Objectives　Japan has accumulated experience in international health, and low- and middle-income countries need to develop, implement, and evaluate health and sanitation policies that effectively use scarce resources. Therefore, the knowledge gained from international health experiences can be applied to the public health administration in Japan. The purpose of this study was to clarify the competencies and knowledge possessed by those with international health experience and their acquisition process, and to examine how they are applied to public health administration in Japan.

Methods　We conducted a survey by interviewing five public health doctors who were engaged in public health administration in Japan and had experience working overseas. The interview items included their background and overseas work experience, and the relationship between overseas work experience and competency development, abilities, and competencies considered important for working in public health administration in Japan. We analyzed the competencies using a modified grounded theory approach method.

Results　The interviewees (three men; two women) worked for government agencies at the time of the survey. Five competencies were identified for those who had worked abroad: an “enterprising spirit,” “integrity,” “adaptability,” “constructiveness,” and “problem analysis and solution strategies.” In the process of acquiring the competencies, an “enterprising spirit,” “integrity,” and “adaptability” served as the foundation, while “constructiveness” and “problem analysis and solution strategies” were strengthened through their international health experience.

Conclusion　Among the competencies of overseas assignees, “adaptability” and “integrity” were thought to be cognitive patterns, while “constructiveness” and “problem analysis and solution strategies” were thought to be behavioral patterns. Those who had worked abroad had a strong “enterprising spirit” characterized by curiosity and a cheerful outlook, and “adaptability” and “integrity” were strengthened through overseas experience. They also acquired an approach to objectively analyze the current situation and issues in local communities and solve problems by involving residents. Such perspectives are necessary for public health administration in Japan and may be useful for addressing health disparities. In the future, we would like to expand the scope of the interview survey to include public health nurses and other professionals to further clarify the competencies of human resources that contribute to improving public health administration in Japan and other countries.

Objective　Enhancing the practical competencies of novice public health nurses is urgently needed, and the identification of organizational factors that management-level public health nurses can improve is crucial for effective human resource development within organizations. This study aimed to explore the challenges and organizational factors perceived by management-level public health nurses when developing 10 types of practical competencies for their novice peers.

Methods　A self-administered questionnaire survey was conducted via postal mail or the Internet in November 2023, targeting five senior management-level public health nurses in each of the 210 municipalities across seven prefectures in the Tokai–Hokuriku region of Japan. The percentages of perceived challenges in developing 10 types of practical competencies of novice public health nurses were calculated. For the competencies with ≥50% perceived challenges, prevalence ratios and adjusted prevalence ratios were estimated using regression analyses, with perceived challenges in developing 10 types of practical competencies as objective variables, 18 organizational factors (3 municipality characteristics, 3 educational personnel, and 12 educational systems) as explanatory variables, and eight moderator variables.

Results　Responses from 326 management-level public health nurses (response rate: 31.0%) were included in the analysis. The respondents had an average of 25.2 years of experience, and 68.5% worked in health departments. The most difficult competencies to develop were the ability to respond to community health crises (57.3%), addressing complex and difficult health issues of individuals and families (52.1%), and support self-help groups and community organizations (50.0%). These challenges were associated with four organizational factors: two educational personnel factors (preceptor assignment for novice public health nurses and the presence of a designated person in charge of human resource development) and two educational system factors (workplace culture that enhances mutual competency and increases interest in human resource development throughout the workplace). In particular, the absence of a “workplace culture that mutually enhance competencies” was identified as a barrier in developing “the ability to support self-help groups and community organizations” (adjusted prevalence ratio 1.52, 95% confidence interval 1.12–1.93). The other three factors pose challenges when educational personnel and systems are implemented.

Conclusion　The lack of a workplace culture that enhances mutual competency is a key organizational factor associated with management-level public health nurse perceptions of developing the competencies of their novice peers. Strengthening this organizational factor could contribute to the development of human resources for novice public health nurses.

