Background: The cost-effectiveness of intervention programs associated with different population characteristics remains unclear, especially in mildly disabled older populations. The purpose of this study was to conduct a cost-utility analysis of a disability prevention program for older adults with mild disabilities in the urban area of Tokyo, Japan from a long-term care system perspective.

Method: In a single blinded, before‒after trial, we recruited 128 mildly disabled participants (age, ≥65 years) who had enrolled in a center-based preventive program under the Japanese long-term care insurance system in Tokyo. All participants attended training sessions (1‒2 session(s)/week; 75 minutes/session), comprising both resistance and aerobic training that were guided and supervised by physiotherapists. A cost-utility analysis using QALY based on EQ-5D-5L and EQ-VAS were performed. Long-term care costs between baseline and follow-up were assessed from a long-term care system perspective. Intervention and nursing-care costs were calculated according to the Japanese long-term care insurance system rates. A cost-effectiveness accessibility curve was constructed, and a probability sensitivity analysis controlling for the influence of the mode of QALY calculation was performed.

Results: 74 participants were included in the analysis. The base costs of total mean ICER (EQ-5D-5L) and ICER (EQ-VAS) were 1,144,020.0 ± 716,568.1 and 1,149,829.1 ± 652,428.8 yen, respectively. The probability of reaching the accepted cost-effectiveness threshold of JPY/5,000,000 per QALY is significantly higher for all simulations.

Conclusion: This study demonstrated that a center-based disability preventive program is likely to be cost-effective. Future research should include larger sample sizes, different participant characteristics, such as moderately disabled and frail participants, and different settings, such as home- or center-based care.

Purpose: Based on the study conducted with home care services providers in Saitama prefecture, Japan, this study investigated the factors affecting the profitability of home care services providers.

Methods: Using the data collected from 370 home care services providers in Saitama prefecture, a multiple regression analysis was performed with the number of home care recipients and the length of services (in minutes) as the dependent variables, and the years of business continuity, service area, the types of care services and the number of nursing staff members as independent variables.

Results: The results revealed that the number of nursing staff members that providers have, the types of organizations - such as facility- and residential-based -, the years of business continuity, and whether they provide their own care management services are associated with the profitability of home care services providers.

Conclusion: When investigating the factors affecting the profitability of home care services providers, it is important to take into consideration, not only factors behind services recipients, but also the environmental factors that affect the delivery system of services providers.

Objective: This study aimed to develop a meaning-making of stressors scale (MMSS) for adolescents and to evaluate its validity and reliability.

Method: A preliminary version of the MMSS questionnaire was administered to 270 undergraduates. An exploratory factor analysis, as well as correlation and partial correlation analyses with kinds of stressors, stressor severity levels, and responses to the 13-item version of the Sense of Coherence Scale (SOC-13) were conducted to examine the MMSS’s validity; reliability was evaluated using the Cronbach’s α coefficient and split-half method.

Result: A factor analysis (least-squares method with promax rotation) revealed three factors: “growth from stressors,” “clarification of purpose in life,” and “appreciation for human relationships.” Cronbach’s α coefficients for the total scale and three subscales of the MMSS ranged from 0.88 to 0.94. The correlation coefficient using the split-half method was 0.90 (p < 0.001). The total score and three subscales of the MMSS showed significant positive correlations with the SOC-13 scores (r = 0.29-0.49, p < 0.001). “Clarification of purpose in life” showed a significant negative correlation with stressor severity levels (r = -0.14, p < 0.05). However, the “course and employment,” “school record and ability,” and “health” stressors were not significantly correlated with the MMSS’s total score or any of the three subscales.

Conclusion: The MMSS was found to be both reliable and valid. However, some stressors did not have a significant relationship with the MMSS total score or any of its three subscales. Therefore, further studies are needed.

Purpose: To define the concept of “coming to terms” with schizophrenia

Methods: Rodgers’ (2000) concept analysis approach was used. Data was collected by searching six databases, including the Japan Medical Abstracts Society. The search keywords “coming to terms” and related keywords “acceptance/schizophrenia” were used. The English literature was searched using the keywords “identity adaptation schizophrenia.” Only original works with abstracts were retrieved, which included 20 Japanese and two English manuscripts. Antecedents, attributes, and conclusions were extracted from each document and categorized as separate items.

Results: Six categories of attributes were extracted: “living with the illness,” “positive recognition of oneself,” “the manner of interaction between oneself and one’s family or other people,” “the acquisition of a new sense of values,” “the reinforcement of self-monitoring,” and “living freely and naturally.” Antecedent factors were broadly divided into two categories, namely, individual and environmental causal factors, and each category was further divided into four subcategories. The individual factors were divided into “illness-related distress”; “illness-related negative experiences”; “sense of negativity toward activities of daily living and “coping response”; and “new questions arising from knowledge of schizophrenia.” The environmental factors were divided into “medical treatment,” “family support,” “interpersonal relations,” and “institutional/social resources.” Six categories of consequences were extracted: “establishing a pattern of living,” “acquiring the confidence to interact with others,” “discovering one’s new role in society,” “self-fulfillment/determination,” “expectations regarding medical treatment,” and “rediscovering oneself.

Conclusion: The concept of “coming to terms” in schizophrenia was defined as “living freely and naturally.” However, those with schizophrenia struggled with illness-related experiences stemming from prejudice. Such experiences amidst an illness-based loss of self-confidence fueled a continual perception that people with schizophrenia were different from who they were prior to their illness, and thus, the definition of “living freely and naturally” was chosen.