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Abstracts in [TEXTO IRREPRODUCIBLE EN ASCII] Francais, Pyccknn and Espanol at the end of each article. Introduction Asking patients to share the cost of health care is a measure frequently [...], Objective To assess the effect on out-of-pocket medical spending and physical and mental health of Japan's reduction in health-care cost sharing from 30% to 10% when people turn 70 years of age. Methods Study data carne from a 2007 nationally-representative cross-sectional survey of 10 293 adults aged 64 to 75 years. Physical health was assessed using a 16-point scale based on self-reported data on general health, mobility, self-care, activities of daily living and pain. Mental health was assessed using a 24-point scale based on the Kessler-6 instrument for nonspecific psychological distress. The effect of reduced cost sharing was estimated using a regression discontinuity design. Findings For adults aged 70 to 75 years whose income made them ineligible for reduced cost sharing, neither out-of- pocket spending nor health outcomes differed from the values expected on the basis of the trend observed in 64- to 69-year-olds. However, for eligible adults aged 70 to 75 years, out-of-pocket spending was significantly lower (P < 0.001) and mental health was significantly better (P < 0.001) than expected. These differences emerged abruptly at the age of 70 years. Moreover, the mental health benefits were similar in individuals who were and were not using health-care services (P= 0.502 for interaction). The improvement in physical health after the age of 70 years in adults eligible for reduced cost-sharing tended to be greater than in non-eligible adults (P= 0.084). Conclusion Reduced cost sharing was associated with lower out-of-pocket medical spending and improved mental health in older Japanese adults. Objectif Evaluer rincidence sur les depenses medicales personnelles et la sante physique et rnentale de la reduction de 30% a 10% du partage des couts de soins de sante lorsque les individus atteignent 70 ans. Methodes Les donnees de retude proviennent d'une enquete nationale transversale, effectuee en 2007, sur 10 293 adultes ages de 64 a 75 ans. Leur sante physique a ete evaluee au moyen d'une echelle de 16 points, basee sur des donnees autodeclarees de sante generale, de mobilite, de soins auto-administres, d'activites de la vie quotidienne et de douleur. Leur sante mentale a ete evaluee au moyen d'une echelle de 24 points sur la base de I'instrument Kessler-6 de detresse psychologique non specifique. Lieffet de la reduction du partage des couts a ete estime en utilisant une approche de discontinuite de la regression. Resultats Pour les individus ages de 70 a 75 ans ineligibles, en raison de leurs revenus, a une reduction du partage des couts, ni les depenses de sante personnelles ni les resultats sanitaires ne differaient des valeurs attendues, sur la base de la tendance observee chez les 64 a 69 ans. Toutefois, pour les individus ages de 70 a 75 ans ayant droit a cette reduction, les depenses personnelles etaient significativement plus faibles (P < 0,001) et leur sante mentale significativement meilleure (P < 0,001) que prevu. Ces differences sont apparues brutalement a l'age de 70 ans. En outre, les avantages en termes de sante mentale etaient similaires chez les individus recourant ou non aux services de sante (P = 0,502 pour l'interaction). L'amelioration de la sante physique apres I'age de 70 ans chez les adultes eligibles a une reduction du partage des couts avait tendance a etre superieure a celle des adultes ineligibles (P = 0,084). Conclusion La reduction du partage des couts etait associee a une baisse des depenses medicales personnelles et a une amelioration de la sante mentale des personnes agees japonaises. Objetivo Evaluar el efecto de la reduccion del 30% al 10% de la participacion en los gastos de asistencia sanitaria sobre los gastos medicos directos y la salud fisica y mental en personas mayores de 70 anos en Japon. Metodos Los datos de estudio se obtuvieron de una encuesta transversal representativa realizada a nivel nacional entre 10.293 adultos con edades comprendidas entre los 64 y los 75 anos. La salud fisica se evaluo por medio de una escala de 16 puntos en funcion de los datos dados por los encuestados sobre salud general, movilidad, cuidados personales, actividades de la vida diaria y dolor. La salud mental se evaluo por medio de una escala de 24 puntos en funcion del instrumento Kessler-6 para la angustia psicologica no especifica. El efecto de la participacion reducida en los gastos se calculo utilizando un diseno de regresiones en discontinuidad. Resultados Entre los adultos con edades comprendidas entre los 70 y 75 anos, cuyos ingresos no les permitian ser seleccionados para la participacion reducida en los gastos, ni los gastos directos ni los costes sanitarios difirieron de los valores esperados en funcion de la tendencia observada entre los adultos con edades comprendidas entre los 64 y los 69 anos. No obstante, los gastos directos fueron significativamente inferiores (P < 0,001) y la salud mental fue significativamente mejor (P< 0,001) de lo esperado entre los adultos elegibles con edades comprendidas entre los 70 y los 75 anos. Estas diferencias surgieron de manera repentina a la edad de 70 anos. Ademas, los beneficios sobre la salud mental fueron similares tanto en individuos que utilizaban los servicios de asistencia sanitaria como en aquellos que no lo hacian (P = 0,502 de interaccion). La mejora en la salud fisica a partir de los 70 anos en adultos elegibles para la participacion reducida en los gastos mostro una tendencia superior que en los adultos no elegibles (P = 0,084). Conclusion La participacion reducida en los gastos se asocio con la reduccion de los gastos medicos directos y mejoro la salud mental de los adultos japoneses de mayor edad.

