Community Support Center Research Articles

Progress report of the Tohoku Medical Megabank Community-Based Cohort Study: Study profile of the repeated center-based survey during second period in Miyagi Prefecture.

The purpose of this study was to report the basic profile of the Miyagi Prefecture part of a repeated center-based survey during the second period (2nd period survey) of the Tohoku Medical Megabank Community-Based Cohort Study (TMM CommCohort Study), as well as the participants' characteristics based on their participation type in the baseline survey. The 2nd period survey, conducted from June 2017 to March 2021, included participants of the TMM CommCohort Study (May 2013 to March 2016). In addition to the questionnaire, blood, urine, and physiological function tests were performed during the 2nd period survey. There were three main ways of participation in the baseline survey: Type 1, Type 1 additional, or Type 2 survey. The 2nd period survey was conducted in the same manner as the Type 2 survey, which was based on the community support center (CSC). In Miyagi Prefecture, 29,383 (57.7%) of 50,967 participants participated in the 2nd period survey. The participation rate among individuals who had visited the CSC was approximately 80%. Although some factors differed depending on the participation type in the baseline survey, the 2nd period survey respondents in the Type 1 and Type 2 survey groups at baseline had similar traits. The 2nd period survey of the TMM CommCohort Study provided detailed follow-up information. Following up on the health conditions of the participants will clarify the long-term effects of disasters and contribute to personalized prevention.

Associations of combined genetic and lifestyle risks with hypertension and home hypertension

No study, to our knowledge, has constructed a polygenic risk score based on clinical blood pressure and investigated the association of genetic and lifestyle risks with home hypertension. We examined the associations of combined genetic and lifestyle risks with hypertension and home hypertension. In a cross-sectional study of 7027 Japanese individuals aged ≥20 years, we developed a lifestyle score based on body mass index, alcohol consumption, physical activity, and sodium-to-potassium ratio, categorized into ideal, intermediate, and poor lifestyles. A polygenic risk score was constructed with the target data (n = 1405) using publicly available genome-wide association study summary statistics from BioBank Japan. Using the test data (n = 5622), we evaluated polygenic risk score performance and examined the associations of combined genetic and lifestyle risks with hypertension and home hypertension. Hypertension and home hypertension were defined as blood pressure measured at a community-support center ≥140/90 mmHg or at home ≥135/85 mmHg, respectively, or self-reported treatment for hypertension. In the test data, 2294 and 2322 participants had hypertension and home hypertension, respectively. Both polygenic risk and lifestyle scores were independently associated with hypertension and home hypertension. Compared with those of participants with low genetic risk and an ideal lifestyle, the odds ratios for hypertension and home hypertension in the low genetic risk and poor lifestyle group were 1.94 (95% confidence interval, 1.34–2.80) and 2.15 (1.60–2.90), respectively. In summary, lifestyle is important to prevent hypertension; nevertheless, participants with high genetic risk should carefully monitor their blood pressure despite a healthy lifestyle.

Reorganization Processes for Setting the Served Areas and Locations of Comprehensive Community Support Centers in Response to an Aging Population

Reorganization Processes for Setting the Served Areas and Locations of Comprehensive Community Support Centers in Response to an Aging Population

Design and Progress of Child Health Assessments at Community Support Centers in the Birth and Three-Generation Cohort Study of the Tohoku Medical Megabank Project.

The Tohoku Medical Megabank Project (TMM) has been conducting a birth and three-generation cohort study (the BirThree Cohort Study). We recruited 73,529 pregnant women and their family members for this cohort study, which included 23,143 newborns and 9,459 of their siblings. We designed and are in the process of conducting three-step health assessments for each newborn at approximately ages of 5, 10 and 16. These health assessments are administered at seven community support centers. Trained genome medical research coordinators conduct physical examinations of and collect biological specimens from each participant. The Sendai Children's Health Square has been established as the headquarters for these child health assessments and is utilized to accumulate knowledge that can facilitate the proper practice of child health assessments. We designed all the relevant health assessments facilities to allow parents and their children to participate in the health assessments concomitantly. Our centers serve as places where child participants and their parents can feel at ease as a result of the implementation of safety measures and child hospitality measures. The TMM BirThree Cohort Study is in the process of conducting strategically detailed health assessments and genome analysis, which can facilitate studies concerning the gene-environment interactions relevant to noncommunicable diseases. Through these operations, our study allows for a significant depth of data to be collected in terms of the number of biospecimens under study and the comprehensiveness of both basic and clinical data alongside relevant family information.

