Objective　This study examined the factors associated with the status of group activities provided to older adults during the COVID-19 pandemic by community groups aiming to improve the health and social interactions of older adults.

Methods　A mail survey was conducted with 372 leaders of neighborhood associations and Senior Citizen Clubs in November 2020 in Ward A, Tokyo. The questionnaire asked leaders about the status of group activities provided by neighborhood associations and the aforementioned clubs for older adults. Leaders responded regarding their group’s activity status from April to October 2020 based on three patterns: 1) suspending the activity, 2) carrying out the activity by modifying the content, and 3) performing the activity without modifying the content. Data from 206 groups were analyzed. A latent class analysis (LCA) was performed using activity status to classify each group’s activity patterns, and a multiple logistic regression analysis was conducted using activity patterns as dependent variables. Variations in activity content, activity frequency, the average number of participants and volunteers, having participants over 80 years old in the group, and the group’s social capital were assigned as covariates. We also included the communication frequency between the volunteers and participants before COVID-19 and during the first state of emergency as covariates. Missing values were supplemented using a multiple imputation model.

Results　Four patterns were identified from the LCA results: “suspended the activity” from April to October, “restarted the activity with modified content” from a specific month, “continued the activity with modified content” from April to October, and “continued/restarted the activity without modified content” from April to October. The multiple logistic regression, with “suspended the activity” as a reference group, demonstrated that a communication frequency of more than once a week was associated with “continued the activity with modified content” (odds ratio: = 5.25, 95% confidence interval (CI) = 1.19–23.21), and “continued/restarted the activity without modified content” (OR = 4.37, 95%CI = 1.07–17.82). In addition, carrying out the activity more than twice a month (OR = 3.12, 95%CI = 1.10–8.87) and having 6–10 volunteers (OR = 0.32, 95%CI = 0.11–0.89) were associated with “restarted the activity with modified content.”

Conclusion　This study emphasizes the importance of communicating with participants more than once a week and having fewer volunteers to restart or continue group activities during the COVID-19 pandemic. The study findings can guide municipal governments and public health professionals in assisting community groups during emergencies, such as the COVID-19 pandemic.

Objectives　We evaluated the number of hospitalizations among public assistance recipients for each major classification according to the International Classification of Diseases 10th Revision (ICD-10), adjusting for sex and age differences in the general Japanese population. This study aimed to provide a comprehensive assessment of hospitalization patterns among public assistance recipients by disease category.

Methods　We used indirect methods to adjust for sex and age, with public assistance recipients and the entire Japanese population as the observation and reference groups, respectively. We calculated the standardized hospitalization ratios (SHRs) for each major classification based on the ICD-10. We only used publicly available government statistics, including data from the 2020 Patient Survey, for hospitalization rates according to sex, age, and major classification. Additionally, we used data from the 2020 National Survey on Public Assistance Recipients conducted for the number of public assistance recipients by sex and age groups and data from the 2020 Survey on the Actual Status of Medical Assistance conducted for the number of hospitalizations by major classification.

Results　After adjusting for age, the overall SHR was 1.49. The major classifications with the high SHRs for men and women were “V. Mental and behavioural disorders” (SHR for men; 4.06, women; 3.45) and “IV. Endocrine, nutritional, and metabolic diseases” (SHR for men; 2.40, women; 1.47). Conversely, the major classifications with low SHRs were “XVI. Certain conditions originating in the perinatal period” (SHR; 0.43) and “VII. Diseases of the eye and adnexa” (SHR; 0.44) for men. For women, these were “XV. Pregnancy, childbirth, and the puerperium” (SHR; 0.17) and “VII. Diseases of the eye and adnexa” (SHR; 0.27).

Conclusion　After adjusting for age, hospitalization status among public assistance recipients was higher overall than in the general Japanese population. However, if divided based on major classifications, higher and lower rates were observed compared with the general population. In assessing the status of medical assistance for public assistance recipients, research should be conducted by disease classification, considering the significant differences in age composition between public assistance recipients and the general Japanese population.

Objective　In 2020, > 6 million individuals with mental disorders received psychiatric care. Advocacy is important to ensure that the rights of psychiatric patients, for whom involuntary hospitalization sometimes occurs, are maintained. This study aimed to develop a Japanese version of the Patient Self-Advocacy Scale (PSAS) by Brashers et al. to measure the degree of patient self-advocacy and examine its reliability and validity.

Methods　Five researchers translated the original PSAS into Japanese. The translated questionnaire was piloted with five psychiatric users and further revised. The revised content was back-translated by a professional translator and checked by the original author. An online questionnaire was administered to verify the validity and reliability of the completed Japanese PSAS. The questionnaire was distributed to individuals who received mental health services on a mailing list. Some respondents were asked to complete the questionnaire a second time to examine the reliability of the retest method. Reliability was examined by calculating Cronbach’s alpha coefficients for the entire scale and subscales and evaluating the results of the correlation coefficients with the retest. For validity, exploratory and confirmatory factor analyses were conducted, and correlation coefficients were calculated using related scales (the Japanese versions of the Desirability of Control, Desire for Autonomy, and Health Locus of Control scales).

