Aichi Health Promotion Foundation

PurposeTo investigate the association between serum high-density lipoprotein cholesterol (HDL-C) levels and ganglion cell complex (GCC) thickness in a nonglaucomatous Japanese population.DesignA retrospective cross-sectional observational study.ParticipantsWe included 588 nonglaucomatous Japanese adults who underwent comprehensive ophthalmic and systemic health screening.MethodsParticipants underwent OCT imaging, anthropometric measurements, including brachial–ankle pulse wave velocity, spirometry, and hematologic profiling. Multivariable linear regression models were used to assess the association between HDL-C levels and GCC thickness. Covariates were selected using a stepwise variable selection procedure, with the final model including age and axial length. A piecewise linear regression model further evaluated the association across different HDL-C ranges.Main Outcome MeasuresAverage GCC thickness.ResultsOlder age (P = 0.002), longer axial length (P < 0.001), and higher HDL-C levels (P < 0.001) were significantly associated with thinner GCC thickness. A nonlinear relationship was observed, with GCC thickness inversely associated with HDL-C levels outside the 60 to 67 mg/dL range (P = 0.005).ConclusionsHigh-density lipoprotein cholesterol levels are significantly associated with GCC thickness in nonglaucomatous individuals, which suggests a potential role of lipid metabolism in early neuroretinal thinning. High-density lipoprotein cholesterol may serve as a biomarker for neurodegenerative changes, even before glaucomatous alterations become clinically apparent.Financial Disclosure(s)Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

BackgroundInformation on the effects of the use of electronic cigarettes and heated cigarettes on oral health status is sparse. In addition, few studies have reported the oral health behaviours of the users of such products. We examined the associations among smoking status (including the use of cigarettes and electronic/heated cigarettes), oral health behaviours, periodontal condition, and tooth loss in employed Japanese adults.MethodsThe participants were 512 employees of 20 business offices of 19 companies that are members of the Aichi Branch of the Japan Health Insurance Association. Between December 2019 and March 2020, we performed dental examinations and asked the participants to complete self-administered questionnaires. We obtained the results of specific health check-ups from the Japan Health Insurance Association. Periodontal status was evaluated using the Community Periodontal Index and the loss of attachment. Multivariable linear regression analysis and structural equation modelling were performed to examine the relationship between periodontal condition/tooth loss and other factors.ResultsIn multivariable linear regression analysis, smokers had 1.38 fewer teeth on average compared to nonsmokers. Compared to nonsmokers, those who smoked cigarettes, electronic/heated cigarettes, or both had 15.4%, 17.9%, and 12.1% greater proportions of teeth with probing depth (PD) ≥ 4 mm and had 16.6%, 19.2%, and 9.99% greater proportions of teeth with attachment loss (AL) ≥ 4 mm, respectively. In structural equation modelling, cigarette smokers and participants who had no interest in oral health had fewer teeth. Cigarette smokers, electronic/heated cigarette smokers, and those who did not make an effort to care for their teeth still had more teeth with ≥ 4 mm PD and teeth with ≥ 4 mm AL.ConclusionThe use of all cigarette types was significantly associated with poor oral health status. Smokers tended to pay less attention to their oral health, leading to poorer oral hygiene habits and worsening periodontal status. Providing smoking cessation support in workplaces and dental offices is important for maintaining the oral health of occupational adults. Because cross-sectional studies cannot clarify causality or the direction of the association between smoking and oral health status, further longitudinal studies are needed.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12903-025-07003-0.

Objective Although pain is one of the most common symptoms experienced by people with dementiain long-term care, there have been few studies on the actionable knowledge of painassessment and management in dementia care from a multidisciplinary perspective. Thisstudy aimed to identify practical tips for pain management of patients with advanceddementia using a multidisciplinary approach.Patients and Methods Individual in-depth interviews were conducted between January and March 2022 with 24healthcare professionals who had ample experience in primary palliative care fordementia. The qualitative data were analyzed using a qualitative content analysis.Results Three main themes and nine subthemes capturing advice in pain assessment andmanagement for advanced dementia were identified: patient assessment (early detection,multidisciplinary comprehensive assessment, drowsiness and inactivity, diagnostictherapy), assessment of family understanding of pain in dementia (willingness to acceptguidance from experts, understanding and acceptance of dementia), and intervention(distraction, resistance and nonadherence to care, care-related pain).Conclusion These findings identified dementia-specific practical advice for pain management.First, multidisciplinary teams are required to better understand slight behavioralchanges of people with advanced dementia. Second, they must be equipped with thenecessary knowledge to differentiate symptoms of advanced dementia from those of otherconditions. Third, pain medicine administration, along with a diagnostic procedure, isrecommended. Fourth, distraction from chronic pain, reduced resistance and nonadherenceto care were offered as pain management strategies for advanced dementia. Finally,family members must be educated about pain in those with advanced dementia because painmanagement was the most identified burden faced by family caregivers.

