Self care: Japan and the U.S. compared

Experience of common symptoms and subsequent self care behaviors among older adults are compared between Japan and the United States, two industrial countries with different cultural backgrounds and health insurance systems. Based on a modification of the Health Belief Model, perceived susceptibility to illness and belief in the efficacy of physician care were selected as major explanatory concepts for the decision to use self care for a complaint. Among 900 respondents in Japan and 728 in the United States, in three communities of varying size, self evaluations of good health, an indicator of low susceptibility, were very similar. Although Japanese respondents claimed fewer experiences of physician error, they still expressed lower preference for physician care than did those in the U.S. In addition, the Japanese reported far fewer symptoms than their U.S. counterparts during a three month period, and were more likely to use self care, even for symptoms they considered more serious. Disparate effects of such variables as good health behaviors, presence of a chronic condition and desire for autonomy are discussed in terms of cultural differences in the two countries.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/29655/1/0000744.pd

Self care: Japan and the U.S. compared

Experience of common symptoms and subsequent self care behaviors among older adults are compared between Japan and the United States, two industrial countries with different cultural backgrounds and health insurance systems. Based on a modification of the Health Belief Model, perceived susceptibility to illness and belief in the efficacy of physician care were selected as major explanatory concepts for the decision to use self care for a complaint. Among 900 respondents in Japan and 728 in the United States, in three communities of varying size, self evaluations of good health, an indicator of low susceptibility, were very similar. Although Japanese respondents claimed fewer experiences of physician error, they still expressed lower preference for physician care than did those in the U.S. In addition, the Japanese reported far fewer symptoms than their U.S. counterparts during a three month period, and were more likely to use self care, even for symptoms they considered more serious. Disparate effects of such variables as good health behaviors, presence of a chronic condition and desire for autonomy are discussed in terms of cultural differences in the two countries.elderly self treatment Japan United States

National trends in the outcomes of subarachnoid haemorrhage and the prognostic influence of stroke centre capability in Japan: retrospective cohort study

Objectives To examine the national, 6-year trends in in-hospital clinical outcomes of patients with subarachnoid haemorrhage (SAH) who underwent clipping or coiling and the prognostic influence of temporal trends in the Comprehensive Stroke Center (CSC) capabilities on patient outcomes in Japan.Design Retrospective study.Setting Six hundred and thirty-one primary care institutions in Japan.Participants Forty-five thousand and eleven patients with SAH who were urgently hospitalised, identified using the J-ASPECT Diagnosis Procedure Combination database.Primary and secondary outcome measures Annual number of patients with SAH who remained untreated, or who received clipping or coiling, in-hospital mortality and poor functional outcomes (modified Rankin Scale: 3–6) at discharge. Each CSC was assessed using a validated scoring system (CSC score: 1–25 points).Results In the overall cohort, in-hospital mortality decreased (year for trend, OR (95% CI): 0.97 (0.96 to 0.99)), while the proportion of poor functional outcomes remained unchanged (1.00 (0.98 to 1.02)). The proportion of patients who underwent clipping gradually decreased from 46.6% to 38.5%, while that of those who received coiling and those left untreated gradually increased from 16.9% to 22.6% and 35.4% to 38%, respectively. In-hospital mortality of coiled (0.94 (0.89 to 0.98)) and untreated (0.93 (0.90 to 0.96)) patients decreased, whereas that of clipped patients remained stable. CSC score improvement was associated with increased use of coiling (per 1-point increase, 1.14 (1.08 to 1.20)) but not with short-term patient outcomes regardless of treatment modality.Conclusions The 6-year trends indicated lower in-hospital mortality for patients with SAH (attributable to better outcomes), increased use of coiling and multidisciplinary care for untreated patients. Further increasing CSC capabilities may improve overall outcomes, mainly by increasing the use of coiling. Additional studies are necessary to determine the effect of confounders such as aneurysm complexity on outcomes of clipped patients in the modern endovascular era