Data as the Basis for Business Goals by Outsource-type Comprehensive Community Support Centers, and the Specific Methods of Presenting These Data

Data as the Basis for Business Goals by Outsource-type Comprehensive Community Support Centers, and the Specific Methods of Presenting These Data

Factors Related to the Care Management Practice for Old Public Assistance Recipients in Osaka City of Japan

The research was conducted between January 22 and February 25, 2021. The data was collected by self-administered questionnaires mailed to the participants at 800 care management centers and comprehensive community support centers in Osaka City. The centers were randomly selected. The response rate was 19.1%. The independent variables were: obtaining the qualification of a Senior Care Manager (SCM), who was a qualified person that acquired advanced knowledge and skills in care management by advanced training; experience years in Social Work (SW); experience years in care management; experiences in training programs for team approach; and experiences in training programs for supporting Old Public Assistance Recipients (OPAR). The dependent variables were the categorized contents in the Care Management Practice for old public assistance recipients. They were: Care planning and Implementation (CI); Assessment; Financial Support and Evaluation (FSE); Contract and Explanations in care management; Coordinating Informal support and Formal services in Care planning; and Arrangements in Financial supports for Formal service costs. The Structural Equation Modeling was performed for the examinations of the relationships. As a result, the goodness of the fit indices was acceptable, and we retained the models. In correlational analyses, CI and Assessment were significantly correlated with SCM (p<.05). FSE was significantly correlated with SW (p<.001) and OPAR (p<.05). In conclusion, the results implied that advanced qualification of a Senior Care Manager and a specified training program for supporting old public assistance recipients were effective in providing appropriate care management services.

Atención de Terapia Ocupacional en Demencias durante el contexto de Pandemia COVID-19. Sistematización de experiencia desde el Centro Kelluwun, Hualpén

One of the emerging challenges at a global level is related to the aging population and the consequent risk of increased incidence of major neurocognitive disorder or dementias, which do not have an effective and currently validated curative treatment. However, the available evidence emphasizes the effectiveness and importance of developing symptomatic and accompanying treatments for maintaining the quality of life of those living with a diagnosis of dementia and their immediate environment, especially caregivers. Taking this approach and under the atrous of the National Dementia Plan, the Community Support Center for People with Dementia “Kelluwun” has been working since 2016, which offers comprehensive and transdisciplinary treatment to people living with the diagnosis of dementia in the municipality of Hualpen. However, the Covid-19 pandemic and its consequences, characterized mainly by restrictive measures focused on preventing and reducing the risk of spreading the SARS-CoV-2 virus, has presented new challenges and opportunities for the continuity of non-pharmacological treatments in people diagnosed with dementia. This article aims to publicize a systematization of work experience from Occupational Therapy in the Center “Kelluwun”, which has been developed during the last 17 months since the beginning of the Covid-19 pandemic.

Development and testing of reliability and validity of a subjective QOL scale for older adults perceiving a dynamic healthy life through the three dimensions of biological life, everyday life, and overall course of life

Objectives To develop and assess the reliability and validity of a scale measuring subjective quality of life (QOL), which encompasses the "strength and ability" to live positively through the three dimensions of biological life, everyday life, and overall course of life, in order to support QOL in older adults.Methods We reviewed related literature and conducted interviews with patients with chronic diseases. Participants rated their QOL on a seven-point scale using the visual analog scale. Interviewer-administered questionnaires were used to collect data from 100 older adults living in their own homes. The participants were between the ages of 70 and 84, and were recruited from comprehensive community support centers or from among hospital outpatients. We assessed scale reliability using Cronbach's α, item-total (I-T) correlation analysis, and calculation of α coefficient-if-item-deleted. We examined content validity by analyzing the content of the free response items. To evaluate construct validity, we carried out a hierarchical multiple regression analysis, examined the semantic content of the factors related to subjective QOL, and confirmed consistency with previous studies.Results Regarding the reliability analysis of the scale, the α coefficient was 0.898, and both the I-T correlation and α coefficient-if-item-deleted exceeded the minimum value considered reliable. In examining content validity, the categories extracted for each of the three dimensions were found to demonstrate the characteristics of the general ideas of each dimension of QOL. Thus, the scale was confirmed to have overall content validity. As for the assessment of validity of its constitutive concepts, subjective QOL scores were significantly high among participants who had jobs, had role-related or financial capacity, used two or more nursing services, or scored high in perceived health competence, social networking, and sense of coherence (SOC). In addition, "meaningfulness" of SOC, and financial capacity had significant correlations with subjective QOL. These results are consistent with past research and therefore confirm construct validity.Conclusion This study sufficiently confirmed the reliability and validity of the scale, and consequently its usability.

