates of sexuality-related consultations in clinical encounters. METHODS: A nationwide, self-administered mail survey was conducted with 1,313 board-certified Japanese breast surgeons in August 2001. Surgeons were asked about their experiences regarding consultations about sexual issues, attitudes toward sex-related statements, and advice to a patient's hypothetical question on having sex after undergoing breast cancer treatment. RESULTS: Of the surveyed sample, 635 surgeons (50.3%) responded. Of these surgeons, 32.4% had been consulted about sexual issues by patients or families. Multiple logistic regression analysis suggested that female respondents (P < .01), respondents whose hospitals conduct a large number of breast cancer operations annually (P < .01), and respondents who agreed that "Surgeons have a professional responsibility to deal with patients' sexual issues" (P < .01) were significantly more likely to be consulted. Respondents who agreed that "If any sexual problem exists, patients will raise the topic before surgeons ask them" were less likely to be consulted (P < .05). Respondents' attitudes toward the sex-related statements showed that, although the majority recognized the importance of patients' sexuality-related concerns, they did not necessarily think that surgeons had a professional responsibility to deal with them. Regarding their advice in response to the question of "Are there any particular things to be careful about when having sex after surgery?", 32.8% answered "nothing in particular." CONCLUSION: This study shows that talking about sex-related topics is still repressed in patient-doctor encounters in Japan. It is an urgent matter to increase doctors' awareness and clinical skills to deal with patients' sexual issues.

Adult↗
PubMed2006

Factors associated with intentions to adhere to colorectal cancer screening follow-up exams.

BACKGROUND: To increase adherence rate to recommendations for follow-up after abnormal colorectal cancer (CRC) screening results, factors that inhibit and facilitate follow-up must be identified. The purpose of this study was to identify the factors associated with intention to adhere to CRC screening follow-up exams. METHODS: During a 4-week period in October 2003, this survey was conducted with 426 subjects participating in a community-based CRC screening program in Nagano, Japan. Study measures included intention to adhere to recommendation for clinical follow-up in the event of an abnormal fecal occult blood test (FOBT) result, perceived susceptibility and severity of CRC, perceived benefits and barriers related to undergoing follow-up examination, social support, knowledge of CRC risk factors, health status, previous CRC screening, personality and social demographic characteristics. Univariate and multivariate logistic regression analyses on intention to adhere to recommendations for follow-up were performed. RESULTS: Among the 288 individuals analyzed, approximately 74.7% indicated that they would definitely adhere to recommendations for follow-up. After controlling for age, gender, marital status, education, economic status, trait anxiety, bowel symptoms, family history of CRC, and previous screening FOBT, analyses revealed that lower levels of perceived barriers, higher levers of perceived benefits and knowledge of CRC risk factors were significantly associated with high intention respectively. CONCLUSION: The results of this study suggest that future interventions should focus on reducing modifiable barriers by clarifying misperceptions about follow-up, promoting the acceptance of complete diagnostic evaluations, addressing psychological distress, and making follow-up testing more convenient and accessible. Moreover, educating the public regarding the risk factors of CRC and increasing understanding of the benefits of follow-up is also important.

Adult↗
PubMed2006

Survey of the general public's attitudes toward advance directives in Japan: how to respect patients' preferences.

BACKGROUND: Japanese people have become increasingly interested in the expression and enhancement of their individual autonomy in medical decisions made regarding medical treatment at and toward the end of life. However, while many Western countries have implemented legislation that deals with patient autonomy in the case of terminal illness, no such legislation exists in Japan. The rationale for this research is based on the need to investigate patient's preferences regarding treatment at the end of life in order to re-evaluate advance directives policy and practice. METHODS: We conducted a cross-sectional survey with 418 members of the general middle-aged and senior adults (aged between 40 and 65) in Tokyo, Japan. Respondents were asked about their attitudes toward advance directives, and preferences toward treatment options. RESULTS: Over 60% of respondents agreed that it is better to express their wishes regarding advance directives (treatment preferences in writing, appointment of proxy for care decision making, appointment of legal administrator of property, stating preferences regarding disposal of one's property and funeral arrangements) but less than 10% of them had already done so. About 60% of respondents in this study preferred to indicate treatment preferences in broad rather than concrete terms. Over 80% would like to decide treatment preferences in consultation with others (22.2% with their proxy, 11.0% with the doctor, and 47.8% with both their proxy and the doctor). CONCLUSION: This study revealed that many Japanese people indicate an interest in undertaking advance directives. This study found that there is a range of preferences regarding how advance directives are undertaken, thus it is important to recognize that any processes put into place should allow flexibility in order to best respect patients' wishes and autonomy.

