Objective　This study aimed to explore the support extended by prefectural public health nurses (PHNs) toward the human resource development (HRD) of municipal PHNs in Japan.

Methods　We performed a qualitative descriptive study involving nine prefectural PHNs from April 2019 to May 2020. The data were collected through semi-structured interviews using an interview guide, described qualitatively, coded, and then categorized.

Results　Five categories were extracted. “Clarifying the needs and problems related to HRD and daily PHN activities in the municipalities,” “Creating an environment where all municipal PHNs have equal opportunities for off-the-job training,” and “Helping municipal PHNs recognize the meaning of practice and develop an evaluation perspective” were extracted from the prefectural government PHNs and prefectural health center (HC) PHNs. “Clarifying problems and future prospects to encourage the growth of PHNs” and “Creating an environment where the significance and value of the activities of PHNs are recognized within the organization and HRD can easily take place” were extracted from the HC PHNs.

Conclusion　Much of the HRD support provided by the prefectural PHNs to the municipal PHNs was analogous to the PHN activities provided to the community and residents. To promote HRD effectively, prefectural PHNs should apply their individual care skills to the HRD of municipal PHNs.

Objectives　The purpose of this study was to clarify the issues behind the increasing number of solitary deaths of older people in central Tokyo.

Methods　In this study a request was made to the national government for information on the 2016 vital statistics survey of ward A, one of the 23 wards of Tokyo. The entries in the death forms do not distinguish between death and post-mortem certificates. However, in the 23 wards where there is a medical examiner system, if the medical institution of the doctor who prepared the post-mortem certificate is the Tokyo-to Medical Examiner's Office, it is possible to identify that the postmortem examination was performed. If the hospital is listed, it is considered a death certificate. A descriptive analytical study was made on the relationship between the cause of death, sex, age and marital status with regard to postmortem examinations of deaths at home or in hospitals resulting from illnesses and home care deaths.

Results　Of the 4,429 deaths in Ward A in 2016, 613 were found to be postmortem examinations, of which 436 (71.1%) were of individuals who were 65 years or older. Of the 757 deaths at home, 399 (52.7%) were postmortem examinations, of which 271 were deaths from illness. The number of home care deaths was 358 (47.3%). The mean age of death was 73.6 years for 145 males and 79.5 years for 123 females, out of 268 home deaths of 34 years or older identified as death from illness by postmortem examination. On the other hand, the mean age of death in 358 home care deaths was significantly older as compared to postmortem examination deaths. 65.3% of deaths at home and 54.1% of hospital deaths were due to sudden death-type diseases such as ischemic heart disease. Of the postmortem examination of home deaths from illness among the older people aged 65 years or older, 65.5% of the 110 males and 87.3% of the 110 females were single. Bereavement occurred in 27.3% of men and 52.7% of women, separation in 16.4% of men and 9.1% of women. 21.8% of men and 25.5% of women were never married.

Conclusions　In the solitary deaths of older people in central Tokyo, sudden death disease is the direct cause of death and, in the background, there are bereavement from a spouse in women, separation or bereavement from a spouse in men, and being unmarried in both.

Objective　Social activities play an important role in the maintenance of health and well-being of the older adults. The aim of this study was to identify characteristics of the rural older adults who do not participate by type of social activities.

Methods　This survey examined 1,537 older adults randomly selected at a sampling rate of 0.5% from among those living in Toyama prefecture of Japan, in 2014. Of the total, 947 ambulatory older adults living in their own homes were analyzed using Poisson regression. Results were presented as prevalence ratio (PR). The level of statistical significance was set at P<0.05 (two-sided test).

Results　The participants included 426 men (mean age 73.9 ± 6.5 years) and 521 women (mean age 74.8 ± 7.0 years).

　In terms of work, both men and women did not work at an older age (men PR 1.15 over 75 years old, women PR 1.11 over 70 years old). Men did not work during outpatient treatment (PR 1.09) and the Revised Hasegawa Dementia Scale (HDS-R) 21-25 points (PR 1.09) and 20 points or below. Women who did not drink alcohol did not work (PR 0.93).

　Both men and women did not participate in residential activities at older ages (men PR 1.12 over 70 years old, women PR 1.11 over 80 years old). Men with 20 points or below on HDS-R (PR 1.16) and with work history of only physical labor (PR 1.12), and women living with family (PR 0.92) were less likely to participate in residential activities.

　In the hobby group, both men and women with work history of only physical labor were less likely to participate (men PR 1.05, women PR 1.08). Men with education of 9 years or below (PR 1.05) and women living alone (PR 1.07) were less likely to participate. Hobby groups did not relate with age and cognitive decline.