Results　The questionnaire received 214 responses, and the test-retest questionnaire received 48 responses. Most respondents had been diagnosed with mood disorders (48.1%) or schizophrenia (40.7%), and 46.8% had been receiving psychiatric care for > 10 years. Cronbach’s alpha coefficients for the overall scale and subscale analyses and correlation coefficients for retests ranged from 0.66–0.83 and 0.69–0.84, respectively. Regarding validity, exploratory factor analysis revealed three factors with items similar to those in the original version, and confirmatory factor analysis showed goodness of fit (CMIN/DF = 2.834, GFI = 0.896, AGFI = 0.841, RMSEA = 0.093, AIC = 198.542, CFI = 0.888). Correlations with relevant scales were significant with those of most subscales.

Conclusion　The Japanese PSAS was valid and reliable. This scale can be used to assess self-advocacy among psychiatric users and may help understand attitudes toward rights and advocacy.

Objectives　To examine a comprehensive monitoring framework for health inequalities in Japan, this study aimed to quantify educational inequalities in mortality and its regional variations, which are widely used internationally as outcome measures of health inequalities.

Methods　Individual data were obtained from the 2010 Population Census and Vital Statistics death records (2010–2015). We used the combination of “sex,” “birth month/year,” “municipality of residence,” “marital status,” and “age of spouse (married individuals only)” as a linkage key. Individuals with a unique “linkage key” were selected and included in the sample population. We included 7,984,451 Japanese individuals (3,992,202 men and 3,992,249 women) aged 30–79 years (9.9% of the total census population). Death records with a unique “linkage key” were linked to these records using the deterministic linkage method (five-year cumulative proportion of deaths; 5.6% for men and 2.5% for women). Inverse probability weights were calculated from the ratio of the total to sample population, using the distributions of sex, age, prefecture, educational attainment, and occupation. Weighted age-standardized mortality rates (ASMR) and ASMR ratios by educational level were calculated, and their variations by prefecture were analyzed.

Results　Estimated all-cause ASMRs (per 100,000 population) for men were 1,025 (95% confidence interval [CI]; 1,013–1,037) for high education (university graduation) and 1,245 (95% CI; 1,238–1,253) for middle/low education (junior/senior high school graduation). The respective values for all-cause ASMRs in women were 496 (95% CI: 485–508) and 640 (95% CI: 636–645). Estimated all-cause ASMR ratios between low/middle and high education levels were 1.21 (95% CI; 1.17–1.26) for men and 1.29 (95% CI; 1.17–1.41) for women. The ASMRs were higher for middle/low education than for high education in each prefecture; this trend was particularly pronounced among men. Additionally, no systematic differences were observed, although geographical backgrounds were considered.

Conclusion　Using the national census-linked mortality data, ASMR was approximately 1.2–1.3 times higher for “junior/senior high school graduates” than for “university and above graduates” in Japan. Although regional variations in the ASMR ratio were small, a more accurate mortality database must be constructed for further analysis in prefectures.

Objectives　Considering the difficulty and importance of supporting persons with disabilities (PWDs) and patients with intractable diseases during the COVID-19 pandemic, we monitored and reported support activities for PWDs and patients with intractable diseases.

Methods　We attempted to identify the issues to be resolved by the keywords “disability” and “intractable disease” from 2019–2022 during the COVID-19 pandemic. The information materials were (1) abstracts from the general meetings of the Japanese Society of Public Health and the Society of Local Public Health journals (2019–2021), (2) foreign academic journals; (3) newspapers (national papers [Asahi Shimbun, Yomiuri Shimbun, Mainichi Shimbun, Sankei Shimbun], in 2021), media information, such as magazines and websites, (4) legislation, notifications, and research expenses, and (5) patient group information. We made several proposals for the Japanese Society of Public Health.

Results　In 2020, facilities for PWDs did not have a system for receiving advice from infection control experts. During the COVID-19 pandemic, PWDs experienced trouble because of the characteristics of their disabilities, such as difficulty in accessing COVID-19 information. Children with disabilities felt stressed owing to the closure of daycare facilities. Further web research is necessary, considering the changes in working style. In 2021, local governments were requested to prepare manuals to provide information to PWDs and respond to infections according to the characteristics of each disability, and support from academic societies was anticipated. In 2022, local governments led collaborations with medical care facilities, health, and welfare. Support from academic societies was desirable to eliminate regional disparities, such as creating manuals for infection control and COVID-19.

Conclusion　We believe that receiving advice from various experts on supporting welfare systems for facilities for PWDs during the COVID-19 pandemic helped us achieve our initial goals. We hope that all the experts will continue to work from the perspective of whether anyone is left behind concerning health and welfare.