AIM: Depression among caregivers of older persons is a serious concern, but it is often overlooked and neglected in developing countries. The aim of this study was to examine the relationship between perceived social support and depression in informal caregivers of community‐dwelling older persons in Chile. Methods: We analyzed cross‐sectional secondary data on 377 dyads of community‐dwelling older persons and their informal caregivers from a nationwide survey in Chile. The Duke‐UNC Functional Social Support Questionnaire (FSSQ) was used to measure caregivers' perceived social support, and the Center for Epidemiologic Studies Depression Scale assessed their depression. Results: In this study, 76.9% of the caregivers perceived a high level of social support, and 46.9% were assessed as having depression. Based on multivariable analysis, factors that decrease the likelihood of being depressed are a high level of social support (odds ratio (OR) = 0.311, 95% confidence interval (CI): 0.167–0.579) and having taken holidays in the past 12 months (OR = 0.513, 95%CI: 0.270–0.975). Factors that increase the likelihood of being depressed are being a female caregiver (OR = 2.296, 95%CI: 1.119–4.707), being uninsured (OR = 4.321, 95%CI: 1.750–10.672), being the partner or spouse of the care recipient (OR = 3.832, 95%CI: 1.546–9.493), and the number of hours of care (OR = 1.053, 95%CI: 1.021–1.085). Conclusion: Higher levels of perceived social support and holidays were associated with lower levels of depression. However, being female, being the care recipient's partner or spouse, being uninsured, and having long care periods had detrimental effects. Interventions to preserve and enhance perceived social support could help improve depressive symptoms in informal caregivers. Additionally, support should be available to caregivers who are women, uninsured, and the care recipient's partner or spouse, as well as those who provide care for long hours, to ensure they have respite from their caregiving role. [ABSTRACT FROM AUTHOR]

Objective: To evaluate how cardiovascular diseases harm labor force participation (LFP) among the Japanese population and verify the validity of plasma biomarkers as instrumental variables of cardiovascular diseases after adjusting for a broad set of confounders including dietary intake. Design: Using nationally representative repeated cross-sectional surveys in Japan, the Comprehensive Survey of Living Conditions and National Health and Nutrition Survey, with plasma biomarkers as instrumental variables for quasi-randomization. Setting: Onset of cardiovascular diseases in those receiving regular treatment for hypertension, intracerebral hemorrhage, intracerebral infarction, angina pectoris, myocardial infarction, or other types of cardiovascular diseases. Participants: A total of 65,615 persons aged ≥ 20 years (35,037 women and 30,578 men) who completed a survey conducted every three years from 1995 through 2013. Main outcome measures: Respondent employment and weekly working hours during each survey year. Results: Cardiovascular diseases significantly and remarkably reduced the probability of working by 15.4% (95% CI: -30.6% to -0.2%). The reduction in working probability was detected for women only. Respondents aged ≥ 40 years were less likely to work once diagnosed and the reduction was enlarged for those aged ≥ 65 years, while those aged < 40 years appeared to be unaffected. Probability of engaging in manual labor significantly decreased once diagnosed; however, no impact was found for cognitive occupations. Among employed respondents, the adverse effects of cardiovascular diseases decreased working hours by five hours per week. Validity of the biomarker instrumental variables was generally verified. Conclusions: A vicious circle is suggested between LFP and unfavorable health. However, the effects vary across age, sex, and occupation type, even after adjusting for causal effects, which could cause a downward bias in LFP impact. Attributes: cardiovascular disease, labor force participation, instrumental variable method as quasi-randomization, plasma biomarker, Comprehensive Survey of Living Conditions, National Health and Nutrition Survey. [ABSTRACT FROM AUTHOR]

