［Objective］ To develop an overview of effective stress management support for nurses, with the following 3 focuses: 1） the techniques used in effective intervention programs provided for nurses to manage their stress, 2） rate of interventional studies focusing on positive psychological functioning in nurses, and 3） scales used in interventional studies on stress management for nurses.

［Methods］ Trends in interventional studies on stress management for nurses were examined by searching for domestic and international research papers, which had been published within the period between 2011 and May 2021, using the Ichushi Web ver. 5 and PubMed databases, respectively, and combining the following keywords: “nurse”, “stress management”, “stress control”, “stress coping”, and “intervention”.

［Results］ Among 161 domestic and 292 international papers, a total of 453 papers identified, 20were included. Among the 20 papers, 6 （30%） reported interventions focusing on positive psychological functioning. The psychological functions examined were subjective well-being and the sense of consistency.

［Discussion］ Many of these stress management programs for nurses were designed to reduce stress responses. As the number of studies focusing on one’s positive aspects is still limited, it may be necessary to adopt the perspective of positive psychology, and establish theories, in order to develop interventional techniques that promote one’s strengths. Furthermore, when evaluating interventions, scales to measure various aspects, including effectiveness, should be used, rather than simply measuring effects.

【Purpose of research】 The purpose of this study was to estimate the direct impact of diabetes itself on mortality, considering the relevance of comorbidities.

【Materials and methods】 To estimate the relationship between diseases in the National Health Insurance receipt data, we used Bayesian network structural learning.

【Results】 In the absence of concomitant metabolic disorders, the results of the analysis showed that diabetes alone had a minor impact on the incidence of mortality.

【Discussion and Conclusion】 This suggests that comprehensive disease management, including comorbidities, is important to reduce the risk of death from diabetes.

At present, local governments throughout the country are considering to realize Regional Integrated Care System through formulation of Regional Health Care Plan and Long Term Care Insurance （LTCI） Plan. In this program, it is required that medical insurance and LTCI claim data be linked on an insured basis to comprehensively evaluate the needs of health care in general. Since the needs of health care differ depending on the population structure of the region, the health care provision system, and the infrastructure of housing and daily life support, it is desirable that there be a system in which the analysis is conducted on a regional basis. However, since analysis of claim data requires specialized knowledge and skill, it is not always easy for the person in charge of each local government to carry out.

In this research, based on the methodology of claim data analysis developed so far in our department, we develop data conversion and connection tools of medical care and LTCI claim data that local government person in charge can use in their daily work.

[Purpose] Using the claim data of medical insurance and long term care insurance （ LTCI） from 5 local governments in Japan, we analyzed the service using pattern and morbidity of dying person in order to consider the ideal system for providing medical care and nursing care in order to improve the quality of recuperative life in the final stages of life. We attempted to visualize the utilization of medical and LTCI services during the end-of-life stage.

[Materials and methods] The claim data of medical insurance and LTCI from 5 local governments in Japan were used for the analysis. At first, the claim data were linked on an individual basis, and death cases aged 65 and over were extracted from this database. Next, starting from the year and month when death occurred （month of death, follow-up month number = 0）, the difference was calculated up to 24 months ago（ eg, -1 for the previous month）. For the deceased patients grasped above, the usage status of medical/LTCI services and the status of injuries and illnesses were grasped for each elapsed month using medical and LTCI claims.

[Results and discussion] This analysis clarified the following interesting finfings. First, the analysis results revealed that the progression of circulatory system failure symptoms such as heart failure and renal failure and the occurrence of pneumonia and aspiration pneumonia were important triggers for the pattern of injuries and diseases leading to death. Next, the prevalence of mood disorders was about 10% in the final stages of life, suggesting the need for mental health measures. Third, looking at the prevalence in the 24 months before death by age group, the prevalence of heart failure and dementia increased in the older group, while the prevalence of malignant tumors decreased. In the field of malignant tumor treatment, even in Japan, there is a long experience in hospice care, etc., so discussions on the way of care in the final stage of life are more advanced than in other fields. On the other hand, in the older group, it was shown that the importance of pneumonia and heart failure as a cause of death increased, rather than cancer being the direct cause of death. In addition, the number of subjects suffering from dementia is increasing with age, and in implementing Advance Care Planning （ACP） in the future, there may be a problem in selecting an advocate person.

[Conclusion] The results of this analysis indicate that the progression of circulatory system failure symptoms such as heart failure and renal failure and the occurrence of pneumonia and aspiration pneumonia are important triggers for the pattern of injury and disease leading to death. It is considered that the time before and after the symptoms of such a condition begin to appear is the timing to start the process related to ACP with the person concerned, including the family. In addition, it is considered necessary to widely provide the public with information on the pattern of these fatal injuries and illnesses so that the public can decide how to live in the final stages of their lives.

【Purpose】 From around 2030, when the baby boomer generation will reach the age of 80, the number of deaths will increase sharply in Japan. Therefore, considering how End-of-Life Care（ EOLC） should be is an urgent issue for society, and it is also indispensable for promoting Advance Care Planning （ACP）, which is currently being discussed. For this discussion, it is desirable to have a model case. Therefore, in this study, we examined the characteristics of patients admitted to an acute care hospital with bradyarrhythmia（ cardiac arrest） using medical and long-term care insurance（ LTCI） claims from four local governments in western Japan.