Welfare Commissioners’ Assistance Requests at Comprehensive Community Support Centers for Older Adults with Suspected Dementia, Related Knowledge of Dementia, and Attitudes Toward People with Dementia

Welfare Commissioners’ Assistance Requests at Comprehensive Community Support Centers for Older Adults with Suspected Dementia, Related Knowledge of Dementia, and Attitudes Toward People with Dementia

Design and Progress of Oral Health Examinations in the Tohoku Medical Megabank Project.

In order to assess the long-term impact of the Great East Japan Earthquake on the oral health of disaster victims and to evaluate gene-environmental interactions in the development of major oral diseases and oral-systemic associations, the oral part of two large-scale genome cohort studies by the Tohoku Medical Megabank Organization (ToMMo), including the Community-based cohort (CommCohort) study and the Birth and Three-Generation cohort (BirThree) study, have been conducted. The study population comprised 32,185 subjects, including 16,886 participants in the CommCohort study and 15,299 participants in the BirThree cohort study, recruited from 2013 to 2017. The oral studies consist of a questionnaire regarding oral hygiene behavior, clinical examinations by dentists, and oral plaque and saliva sampling for microbiome analyses, which were carried out at seven community support centers in Miyagi prefecture. The median age of all participants was 55.0 years, and 66.1% of participants were women. Almost all participants reported that they brushed their teeth more than once a day. The median number of present teeth was 27.0, and the decayed, missing and filled tooth number was 16.0, with a significant difference according to age and sex. The median periodontal pocket and clinical attachment level was 2.48 mm and 4.00 mm, respectively. Periodontal parameters increased significantly according to age, except for the accumulation of dental calculus. The oral part of these extensive cross-sectional studies provides a unique and important platform for future studies on oral health and diseases that elicit through interactions with systemic diseases, lifestyles, life events and genetic backgrounds, and contributes to researches clarifying the long-term effects of disasters on oral health.

Specialties of Public Health Nurses at a Comprehensive Community Support Center :

Specialties of Public Health Nurses at a Comprehensive Community Support Center :

A Study on Support System of Intermediary Organization for Community Activities: Focusing on Goyang City Community Support Center

A Study on Support System of Intermediary Organization for Community Activities: Focusing on Goyang City Community Support Center

Impact of support agreement between municipalities and convenience store chain companies on store staff’s support activities for older adults

In the continuously aging society, private sectors are expected to play a role in older adult care. Implementing an agreement between municipalities and private sectors is one of the key mechanisms for encouraging private sectors to participate in supporting older adults. The study’s aim was to evaluate whether the support agreement has promoted support activities by convenience store staff for older adults. A retrospective observational study was conducted between 2013 and 2016 using data from a nationwide survey of convenience stores. The municipality-level matching produced 168 municipality pairs, with 2242 convenience stores that entered into a support agreement with municipalities from 2014 to 2015, and 2141 stores without such an agreement. Convenience store-level logistic regression analysis evaluated the impact of the agreement on staff activities. The analysis showed that some staff activities increased significantly with the support agreement, such as corresponding or collaborating with community support centers (AOR = 3.40; 95% CI: 2.22 to 5.26), participating in role-playing programs for older adult care (AOR = 2.05; 95% CI: 1.01 to 4.26), and attending dementia support lectures (AOR = 18.21; 95% CI: 8.27 to 45.34). Emergency protection for older adults did not increase with the support agreement. The results suggest that the support agreement positively influenced some convenience store staff’s support activities for older adults.