Advance Directives↗
PubMed2006

Caregiving in the Philippines: a quantitative survey on adult-child caregivers' perceptions of burden, stressors, and social support.

This study aims to describe the present caregiving situation of Filipino adult-child caregivers (CGs) particularly aiming to identify the predictors of CG burden and to assess the effect of social support on stressors and perception of burden. A cross-sectional survey employing face-to-face interviews with 193 adult-child CGs in Davao City, Philippines, measured the perception of burden using the Cost of Care Index (CCI) by Kosberg and Cairl. Results indicated the majority were daughter CGs living with their elderly parents, who were receiving high levels of informal social support. A moderate to high level of burden perception (mean+/-S.D. score of 47.0+/-9.1) was found among respondents. CGs with higher educational attainment showed low burden perception. However, higher family income and higher State-Trait Anxiety Inventory (STAI) anxiety scores were associated with higher burden perception. Also, longer caregiving hours, a male care recipient (CR), and the presence of CR's memory and behavior problems predicted higher CG burden. The interaction between stressors and perceived burden showed that social support provided a buffering effect for CGs experiencing higher burden perception. This suggests that respite and support resources including community-based counseling and education programs to assist CGs in dealing with stress may positively contribute to reduce burden.

Adaptation, Psychological↗
PubMed2006

The cross-validity of the filial obligation scale.

The filial obligation scale we developed needed examining cross-validity to make it more precise. In this study, by examining this scale in an area different from the previous study in terms of characteristics (e.g., rural v. urban), we verify its cross-validity. The results showed that three factors extracted from factor analysis precisely reflected Morioka's theory and the correlation coefficients with affiliation and geographic distance that were indicated to be related with filial obligation in the previous studies showed significance. The results of this study support reliability and validity of this scale.

Adult↗
PubMed2006

Relationship specialization amongst sources and receivers of social support and its correlations with loneliness and subjective well-being: a cross sectional study of Nepalese older adults.

Social support, subjective well-being (SWB), and loneliness are issues of central importance in research concerned with the quality of life (QOL) of elderly people in the 21st century. However, very little is known about the situation in low-income countries such as in Nepal. The purpose of this paper is to identify the relationships significant in social support (received (SSR) and provided (SSP)) and analyze their connections with loneliness and SWB. The subjects, not suffering from dementia, were 60 years and above living in Kathmandu city. The data was analyzed using logistic regression with some confounding variables controlled. The results indicate that loneliness is high and SWB is low amongst Nepalese older adults. SSR from children living together and SSP to spouse, children living together and friends and neighbors reduce loneliness. SSP to children living apart increases SWB-life satisfaction. SSR from children living together and SSP to children (living together and apart) increases SWB-life stability. However, SSP to relatives reduces SWB-life satisfaction and SSR from relatives reduces SWB-life stability in Nepalese older adult men.

Aged↗
PubMed2006

Public, experts, and acceptance of advanced medical technologies: the case of organ transplant and gene therapy in Japan.

In 1997, after long social debates, the Japanese government enacted a law on organ transplantation from brain-dead bodies. Since 1993, on gene therapy, administrative agencies have issued a series of guidelines. This study seeks to elucidate when people became aware of the issues and when they formed their opinions on organ transplant and gene therapy. At the same time, it aims to examine at which point in time experts, those in university ethical committees and in academic societies, consider these technologies became accepted among the public. A self-administered questionnaire was sent by mail to a stratified random sampling of 3,000 people nationwide in Japan. Another questionnaire was sent both to the member societies of the Japanese Association of Medical Sciences and to the ethical committees of all the medical schools in Japan. Results of the surveys indicated that many of the public remained undecided on the desirability of organ transplant or gene therapy at the time of enactment of official guidelines. A substantial part of them formed their opinions in subsequent periods, especially around the time of first implementation and thereafter. Experts of the academic societies and of the university ethical committees regarded the time of implementation as an important factor in the acceptance of the technologies in society. Since many people formed their opinion during the period of technological implementation, communications efforts to facilitate public understanding of science and technology, as well as to advance practical discussion on policy alternatives in this period can play a key role in determining the fate of technological innovation and ethical debates in medicine.