【Data and analysis method】 Data used for analysis are health and LTCI insurance claim data of patients aged 65 and over who were hospitalized in general hospitals （excluding tuberculosis wards） and long-term care hospitals in four municipalities in Japan from April 2011 to March 2018 with a diagnosis corresponding to bradyarrhythmia （cardiac arrest）. In this study, subjects were defined as those who used long-term care insurance services in the current and previous month of hospitalization in a general ward or long-term care ward with the above mentioned diagnosis. For these subjects, the status of use of medical and LTCI care services and the status of injuries and illnesses for one year before and one year after hospitalization were grasped and analyzed using a database that linked medical and LTCI claims on an individual basis.

【Results】 During the observation period, 15,147 cases were followed up for 1 year before and after hospitalization, with an average age of 85.5 years （standard deviation of 7.3 years） and a female ratio of 56.8%. The mortality rate was 65.3%, and 52.0% died during the month of admission. Looking at the month of admission, 74.8% were admitted to general wards. Looking at whereabouts before admission to a general ward one month ago, about 17% of those who were receiving institutional LTCI care services. In addition, 17.4% of the patients received home-visit medical care. When looking at the prevalence of injuries and diseases one month before, heart failure was the most common at 45.6%. Pneumonia accounted for 11.4% and aspiration pneumonia for 4.5%.

【Discussion】 Even if terminally ill elderly patients undergo cardiac arrest and are taken to hospital and given cardiopulmonary resuscitation, 50% die at discharge, and 65% die within a year. From the point of view of death with dignity, this kind of medical care is not necessarily what the person wants. In order to avoid such an inappropriate situation, it is necessary to practice ACP. There is a need for research practices that clarify the events that trigger the process.

[Purpose] To develop a specific evaluation index for acute medical care patients through grasping patient images related to medium- to long-term hospitalization, targeting all medical functions from acute to chronic and home care. Therefore, we examined the status of B items in elderly patients admitted to DPC hospitals.

[Data and methods] Using DPC data in 2018, patients aged 75 years or older who were hospitalized for cerebral infarction, cataract, pneumonia（other than aspiration pneumonia）, aspiration pneumonia, heart failure, and hip fracture were evaluated for general ward use. We analyzed the changes in each item of the B items in the severity of the disease and the need for medical/nursing care. In this analysis,（score at admission - score at discharge）/length of stay× 100 was defined as the amount of change in each item, and the mean value was calculated.

[Results] It was clarified that age lowers the level of independence in all B items and acts in the direction of hindering improvement by hospitalization. By type of disease, it was shown that the longer the period of hospitalization, the better the B items in locomotor organ diseases such as hip fractures. On the other hand, in cerebral infarction, pneumonia, and heart failure, longer hospital stays were associated with significantly lower changes.

[Discussion and conclusion] From the results of this analysis, it was clarified that higher age lowers the level of independence in all B items and acts in the direction of hindering improvement through hospitalization. In addition, it was shown that the longer the hospitalization period, the better the B items in locomotory diseases such as hip fractures. The reason for this was thought to be the large amount of rehabilitation care provided during the hospitalization period. On the other hand, for ischemic cerebral infarction and heart failure, longer hospital stays were associated with significantly smaller changes. This was thought to suggest a reverse causal relationship, with the length of hospital stay being longer in critically ill elderly patients who are unlikely to improve.

In the current system, wards are evaluated based on a combination of severity and medical/nursing need A, B, and C items. While care is time-consuming, there is a possibility that there are few items to be evaluated in A and C items, and the average length of hospital stay is longer, which may affect facility standards in terms of medical fees. Therefore, it is considered appropriate to separately evaluate the patient’s condition image focusing on ADL care using the B item

【Purpose】 Each Japanese local government conducts a survey of needs in the daily living area for the purpose of utilizing it for the planning and evaluation of measures related to long-term care insurance. However, the analysis is limited to descriptive statistics, and it is hard to say that it is being fully utilized. Therefore, in this paper, we analyzed individual data from the 2016 daily living area survey in a municipality in Fukuoka Prefecture, and attempted to formulate a hypothesis for effective local public health activities.

【Subjects and methods】 The data used for the analysis were the 2016 daily living area survey of a municipality in Fukuoka Prefecture （2,157 subjects）. 55.4％ were women, 68％ were elderly less than 75 years old, 17.0％ lived alone, and 50.9％ were couples. The daily living area needs survey includes a basic checklist used by the Ministry of Health, Labor and Welfare to screen people eligible for prevention projects, and questionnaire items for the Tokyo Metropolitan Institute of Gerontology Index of Competence （TMIG-IC） developed by Koyano et al. In this study, we compared the average values for these items according to the characteristics of the elderly （sex, age group, family structure, employment status, economic status, housing status, social network status, hobbies, etc.）.

【Results and discussion】 As a result of the analysis, it was found that the degree of independence was significantly lower among males, older age groups, those living in public housing, those in severe economic situations, those with fewer social networks, and those without hobbies. In addition, although the elderly living alone were independent in the IADL, they tended to withdraw, and the degree of independence was low in many other items. This analysis showed that a detailed analysis of the daily living area needs survey can clarify the target group that needs support and make it possible to specifically consider the content of support.

【Conclusion】 A detailed analysis of the daily living area needs survey will enable us to clarify the target group that needs support and to consider the details of the support.