Introduction: High-quality, community-based dementia care requires a comprehensive, holistic approach. This study aimed to identify the barriers to achieving efficient cooperation and coordination among medical professionals, care managers, and medical social workers, and to improve the management model of community-based, integrated dementia care.

Methods: We collected qualitative data through three focus group discussions at JA Konan Kosei Hospital. Thirteen participants (four directors of nursing service departments, three chief nurses, four medical social workers, and two care managers) were recruited for the discussions. The data were analyzed using an inductive, multi-step approach referred to as the qualitative content analysis.

Results: Nine themes arose as follows: little attention given to patient wishes, lack of time and space to provide high-quality care, disturbing hospital environment, poor compensation for staff members, refusing to visit outpatient clinics, declined admission, daily life support by family members and caregivers, dementia care team, and community bonding.

Conclusion: The participants wanted to launch a dementia care team in their hospital to improve the care environment and the quality of dementia-specific care. The study also suggested that advance care planning could be systematically implemented in clinical practice as a way to honor the decisions made by dementia patients.

Introduction
Health Sector Reform Program (HSRP) in Egypt started in 1997 to improve equity, efficiency, quality and sustainability of Egyptian health systems. This study aims to review reports and publications regarding HSRP in Egypt and to analyze its achievements and problems.
Methods
Documents of international organizations and other relevant agencies, such as reports of health sector reform programs and statistics, were reviewed and analyzed.
Results
HSRP aimed to improve quality of health services and equality of access, and to establish sustainable health financing mechanisms, while focusing on primary health care. Major components of HSRP were: health service delivery, health financing, and evaluation. It started in five pilot governorates. Based on the Family Health Model (FHM), each family registered to a physician or a health facility, and was provided with essential medical services called Basic Benefits Package (BBP). Family Health Fund (FHF), the newly established financing agency of FHM, provided health staff with incentives from a pooled fund. Against the original plan, FHF could not function as a health insurance fund, and was financially unsustainable. Mechanisms of health facility accreditation and health services performance evaluation with incentives were installed to ensure the quality of health services.In addition, health staff training programs were enhanced, health facilities and equipment in rural areas were improved, and referral systems were strengthened.
Conclusions
HSRP introduced a family health model for the first time in Egypt in pilot governorates. Focusing basic health service provision, HSRP succeeded to improve equity, efficiency and quality of health services. However, sustainable health insurance mechanisms were not established yet, and involvement of private health service providers were very limited. It is needed to bring in commitment of Egyptian government across the sectors and to develop health systems that secure good quality of health services for all Egyptians.

Introduction
The use of medicines among Brazilian workers in Japan has not been documented. This study examines the preferences and use of medicines among Brazilian workers of Japanese origin in Japan.
Methods
A cross-sectional survey was conducted in 2011 in a community in Nagoya, where many Brazilian workers lived. Questionnaires were distributed to 206 Brazilian households, and asked about preferences and use of Japanese or Brazilian medicines. Associations with socioeconomic factors were analyzed using Fisher's exact test.
Results
The response rate was 36% (74 households). Of these, 66% had lived in Japan for over 10 years, and 88% held health insurance. Over 80% reported a preference for Japanese medicines. However, Brazilian medicines were used in more than 40% of the households. Employed Brazilians tend to use Brazilian medicines compared to the unemployed. Most respondents answered that Brazilian medicines were more effective, but were more expensive and produced worse side effect than Japanese medicines.
Households with children showed a preference for Japanese medicines for children's illnesses. However, more Brazilian medicines were used when the length of household's stay in Japan was less than 10 years, and when the respondent's perceived listening ability of Japanese language was poor.
Conclusion
Almost all respondents were using the medicines they preferred, suggesting that access to medicine was generally good in the community. However, 40% of respondents used Brazilian medicines, despite their long stay in Japan, their health insurance status, and their recognition of Japanese medicines as inexpensive and safe. This might be explained by familiarity with Brazilian medicines, or perception of their effectiveness.
Continuous self-administration of medicines without consultation has potential harm to the health. This study also suggests the importance of arranging social environments such as facilitating the taking of sick leaves, so that immigrant workers can secure their access to health services.

