BACKGROUND: Early childhood caries (ECC) affects children across Japan and throughout the world. Thus, it is important to identify dietary and dental care habits that either promote oral health or cause ECC. The objective of this study was to identify protective and risk factors associated with ECC in Japan. METHODS: In a typical rural Japanese community, we selected children born between 2004 and 2008 who had received checkups at their community health center including oral examinations conducted by dentists. We obtained data from children's records and from a questionnaire filled out by parents. We enrolled only children who at their checkup for 18-month-olds had no caries, and we obtained data about them at their checkup for 3-year-olds. We classified children as either having caries (treated or untreated) or being caries-free. We conducted bivariate analyses using data on child/family demographic characteristics, child's dietary habits, and child/parental oral health habits. We also conducted logistic regression analysis to control for variables and identify predictors of the presence/absence of caries. RESULTS: Five hundred sixty six children (278 boys, 288 girls) were enrolled and followed. After 2 years, 173 children (30.6%) presented with caries. Logistic regression analysis predicting caries at follow-up identified the interaction term "bottlefed overnight and brushed irregularly" at 18 months of age as a highly significant predictor of developing caries-adjusted odds ratio (AOR) of 14.27, 95% confidence interval (CI) 1.02-199.71. Two variables measured at follow-up were also significant predictors: having low levels of dental plaque (AOR 2.41, 95% CI 1.34-4.35) and having a mother who had untreated caries (AOR 1.84, 95% CI 1.09-3.12). CONCLUSION Public health efforts should encourage parents to eliminate bottle feeding overnight and promote brushing twice daily as children's teeth begin to erupt. Greater efforts should be made to teach parents and daytime caregivers how to brush effectively to remove all plaque. Health professionals should pay close attention to mothers' oral health status. Mothers with caries should receive prompt treatment and be assisted in developing better dietary and oral health habits that will benefit themselves and their children. Policies and programs should focus more on family oral health rather than just child oral health.
Dental Caries ; epidemiology ; etiology ; Female ; Home Care Services ; statistics & numerical data ; Humans ; Incidence ; Infant ; Japan ; epidemiology ; Male ; Oral Health ; statistics & numerical data ; Prevalence ; Protective Factors ; Risk Factors

PURPOSE: The purpose of this study was to examine the association between utilization of home care services under the national long-term care insurance system and family caregiver distress. METHODS: A secondary data analysis was conducted in this study using data collected in 2011 and 2012 from the Korean version of International Resident Assessment Instrument (interRAI) Home Care assessment system. The study sample included 228 clients receiving community based home care and their family caregivers in Korea. Descriptive statistics, χ² test, t-test, and Heckman selection model analysis were conducted using SAS 9.3. RESULTS: Presence of family caregiver distress was significantly associated with days of nurse visits (β=-.89, p=<.001) and home helper visits (β=-.53, p=.014). Level of caregiver distress was also significantly associated with days of nurse visits (β=-.66, p=.028). Other factors which were significantly associated with caregiver distress were depression, cognitive function, inadequate pain control, social support for older adult, and caregiver relationship to the older adult. CONCLUSION: The results of this study show that visiting nurse service and appropriate support programs for Older Adults and family caregivers experiencing caregiver distress should be developed and provided to families based on the health care needs of older adults and their family caregivers for effective and sustainable home care.
Adult* ; Caregivers* ; Cognition ; Delivery of Health Care ; Depression ; Home Care Services* ; Humans ; Insurance, Long-Term Care ; Korea ; Long-Term Care ; Nurses, Community Health ; Social Control, Formal ; Statistics as Topic