　In the senior citizens' club, men and women who did not drink alcohol were less likely to participate (men PR 0.91, women PR 0.89). Men who smoked (PR 1.06), men with psychological symptoms (PR 1.09), and women with 20 points or below on HDS-R (PR 1.13) were less likely to participate.

Conclusion　Factors related to non-participation of older adults in rural cities depended on the type of social activities. In order to promote social activity among the older adults in rural cities, it is important to consider specific measures taking into account the type of social activities.

Objectives　Using a nationally representative dataset, this study aimed to analyze associations between labor-related and socioeconomic factors and unmet healthcare needs among working women, stratified by employment status.

Methods　Secondary data analyses were conducted on the data extracted for 639 working women, aged 20 to 65 years, from the 2,496-person dataset of the Japanese General Social Survey 2010 (JGSS-2010). First, unmet healthcare needs, labor-related factors (occupation, years of employment, working hours, and company size), and socioeconomic factors (age, marital status, number of children under 15 years age, education, and equivalent disposable income) were cross-tabulated by employment status. Second, logistic regression analyses were conducted, stratified by employment status, with experience of an unmet healthcare need as the objective variable and labor-related and socioeconomic factors as explanatory variables.

Results　Of the total sample, 227 (35.5%) experienced an unmet healthcare need in the past year. There was no significant association between unmet healthcare needs and employment status. Labor-related and socioeconomic factors were strongly associated with employment status. Restricting women in regular employment and managerial positions, odds ratios (ORs) of having experienced an unmet healthcare need for those with 2-5 years of employment, 5-10 years and over 10 years, compared to under 2 years, were 3.91 (95% confidence interval (CI): 1.31-11.7), 2.86 (95%CI: 0.97-8.44), 1.99 (95%CI: 070-5.66), respectively. Among women in non-regular employment and others, adjusted ORs (aORs) of having experienced an unmet healthcare need in their 50s, 40s, 30s, and 20s compared to those in their 60s were 2.26 (95%CI: 0.99-5.16), 4.09 (95%CI: 1.70-9.82), 5.03 (95%CI: 1.90-13.30), and 5.32(95%CI: 1.87-15.10) respectively with younger age groups showing higher aORs. No significant association between other labor-related and socioeconomic factors and unmet healthcare needs was found.

Conclusion　More than 30% of participants had experienced unmet healthcare needs in the past year. Although no association between employment status and unmet healthcare needs was found, aORs of having experienced an unmet healthcare need were significantly higher among regularly employed women at mid-career level and among non-regularly employed women of reproductive and child-rearing age. This implies differences in women's health issues due to employment status. It is considered necessary to provide health support, taking into account the individual's work situation and environment, along with their life stage and family relationships.

Objectives　We selected assessment items that can be used to evaluate the physical, mental, and social functions of community-dwelling older people comprehensively and easily, and examined whether these items could predict a future transition to the requirement for nursing care and dementia.

Methods　We conducted a self-administered mail survey of 4,439 community-dwelling older people, who were not certified as requiring nursing care in 2011. The items for the survey were shortlisted out of a total of 54 items that were selected by referring to existing scales, and the evaluation items were determined by pass rate and factor analysis. The cut-off point of the total scores was estimated by ROC analysis using the certification of requiring long-term care (support level 1 or higher) and level of independence in the daily lives of older people with dementia (independence level I or higher) in 2014 as external criteria. The predictive validity was examined by binomial logistic regression analysis using the cut-off point of the total score and the score of the sub-domains as explanatory variables, and the requirement of nursing care and independence level of dementia in 2014 as objective variables.

Results　A factor analysis of 1,810 subjects with no deficiencies in the 54 items identified 24 items in five domains (mental health, walking function, Instrumental Activities of Daily Living (IADL), cognitive function, and social support). During the ROC analysis, the cut-off point of the total score was estimated to be 20/21 points (nursing care: AUC 0.75, sensitivity 0.77, specificity, 0.56; dementia: AUC 0.75; sensitivity 0.79, specificity 0.55). The binomial logistic regression analysis showed that persons with a total score of less than 20 points in 2011 were significantly more likely to be certified as requiring nursing care (odds ratio 2.57, 95%CI 1.69-3.92, P<0.01) or show a decline in their independence level of dementia (odds ratio 3.12, 95%CI 1.83-5.32, P<0.01) in 2014. The scores of mental health, walking function, and IADL were significantly associated with certification of requiring nursing care, while walking function and cognitive function were significantly associated with dementia.

Conclusion　We believe that the selected items in this study can successfully predict a transition to needing nursing care and dementia in the future. In the sub-domains, the results suggested an association with physical and mental function, as has been previously reported, but little association with social function.