Faculty Profiles - KAZAWA KANA

Papers - KAZAWA KANA

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Experiences with COVID-19 cluster infections in geriatric care facilities. Reviewed

Geriatr Gerontol Int 2022.5

Long-term effectiveness of a disease management program to prevent diabetic nephropathy: a propensity score matching analysis using administrative data in Japan Reviewed International journal

Watanabe, Hirohito, Anezaki, Hisataka, Kazawa, Kana, Tamaki, Yuya, Hashimoto, Hideki, Moriyama, Michiko

BMC ENDOCRINE DISORDERS 22 ( 1 ) 135 - 135 2022.5

Language：English Publishing type：Research paper (scientific journal) Publisher：BMC

Background Existing reviews indicated that disease management for patients with diabetes may be effective in achieving better health outcomes with less resource utilization in the short term. However, the long-term results were inconsistent because of the heterogeneous nature of the study designs. In the present study, we evaluated the 5-year follow-up results of a local disease management program focused on diabetic nephropathy prevention under the universal public health insurance scheme in Japan. Methods Patients diagnosed with type 2 diabetes who had stage 3 or 4 diabetic kidney disease and were aged between 20 and 75 years were invited to join a disease management program to support self-management and receive a recommended treatment protocol between 2011 and 2013. Follow-up data were collected from an electronic claims database for the public insurance scheme. Considering the non-random selection process, we prepared two control groups matched by estimated propensity scores to compare the incidence of diabetes-related complications, death, and resource utilization. Results The treatment group was more likely to receive clinical management in accordance with the guideline-recommended medication. After propensity score matching, the treatment group had lower incidence of diabetic nephropathy and emergency care use than the control group selected from a beneficiary pool mainly under primary care. Comparisons between the treatment group and the control group with more selected clinical conditions did not show differences in the incidence rate and resource utilization. Conclusions The present results demonstrated limited effectiveness of the program for reducing complication incidence and resource utilization during the 5-year follow-up. Further research on the long-term effectiveness of co-management by primary care physicians, subspecialists in endocrinology and nephrology, and nurse educators is required for effective management of diabetes-related nephropathy.

DOI： 10.1186/s12902-022-01040-4

Characteristics of early-career nurse researchers negatively impacted during the COVID-19 pandemic: a cross-sectional study. Reviewed International journal

Kana Kazawa, Yoko Shimpuku, Naoki Yoshinaga

BMJ open 12 ( 4 ) e059331 2022.4

Authorship：Lead author,　Corresponding author Language：English Publishing type：Research paper (scientific journal)

OBJECTIVES: This study aimed to identify typical patterns and determinants of early-career nurse researchers (ECNRs: age ≤45 years) who reported that their research activities were negatively impacted during the COVID-19 pandemic, using a data mining methodology. To gain a deeper understanding of the characteristics of these ECNRs, we compared them with the characteristics of senior nurse researchers (SNRs: age ≥46 years). DESIGN: A cross-sectional study. PARTICIPANTS: 1532 nurse researchers. DATA COLLECTION AND ANALYSIS: We conducted an anonymous online questionnaire survey that assessed individual and professional attributes of nurse researchers and their experiences from April to June 2020. We analysed the association between the impact on research activities and the individual and professional attributes using cross-tabulation, and employed the chi-square automatic interaction detection technique to perform population segmentation. RESULTS: We found that difficulties in research management, an increased burden of student education and organisational management, and organisational management position were relatively important factors for determining the negative impact of COVID-19 on the research activities of ECNRs (p<0.05). For both ECNRs and SNRs, the most relevant determinant of disrupted research activities was 'difficulties in research management' (χ2=34.7 and 126.5, respectively, p<0.001 for both). However, only ECNRs yielded 'position in organisational management' and was extracted only for ECNRs (χ2=7.0, p=0.008). CONCLUSIONS: Difficulties in research management and an increased burden of student education and organisational management had an unfavourable impact on the research activities of ECNRs. To ensure quality of nursing care and nursing science development during and after the COVID-19 era, it is important to support ECNRs in their nursing research activities and career development. Our findings could contribute to the prioritisation of interventions and policymaking for ECNRs who are particularly at risk of being negatively affected by the pandemic.