Objectives　The Basic Act on Suicide Prevention was enacted in 2006, and 2026 will mark the 20th anniversary of this act. To commemorate this milestone, a symposium titled “20th Anniversary of the Basic Act on Suicide Prevention: Understanding the Reality of Suicide” was held at the 83rd Annual Meeting of the Japanese Society of Public Health. The aim was to reflect on Japan’s suicide prevention efforts to date through collaboration with experts.

Methods: To accelerate suicide prevention efforts in Japan, we identified and organized the key challenges involved in understanding the reality of suicide.

Results　Considering the history of suicide prevention, we carefully reviewed the issues surrounding the Basic Act on Suicide Prevention and the Act on the Promotion of Research and Studies on Suicide. We conclude that revisions are necessary where appropriate. It is also important to incorporate measures for cultivating specialized professionals across various fields into the Basic Act on Suicide Prevention that will be responsible for suicide prevention in the next generation, as well as mechanisms that enable suicide-bereaved families to participate in policymaking. In terms of statistical issues, there has been a significant “apparent change” in the suicide statistics between 2021 and 2022 due to the revision of original data, which requires careful attention. There is an upward trend in deaths from external causes, including suicide and deaths from unknown causes, and it is necessary to analyze these trends carefully. In addition, municipalities can use police statistics to understand the realities of regional suicides. However, when analyzing municipal-level data, it is important to consider the underlying processes that lead to self-harm and suicide attempts, using regional suicide profiles as a reference. In addition, conducting independent surveys and research at the municipal level, separate from national statistics, is crucial for suicide prevention.

Conclusion　Suicide-related behavior is a complex issue influenced by various factors. It is essential to coordinate national measures with local initiatives. The following proposals are suggested to enhance future suicide prevention efforts:

1. A review of the legal frameworks and establishment of support systems involving diverse stakeholders.

2. Training of specialized personnel, including bereaved families, in the policymaking process.

3. Conducting a thorough analysis of the statistical changes.

4. Encouraging independent research and studies at the municipal level.

By continuously updating our knowledge and fostering interdisciplinary discussions, we aim to ensure that these efforts are effectively implemented.

Objectives　This study aimed to determine how turnover intentions among public health nurses have changed following their coronavirus disease 2019 (COVID-19) response compared to 10 years ago, using propensity score matching.

Methods　As part of the Committee on Public Health Nursing’s 2022/2023 activities, we conducted a repeated cross-sectional survey among public health nurses based on the Job Demands-Resources Model, a theoretical framework for turnover intentions. We collected cross-sectional observational data from periods before and after the COVID-19 outbreak. Pre-pandemic data came from a 2013 survey (“2013 survey”), while post-pandemic data were collected between December 2022 and February 2023 (“2023 survey”). For the 2023 survey, we created a self-administered questionnaire similar to the 2013 instrument. We stratified and sampled 4,000 full-time public health nurses for distribution, ensuring the proportion of full-time public health nurses matched that of employees in established administrative organizations nationwide. After adjusting for 11 covariates—including sex and administrative classification of respondents’ municipalities—through propensity scores, we extracted data for analysis. We compared turnover intentions using the χ² test and compared burnout and work engagement, as mediating variables for turnover intention, using t-tests.

Results　The 2023 survey yielded 2,127 valid responses (53.2% valid response rate), and the 2013 survey provided 1,798 responses. After propensity score matching, 2,492 responses (1,246 per group) were used for analysis. Compared to the survey conducted ten years ago, the 2023 survey included more respondents who were staff members or chiefs in health sectors, prefectures, and local governments with jurisdictions exceeding 300,000 people. However, after propensity score matching adjustment, standardized differences for all adjustment variables fell below 0.1, confirming homogenized distributions and composition ratios between groups. Compared to 2013, significantly more public health nurses in the 2023 survey reported turnover intentions. Additionally, public health nurses experienced greater burnout and lower work engagement than 10 years ago.

