Objectives　Medical expenses for diabetes differ between Japan's 47 prefectures. The medical care expenditure regulation plan aims to reduce regional differences in outpatient medical costs through prevention of severe diabetes, promotion of specific health checkups and specific health guidance, promotion of generic drugs, and proper use of medicines. To achieve this goal, we need to conduct an in-depth analysis of inter-prefecture differences in diabetes care expenses. This study analyzed regional differences in prescription fees for dipeptidyl peptidase-4 (DPP-4) inhibitors and the use of generic sulfonylureas (SUs), glinides, biguanides, α-glucosidase inhibitors (α-GIs), and thiazoline derivatives, using the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB). Furthermore, we analyzed regional differences in consultancy fees for dialysis prevention.

Methods　We analyzed the 2nd NDB Open Data Japan website of the Ministry of Health, Labor, and Welfare. Pearson's correlation coefficient (r) was used to evaluate the relationship between the medical costs of diabetes and each factor. The correlation coefficient was analyzed with Student's t-test, and a P-value<0.05 was considered statistically significant.

Results　Regarding oral hypoglycemic drugs, prefectures with a large number of DPP-4 inhibitors tended to have higher medical costs of diabetes (r=0.40, P=0.0048). Furthermore, such expenses tended to be low in prefectures where the use of generic SU drugs was high (r=−0.43, P=0.0023).

Conclusions　In conclusion, the results revealed regional differences in the use of DPP-4 inhibitors and generic SU drugs, which may contribute to the regional differences in medical expenses for diabetes. This study suggests that NDB open data are useful for policy making to reduce regional differences in outpatient medical costs of diabetes.

Objective　To explore health-related and socioeconomic factors that can predict future deterioration in Psychological Distress Scale (K6) scores.

Method　We conducted a baseline (2010, 2011) self-administered questionnaire survey of the Kobe Orthopedic and Biomedical Epidemiological study (KOBE study) involving 1,117 participants who had no previous history of cancer or cardiovascular diseases and were not under treatment for hypertension, diabetes, or dyslipidemia. We used the Japanese K6 as an indicator of stress and defined K6≧5 points as a high-stress group and K6<5 points as a low-stress group. A four-year follow-up survey (2014, 2015) was conducted on 1,004 people (follow-up rate of 90%). We excluded 39 participants with missing values, and 185 people whose K6 score was higher than 5 points at baseline. A final total of 780 participants' scores were examined for: gender, age, living situation, physical activity level, average sleep time, as well as the K6 score, the Japanese Hearing Handicap Inventory for Elderly (HHIE-S), and the Japanese Oswestry Disability Index (ODI). We conducted a logistic regression analysis using K6≧5 points at the four-year follow-up survey as the dependent variable and each factor at the baseline survey as the independent variable.

Results　Of the 780 subjects analyzed, 132 (16.9%) were highly stressed (K6≧5 points) at the four-year follow-up point. A logistic regression analysis found age (40s/70s) (odds ratio 3.38, 95% confidence interval 1.45-7.86), living situation (single/living together) (odds ratio 1.98, 95% confidence interval 1.07-3.68), and ODI scores (every 1%) (odds ratio 1.05, 95% confidence interval 1.01-1.09), to all be significantly associated with high stress.

Conclusion　This study suggests that age, living situation, and ODI scores are related to future stress.

Objectives　We hypothesized that the motivation for improving physical function could be increased by increasing the awareness of social role expectations among frail community-dwelling older adults through an intervention based on the Community-as-Partner (CAP) model. We also developed a program for supporting community activities to prevent frailty, utilizing the CAP model. Program feasibility was assessed by implementing it under the local government's frailty prevention service.

Methods　The CAP-based program consisted of a “learning period,” a “regional issue extraction period,” and a “practice period,” scheduled once a week for four months. Public health nurses and/or physical therapists assisted with the program. The intervention was conducted with a cohort study of community-dwelling older adults. About 160 participants identified as frail and pre-frail on the Kihon Checklist were recruited. Program feasibility was assessed through participation rate, number of pre-frail and frail individuals, and drop-out rate; scores of a pre-post intervention questionnaire assessing the understanding of frailty and regional resources; and behavioral change stage on frailty prevention.

Results　A total of 42 participants were recruited (participation rate=26.3%; 25 were pre-frail and 17 were frail). The drop-out rate was 23.8% (n=10). The scores on four out of five items and six out of eleven items on the understanding of frailty and regional resources, respectively, improved significantly after the intervention. Regarding the behavioral change stage, 26 participants (81.2%) maintained or improved.

Conclusion　The participation rate was approximately 30%, similar to conventional programs with direct professional intervention. Conversely, a higher drop-out rate compared to conventional programs suggested the importance of explaining the workshop in the program introduction and publicizing the workshop. The results indicated that the program improved the understanding of frailty and regional resources, and led to behavioral change for frailty prevention.