DOI： 10.1136/bmjopen-2021-059331

Assessing Burden, Anxiety, Depression, and Quality of Life among Caregivers of Hemodialysis Patients in Indonesia: A Cross-Sectional Study Reviewed International coauthorship International journal

Pio, Theresia Maria Toji, Prihanto, Junaidi Budi, Jahan, Yasmin, Hirose, Naoki, Kazawa, Kana, Moriyama, Michiko

INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 19 ( 8 ) 2022.4

Language：English Publishing type：Research paper (scientific journal) Publisher：MDPI

Family caregivers endure the burden of caring for patients receiving hemodialysis, which can affect their psychological status and may disrupt the care process. This study aims to assess the level of burden, anxiety, depression, and quality of life (QOL) among family caregivers, to investigate the influence of caregivers' sociodemographic factors and patients' clinical conditions on the level of burden, and investigate how burden affects anxiety/depression and QOL. A descriptive, cross-sectional study was conducted from September to October 2020. A total of 104 caregivers with a mean age of 44.4 +/- 12.7 years (63.5% women) in the hemodialysis department of a hospital in Indonesia were examined. Zarit Burden Interview (ZBI), Hospital Anxiety and Depression Scale, and WHOQOL-BREF were used. Descriptive analysis was conducted to assess the level of psychological status, and multiple regression analysis and path analysis were performed to evaluate the association among all factors. As result, regarding burden, 10.2% had a moderate-to-severe burden, and in terms of anxiety and depression, 25% and 9.6% showed abnormal cases; the mean scores of 4 domains of QOL were about 60 points. Burden and anxiety/depression were significantly negatively associated with all domains of QOL (p < 0.001); however, sociodemographic and clinical factors were not associated with any of the QOL domains. The path analysis results showed that burden positively correlated with anxiety/depression and negatively correlated with QOL via anxiety/depression. In conclusion, family caregivers' QOL was found to be indirectly influenced by burden through anxiety/depression. Further evaluation of clinical significance and implications for caregiver's lifestyle regarding anxiety and depression, which result in caregiver burden, is warranted.

DOI： 10.3390/ijerph19084544

Factors That Facilitate Discussion and Documentation of End-of-Life Care among Community-Dwelling Older Adults: A Cross-Sectional Study Reviewed International coauthorship

Ishibashi, Tomoyuki, Kazawa, Kana, Jahan, Yasmin, Moriyama, Michiko

INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 19 ( 7 ) 2022.4

Authorship：Corresponding author Language：English Publishing type：Research paper (scientific journal) Publisher：MDPI

We aimed to clarify the regional cultural characteristics in areas with different death rates at home, and to identify factors that influence the discussion and documentation of end-of-life care (EOLC) among community-dwelling older adults. This study was a cross-sectional study using a self-administered questionnaire survey, and participants were Japanese older adults. A chi-square test and multiple regression analysis were conducted. Among the 227 respondents, 143 were analyzed. There were no statistical differences by area. Participants who had intentions to discuss EOLC tended to discuss EOLC with their families and family doctors and tended to create documents to show their wills on EOLC (p < 0.05). The following factors that influence the intentions to discuss EOLC were extracted: experience in providing EOLC; information on EOLC; having religious and spiritual beliefs, and not avoiding the subject of death as part of beliefs related to life and death. These results indicate that beliefs and intentions regarding EOLC may be similar across Japan. Moreover, our findings suggest that to increase the interest of older adults on EOLC, it is important to provide opportunities for older adults to share and discuss information about EOLC with healthcare professionals and others who have experience providing EOLC.

DOI： 10.3390/ijerph19074273

Undergraduate nursing students' learning experiences of a telehealth clinical practice program during the COVID-19 pandemic: A qualitative study Reviewed

Kazawa, Kana, Teramoto, Chie, Azechi, Ayako, Satake, Hiroki, Moriyama, Michiko

NURSE EDUCATION TODAY 111 2022.4

Authorship：Lead author,　Corresponding author Language：English Publishing type：Research paper (scientific journal) Publisher：CHURCHILL LIVINGSTONE

Background: Against the backdrop of the COVID-19 pandemic, nurse education institutions are required to create innovative and diverse educational methods to ensure the continued learning of undergraduate nursing students. We developed a telehealth clinical practice program to address this challenge. Objectives: We explored the students' learning experiences of our telehealth clinical practice program by qualitatively analyzing student reports. Methods: The participants were fourth-year undergraduate students who had taken the telehealth clinical practice program at Hiroshima University. Data were collected as reports from the participants during clinical practice and analyzed using thematic analysis. Results: Of the 59 students who completed the practical training, 26 agreed to participate in the study (consent rate: 44.1%). Sixteen themes emerged from the analysis as the students' learning experiences, and were classified into four thematic categories: (1) recognition of continued self-improvement required to become a nurse and development of a sense of ethics, (2) improvement of knowledge and practical skills in chronic care nursing, (3) acquisition of telehealth skills, and (4) learning through modeling and teamwork, and improvement of self-efficacy. Interacting with persons through telehealth provided an opportunity to learn directly about persons' lives and their experiences of illness, and helped participants develop a sense of responsibility and ethical nursing. Conclusions: Our study findings indicate that undergraduate nursing students perceived that their attitude, knowledge and skill acquisition improved through this program. We believe that telehealth can have a place as a teaching strategy and this telehealth clinical practice program can be further enhanced the learning effects by combining it with face-to-face training and multidisciplinary education in the future.