Aim: To determine the resident and facility characteristics associated with residents’ care‐need level deterioration in long‐term care welfare facilities in Japan. Methods: A nationally representative sample of 358 886 residents who lived in 3774 long‐term care welfare facilities for at least 1 year from October 2012 was obtained from long‐term care insurance claims data. Facility characteristics were linked with a survey of institutions and establishments for long‐term care in 2012. We used a multilevel logistic regression according to the inclusion and exclusion of lost to follow‐up to define the resident and facility characteristics associated with resident care‐need level deteriorations (lost to follow‐up: the majority were hospitalized residents or had died; were treated as deterioration in the including loss to follow‐up model). Results: Adjusting for the covariates, at the resident level, older age and lower care‐need level at baseline were more likely to show deterioration in the care‐need level. At the facility level, metropolitan facilities, unit model (all private room settings) and mixed‐model facilities (partly private room settings) were less likely to experience care‐need level deterioration. A higher proportion of registered nurses among all nurses was negatively related to care‐need level deterioration only in the model including lost to follow‐up. A higher proportion of registered dietitians among all dietitians and the facilities in business for fewer years were negatively associated with care‐need level deterioration only in the model excluding lost to follow‐up. Conclusions: The present study could help identify residents who are at risk of care‐need level deterioration, and could contribute to improvements in provider quality performance and enhance competence in the market. Geriatr Gerontol Int 2018; 18: 758–766. [ABSTRACT FROM AUTHOR]

The present study examines the relationships between changes in bonding and bridging types of social capital and depressive states among middle-aged adults in Japan using a nationally representative sample. Data was collected from a nationwide, population-based survey conducted from 2005 to 2013 in nine annual waves. A total of 16,737 middle-aged men and 17,768 middle-aged women provided data. They reported about depressive states, measured by Kessler 6 scores, and bonding and bridging types of social capital, measured by reported participation in different social activities. Latent growth modeling was conducted to examine relations between changes in bonding and bridging types of social capital and depressive states within individuals across the nine waves. The results showed that, for both men and women, increases in bonding social capital were associated with decreases in depressive states, while changes in bridging social capital were not related to changes in depressive states. In addition, the results showed that changes in bonding social capital, but not bonding social capital at the baseline, affected changes in depressive states. Future studies should take changes in social capital as an independent variable into consideration. [ABSTRACT FROM AUTHOR]

This study investigated the effects of leisure and social activities on the ability of middle-aged adults to maintain activities of daily living (ADL), and whether performing these activities alone or with others contributed to the ability to perform ADL. The study used nationally representative longitudinal data of 22,770 adults in Japan, aged 50–59 years, who did not have limitations in performing ADL at the beginning of the 5-year survey period. The study considered six activity categories: two leisure activities (“hobbies or cultural activities” and “exercise or sports”) and four social activities (“community events,” “support for children,” “support for elderly individuals,” and “other social activities”). Multiple logistic regression analysis was used to examine the relation between participation in these categories at baseline and difficulties in ADL at the 5-year follow-up. The association between the extent of social interaction during these activities (“by oneself,” “with others,” or “both”) and difficulties in ADL was also investigated. The analysis yielded significant negative correlations between “exercise or sports” and difficulties in ADL for both men and women, and between “hobbies or cultural activities” and difficulties in ADL for women. However, these significant relationships occurred only when activities were conducted “with others.” The present findings might help prevent deterioration in middle-aged adults’ performance of ADL in Japan. [ABSTRACT FROM AUTHOR]

Aim The effects of family caregiving, especially long-hours caregiving, on coronary heart disease (CHD) are debatable. We examined the impact of family caregiving on incident non-fatal CHD. Methods We used data from the Longitudinal Survey of Middle-Aged and Elderly Persons from 2005 to 2010, a nationwide panel survey for Japanese people aged 50-59 years in 2005 (baseline). After we excluded non-respondents and people with missing key variables at baseline, 25 121 individuals without CHD, stroke or cancer were followed up for a mean of 4.6 years. The exposure was assessed at baseline by three indicators: (i) family caregiving; (ii) hours spent caregiving; and (iii) kinship type of care recipient. The non-fatal CHD incidence was identified according to questionnaire responses from 2006 to 2010. Results Cox's proportional hazards analysis did not show a statistically significant association between family caregiving and incident non-fatal CHD (hazard ratio [HR] 1.13, 95% confidence interval [CI] 0.92-1.40). Caregivers who spent 20-69 h per week on care showed a statistically significant increased risk for non-fatal CHD (HR 1.78, 95% CI 1.23-2.58) compared with non-caregivers; whereas this increased risk was statistically significant only among women (HR 1.98, 95% CI 1.27-3.08), but not among men (HR 1.35, 95% CI 0.67-2.71). Kinship type of care recipient did not make a significant difference to the effects of family caregiving on incident non-fatal CHD. Conclusions Long-hours family caregiving could be an independent risk factor for incident non-fatal CHD among middle-aged women in Japan. Geriatr Gerontol Int 2017; 17: 2109-2115. [ABSTRACT FROM AUTHOR]