Papers

Large-Scale Fandom-based Gamification Intervention to Increase Physical Activity: A Quasi-experimental Study.

A new paper was published from Sci Sports Exerc.

Kamada M, Hayashi H, Shiba K, Taguri M, Kondo N, Lee IM, Kawachi I. Large-Scale Fandom-based Gamification Intervention to Increase Physical Activity: A Quasi-experimental Study. Med Sci Sports Exerc. 2021 Aug. DOI: 10.1249/MSS.0000000000002770 Epub ahead of print. PMID: 34366420.

Abstract

Purpose: Gamification, the use of game design elements in nongame contexts, in combination with insights from behavioral economics has been applied increasingly to behavior change interventions. However, little is known about the effectiveness or scalability of this approach, especially in the long term. We tested a large-scale smartphone-based intervention to encourage physical activity among Japanese baseball fans using gamification techniques that leveraged fandom and inter-team competition inherent in sports.

Methods: A quasi-experimental study was conducted among fans of the Japanese Pacific League. The app, Pa-League Walk, included gamification elements, such as competition between opposing teams’ fans based on total daily step counts on game days (>60,000 free downloads since March 2016). We analyzed daily steps of 20,052 app users, supplemented by online survey data of 274 users and 613 matched controls. Difference-in-differences estimators evaluated change in daily steps before and after app installation in users versus matched controls.

Results: Users’ daily steps increased by 574 (95% confidence interval: 83, 1064) steps three months after installation, compared to controls. The increase was maintained for up to nine months (559 [99, 1018] more steps per day versus baseline), attenuating over a longer follow-up. Positive effect modification was found by high frequency of the app use (P < 0.001) but not by other covariables (P ≥ 0.14) such as education or income. Days with 10,000 steps achievement increased from 24.4% to 27.5% after the additional introduction of incentives (digital player photos) (P < 0.001).

Conclusion: Using existing fandom and solidarity, the gamification app increased physical activity at scale among baseball fans, including people with lower socioeconomic status under-represented in traditional health programs.

Accumulated long-term care benefits by risk assessment scales for incident functional disability: A six-year follow-up study of long-term care receipt data

A new paper was published from Nihon Koshu Eisei Zasshi.

Saito M, Tsuji T, Fujita K, Kondo N, Aida J, Ojima T, Kondo K. [Accumulated long-term care benefits by risk assessment scales for incident functional disability: A six-year follow-up study of long-term care receipt data]. Nihon Koshu Eisei Zasshi. 2021 Aug 6. Japanese. DOI: 10.11236/jph.21-056 Epub ahead of print. PMID: 34373427.

Abstract

Objectives This study aims to evaluate the differences in the cumulative benefit costs of public long-term care [LTC] insurance services, using a risk assessment scale score, which predicts incident functional disability among older people.Methods A baseline survey was conducted in 2010 involving individuals aged 65 and above from 12 municipalities in Japan who were not eligible for public LTC insurance benefits (response rate: 64.7%). Using public LTC claim records, we followed LTC service costs among 46,616 individuals over a period of about six years (up to 76 months). We used risk assessment scales to assess incident functional disability (0-48). We adopted a classical linear regression model, Tobit regression model, and linear regression with multiple imputation for missing values.Results Overall, 7,348 (15.8%) of the participants had used LTC services during the follow-up period. The risk assessment score for incident functional disability was positively associated with the cumulative costs of LTC services per person, length of usage period of LTC services, and proportion of people certified for long-term care/support need and for over long-term care level 2. After adjusting for confounding variables, the six-year cumulative costs of LTC services were around JPY 31.6 thousand higher per point of risk score (95% confidence interval [CI]: 28.3 to 35.0). The costs were around JPY 8.9 thousand (95%CI: 6.5 to 11.3) higher in the low score group (risk score ≤ 16), and JPY 75.3 thousand (95%CI: 67.4 to 83.1) higher in the high score group (risk score ≥ 17). When we adopted other estimated models, the major results and trends were not largely different.Conclusions In this study, the risk assessment scale score could estimate subsequent LTC benefit costs. Community interventions to improve and maintain variable aspects of risk assessment scores may help contribute to a reduction in public LTC benefits within municipalities.

Keywords: leading indicator; long-term care benefit; long-term care prevention; long-term care receipt data; older adults; risk assessment scales for incident functional disability.

Article: Income Inequality Becomes Health Inequality (Public Assistance Research Quarterly)

Naoki Kondo and Daisuke Nishioka (visiting researcher) have published an article in the latest issue of the Quarterly Journal of Public Assistance Research.

Click here for the table of contents of the Quarterly Journal of Public Assistance Research No. 261 (in Japanese).
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Daisuke Nishioka will continue to write a series of articles.

Special Feature: Income Inequality Becomes Health Inequality
Why Health Care Assistance is Necessary: A Perspective from the Concept of Capital
Naoki Kondo, Graduate School of Kyoto University

Toward Effective Implementation of Health Management Support Program for Protected Persons
Daisuke Nishioka, Osaka Medical College Graduate School of Medicine

Reference
The Power of Accompaniment: A Survey Study on the Actual Conditions of Medical Service Use by the Needy and the Effectiveness of Accompaniment Support for Medical Consultations（PDF, in Japanese)

Daisuke Nishioka’s website is here.