DOI： 10.1016/j.nedt.2022.105297

Person-centered dementia care during COVID-19: a qualitative case study of impact on and collaborations between caregivers Reviewed International coauthorship International journal

Kazawa, Kana, Kodama, Ayuto, Sugawara, Kaoru, Hayashi, Mikio, Ota, Hidetaka, Son, Daisuke, Ishii, Shinya

BMC GERIATRICS 22 ( 1 ) 107 - 107 2022.2

Authorship：Lead author,　Corresponding author Language：English Publishing type：Research paper (scientific journal) Publisher：BMC

Background Little is known about the actual impact of COVID-19 on caregivers of older people with dementia and resultant collaborations among them to provide continued person-centered care while undertaking infection control measures. In this study, we explored the impact of providing dementia care during COVID-19 on caregivers involved in dementia care. Methods This is an exploratory qualitative case study. The participants were family members living with older people with dementia, care managers, and the medical and long-term care facility staff. Data were collected from 46 caregivers via face-to-face and semi-structured interviews and analyzed using thematic analysis. Results The interviews identified 22 themes related to the impact of COVID-19 on different positions of the caregivers involved in dementia care and their collaboration, and we categorized them into six categories. The core themes were "re-acknowledgement of care priorities" and "rebuilding of relationships." When caregivers' perceptions were aligned in the decision-making processes regarding care priorities, "reaffirmation of trust" and "strengthening of intimate relationships" emerged as positive changes in their relationships. Furthermore, the differences in the ability of each caregiver to access and select correct and appropriate information about COVID-19, and the extent of infection spread in the region were related to "anxiety during COVID-19 pandemic" and caused a "gap in perception" regarding infection control. Conclusions The present study clarified that the process of aligning the perceptions of caregivers to the objectives and priorities of care for older people with dementia during COVID-19 pandemic strengthened the relationships among caregivers. The findings of this study are useful for caregivers involved in person-centered dementia care.

DOI： 10.1186/s12877-022-02794-1

Experts' perception of support for people with dementia and their families during the COVID-19 pandemic Reviewed International coauthorship

Kazawa, Kana, Akishita, Masahiro, Ikeda, Manabu, Iwatsubo, Takeshi, Ishii, Shinya

GERIATRICS & GERONTOLOGY INTERNATIONAL 22 ( 1 ) 26 - 31 2022.1

Authorship：Lead author,　Corresponding author Language：English Publishing type：Research paper (scientific journal) Publisher：WILEY

Aim This study aimed to explore the perceptions of dementia experts on support for people with dementia (PWD) and their families, considering PWD's vulnerability regarding COVID-19 prevention. Methods A collaborative qualitative study was conducted, involving Hiroshima University, the Japan Geriatrics Society, the Japan Society for Dementia Research, and the Japanese Psychogeriatric Society. An anonymous, self-reported questionnaire survey was sent to dementia experts from 456 medical centers for dementia in Japan. The responses were categorized in a qualitative inductive manner. Results A total of 214 experts from 119 centers responded (facility recovery rate: 26.1%). Four core themes emerged from the data analysis. Of these themes, three were related to support for infection prevention and related issues and response to infection: (i) support for continuation of daily life while preventing infection; (ii) support to mitigate the unfavorable effects of infection prevention measures; and (iii) decision-making support and treatment for infected PWD. The remaining theme, (iv) community building for PWD living together, was extracted as a basis for facilitating themes (i) to (iii). Furthermore, in each theme, the roles of medical and long-term care facilities, administration, and the need for community collaboration were identified. Conclusions Dementia experts strongly felt the need not only for short-term support to prevent the spread of infection to PWD and their families during the pandemic, but also for long-term support to enable them to maintain their daily lives and mitigate the impact of infection prevention measures. Geriatr Gerontol Int 2021; center dot center dot: center dot center dot-center dot center dot.