Conclusion　These findings suggest that the COVID-19 response may have exhausted public health nurses and increased their turnover intentions. Further analysis of job demands and resources as factors influencing burnout and work engagement is needed to ensure the career continuity of public health nurses.

Objectives　This study aimed to identify the learning needs that public health nurses (PHNs) wish to meet in addressing postpartum depression among mothers in municipalities Japan.

Methods　A mail survey was conducted with PHNs working in maternal and child health departments in 1,741 cities, wards, towns, and villages throughout Japan by a representative from each facility using a self-administered, unmarked questionnaire. The questionnaire included 23 items pertaining to sex, age, years of experience as a PHN, previous participation fees, method of participation, and desired future study content regarding postpartum depression. The analysis used Spearman’s rank correlation coefficient for the association with each attribute, Mann–Whitney U test for comparisons based on training participation, and Kruskal–Wallis test for comparisons by years of experience. The Bonferroni correction was applied for multiple comparisons.

Results　In total, 1,741 questionnaires were distributed and 630 were returned (response rate: 36.2%). The participants’ mean age was 40.0 ± 9.4 years, with 233 (37.0%) in their 40s. The average number of years of experience as a PHN was 12.7±8.9, with 166 (26.3%) having 1–5 years of experience. Approximately 501 nurses (79.5%) had attended workshops on postpartum depression. Regarding the desire to participate in future training sessions for postpartum depression, 476 (75.6%) responded “Yes.” The most common method of payment for participation in past training was “free of charge” (427 respondents, 67.8%), followed by “publicly funded” (242 respondents, 38.4%). Regarding the preferred mode of training, 325 (51.6%) preferred on-demand (video viewing-on-demand) training and 284 (45.1%) preferred real-time online training. Regarding the desired content of training on postpartum depression, the items for which > 60% answered “Yes” were the pathogenesis of postpartum depression, correct use of the Edinburgh Postnatal Depression Scale (EPDS), perspectives on assessing mothers’ psychiatric symptoms, and how to deal with suicidal thoughts and feelings.

A significant difference was observed in the participation status of training sessions on postpartum depression and learning content regarding the “correct use of the EPDS (P = .004)” and “social resources available in the community (P = .002).”

Conclusion　Approximately 80% of PHNs have participated in training sessions on postpartum depression and would want to receive further training eventually.

Regarding future training methods, PHNs desired learning methods using information and communication technology, and > 60% desired learning content with practical application, such as “perspectives for assessing psychiatric symptoms in mothers,” “methods for dealing with suicidal thoughts and feelings,” “correct use of EPDS,” and “pathophysiology of postpartum depression.”

Objective　The study aim was to evaluate the effectiveness of dental health guidance in improving self-reported oral symptoms and oral health behaviors through two interventions: dental checkups using the Dental Lifestyle Support Program questionnaire and dental health guidance provided by dental hygienists in workplace settings.

Methods　This study targeted employees without dental checkups at five workplaces in the Aomori Prefecture. Support materials (“tools”) were created based on the Dental Lifestyle Support Program. An initial 21-item questionnaire survey was conducted at each facility. After completing the survey, participants were alternately assigned to ensure equal numbers in both groups: the individualized guidance group, who received the survey results and tools, followed by a five-minute individual dental health guidance session using the tools; and the information-only group, who received only the results and tools without further guidance. Three months later, the same questionnaire survey was conducted. Changes within groups were analyzed using McNemar’s test, and between-group changes were assessed using a logistic regression.

Results　Of 448 participants, 411 were analyzed (individual guidance group: 204; information-only group: 207). The male-to-female ratios were 74:130 and 67:140, respectively, with median ages of 45 (IQR36–53) years and 42 (IQR34–54) years. Within-group comparisons revealed significant improvements in oral symptoms and behaviors in both groups. The individualized guidance group showed improvements in one item related to oral health issues, two oral condition items, and four oral health behavior items, whereas the information-only group showed improvements in one item related to oral issues, one environmental support item, and one oral health behavior item. Between-group comparisons revealed a significant improvement in “snack intake” for the individualized guidance group.