OBJECTIVES: Monitoring heart failure patients through continues assessment of sign and symptoms by information technology tools lead to large reduction in re-hospitalization. Agent technology is one of the strongest artificial intelligence areas; therefore, it can be expected to facilitate, accelerate, and improve health services especially in home care and telemedicine. The aim of this article is to provide an agent-based model for chronic heart failure (CHF) follow-up management. METHODS: This research was performed in 2013-2014 to determine appropriate scenarios and the data required to monitor and follow-up CHF patients, and then an agent-based model was designed. RESULTS: Agents in the proposed model perform the following tasks: medical data access, communication with other agents of the framework and intelligent data analysis, including medical data processing, reasoning, negotiation for decision-making, and learning capabilities. CONCLUSIONS: The proposed multi-agent system has ability to learn and thus improve itself. Implementation of this model with more and various interval times at a broader level could achieve better results. The proposed multi-agent system is no substitute for cardiologists, but it could assist them in decision-making.
Artificial Intelligence ; Follow-Up Studies* ; Health Information Systems ; Health Services ; Heart Failure* ; Heart* ; Home Care Services ; Humans ; Learning ; Negotiating ; Statistics as Topic ; Telemedicine

PURPOSE: To survey the use of invasive and noninvasive home mechanical ventilation (HMV) methods in South Korea from the perspective of physical medicine and rehabilitation (PM&R). MATERIALS AND METHODS: For 413 users of HMV, retrospective reviews of PM&R interventions and survey of HMV methods employed from Mar 2000 to Dec 2009. RESULTS: Of the 413 users, the majority of whom with progressive neuromuscular disorders (NMDs) (n=358), 284 patients initially used noninvasive mechanical ventilation (NIV), while 63 others who were using tracheostomy mechanical ventilation switched to NIV as part of their rehabilitation. The NMD patients began HMV at an earlier age (34.9+/-20.3 yrs), and used for longer (14.7+/-7.5) hours than patients with non-neuromuscular causes of respiratory impairment. CONCLUSION: Noninvasive management was preferred over invasive ones, and transition to the former was a result of PM&R interventions.
Adult ; Female ; Health Care Surveys ; Home Care Services/*statistics & numerical data ; Humans ; Male ; Middle Aged ; Muscular Dystrophies/*therapy ; Neuromuscular Diseases/therapy ; Republic of Korea ; Respiration, Artificial/*statistics & numerical data ; Retrospective Studies ; Ventilators, Mechanical/*statistics & numerical data

PURPOSE: This study was attempted to provide quality improvement and revitalization of visiting nurse services by Importance-Performance Analysis of persons being provided with the services. METHODS: The subjects were 350 people being provided with visiting nurse services from a long term home care institution in the kangwon Province during the period of data collection between Aug. 16 and Sep. 15, 2011. Data analysis was conducted through t-test, ANOVA, and IPA by using the SPSS/WIN 12.0 program. RESULTS: As a result of the Importance-Performance Analysis of visiting nurse services, it turned out that the strength on reliability, assurance, and empathy should be maintained with good work and the aspects of responsiveness appeared to be intensively improved, and the tangibility proved to be subject to improvement. CONCLUSION: For the activation of visiting nurse services, methods for improving the performance in the intensive care area and management strategy establishment which highlights the advantages of strength maintenance area are needed.
Community Health Nursing* ; Data Collection ; Empathy ; Home Care Services ; Humans ; Insurance, Long-Term Care* ; Critical Care ; Long-Term Care* ; Quality Improvement ; Statistics as Topic

INTRODUCTIONIn end-stage heart failure (HF) that is not eligible for mechanical assist device or heart transplant, palliative care serves to maximise symptom control and quality of life. We sought to evaluate the impact of home-based advance care programme (ACP) on healthcare utilisation in end-stage HF patients.

MATERIALS AND METHODSProspectively collected registry data on all end-stage HF recruited into ACP between July 2008 and July 2010 were analysed. Chart reviews were conducted on HF database and hospital electronic records. Phone interview and home visit details by ACP team were extracted to complete data entry. HF and all-cause hospitalisations 1 year before, and any time after ACP inception were defined as events. For the latter analysis, follow-up duration adjustment to event episodes was performed to account for death less than a year.