DOI： 10.1111/ggi.14307

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

Tantut Susanto, Retno Purwandari, Emi Wuri Wuryaningsih, Hirohito Watanabe, Kana Kazawa, Michiko Moriyama

Frontiers of Nursing 8 ( 4 ) 365 - 374 2021.12

Can a sleep disorder intervention-embedded self-management programme contribute to improve management of diabetes? A pilot single-arm pretest and post-test study Reviewed International coauthorship

Sakamoto, Ritsuko, Kazawa, Kana, Jahan, Yasmin, Takeyama, Naoko, Moriyama, Michiko

BMJ OPEN 11 ( 9 ) 2021.9

Authorship：Corresponding author Publisher：BMJ PUBLISHING GROUP

Objective To investigate the efficacy and feasibility of a self-management programme incorporating a sleep intervention for improving diabetes outcomes. Design A single-arm pre-test and post-test study was conducted within a community setting in Hiroshima, Japan. Participants Participants were aged 52-74 years and diagnosed with type 2 diabetic nephropathy stages 1-3. Interventions Participants received self-management education from nurses for 6 months. First, the nurses assessed their sleep conditions using insomnia scales and a sleep metre. Then, the participants learnt self-management to increase their physical activity and improve their sleep condition. They also implemented diet therapy and medication adherence. Outcome measures Physiological indicators, subjective and objective indicators of sleep quality, self-management indicators, quality of life (QOL) and feasibility were evaluated. To confirm the efficacy of intervention, Freidman tests, analysis of variance, Wilcoxon signed-rank test and t-test were performed. Pearson's correlations were analysed between activities and sleep condition. Results Of the 26 enrolled participants, 24 completed the programme and were analysed. Among them, 15 participants (62.5%) had sleep disorders caused by multiple factors, such as an inappropriate lifestyle and physical factors that interfere with good sleep. Although insomnia scales did not change for the sleep disorders, their subjective health status improved. Regarding indicators related to diabetes management, lifestyles improved significantly. Haemoglobin A1c, body mass index, systolic blood pressure, non-high-density lipoprotein-cholesterol and QOL also improved. All participants except one were satisfied with the programme. However, use of the sleep metre and nurses' consultation about sleep disturbance were not well evaluated. Conclusions This programme was effective in improving diabetes status, lifestyle and behaviour changes. However, its effect on sleep condition was limited because of its complexity. A simple and novel approach is needed to strengthen the motivation for sleep behaviour change and to increase programme efficacy and feasibility.

DOI： 10.1136/bmjopen-2020-045783

The Effectiveness of Telenursing for Self-Management Education on Cardiometabolic Conditions: A Pilot Project on a Remote Island of Osakikamijima, Japan Reviewed International coauthorship

Moriyama, Michiko, Kazawa, Kana, Jahan, Yasmin, Ikeda, Mika, Mizukawa, Mariko, Fukuoka, Yasuko, Harada, Koji, Rahman, Md Moshiur

JOURNAL OF PRIMARY CARE AND COMMUNITY HEALTH 12 2021.7

Language：English Publishing type：Research paper (scientific journal) Publisher：SAGE PUBLICATIONS INC

Introduction: Providing self-management education for residents with cardiometabolic conditions in remote islands is a challenge due to the shortage of primary care practitioners (PCPs), specialist physicians, and nurses. Therefore, we applied telenursing with lifestyle-related chronic diseases in remote island residents in Japan. This project aimed to improve the self-management behavior, cardiometabolic indicators, self-efficacy, and quality of life (QoL) of residents with cardiometabolic risks. Methods: We chose Osakikamijima Island, Hiroshima Prefecture, Japan, which is designated under the Remote Islands Development Act. The project was conducted from 2013 to 2014. The residents aged over 40 and under 75 years old, selected from the annual specific health check-up examination and from PCPs for screening cardiometabolic risks (urinary protein, glycohemoglobin A1c, systolic and diastolic blood pressure (BP), Low-density lipoprotein cholesterol, High-density lipoprotein cholesterol, and triglyceride) were included. The effectiveness of telenursing for self-management education was 6-month-long with a 6-month follow-up and evaluated by a single-group pre-and post-test design. Face-to-face health education was applied at the initial interview followed by telenursing (biweekly telephone calls till third-month, and a monthly telephone call during the fourth and fifth-month) by the trained nurses outside the island. To enhance participants' self-monitoring health behavior changes, the nurses used motivational interviewing and behavior change techniques based on the transtheoretical model. Results: A total of 130 residents, 42 agreed to participate, 41 finished the 6-month program, and 33 completed the 12-month follow-up. Most of their behavior changes like self-management behaviors, cardiometabolic indicators, and self-efficacy at 6-month were improved significantly except QoL. Among the 12-month study periods, self-management behaviors, body mass index, systolic BP, diastolic BP, and self-efficacy (sense of control), (all P < .05) showed significant improvement. Conclusion: This study results indicated that telenursing might be effective to improve the lifestyles-related behaviors in chronic diseases on the remote island of Osakikamijima, Japan.