Background and Objective
  The prevalence of non-communicable diseases (NCD) is increasing in low- and middle-income countries, imposing major public health and development threats. However, there is difference among countries with regard to the patterns of NCD metabolic risk factors. This study aims to categorize the pattern of metabolic risk factors in East Asia, Southeast Asia and Oceania.
Methods
  Age-standardized prevalence of obesity, raised blood pressure, raised blood glucose, and raised blood cholesterol for 2008 were obtained from the World Health Organization (WHO) Global Health Observatory Data Repository. We used hierarchical cluster analysis to categorize countries in East Asia, Southeast Asia and Oceania based on the prevalence of NCD metabolic risk factors of each country.
Results
  Three patterns of NCD metabolic risk factors were identified. The first pattern showed relatively high prevalence of raised blood cholesterol, while prevalence of obesity, raised blood pressure and raised blood glucose remain relatively low. Most high- and upper-middle-income Asian countries were included in this pattern. The second pattern presented relatively high prevalence of raised blood pressure, although prevalence of obesity, raised blood glucose, and raised blood cholesterol stay relatively low. Most low- and lower-middle-income Asian countries were categorized in this pattern. The third pattern presented high prevalence of obesity and relatively high prevalence of raised blood pressure and raised blood glucose. This pattern included most Pacific island countries.
Conclusions
  Policy makers in countries in East Asia, Southeast Asia, and Oceania should take into account for the features of the pattern they are in, when they set priorities for developing effective NCD control measures.

Objective: Assistance from health professionals is very important to ensure medication adherence among older people. The present study aimed to assess the relationship between receipt of comprehensive medication management services by primary care physicians and medication adherence among community-dwelling older people in rural Japan.Methods: Data including medication adherence and whether or not a doctor knew all the kinds of medicines being taken were obtained from individuals aged 65 years or older who underwent an annual health checkup between February 2013 and March 2014 at a public clinic in Asakura. The subjects were divided into 2 groups: adherent (always) and non-adherent (not always). A logistic regression analysis was performed to assess the association between the presence of a doctor who was fully responsible for medication adherence and self-reported adherence. Predictors that exhibited significant association (p-value < 0.05) with medication adherence in a univariate analysis were entered in the model as possible confounding factors. The results were presented as odds ratios (OR) and 95% confidence intervals (CI).Results: Among four-hundred ninety-seven subjects in total, the adherent group included 430 subjects (86.5%), and its members were older than those of the non-adherent group. Significant predictors of good medication adherence included older age, no discomforting symptoms, eating regularly, diabetes mellitus and having a doctor who knew all the kinds of medicines being taken. After being adjusted for confounding variables, the subjects with a doctor who knew all the kinds of medicines they were taking were three times more likely to be adherent to medication (OR 3.01, 95% CI 1.44-6.99).Conclusion: Receipt of comprehensive medication management services for older people was associated with medication adherence.

Objective: The aim of this study was to examine the effectiveness and efficiency of interprofessional case conferences on home-based end-of-life care to bridge perceptions gaps regarding ethical dilemmas among different healthcare professionals and analyze essential issues extracted the interprofessional discussions.Patients and Methods: The participants could spend only a limited amount of time after their working hours. Therefore, we shortened and simplified each of three case scenarios so that the discussions do not last longer than 90 minutes. For the case conferences, we selected 3 cases, which entailed the following ethical dilemmas pertaining to home-based end-of-life care: refusal of hospital admission, passive euthanasia, and emergency transport. Participant responses were audio-recorded, transcribed, and analyzed using qualitative content analysis and Jonsen’s four topics approach.Results: A total of 136 healthcare professionals (11 physicians, 35 nurses, and 90 care workers) participated in the case conferences. The physicians, nurses, and care workers differed in their perceptions of and attitudes toward each case, but there were no interprofessional conflicts. Despite the short duration of each case conference (90 minutes), the participants were able to discuss a wide range of medical ethical issues that were related to the provision of appropriate home-based end-of-life care to older adults. These issues included discrimination against older adults (ageism), self-determination, an unmet desire for caregiver-patient communication, insufficient end-of-life care skills and education, healthcare costs, and legal issues.Conclusion: The physicians, nurses, and care workers differed in their perceptions of and attitudes toward each case, but there were no interprofessional conflicts.

Objective: The non-medical needs of patients, such as values and personal preferences, are likely to be omitted from advance care planning (ACP) discussions because of a lack of readiness and awareness on the part of healthcare professionals. The aim of the present study was to identify core components perceived by multidisciplinary healthcare professionals to improve person-centered ACP conversations with older people.Methods: The study participants were healthcare professionals (physicians, nurses, and care managers) working in different cities. This qualitative study was performed online using eight individual in-depth interviews and one subsequent focus group composed of eight healthcare professionals. The interviews and focus group discussion were audio-recorded online and transcribed verbatim. The aim of the analysis of the individual in-depth interviews was to summarize the transcribed results, create a conceptual framework for person-centered ACP conversation, and provide meaningful interpretations of the focus group participant discourse. The qualitative data were then analyzed by inductive manual coding using a qualitative content analysis approach.Results: Five themes capturing the core components for successful person-centered ACP were extracted from the ideas voiced by participants: Placing highest value on patient autonomy and human life; uncovering patient’s true feelings and desires; sharing collected information on patients’ end-of-life wishes with other team members; relaying patients’ wishes to the physician; and handling conflicts among patients, relatives, and healthcare professionals.Conclusion: The results provide guidelines for the future development of novel, value-based, person-centered ACP practice for multidisciplinary healthcare professionals.