RESULTSForty-four patients (mean age 79 years, 39% men) were followed up for 15±8 months. Fifty-seven percent had diabetes, 80% ischaemic heart disease, and 60% chronic kidney disease. All reported functional class III/IV at enrolment. Mean serum sodium was 136±6 mmol/L, and creatinine 186±126 mmol/L. Thirty (68%) died within the programme. Mean time to death was 5.5 months. Mean all-cause and HF hospitalisations were 3.6 and 2.0 per patient before enrolment, but improved to 1.0 and 0.6 respectively after ACP. Thirty-six (71%) patients had fewer HF hospitalisations. When only those who survived more than a year were considered (n = 14), 10 (71%) and 9 (64%) experienced reduced HF (mean: 1.4 episodes per patient) and all-cause hospitalisations (mean: 2.2 episodes per patient) respectively.

CONCLUSIONHome-based advance care programme is potentially effective in reducing healthcare utilisation of end-stage HF patients, primarily by reducing HF rehospitalisations, and in probably saving costs as well.

Aged ; Aged, 80 and over ; Diabetes Mellitus ; Female ; Health Care Costs ; Health Services ; economics ; utilization ; Heart Failure ; complications ; economics ; therapy ; Home Care Services, Hospital-Based ; economics ; Hospitalization ; economics ; statistics & numerical data ; Humans ; Male ; Myocardial Ischemia ; complications ; Palliative Care ; economics ; methods ; Prospective Studies ; Registries ; Renal Insufficiency, Chronic ; complications ; Tertiary Care Centers

BACKGROUND: This study aimed to identify the level of frailty and major health problems among participants of a tailored home visiting service. METHODS: This secondary data analysis study used the 2009 data of 588 participants of a tailored home visiting service in 2 public health centers in Busan. Data on demographics and health-related characteristics were collected from household sheet, disease sheet, and health interview sheet for the elderly. The level of frailty was measured by an instrument developed by the Japanese Ministry of Health. RESULTS: 15.3% of the elderly subjects were considered frail elderly (FE). The major health problems of the FE were poorer activities of daily living skills and higher prevalences of stroke and cognitive impairment than their non-frail counterpart. The mean number of disease was 3 for the FE and 2 for the non-FE. The prevalence of stroke was 12.2% for the FE and 5.8% for the non-FE (p=0.014). The mean dementia screening score was 2.2 (of maximum 10 points) for the FE and 1.4 for the non-FE (p=0.040). CONCLUSIONS: Our results showed that one of seven vulnerable elderly individuals was frail; and stroke and dementia were more prevalent in the frail elderly. We recommend the further developing of service programs for the participants of tailored home visiting services to better manage and prevent the deterioration of stroke and cognitive impairment.
Activities of Daily Living ; Aged ; Asian Continental Ancestry Group ; Dementia ; Demography ; Family Characteristics ; Frail Elderly ; Home Care Services ; House Calls ; Humans ; Mass Screening ; Prevalence ; Public Health ; Statistics as Topic ; Stroke