DOI： 10.1177/21501327211030817

Preparedness guide for people with dementia and caregivers in COVID-19 pandemic.

Kana Kazawa, Tatsuhiko Kubo, Hiroki Ohge, Masahiro Akishita, Shinya Ishii

Geriatrics & gerontology international 21 ( 7 ) 593 - 595 2021.7

The Effectiveness of Telenursing for Self-Management Education on Cardiometabolic Conditions: A Pilot Project on a Remote Island of Ōsakikamijima, Japan Reviewed International coauthorship

Michiko Moriyama, Kana Kazawa, Yasmin Jahan, Mika Ikeda, Mariko Mizukawa, Yasuko Fukuoka, Koji Harada, Md Moshiur Rahman

Journal of Primary Care & Community Health 12 215013272110308 - 215013272110308 2021.7

Language：English Publishing type：Research paper (scientific journal) Publisher：SAGE Publications

<sec><title>Introduction:</title> Providing self-management education for residents with cardiometabolic conditions in remote islands is a challenge due to the shortage of primary care practitioners (PCPs), specialist physicians, and nurses. Therefore, we applied telenursing with lifestyle-related chronic diseases in remote island residents in Japan. This project aimed to improve the self-management behavior, cardiometabolic indicators, self-efficacy, and quality of life (QoL) of residents with cardiometabolic risks.

</sec><sec><title>Methods:</title> We chose Ōsakikamijima Island, Hiroshima Prefecture, Japan, which is designated under the Remote Islands Development Act. The project was conducted from 2013 to 2014. The residents aged over 40 and under 75 years old, selected from the annual specific health check-up examination and from PCPs for screening cardiometabolic risks (urinary protein, glycohemoglobin A1c, systolic and diastolic blood pressure (BP), Low-density lipoprotein cholesterol, High-density lipoprotein cholesterol, and triglyceride) were included. The effectiveness of telenursing for self-management education was 6-month-long with a 6-month follow-up and evaluated by a single-group pre-and post-test design. Face-to-face health education was applied at the initial interview followed by telenursing (biweekly telephone calls till third-month, and a monthly telephone call during the fourth and fifth-month) by the trained nurses outside the island. To enhance participants’ self-monitoring health behavior changes, the nurses used motivational interviewing and behavior change techniques based on the transtheoretical model.

</sec><sec><title>Results:</title> A total of 130 residents, 42 agreed to participate, 41 finished the 6-month program, and 33 completed the 12-month follow-up. Most of their behavior changes like self-management behaviors, cardiometabolic indicators, and self-efficacy at 6-month were improved significantly except QoL. Among the 12-month study periods, self-management behaviors, body mass index, systolic BP, diastolic BP, and self-efficacy (sense of control), (all P < .05) showed significant improvement.

</sec><sec><title>Conclusion:</title> This study results indicated that telenursing might be effective to improve the lifestyles-related behaviors in chronic diseases on the remote island of Ōsakikamijima, Japan.

</sec>

DOI： 10.1177/21501327211030817

Other Link： http://journals.sagepub.com/doi/full-xml/10.1177/21501327211030817

Understanding the process for developing sleep disorders among Japanese workers: a qualitative study Reviewed International coauthorship

Toyoshima, Ayako, Moriyama, Michiko, Yamashita, Hidehisa, Rahman, Md Moshiur, Huq, K. A. T. M. Ehsanul, Jahan, Yasmin, Kazawa, Kana

HEALTH PROMOTION PERSPECTIVES 11 ( 1 ) 87 - 96 2021

Authorship：Last author Language：English Publishing type：Research paper (scientific journal) Publisher：TABRIZ UNIV MEDICAL SCIENCES & HEALTH SERVICES

Background: Sleep disorders have an enormous impact on occupational health and are counterproductive from an economic perspective. However, the processes of causing sleep disorders from psychosocial aspects have not yet been known. The purpose of this study was to describe how sleep disorders develop among workers with respect to different psychosocial conditions. Methods: A conventional qualitative content analysis was conducted with a semi-structured interview among twenty-seven workers (14 males and 13 females) who were diagnosed with sleep disorders or had a self-reported history of sleep difficulties. Study participants were recruited from a specialized clinic and communities using snowball sampling. This paper adhered to the Standards for Reporting Qualitative Research (SRQR) checklist. Results: the results showed that there were four steps involved in the sleep disorders development process. Firstly, participants with sleep disorders developed 'early warning signs' with 11 categories of triggers; secondly, 'aggravating factors' on top of these early warning signs; thirdly, workers tried to 'cope with' their sleep disorders in the ways they thought would be effective. Finally, when coping failed to improve the quality of sleep, it led to the onset of sleep disorders. Conclusion: The development of sleep disorders and triggers of psychosocial factors were revealed. An occupational health nurse can bring these findings in practice for preventing worker's sleep disorders.