Objective: This study aimed to explore the gender differences in wishes and feelings regarding end-of-life care among Japanese elderly people requiring home care services.Patient/Materials and Methods: This study was a secondary analysis of the qualitative data previously compiled from a total of 102 elderly people living at home. The data was retrospectively collected from the participants’ nursing records, which included a designated advance care planning (ACP) form completed between January and July 2015. Out of the 102 participants, 86 men and women who were either living alone or with a spouse were selected for the present analysis. We reviewed the participants’ ACP forms based on which of the sentiments on the following checklist were expressed: anxiety about the future, abandonment of control, clinging to current daily life, inadequate support from spouse, and a tendency to delegate decision-making.Results: The most commonly expressed feeling was abandonment of control, among both men and women. Among elderly people living alone, women were more likely to want to be surrounded by good, caring people when approaching the end of their lives. Among elderly people living with a spouse, women were more likely to want to delegate decision-making to others.Conclusion: Our results pointed to a gender difference in the attitudes of elderly people toward interactions with the people surrounding them during the end-of-life decision-making process. In order to provide better overall care, health care professionals must come to realize the importance of this gender difference, as it has an impact on the ACP choices made by elderly people living in the community.

Objective: The burden of noncommunicable diseases (NCDs) is increasing in China, together with economic development and social changes. The prevalence of risk factors for NCDs, such as overweight/obesity, hypertension, diabetes, and dyslipidemia, is reported to be high even among poor residents of rural areas. We aimed to investigate the prevalence of hypertension among elderly adults in rural Northeast China and the proportion with controlled hypertension among those on antihypertensive medication (hypertension control rate). We also aimed to examine the association of hypertension control with health facilities that provide treatment.Methods: We conducted a community-based cross-sectional study in six rural villages of Northeast China from February to early March, 2012. We interviewed 1593 adults aged 50–69 years and measured their blood pressure. We examined the differences in mean blood pressure between participants who obtained antihypertensive medication from village clinics and those who obtained medication from other sources, using analysis of covariance adjusted for several covariates.Results: The prevalence of hypertension among participants was as high as 63.3%, but the hypertension control rate was only 8.4%. Most villagers (98.1%) were not registered in the chronic disease treatment scheme of the public rural health insurance. The mean systolic blood pressure, adjusted for the covariates, of participants who obtained antihypertensive medication from village clinics was significantly lower than that of participants who obtained medication from township hospitals (by 16.5 mmHg) or from private pharmacies (by 7.3 mmHg).Conclusion: The prevalence of hypertension was high and the hypertension control rate low among elderly villagers during the cold season. As treatment at village clinics, which villagers can access during the cold season seems to be more effective than self-medication or treatment at distant hospitals, improving the quality of treatment in village clinics is urgently needed.

BACKGROUND: This study aimed to describe the status of alcohol consumption and drug use among young adults as well as their determinants. METHODS: We conducted a cross-sectional study of 356 young adults (aged 18 to 24 years) living in Palau in 2013. The prevalence of self-reported alcohol and marijuana usage were compared within and between sexes, age groups, ethnicities, and education levels. RESULTS: The proportion of current drinking was higher in people aged 21-24 than in those aged 18-20 (73.2% vs. 60.9%, p = 0.09 in men and 48.3% vs. 30.0%, p = 0.02 in women), while that of marijuana use did not differ between the age groups. The proportions of current drinking and marijuana use were higher in Palauan than in other ethnicities (current drinking: 70.6% vs. 40.6%, p = 0.005 in men and 38.8% vs. 16.6%, p = 0.04 in women; lifetime marijuana use: 80.0% vs. 52.9%, p = 0.02 in men and 56.1% vs. 30.6%, p = 0.09 in women). The proportion of frequent (3 times or more) marijuana users was higher for the lower educated than for the higher educated (62.5% vs. 32.1%, p < 0.001 in men and 33.9% vs. 24.4%, p = 0.12 in women). CONCLUSIONS Sex, age, ethnicity, and education were significant determinants of alcohol and marijuana use.
Age Factors ; Alcohol Drinking/ethnology* ; Cross-Sectional Studies ; Educational Status ; Female ; Humans ; Male ; Marijuana Use/ethnology* ; Palau/epidemiology* ; Prevalence ; Sex Factors ; Young Adult