障害者地域生活支援センターにおける"ピア・サポート"に関する一考察 : 名古屋市M区障害者地域生活支援センターの中途視覚障害者相談記録の調査分析から

障害者地域生活支援センターにおける"ピア・サポート"に関する一考察 : 名古屋市M区障害者地域生活支援センターの中途視覚障害者相談記録の調査分析から

Issues and efforts regarding community care meetings managed by community-based comprehensive support center staff

Objectives Due to the revision of the Public Nursing Care Insurance Law in 2015, social insurance services became obliged to conduct community care meetings. However, staff members of community-based comprehensive support centers (henceforth, community support centers) have difficulty planning and managing such meetings. The present study aimed to clarify the issues regarding community care meetings planned and managed by these staff members, as well as their efforts to manage them, and to discuss effective management strategies.Methods To examine staff members' process of conducting community care meetings, difficulties and challenges faced by them, and effective approaches from their viewpoint, group interviews were conducted with 30 staff members managing community care meetings. They were divided into 3 outsourced community support center groups and 1 social insurance service group, each of which comprised 5-9 persons. The results of the interviews were qualitatively and inductively analyzed according to the group, based on their issues and efforts regarding the management of community care meetings. Similarities and differences among the 4 groups were also analyzed to obtain overall findings.Results The analysis yielded 91 subcategories, and 29 medium, 11 major, and 4 core categories from 454 codes. Concerning the issues regarding the planning and management of community care meetings, the following core categories were extracted: [roles of community care meetings and indecisiveness about goal setting], [burdens associated with a lack of skills for meeting management], [difficulty with community establishment that involves outsourced chief care managers (CM) and residents]. Further, associations were observed among these categories. The core-category [realizing the effectiveness of approaches adopted to conduct productive meetings] recounted the favorable outcomes of the staff members' approaches to overcome these difficulties and challenges. Such realization may have been a result of the structuring of community care meetings, skill improvements through accumulated experience, training for CMs to promote community care, and enhanced recognition of community care meetings as opportunities to collaborate with residents.Conclusion In order to effectively manage community care meetings, social insurance services need to systematize them, clarify their goals, and improve comprehensive community staff's skills to facilitate them. In addition, it is necessary to strengthen the functions of insurers in order to collect/analyze data related to the results of meetings, and to use them to develop appropriate community policies.

Strategic Methods for Recruiting Grandparents: The Tohoku Medical Megabank Birth and Three-Generation Cohort Study.

Involvement of family members, especially grandparents, in genome epidemiological research is important to investigate both genetic and environmental factors of common diseases. The aim of the present study was to establish strategies to obtain enough number of family recruitment, especially focusing on grandparents, for the Tohoku Medical Megabank Birth and Three-Generation Cohort Study. Our main strategies are summarized below. 1) We standardized informed consent process with reference materials to help people understand the consent form, 2) we created an invitation letter to contact family members, and 3) we recruited family members in several settings. To obtain informed consent, we were careful of explaining clearly the complex reasons as well as drawing people's attention. By the end of March 2017, the number of invitation letters distributed to family members through the pregnant women was 23,806, including 18,702 grandparents. Among the grandparents who received invitation letters, 2,935 (15.7%) responded to us. Furthermore, some grandparents were asked to provide informed consent with other family members by staff at maternal clinics or Community Support Centers, and others directly booked Community Support Centers without responding to the invitation letter. Grandparents joined the study anytime during mother's maternal check-ups or delivery. Overall, 8,054 grandparents participated in our birth cohort study. The setting in which most grandparents were recruited was our own facilities. Importantly, both paternal and maternal grandparents more frequently participated in the study if the father also participated. In conclusion, we are able to recruit not only pregnant women but also fathers and grandparents.

Survey on cooperation between regional medical practice hospitals at Iwate Medical University, and comprehensive community support center

Survey on cooperation between regional medical practice hospitals at Iwate Medical University, and comprehensive community support center

Building a Population Based Cognitive Screening System to Improve the Early Diagnosis of Dementia in Japan