DOI： 10.34172/hpp.2021.12

A Health Guidance App to Improve Motivation, Adherence to Lifestyle Changes and Indicators of Metabolic Disturbances among Japanese Civil Servants. Reviewed International journal

Naoko Takeyama, Michiko Moriyama, Kana Kazawa, Malinda Steenkamp, Md Moshiur Rahman

International journal of environmental research and public health 17 ( 21 ) 2020.11

Language：English Publishing type：Research paper (scientific journal)

We investigated whether an Information and Communication Technology (ICT) application (app) motivated to increase adherence to lifestyle changes, and to improve indicators of metabolic disturbances among Japanese civil servants. A non-randomized, open-label, parallel-group study was conducted with 102 participants aged 20-65 years undergoing a health check during 2016-2017, having overweight and/or elevated glucose concentration. Among them, 63 participants chose Specific Health Guidance (SHG) and ongoing support incorporating the use of an app (ICT group) and 39 individuals chose only SHG (control group). Fifty from the ICT group and 38 from the control group completed the study. After completing the 6-month program, the control group showed a significant decrease in body mass index (p = 0.008), male waist circumference (p < 0.001), systolic blood pressure (BP) (p = 0.005), diastolic BP (p < 0.001), and glycated hemoglobin (HbA1c) (p < 0.001), and increase in high-density lipoprotein (HDL) cholesterol (p = 0.008). However, the ICT group showed a significant decrease in male waist circumference (p < 0.001), diastolic BP (p = 0.003), and HbA1c (p < 0.001), and increase in HDL cholesterol (p = 0.032). The magnitude of change for most indicators tended to be highest for ICT participants (used the app ≥5 times/month). Both groups reported raised awareness on BP and weight. The app use program did not have a major impact after the observation period. Proper action requires frequent use of the app to enhance best results.

DOI： 10.3390/ijerph17218147

Increasing Awareness and Use of Mobile Health Technology Among Individuals With Hypertension in a Rural Community of Bangladesh: Protocol for a Randomized Controlled Trial. Reviewed International journal

Yasmin Jahan, Michiko Moriyama, Md Moshiur Rahman, Kana Kazawa, Atiqur Rahman, Abu Sadat Mohammad Sayeem Bin Shahid, Sumon Kumar Das, Asg Faruque, Mohammod Jobayer Chisti

JMIR research protocols 9 ( 8 ) e15523 2020.8

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Hypertension remains one of the foremost noncommunicable diseases that most often lead to cardiovascular diseases and its different complications. The prevalence of hypertension in Bangladesh has been increasing. However, there are very limited studies that have evaluated the impact of health education and awareness development in mitigating the burden of hypertension and its complications in Bangladesh. OBJECTIVE: This study aims to increase awareness, enhance knowledge, and change lifestyle behaviors through health education and the use of mobile health (mHealth) technology among individuals with hypertension living in a rural community of Bangladesh. METHODS: A randomized controlled trial is underway in a Mirzapur subdistrict of Bangladesh. This trial compares two groups of individuals with hypertension: The comparison arm receives health education and the intervention arm receives health education and a periodic mobile phone-based text message intervention. The trial duration is 5 months. The primary end point is participants' actual behavior changes brought about by increased awareness and knowledge. RESULTS: Enrollment of participants started in August 2018, and collection of follow-up data was completed at the end of July 2019. A total of 420 participants volunteered to participate, and among them, 209 and 211 were randomly allocated to the intervention group and the control group, respectively. Among them, the ratio of males/females was 12.0/88.0 in the intervention group and 16.1/83.9 in the control group. Data cleaning and analyses have been completed and the results have been submitted for publication. CONCLUSIONS: Periodic short education using mHealth technology in addition to face-to-face health education may be an effective method for increasing awareness and knowledge about behavioral changes and maintaining healthy lifestyle behaviors. TRIAL REGISTRATION: Bangladesh Medical Research Council (BMRC) 06025072017; ClinicalTrials.gov NCT03614104, https://clinicaltrials.gov/ct2/show/NCT03614104; University hospital Medical Information Network (UMIN) R000033736, https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_his_list.cgi?recptno=R000033736. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/15523.