Expert Testimony↗
PubMed2006

The association between breast surgeons' attitudes toward breast reconstruction and their reconstruction-related information-giving behaviors: a nationwide survey in Japan.

BACKGROUND: Breast reconstruction after breast cancer surgery has come to be regarded as an achievable treatment option to improve patients' quality of life. Although it has been pointed out that surgeons' information-giving behaviors affect women's decision to undergo breast reconstruction surgery, little is known about the factors that influence these behaviors. This study investigated Japanese surgeons' reconstruction-related information giving to patients and the factors that affect these behaviors. METHODS: A nationwide postal survey of 1313 board-certified Japanese breast surgeons was conducted. In the questionnaire, surgeons were asked about their reconstruction-related information-giving behaviors and their attitudes toward six hypothetical critical statements regarding breast reconstruction. RESULTS: Among 635 responding surgeons, 199 (31.3 percent) answered that they did not give reconstruction-related information at all when explaining breast cancer treatment options, and 291 (45.8 percent) stated that they selectively choose patients with whom they provide information based on patients' backgrounds such as age and marital status. Results from the multiple logistic regression analysis indicated that respondents who agreed to the statements "Breast reconstruction may delay the detection of local recurrence," "The aesthetic results of reconstructed breasts are not worth the cost and effort involved," "Breast reconstruction is a luxury," and "Surgeons should pursue breast conserving surgery rather than breast reconstruction" showed significantly decreased likelihood to give reconstruction-related information to patients. CONCLUSION: Surgeons need to be aware of the adverse effect that their own attitudes and values with regard to breast reconstruction may have on a patient's ability to choose treatment options.

Adult↗
PubMed2006

[Care managers' perceived problems regarding case management of difficult cases and their correlates].

OBJECTIVE: In Japan, a National Long-Term Care Insurance that provides care for older and infirm people was started in 2000 and the role of care manager (CM) was established to coordinate care plans. As a new profession, CMs have experienced difficulties. This study aimed to clarify CMs' perceived problems regarding case management of difficult cases. SUBJECTS AND METHODS: A nationwide mail survey was conducted with CMs in 500 public and privately run home care management organizations who were randomly sampled in 10 prefectures. A total of 556 CMs in 268 organizations returned the questionnaire, which asked questions about the demographics of CMs, their training background, employment experience, caseloads, hours worked, whether full-time or part-time, social support, and training given in the previous year. Questions about 12 different types of difficult cases, devised from a previous study by the authors were further developed in this research's preliminary interviews. The difficult cases identified included: clients with dementia, clients living alone, conflict laden families, over-demanding clients and/or family members, individuals with economic difficulties, reluctance to accept formal services, absence of a responsible family member, clients with medical needs, clients and/or family members with mental or psychological disorders, subjects of mistreatment and abuse, and those having disagreement with service providers. Bivariate analysis was conducted on the variables. RESULTS: More than 40% of the CMs felt difficulties in all of the 12 case types. Among those who have taken charge of these cases within the previous year, around 80% of the CMs felt difficulties in nearly all cases. From the bivariate analysis, CMs with a registered nursing background reported less difficulty in dealing with clients with medical needs (P<.001) and clients and/or family members with mental or psychological disorders (P< .01). Paradoxically, CMs with longer experience in the job felt greater difficulty with a majority of the 12 case types. This result might be explained by the fact they are given charge of more difficult cases. DISCUSSION: These results suggest that registered nurses have a background suitable for dealing with medical and psychological cases, while those with other backgrounds may need further training and support in these areas. Furthermore, there is a need to provide more intensive training and support to CMs with longer experience in the job who are providing care management to more difficult cases.

Case Management↗
PubMed2006

[Reconsidering evaluation criteria regarding health care research: toward an integrative framework of quantitative and qualitative criteria].