Press Release: Possible Regional Disparities in the “Improvement” of Care Needs

Airi Amamiya, a visiting researcher, published a paper in International Journal of Environmental Research and Public Health A press release was issued on a paper published in the International Journal of Environmental Research and Public Health.

The Possibility of Regional Disparities in the “Improvement” of Care Needs(PDF)
～Social capital in the community may not be effective for certain people. ～(PDF)

This study suggests that although men live in areas with strong community ties (social cohesion), they are less likely to improve their care needs if they have a low opinion of those ties. For women, despite living in a community with high civic participation, if they do not participate in the community, they are less likely to improve after needing care. In areas with rich social capital, it is necessary to consider whether anyone is excluded from these connections.

Reference
Amemiya A, Saito J, Saito M, Takagi D, Haseda M, Tani Y, Kondo K, Kondo N. Social Capital and the Improvement in Functional Ability among Older People in Japan: A Multilevel Survival Analysis Using JAGES Data. Int J Environ Res Public Health. 2019 Apr 12;16(8):1310. doi: 10.3390/ijerph16081310. PMID: 31013681; PMCID: PMC6518128.

Press Release: Socioeconomic disparities may exist in “improvement” of care needs

Airi Amamiya, a visiting researcher, has published a press release on a paper published in BMC Public Health.

Possible socioeconomic disparities in the “improvement” of care needs
– Longer education is twice as likely to improve as shorter education – (PDF, in Japanese)

It is known that there is a possibility of improvement in the condition of the elderly even after they require long-term care. This study found that those who are socioeconomically disadvantaged are less likely to improve their condition after needing care. This suggests that there is a socioeconomic disparity in the improvement of care needs. There is a need to focus on supporting those who are in a socioeconomically disadvantaged position.

Reference
Amemiya A, Kondo N, Saito J, Saito M, Takagi D, Haseda M, Tani Y, Kondo K. Socioeconomic status and improvement in functional ability among older adults in Japan: a longitudinal study. BMC Public Health. 2019 Feb 19;19(1):209. doi: 10.1186/s12889-019-6531-9. PMID: 30782149; PMCID: PMC6381753.

New Paper: Mobility restrictions were associated with reductions in COVID-19 incidence early in the pandemic: evidence from a real-time evaluation in 34 countries

We published a paper from Scientific Reports.

Oh J, Lee HY, Khuong QL, Markuns JF, Bullen C, Barrios OEA, Hwang SS, Suh YS, McCool J, Kachur SP, Chan CC, Kwon S, Kondo N, Hoang VM, Moon JR, Rostila M, Norheim OF, You M, Withers M, Li M, Lee EJ, Benski C, Park S, Nam EW, Gottschalk K, Kavanagh MM, Tran TGH, Lee JK, Subramanian SV, McKee M, Gostin LO. Mobility restrictions were associated with reductions in COVID-19 incidence early in the pandemic: evidence from a real-time evaluation in 34 countries. Sci Rep. 2021 Jul 2;11(1):13717. doi: 10.1038/s41598-021-92766-z. PMID: 34215764.

Abstract

Most countries have implemented restrictions on mobility to prevent the spread of Coronavirus disease-19 (COVID-19), entailing considerable societal costs but, at least initially, based on limited evidence of effectiveness. We asked whether mobility restrictions were associated with changes in the occurrence of COVID-19 in 34 OECD countries plus Singapore and Taiwan. Our data sources were the Google Global Mobility Data Source, which reports different types of mobility, and COVID-19 cases retrieved from the dataset curated by Our World in Data. Beginning at each country’s 100th case, and incorporating a 14-day lag to account for the delay between exposure and illness, we examined the association between changes in mobility (with January 3 to February 6, 2020 as baseline) and the ratio of the number of newly confirmed cases on a given day to the total number of cases over the past 14 days from the index day (the potentially infective ‘pool’ in that population), per million population, using LOESS regression and logit regression. In two-thirds of examined countries, reductions of up to 40% in commuting mobility (to workplaces, transit stations, retailers, and recreation) were associated with decreased cases, especially early in the pandemic. Once both mobility and incidence had been brought down, further restrictions provided little additional benefit. These findings point to the importance of acting early and decisively in a pandemic.

New Paper: Disability and psychological distress in nine countries of the former Soviet Union

We published a paper from J Affect Disord.

Stickley A, Kondo N, Roberts B, Kizilova K, Waldman K, Oh H, Inoue Y, Shin JI, Shakespeare T, McKee M. Disability and psychological distress in nine countries of the former Soviet Union. J Affect Disord. 2021 Jun 2;292:782-787. doi: 10.1016/j.jad.2021.05.061. Epub ahead of print. PMID: 34175591.

Abstract

Background: People with disabilities (PWD) are at increased risk of poor mental health. However, this association and the pathways involved remain under-researched in many parts of the world. This study examined the association between disability and psychological distress in nine countries of the former Soviet Union (FSU).