PURPOSE: This study was done to determine the risk factors for recurrent fallers (2+falls) compared to single fallers. METHODS: Participants were 104 community-dwelling people 65 yr of age or older. The data were collected from June 1, 2008 to June 30, 2009 using the Residential Assessment Instrument-Home Care. RESULTS: Over the past 90 days, 55.7% of the 104 participants fell once, and 44.2% experienced recurrent falls (2+falls). In comparison of recurrent fallers with single fallers, there were significant differences in scores on the following factors: gender (chi2=4.22, p=.040), age (chi2=5.74, p=.017), educational level (chi2=5.22, p=.022), living arrangements (chi2=35.02, p<.001), cardiovascular diseases (chi2=17.10, p<.001), hypertension (chi2=4.43, p=.035), diabetes mellitus (chi2=4.44, p=.035), glaucoma (chi2=13.95, p<.001), Minimal Data Set (MDS)-Pain (t=-2.56, p=.012), fear of falling (chi2=4.08, p=.034), reduced vision (t=-3.06, p=.003), MDS-activity of daily living (t=3.46, p=.001), MDS-Instrumental Activities of daily living (t=3.24, p=.002), cognition (MDS-Cognition Performance Scale) (t=3.40, p=.001), and 'difficulties entering and leaving the house' (chi2=4.53, p=.033). CONCLUSION: It is important to assess the risk factors for recurrent falls and develop differentiated strategies that will help prevent recurrent falls. Additionally, utilizing a standardized tool, such as RAI-HC, would help health professionals assess multi-variate fall risk factors to facilitate comparisons of different community care settings.
Accidental Falls/*prevention & control/statistics & numerical data ; Activities of Daily Living ; Age Factors ; Aged ; Aged, 80 and over ; Cardiovascular Diseases/complications ; Cognition ; Diabetes Complications ; Educational Status ; Fear ; Female ; Glaucoma/complications ; Home Care Services ; Humans ; Hypertension/complications ; Male ; Risk Factors ; Sex Factors ; Vision, Low/complications

PURPOSE: The purpose of this study was to identify the predictors of health-related quality of life and to examine their effects in frail elderly. METHODS: This was a correlation study. The subjects were 680 frail elders aged over 65 who were receiving home care from one of 253 public health centers in 16 provinces, and data were collected from the 1st to 30th of April, 2008. RESULTS: The mean health-related quality of life in the subjects was 6.0+/-2.0. The predictors identified in this study significantly explained 41.3% of health-related quality of life. Self-rated health was the most significant predictor of health-related quality of life. ADL and depression had an effect on health-related quality of life. CONCLUSION: Self-rated health, ADL and depression were the predictors of health-related quality of life in the frail elderly.
Activities of Daily Living ; Aged ; Depression ; Frail Elderly* ; Home Care Services ; Humans ; Public Health ; Quality of Life* ; Statistics as Topic

The aims of this study were to identify the mothers educational needs when they have children who have had open heart surgery in congenital heart disease, to identify the children's characteristics with this problem, and also to provide the basic information on the development of the educational program for the mothers. The subjects of the study were 101 mothers of children and their children hospitalized with congenital heart disease in pediatric wards of G. University Hospital in Inchon and S. Hospital in Puchon from June to November 2000. The study used a Likert-type questionnaire with 39 questions which was based on a previous questionnaire developed by Lee Mi-ryun(1989) for adult open heart surgery patients. The reliability of the questionnaire was Cronbach' alpha= .9375. The data were collected directly from mothers of the patients in wards, The t-test, ANOVA was adopted for the data analysis. The key results of the study are as follows: 1) The average age of the children was 32.90 months. The majority of the children are male and weighted 3.0-3.5kg at birth. Most of the children had VSD(29.7%). and 10.9% of children had a family history of heart disease. 2) An average score of 4.62 out of a maximum of 5,00 was recorded for the educational needs of the children's mother. The highest score of 4,69 was for home care after discharge followed by a score of 4.67 for diagnosis and prognosis on congenital heart disease. And pre-post operation care scored 4.51. The mean scores of single-question items of educational need were. in order. 4.81 for immunization after operation, 4.80 for recovery process, and 4.77 for prognosis of the disease. The score of 4.18 for measurement of intake and output was the lowest. 3) The analysis on the children's mothers educational needs by social-demographic characteristics such as sex. age of patient and mother. economical status. educational status. number of child. hospitalization times. and hospitalization cause showed no significant difference statistically. but there was a significant difference between mothers with jobs and without jobs.
Adult ; Child* ; Diagnosis ; Educational Status ; Gyeonggi-do ; Heart Defects, Congenital* ; Heart Diseases ; Heart* ; Home Care Services ; Hospitalization ; Humans ; Immunization ; Incheon ; Male ; Mothers* ; Parturition ; Prognosis ; Surveys and Questionnaires ; Statistics as Topic ; Thoracic Surgery*