Debate about the relationship between quantitative and qualitative paradigms is often muddled and confused and the clutter of terms and arguments has resulted in the concepts becoming obscure and unrecognizable. It is therefore very important to reconsider evaluation criteria regarding rigor in social science. As Lincoln & Guba have already compared quantitative paradigms (validity, reliability, neutrality, generalizability) with qualitative paradigms (credibility, dependability, confirmability, transferability), we have discuss use of evaluation criteria based on pragmatic perspective. Validity/Credibility is the paradigm concerned to observational framework, while Reliability/Dependability refer to the range of stability in observations, Neutrality/Confirmability reflect influences between observers and subjects, Generalizability/Transferability have epistemological difference in the way findings are applied. Qualitative studies, however, does not always chose the qualitative paradigms. If we assume the stability to some extent, it is better to use the quantitative paradigm (reliability). Moreover as a quantitative study can not always guarantee a perfect observational framework, with stability in all phases of observations, it is useful to use qualitative paradigms to enhance the rigor in the study.

Evaluation Studies as Topic↗
PubMed2006

Appraisal of the policymaking process in Japan for gene therapy: results of national surveys of academic societies, hospitals, and medical schools.

BACKGROUND: Since 1993, government agencies in Japan have introduced a series of guidelines for gene therapy clinical trials. Appraisals of these guidelines were obtained from academic societies, institutional review boards (IRBs) of hospitals, and ethics committees (ECs) at medical schools nationwide. MATERIAL/METHODS: Using data from a large-scale national opinion survey, this study evaluates the experts' appraisals of the contents of these official guidelines in Japan and the process of their development. RESULTS: 26.3% of the respondents from academic societies and 39.3% of those from university ECs gave positive appraisals of the speediness of the decision process for the 1994 guidelines. Appraisals of speediness improved for the 2002 guidelines. Concerning the clarity of the 1994 guidelines, the proportion of positive appraisals was slightly smaller than negative appraisals among academic societies and hospital IRBs, though the majority of university ECs gave positive ratings. The 2002 guidelines were appraised significantly more positively than the 1994 guidelines. Information received after the decision was consistently rated better than the information before the decision. All groups reported that the opinions of patients and those of citizens were less adequately considered than were the opinions of experts. A majority of respondents rated information disclosure as important for future agendas. CONCLUSIONS: Clarity of the guidelines could be improved by revision. More information disclosure was considered desirable, especially information available before decisions are made. Incorporation of patients and citizens in policymaking is an important future goal.

Clinical Trials as Topic↗
PubMed2005

Self-rated health and social role as predictors for 6-year total mortality among a non-disabled older Japanese population.

We examined whether social role and self-rated health in an older population were predictors for 6-year total mortality among a non-disabled community-dwelling older population in Saku City, Nagano Prefecture, Japan, surveyed in 1992 and 1998. A total of 8090 men and women aged 65-99 years who reported no disability in performing activities of daily living (ADL) at the time of the survey in 1992 and provided information on their survival status at follow-up 6 years later were analyzed in this study. One dependent variable was survival status in 1998 and independent variables were various factors potentially associated with total mortality, which were obtained from a questionnaire survey at the baseline. During the 6-year interval, having poor self-rated health and poor social roles were identified as significant predictors for total mortality among both men and women. This study revealed that social role and self-rated health are independent predictors for 6-year total mortality for non-disabled Japanese aged 65 years or older.

Aged↗
PubMed2005

Public appraisal of government efforts and participation intent in medico-ethical policymaking in Japan: a large scale national survey concerning brain death and organ transplant.

BACKGROUND: Public satisfaction with policy process influences the legitimacy and acceptance of policies, and conditions the future political process, especially when contending ethical value judgments are involved. On the other hand, public involvement is required if effective policy is to be developed and accepted. METHODS: Using the data from a large-scale national opinion survey, this study evaluates public appraisal of past government efforts to legalize organ transplant from brain-dead bodies in Japan, and examines the public's intent to participate in future policy. RESULTS: A relatively large percentage of people became aware of the issue when government actions were initiated, and many increasingly formed their own opinions on the policy in question. However, a significant number (43.3%) remained unaware of any legislative efforts, and only 26.3% of those who were aware provided positive appraisals of the policymaking process. Furthermore, a majority of respondents (61.8%) indicated unwillingness to participate in future policy discussions of bioethical issues. Multivariate analysis revealed the following factors are associated with positive appraisals of policy development: greater age; earlier opinion formation; and familiarity with donor cards. Factors associated with likelihood of future participation in policy discussion include younger age, earlier attention to the issue, and knowledge of past government efforts. Those unwilling to participate cited as their reasons that experts are more knowledgeable and that the issues are too complex. CONCLUSIONS: Results of an opinion survey in Japan were presented, and a set of factors statistically associated with them were discussed. Further efforts to improve policy making process on bioethical issues are desirable.