DOI： 10.2196/15523

Patterns of elderly people's long-term care risks and determinants: A methodological study in a Japanese city. Reviewed

Kanae Sato Osaki, Junyi Zhang, Kana Kazawa, Michiko Moriyama

Geriatrics & gerontology international 20 ( 7 ) 674 - 679 2020.7

Language：English Publishing type：Research paper (scientific journal)

AIMS: Existing analysis methods about the relationships between the long-term care (LTC) risks and determinants of the elderly often experience issues of independence, linearity and homogeneity. Such methodological issues are particularly problematic when the relationships are complicated, making the prioritization of LTC interventions to groups with different care needs difficult. To overcome these shortcomings, this study made an initial attempt to identify representative patterns of elderly people's LTC risks associated with different determinants, from a methodological perspective. METHODS: A data mining approach (Exhaustive CHAID) is applied to data collected from 26 357 elderly people in a Japanese city in 2016. It can automatically segment the samples into a tree structure that accommodates nonlinear, heterogeneous and sequential relationships, without caring about issues of independence across determinants. RESULTS: In total, 16 representative patterns are derived, among which four patterns are considerably riskier (the unhealthy percentage >10.0%), and five are moderately riskier (the unhealthy percentage is 5.0%-10.0%). Age is the most important determinant, followed by locomotor function, cognitive function, homebound, gender and residential location, in that order, which all show heterogeneous associations with the risk patterns. CONCLUSIONS: The Exhaustive CHAID is suitable to derive scientifically-sound insights into an early screening of risk factors for pre-frail groups and tailor-made preventive LTC interventions for frail groups in a flexible and objective way. Geriatr Gerontol Int 2020; 20: 674-679.

DOI： 10.1111/ggi.13936

Presenteeism among Chinese workers in Japan and its relationship with mental health and health-promoting lifestyles. Reviewed

Weng Li, Michiko Moriyama, Ying Cui, Kana Kazawa, Takashi Nakaya, Tantut Susanto

Industrial health 58 ( 1 ) 35 - 45 2020.2

Language：English Publishing type：Research paper (scientific journal)

This study aimed to investigate factors related to presenteeism among Chinese workers residing in Japan by assessing their mental state and health-promoting lifestyles. An anonymous, self-reported questionnaire was administered to 450 Chinese workers living in Hiroshima Prefecture, of whom, 313 completed it in its entirety. Results showed that 40.6% reported suffering from depression (Center for Epidemiologic Studies Depression Scale, CES-D). Sociodemographic characteristics such as being female, having a lower educational background, being widowed/divorced, having fewer years of residence, fluency in basic-level Japanese, being employed part-time, being an engineer, and workplace environment (having no health education in the workplace) increased the likelihood of depression. Path analysis indicated that marital status (being married) was negatively associated with presenteeism on the Work Limitations Questionnaire-Chinese version via work-related stress. There was a positive correlation between work-related stress and presenteeism through mental health (CES-D). Health-promoting lifestyles (Health-Promoting Lifestyle Profile II) showed a negative correlation with presenteeism, via work-related stress and mental health. Furthermore, health-promoting lifestyles showed a direct negative association with presenteeism. Thus, health education that emphasizes mental health was a significant factor for improving presenteeism. Furthermore, the provision of health education shortly after Chinese workers had arrived in Japan is important.

DOI： 10.2486/indhealth.2018-0201

Awareness Development and Usage of Mobile Health Technology among Hypertensive Individuals in a Rural Community of Bangladesh: A Randomized Controlled Trial Reviewed International coauthorship International journal

Yasmin Jahan, Md Moshiur Rahman, Abu S G Faruque, Mohammod Jobayer Chisti, Kana Kazawa, Ryota Matsuyama, Michiko Moriyama