An introduction: Since the global population is rapidly ageing dementia has become a worldwide concern; the illness places considerable burdens on individuals and their family members as well as on a health and social care provisions. By 2050, 135 million people are estimated to have dementia in the world. In 2010 the global cost of dementia care was estimated at $604bn and was estimated to increase to $1tr by 2030. Japan, a rapid ageing country, is requiring urgent interventions regarding dementia. Of all chronic diseases, dementia is one of the most significant contributors to dependence and disabilities of individuals. Because of the absence of a cure, a professional's belief; nothing can be done to dementia, has contributed to the delay of its diagnosis. However, the increasing number of evidences showing possibilities of prevention, earlier diagnosis and interventions of dementia begin to draw international attentions. In Japan, although every municipality is obligated to have a multidisciplinary team to cope with dementia since 2015 under the national policy, the actual implementation hasn't developed so much yet. This research aims to summarise establishment of the population based cognitive screening system project in M-city in Japan to provide the evidences of the diagnosis and early interventions in dementia care. Short description of practice change implemented: We conducted a pilot project in M-city. We chose this city, located within 20km area from the centre of Tokyo, because of the great necessity to develop interventions for dementia while their elderly population rises rapidly. We organized a study committee composed of the city workers, the representatives of long-term care providers, and academic experts in order to develop methodologies for the dementia screening and the steps of interventions afterward. The intervention includes following steps; 1) consultation of memory problems, 2) explanation of the project to individuals with dementia and their families, 3) execution of the questionnaire survey (DASC-21 (AWATA2016., et al)), 4) care management (i.e. encourage visiting a home doctor or medical institutes supporting dementia, education of self-care, adjust the use of long-term care services etc.) and 5) monitoring, and they were applied in all Community-based integrated Centres and some of primary care doctors, pharmacists, and long-term care providers. DASC scores of each participant at the points of the screening and the monitoring were collected together with the participant's self-reports about their daily practices in self management. Key findings: In order to promote the early diagnosis and interventions for people with dementia, it is necessary to focus on patients who are discharged from acute hospitals. Moreover, cooperation with primary care doctors is indispensable (essential) in cognitive screening systems, and it is important that those doctors take a role in exclusion of non-dementia diseases and in an appropriate management of coexisting conditions and daily lives of dementia patients. Although DASC-21 is useful as a screening tool, development of a simpler tool is needed. Highlights: M-city continues the project of the cognitive screening system and publishes the results to the citizens. Furthermore, M-city is considering to strengthen the coordination between Community-support centers and primary care providers in order to establish a screening system. The city is also preparing to introduce financial incentives to encourage screening. Conclusion: While Japan is promoting to construct the community-based integrated care system, the measures to achieve so are depending on the decisions of each municipal government. M-city started to build the cognitive screening system to improve early diagnosis of dementia and they investigate whether the screening system influences on containment of future medical and care cost as one of the outcomes. Although this practice is currently considered as advance in Japan, such practices need to be more common in the future.

Partnership between Intermediary Organization and Administrative Agency : The case of the Relationship between Seoul Community Support Center and City of Seoul

Partnership between Intermediary Organization and Administrative Agency : The case of the Relationship between Seoul Community Support Center and City of Seoul

FACTORS RELATING TO SATISFACTION AND MOTIVATION OF DISTRICT WELFARE COMMISSIONERS IN JAPAN.

AbstractFormal volunteering offers broad benefits to the community. Therefore, understanding the strategy for the recruitment and retention of volunteers has been considered as an important policy issue. In Japan, district welfare commissioners are important formal volunteers that deal with community care and support. However, there are few people that willingly undertake work as the commissioners. This study examined factors associated with the satisfaction and motivation to continue working of district welfare commissioners, with a focus on the roles of “psychosocial gains,” “role strain,” and “support from others”. Questionnaires were sent by mail to district welfare commissioners (N=1,936) living in Tokyo in 2012 (response rate: 69.5%). The results from structural equation modeling showed that those having high psychosocial gains such as feelings of fulfillment about their activities had a high level of satisfaction and motivation to continue working, whereas those feeling role conflicts (e.g. “I am assigned meaningless work.”) and role ambiguity (e.g. “I don’t know what to do.”) had a low level of satisfaction and motivation. Role overload was not significantly related to the level of satisfaction and motivation. Although support from municipal offices, community support centers and other sources did not have direct effects on satisfaction and motivation, consultation and information support from them had indirect effects mediated by an increase in psychosocial gains and a decrease in role conflicts and ambiguity. These results suggest the importance of managing psychosocial gains and role conflict/ambiguity and promoting backup support for the retention of district welfare commissioners.