Methods: Data were analysed from 18,000 adults aged ≥18 years collected during the Health in Times of Transition (HITT) survey undertaken in Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia, and Ukraine in 2010 and 2011. Information was obtained on disability status, the severity of the disability and psychological distress. Logistic regression analysis was used to estimate associations.

Results: In a fully adjusted combined country analysis, disability was associated with over two times higher odds for psychological distress (odds ratio [OR]: 2.19, 95% confidence interval [CI]: 1.86-2.58). The strength of the association varied across the individual countries. Among PWD more severe disability was associated with significantly higher odds for psychological distress (OR: 2.12, 95%CI: 1.26-3.55).

Limitations: The data were cross-sectional and disability status was self-reported, possibly resulting in underreporting.

Conclusions: Disability is associated with worse psychological health in FSU countries, especially among those with more severe disabilities. As poor mental health may also increase the risk of negative outcomes in PWD, this finding highlights the importance of the early detection and treatment of mental disorders in PWD in these countries.

New paper: Disability and loneliness in nine countries of the former Soviet Union

We published a paper from Disabil Health J.

Stickley A, Kondo N, Richardson E, Leinsalu M, Waldman K, Oh H, Inoue Y, Shakespeare T, McKee M. Disability and loneliness in nine countries of the former Soviet Union. Disabil Health J. 2021 May 28:101123. doi: 10.1016/j.dhjo.2021.101123. Epub ahead of print. PMID: 34147415.

Abstract

Background: People with disabilities (PWD) often face structural and other barriers to community involvement and may therefore be at risk of loneliness. Yet, so far, this issue has received little attention.

Objective: This cross-sectional study aimed to examine the association between disability and loneliness in nine countries of the former Soviet Union (FSU).

Methods: Data were analyzed from 18000 respondents aged ≥18 that came from the Health in Times of Transition (HITT) survey that was undertaken in Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia and Ukraine in 2010/11. Respondents reported on whether they had a disability (no/yes) and its severity. A single-item question was used to assess loneliness. Logistic regression analysis was used to examine the associations.

Results: Across the countries, 6.8% of respondents reported being disabled. In a fully adjusted combined country analysis, disability was associated with higher odds for loneliness (odds ratio: 1.30, 95% confidence interval: 1.06-1.60). In an analysis restricted to PWD, individuals in the most severe disability category (Group 1) had over two times higher odds for loneliness when compared to those in the least severe disability category (Group 3).

Conclusions: Disability is associated with higher odds for reporting loneliness in the FSU countries and this association is especially strong among those who are more severely disabled. An increased focus on the relationship between disability and loneliness is now warranted given the increasing recognition of loneliness as a serious public health problem that is associated with a number of detrimental outcomes.

Keywords: Adult population; Disabled; HITT survey; Lonely.

New paper: Sociodemographic inequities in dental care utilisation among governmental welfare recipients in Japan: a retrospective cohort study

We published a paper from Int J Equity Health.

Nishioka D, Ueno K, Kino S, Aida J, Kondo N. Sociodemographic inequities in dental care utilisation among governmental welfare recipients in Japan: a retrospective cohort study. Int J Equity Health. 2021 Jun 16;20(1):141. doi: 10.1186/s12939-021-01473-8. PMID: 34134717.

Abstract

Background: Maintaining oral health is one of the global public health challenges. Income and out-of-pocket payments for dental care services are predictors of dental care utilisation. Although public assistance programmes guarantee income security for impoverished people, access barriers other than financial costs may cause unmet dental care needs. We aimed to explore the potential sociodemographic factors determining dental care utilisation among recipients of public assistance in Japan using linkage data of public assistance database and medical assistance claim data administered by municipalities.

Methods: This was a retrospective cohort study involving a sample of public assistance recipients. We extracted the recipients’ sociodemographic data (age, sex, household number, employment status, nationality, disability certificates, and long-term care status) in January 2016 and observed them until December 2016 to identify incidences of dental care utilisation as outcomes. We performed a multivariable modified Poisson regression analysis with a robust standard error estimator to calculate the incidence ratio (IR) of dental care utilisation in each variable.

Results: We identified a total of 4497 recipients at risk. Among them, 839 recipients used dental care services. Younger age was associated with a higher incidence of dental care utilisation. The female recipients had a higher incidence of dental care utilisation when compared to the male ones (adjusted IR, 1.22; 95% confidence interval [CI], 1.08-1.38). Immigrant recipients had a higher incidence of dental care utilisation than the Japanese ones (IR, 1.53; 95% CI, 1.16-2.01). Recipients with mental disabilities had higher incidences than those without disability certificates (IR, 1.30; 95% CI, 1.08-1.56).

Conclusions: Non-financial sociodemographic inequities in dental care utilisation stemming from age, sex, nationality, and presence of mental disability were found despite minimum income protection and equitable financial dental service access amongst public assistance recipients in Japan. Providing targeted preventive care and treatments for dental care among underserved populations is required to tackle oral health inequities.

Keywords: Free dental care access, Japan; Oral health inequities; Poverty; Public assistance.