The term “hikikomori” was recognized by society between 1980 and 2000, when the term “NEET” also appeared and it was regarded as a problem of irresponsible youth. However, accumulation of surveys and research both in Japan and abroad, including those conducted by the Cabinet Office, has revealed that the reasons behind social withdrawal are not only limited to mental illness. There are many people who exhibit withdrawal because they are unable to establish relationships with the community and other people owing to various factors such as social systems, attachment formation, family background, and education. In other words, withdrawal is better described as a “symptom” or “condition” than a disease. Therefore, it is necessary to understand and analyze the diverse backgrounds and needs of individuals with withdrawal and confront them about their state. Currently, many hikikomori people with prolonged withdrawal are now in their 40s and 50s. With their parents' aging, there are cases where people with hikikomori and their families become socially isolated and are unable to make ends meet. It is undeniable that, until now, the society we live in as a whole has little interest in or understanding of hikikomori. In contrast, withdrawal among older adults (tojikomori), which has become a problem in the super-aging society. Tojikomori is defined as “going out less than once a week and not requiring nursing care”, which is not equivalent with hikikomori. Owing to the decline in the frequency of going out among the elderly in the recent coronary crisis, the number of pre-frailty in older adults has become a nationwide problem.

　Thus, both hikikomori and tojikomori are reversible conditions, and can be alleviated by providing necessary support. This paper summarizes the findings of the symposium “Challenges, Prevention, and Countermeasures for Social Withdrawal (Hikikomori) by Age Group” organized by the Committee on Mental Health and Suicide Prevention of the Japanese Society of Public Health at the 79th Annual Meeting of the Japanese Society of Public Health. This article is a compilation of findings that can benefit public health practitioners and researchers.

Objective　Tuberculosis (TB) patients are discharged after confirming their non-infective status. However, elder-care facilities often refuse to admit discharged TB patients. As no study has investigated anxiety among elder-care facility employees, we aimed to identify anxiety-associated factors among elder-care facility employees regarding the post-discharge admission of TB patients who have completed inpatient treatment.

Methods　Among the 74 elder-care facilities under the jurisdiction of the Ibaraki Public Health Center in Osaka, Japan, (we excludes facilities that provided only daycare services), and invited all 3,213 employees of the remaining 70 facilities to participate in this questionnaire-based survey. Copies of an anonymous, self-administered questionnaire were mailed to the manager of each facility and were further distributed among employees. Responses were initially collected individually and subsequently directly collected from each facility by a public health nurse at the center. The questionnaire items included: the presence/absence of anxiety, resistance, and/or a feeling of difficulty about admitting TB patients who had completed inpatient treatment (“anxiety”), age, sex, occupation, years of work, total experience caring for TB patients, and knowledge of TB. The correlation between the presence/absence of anxiety and each item was analyzed using the chi-square test.

Results　Completed questionnaires were obtained from 1,950 employees (response rate, 60.7%), of which 1,290 without missing data for relevant items were analyzed. Anxiety was present in 987 (76.5%) respondents. A significantly higher proportion of anxiety was observed in relation to the occupation (care workers and helpers), experience of caring for TB patients (respondents without such experience), and among employees who incorrectly answered questions on knowledge of TB, such as the infectiveness of TB patients after discharge, their management, and the risk of developing TB following infection.

Conclusion　The study identified anxiety-associated factors among employees of elder-care facilities about admitting TB patients who had completed inpatient treatment for TB. Therefore, anxiety-mitigating environments may need to be established for such employees to facilitate the admission of discharged TB patients and their smooth return of patients to their pre-TB lives.

Objectives　The purpose of the study is to compare the results of doctor sampling and self-collection of specimens in the same examinee for cervical cytopathology and human papillomavirus (HPV) testing.

Methods　Patients who have undergone cervical cancer screening at the four clinics affiliated with the Association for Preventive Medicine of Japan and who consented to participate were included in the study. Approximately one month after undergoing cervical cancer screening at the clinic, we tested a method of self-collection by mailing a Kato-type self-collection container to the participants. We evaluated the results of cytopathology and HPV testing obtained by self-collection and doctor sampling in the same patients. We used the χ² test and κ analysis for the evaluation of the results.

Results　A total of 134 health checkup participants each underwent both doctor sampling and self-collection. The positive rate of cytology was 6.0% in doctor sampling and 2.2% for self-collection, but there was no evidence in statistical significance (P>0.05). However, cervical duct lining membrane cells could not be detected by self-collection. The positive rate of HPV testing in both doctor sampling and self-collection was the same at 14.2%. However, HPV18 type was positive only in one case by self-collection.

Conclusion　The results of this study suggest that it is necessary to proceed with studies by self-collection, and introduce the applications of liquid cytopathology and its combined uses with HPV testing.