ObjectivesSeveral instruments for evaluating patient complexity have been developed from a biopsychosocial perspective. Although relationships between the results obtained by these instruments and the length of stay in hospital have been examined, many instruments are complicated and not easy to use. The Patient Centred Assessment Method (PCAM) is a candidate for practical use. This study aimed to test the validity and reliability of the PCAM and examine the correlations between length of hospital stay and PCAM scores in a regional secondary care hospital in Japan.DesignProspective cohort study.Participants and settingTwo hundred and one patients admitted to Ouji Coop Hospital between July 2014 and September 2014.Main predictorPCAM total score in initial phase of hospital admission.Main outcomeLength of stay in hospital.ResultsAmong 201 patients (Female/Male=98/103) with mean (SD) age of 77.4±11.9 years, the mean PCAM score was 25±7.3 and mean (SD) length of stay in hospital (LOS) 34.1±40.9 days. Using exploratory factor analysis to examine construct validity, PCAM evidently has a two-factor structure, comprising medicine-oriented and patient-oriented complexity. The Spearman rank correlation coefficient for evaluating criterion-based validity between PCAM and INTERMED was 0.90. For reliability, Cronbach’s alpha was 0.85. According to negative binomial regression analyses, PCAM scores are a statistically significant predictor (p<0.001) of LOS after adjusting for age, gender, Mini Nutritional Assessment Short-Form, Charlson Comorbidity Index, serum sodium concentration, total number of medications and whether public assistance was required. In another model, each factor in PCAM was independently correlated with length of stay in hospital after adjustment (medicine-oriented complexity: p=0.001, patient-oriented complexity: p=0.014).ConclusionPCAM is a reliable and valid measurement of patient complexity and PCAM scores have a significant correlation with hospital length of stay.

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Emotional facial expressions are thought to have evolved because they play a crucial role in species' survival. From infancy, humans develop dedicated neural circuits [1] to exhibit and recognize a variety of facial expressions [2]. But there is increasing evidence that culture specifies when and how certain emotions can be expressed - social norms - and that the mature perceptual mechanisms used to transmit and decode the visual information from emotional signals differ between Western and Eastern adults [3-5]. Specifically, the mouth is more informative for transmitting emotional signals in Westerners and the eye region for Easterners [4], generating culture-specific fixation biases towards these features [5]. During development, it is recognized that cultural differences can be observed at the level of emotional reactivity and regulation [6], and to the culturally dominant modes of attention [7]. Nonetheless, to our knowledge no study has explored whether culture shapes the processing of facial emotional signals early in development. The data we report here show that, by 7 months, infants from both cultures visually discriminate facial expressions of emotion by relying on culturally distinct fixation strategies, resembling those used by the adults from the environment in which they develop [5].