Globally, multi-disciplinary advance care planning (ACP) in multi-facility settings for aging communities is essential; however, it does not consistently yield the desired outcomes. Japan's population is rapidly aging; nonetheless, no studies have examined comprehensive ACP implementation by diverse professionals across various community healthcare facilities. Within the context of an aging community, this study aimed to identify the barriers and facilitators to ACP implementation by multiple professionals in various healthcare facilities. A qualitative research design was employed. The study participants included 22 multidisciplinary members of a community-based palliative care (CBPC) team. Individual semi-structured interviews were conducted between September and October 2019. A total of 19 barriers and 19 facilitators were identified and categorized into seven practice domains: "Understanding patients' intentions," "Family support," "Information sharing using tools," "Collaboration among multiple professions," "Cross-facility and cross-departmental cooperation," "Raising awareness in the community," and "Efforts by implementation promoters and their departments." Barriers included "Inability to understand the patient's intentions," "Physical and psychological distance between patient and family," and "Different information needs and sharing methods at each facility," among others. Facilitators included "Skills for better understanding the true meaning of patients' intentions," "Compatibility of daily tasks and ACP by utilizing tools," "Human connections between professionals in multiple facilities and departments," and "Engagement with ACP implementation," among others. The study identified important domains for practical ACP implementation using a community-based palliative care team collaborating across multiple community facilities, as well as the barriers and facilitators. The findings indicate that multi-disciplinary, multi-facility ACP implementation in regions with aging populations requires establishing a regional collaborative network system and a human network. Healthcare professionals must develop practical ACP experience to identify its benefits while enhancing their skills as "advocates."

Objective Under Japan’s Long-term Care Insurance system, care managers(CMs) are expected to function as coordinators in the community-based integrated caresystem. However, few studies have focused on inter-professional collaboration betweenmedical and non-medical professionals. The aim of this study was to identify CMs’perspectives on enablers and barriers to successful collaboration between care managersand physicians within the community.Patient/Materials and Methods We targeted care managers with ampleexperience working as CMs in the community and recruited 12 CMs using snowball sampling.Online interviews were conducted from January to May 2023 using an open-endedquestionnaire concerning participants’ experiences of collaborating with physicians andintegrating medical services into care management. Qualitative data were analyzed throughinductive manual coding using a qualitative content analysis approach.Results Four main themes were identified as enablers and barriers tosuccessful CM–physician collaboration in the community: medical knowledge, professionalattitudes, communication skills, and the professional culture of medicine. Equipping CMswith practical medical knowledge is essential for effective communication. Professionalattitudes among CMs are imperative to fostering collaborative relationships. Effectivecommunication skills are another critical factor, emphasizing the need for clarity,specificity, and utilization of nurses as key mediators in physician–care managerdialogue. Recognizing and navigating the professional culture of medicine is essential toovercome barriers stemming from differences in norms, beliefs, and practices between CMsand medical professionals.Conclusion This study underscores the significance of interprofessionaleducation focusing on cultural differences and the development of systematic learningapproaches to enhance CMs’ medical knowledge of CMs. Furthermore, the findings highlightthe need for clarity in defining CMs’ roles within healthcare teams and addressingphysicians’ misperceptions regarding their contributions and responsibilities.

Long-term care (LTC) settings are increasingly used for palliative care in Japan. This study aimed to assess the proportion of LTC settings that provide palliative care services for older clients with advanced dementia in Japan and the trends across the types of settings. A nationwide questionnaire survey was conducted between November 2022 and January 2023, targeting 1,000 geriatric hospitals (GHs), 1,000 geriatric health services facilities (GHSFs), and 1,000 home nursing care stations (HNCSs). The palliative care practices for older patients with advanced dementia and their families in the agencies were assessed. Less than half of the GHs supported family participation or the spiritual needs of their older clients with dementia, while many had access to pain and symptom assessments and analgesic prescriptions by physicians. Less than half the GHSFs used pain assessment tools, assessed and supported family caregivers' pain and distress, and supported family participation in palliative care. More than 80% of the HNCSs practiced most of the listed palliative care. Current palliative care practices for older adults with dementia vary among GHs, GHSFs, and HNCSs. This emphasizes the need for targeted approaches to improve the provision of palliative care for patients with dementia across LTC settings in Japan.

Background:Advance care planning (ACP) is beneficial for the quality of death (QOD). However, the effects of ACP on the QOD may vary across cultures.Objectives:This study aimed to explore the relationship between the 15-step ACP program and the QOD among Japanese nursing home residents.Design:A cross-sectional survey.Methods:A cross-sectional survey was conducted among the family members of 39 nursing home residents who died between April 2017 and March 2019 by distributing the survey questionnaire by post. The survey included questions about the QOD of residents, and responses were evaluated using the Good Death Inventory (GDI) scale.Results:Responses were obtained from 30 of the 39 bereaved families (76.9%). Data were analyzed using hierarchical clustering to determine five groups and conduct multiple comparisons. The following three domains of interest were identified: ‘Dying in a favorite place’, ‘Good relationship with the medical staff’, and ‘Independence’. GDI scores were significantly higher for residents with higher ACP completion rates than for those with lower rates (p < 0.01). Residents who had taken ACP interviews had significantly higher GDI scores (p < 0.01) than those who had not taken interviews.Conclusion:Overall, these findings suggest that systematic ACP might be related to the QOD among Japanese nursing home residents in the above mentioned three domains. Limitations of the present study were small sample size, cross-sectional survey design as opposed to a cohort survey design, and multiple biases, including the emotional instability of bereaved family members, the length of stay of the residents, the degree of dementia of the residents, and their tendency to talk about the place of death and to develop good relationships with the medical staff.