Bioethical Issues↗
PubMed2005

Sexuality after breast cancer treatment: changes and coping strategies among Japanese survivors.

Sexuality after a cancer diagnosis has long been neglected in the clinical and research settings in many countries. In particular, research in Asia on sexuality and cancer among women is extremely scarce. Semi-structured interviews were conducted with 21 Japanese women with breast cancer (mean age 42.2 years; median length between surgery and first interview 17 months) to explore their views on sexuality following breast cancer treatment. Analysis using the Grounded Theory approach revealed four major themes: (a) hesitation in resuming sex after treatment, (b) sexual changes after resuming sex, (c) coping attitudes to the changes, and (d) long-term outcomes of the relationship with partners. Contrary to Japanese breast surgeons' optimistic outlooks, the majority of informants referred to the impact of treatment on the physical as well as psychological aspects of their sexuality. Factors that influenced women's experiences included the pace of their psychological and physical recovery after treatment, fear of their partner's negative response, the importance of the sexual relationship for the couple, and their partner's understanding and support. Suggestions for medical professionals on how to support women's sexuality after cancer are discussed with reference to the Japanese socio-cultural and medical context.

Adaptation, Psychological↗
PubMed2005

Evaluation of universal newborn hearing screening in Japan: an analysis of the literature.

INTRODUCTION: To address delayed language development associated with severe-to-profound congenital hearing loss (CHL), universal newborn hearing screening (UNHS) has been implemented in many countries. In Japan, approximately 27,000 neonates (2.5% of newborn) are screened annually through public-funded programs. While foreign literature highlights the need for assessment, in Japan this has hitherto not been evaluated in detail. OBJECTIVE: To investigate the efficacy of UNHS in Japan. METHODS: We used two criteria to evaluate UNHS; accuracy of screening and the effectiveness of early detection, and searched the major medical and social research journal data bases for related research papers. Eleven articles were identified providing information on accuracy of screening tests and two on effectiveness of early detection. RESULTS: 1) In two prefecture-based studies, 900 and 1,272 newborns were screened to find one case of bilateral CHL. In nine hospital-based programs, the number tested ranged from 313 to 1,910. None of the studies measured the sensitivity and specificity against a best practice standard. 2) The two studies suggested that early intervention might be beneficial, but neither provided conclusive evidence. CONCLUSION: The effectiveness of UNHS in Japan is still equivocal because of the difficulties associated with differential diagnosis of hearing loss and normal hearing at the early stage of life and the lack of evidence on effectiveness of early intervention. Before nationwide implementation of UNHS, these issues should be fully investigated and evaluated.

Diagnosis, Differential↗
PubMed2004

Disclosure of cancer diagnosis and prognosis: a survey of the general public's attitudes toward doctors and family holding discretionary powers.

BACKGROUND: This study aimed to ask a sample of the general population about their preferences regarding doctors holding discretionary powers in relation to disclosing cancer diagnosis and prognosis. METHODS: The researchers mailed 443 questionnaires to registered voters in a ward of Tokyo which had a socio-demographic profile similar to greater Tokyo's average and received 246 responses (response rate 55.5%). We describe and analysed respondents' attitudes toward doctors and family members holding discretionary powers in relation to cancer diagnoses disclose. RESULTS: Amongst respondents who wanted full disclosure about the diagnosis without delay, 117 (69.6 %) respondents agreed to follow the doctor's discretion, whilst 111 (66.1 %) respondents agreed to follow the family member's decision. For respondents who preferred to have the diagnosis and prognosis withheld, 59 (26.5 %) agreed to follow the doctor's decision, and 79 (35.3 %) of respondents agreed with following family member's wishes. CONCLUSIONS: The greater proportion of respondents wants or permits disclosure of cancer diagnosis and prognosis. In patients who reveal negative attitudes toward being given a cancer disclosure directly, alternative options exist such as telling the family ahead of the patient or having a discussion of the cancer diagnosis with the patient together with the family. It is recommended that health professionals become more aware about the need to provide patients with their cancer diagnosis and prognosis in a variety of ways.

Adult↗