Journal of Medical Internet Research 22 ( 12 ) 1 - 15 2020

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Hypertension (HTN) is a major modifiable risk factor and the leading cause of premature deaths globally. The lack of awareness and knowledge have been identified as risk factors in low- and middle-income countries including Bangladesh. Recently, the use of mobile phone SMS text messaging is found to have an important positive impact on HTN management. OBJECTIVE: The study aimed to develop awareness and knowledge in order to enhance lifestyle behavior changes among individuals with HTN in a rural community of Bangladesh by using health education and mobile health (mHealth) technology (SMS text messaging). METHODS: A prospective randomized 5-month intervention, open-label (1:1), parallel-group trial was implemented among the individuals with HTN aged 35 years or older. Both men and women were included. Between August 2018 and July 2019, we enrolled 420 participants, selected from a tertiary level health facility and through door-to-door visits by community health workers. After block randomization, they were assigned to either the intervention group (received SMS text messaging and health education; n=209) or the control group (received only health education; n=211). The primary outcome was the evaluation of self-reported behavior changes (salt intake, fruits and vegetables intake, physical activity, and blood pressure [BP], and body weight monitoring behaviors). The secondary outcomes were measurements of actual salt intake and dietary salt excretion, blood glucose level, BP values, and quality of life (QOL). RESULTS: During the study period, a total of 8 participants were dropped, and the completion rate was 98.0% (412/420). The adherence rates were significantly higher (9%) among the control group regarding salt intake (P=.04) and physical activity behaviors (P<.03), and little differences were observed in other behaviors. In primary outcome, the focused behavior, salt intake less than 6 g/day, showed significant chronological improvement in both groups (P<.001). The fruits intake behavior steadily improved in both groups (P<.001). Participants in both groups had a custom of vegetables intake everyday/week. Physical activity suddenly increased and continued until the study end (P<.001 in both groups). Both BP and body weight monitoring status increased from baseline to 1 month but decreased afterward (P<.001). In case of secondary outcomes, significant chronological changes were observed in food salt concentration and urinary salinity between the groups (P=.01). The mean systolic BP and diastolic BP significantly chronologically decreased in both groups (systolic BP, P=.04; diastolic BP, P=.02.P<.05). All of these supported self-reported behavior changes. For the QOL, both groups showed significant improvement over the study periods (P<.001). CONCLUSIONS: Based on these results, we suggest that face-to-face health education requires integration of home health care provision and more relevant and timely interactive SMS text messages to increase the effectiveness of the intervention. Besides, community awareness can be created to encourage "low-salt culture" and educate family members. TRIAL REGISTRATION: Bangladesh Medical Research Council (BMRC) 06025072017; ClinicalTrials.gov NCT03614104; https://clinicaltrials.gov/ct2/show/NCT03614104 and UMIN-CTR R000033736; https://tinyurl.com/y48yfcoo. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/15523.

DOI： 10.2196/19137

Evaluating the effectiveness and feasibility of nurse-led distant and face-to-face interviews programs for promoting behavioral change and disease management in patients with diabetic nephropathy: a triangulation approach. Reviewed International journal

Kana Kazawa, Kanae Osaki, Md Moshiur Rahman, Michiko Moriyama

BMC nursing 19 16 - 16 2020

Authorship：Lead author,　Corresponding author Language：English Publishing type：Research paper (scientific journal)

Background: We examined whether telecommunication-device-based distance interviews are inferior to face-to-face interviews in terms of facilitating behavioral changes and disease management in patients with diabetic nephropathy. We also examined the feasibility of a newly designed six-month telenursing program. Methods: This study represents a post-hoc analysis of data from a randomized controlled trial, in which we compared the efficacy of remote self-management education with that of direct education for patients with diabetic nephropathy. The participants were 40 company employees, who were randomly divided into two groups. Over 6 months, the intervention group (n = 21) received three distance interviews using a tablet computer. Meanwhile, the control group (n = 19) received three face-to-face interviews. In addition, both groups received biweekly nine telephone calls. A triangulation approach was used. We first compared the two groups in inferiority tests. Then, we analyzed data from semi-structured interviews with all participants and nurses, examining whether trusting relationships and motivation were developed, and the accuracy of the information exchanges. Further, for the intervention group, we also enquired about the overall operability of the telenursing device. Results: The completion rates for the program were 81.0 and 78.9% for the participants in the intervention and control groups, respectively. Both groups showed similar behavioral changes, and the participants verified the feasibility of the distance interviews. The participants in the intervention group felt that they understood the severity of their diseases and the necessity of self-management, and felt confidence in the nurses. On the other hand, their degree of behavioral change regarding self-monitoring was lower than that shown by the control group. Conclusion: Our findings show that both interview methods are effective for encouraging the adoption of self-management; further, in terms of taking medication and improving the main clinical indicators, we found that the distance method is not inferior to the direct face-to-face method. However, when considering long-term effects, based on the respective degrees of improvement in behavioral change, the direct method seems to be more effective. Trial registration: The trial was registered with the University Hospital Medical Information Network clinical trial registry (No. UMIN000026568) on March 15, 2017, retrospectively.

DOI： 10.1186/s12912-020-0409-0

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