Conclusion　Both groups showed positive changes in oral symptoms and health behaviors with minimal differences between them. Results of the intervention suggest that dental health guidance is effective in improving oral symptoms and health behaviors in workplaces where dental checkups are not provided.

Objective　The Ministry of Land, Infrastructure, Transport, and Tourism of Japan has recently been promoting the adoption of green (i.e., electric-powered) slow mobility carts, which can operate on public roads at speeds <20 km/h. A two-month trial of electric-powered cart services showed improvements in subjective indicators such as social interaction among older adults, with potential long-term benefits related to preventing the eventual need for long-term care (LTC). This study investigated whether the risk of requiring LTC decreased one year after the introduction and use of electric-powered carts in older adults whose subjective indicators improved following the introduction of the service.

Methods　Electric-powered cart services were introduced in Kawachinagano City (Osaka Prefecture) and Oji Town (Nara Prefecture), beginning in July–August of 2022. Our analysis included 726 adults aged ≥65 years (385 from Kawachinagano City and 341 from Oji Town) who provided valid responses to a self-administered postal survey conducted at the baseline (i.e., when the program was introduced), as well as at a follow-up one year later. At the follow-up, operations had concluded in Kawachinagano City, but continued in Oji Town. LTC risk at the one-year follow-up was assessed using the LTC risk assessment scale, with higher scores indicating a greater risk. The explanatory variables included electric-powered cart usage (defined as cart usage several times per year or more) and changes in subjective indicators prompted by cart usage. The subjective indicators assessed were outings (three items), social activities (five items), and positive emotions (four items). Covariates included sex, LTC risk score, educational background, subjective economic status, employment, activities of daily living, marital status, and cohabitation at the baseline survey. Missing data were handled using multiple imputations (m = 200). Linear regression analysis was used to calculate the coefficients (B).

Results　Of the total respondents, 290 (39.9%) reported using the electric carts. Electric-powered cart use was not significantly associated with LTC risk (B = 0.11, 95% confidence interval [CI]: –0.40 to 0.63). No significant associations were found between changes in subjective indicators and LTC risk across the overall cohort. However, in Oji Town, older adults who reported increase in positive emotions such as enjoyment of daily life (–1.78, –3.21 to –0.35), feeling uplifted (–1.51, –2.87 to –0.15), and finding life more meaningful (–1.91, –3.53 to –0.30) showed significant reductions in LTC risk.

Conclusion　While no overall association was found between electric-powered cart usage and LTC risk, certain positive emotional changes reported in the respondents from Oji Town were associated with reduced LTC risk. These findings suggest that electric-powered carts may contribute not only to mobility support but also to LTC prevention, by fostering positive emotions among older adults.

Objectives　Recently, step-count, as an objective measure of physical activity, has become available on smartphones and is recorded by default on an iPhone (Apple Inc.). Using screenshot images of the step-count graph of the iPhone healthcare application, an image analysis tool was developed to enable a large-scale and retrospective physical activity assessment. However, the characteristics of the respondents involved in the collection of such step-count images remain unclear. We aimed to investigate the characteristics of iPhone users and respondents who provided step-count images via an Internet survey.

Methods　We conducted an Internet survey in December 2022 among 5,346 Kobe residents aged ≥ 20 years from a survey company’s panel population. They previously responded to a web-based survey on physical activity, health, and community environment administered in 2021. The participants were asked to provide their demographics and walking time. iPhone users were additionally asked to take and upload two screenshots of step-count graphs on their iPhones; one-month and one-year graphs. We conducted multivariable logistic regression analysis to examine the factors associated with iPhone use and image provision.

Results　Among 3,308 respondents, 349 (11%) provided images, 1,138 (34%) were iPhone users who did not provide images, and 1,821 (55%) did not use an iPhone. Those aged ≤ 64 years exhibited a higher likelihood of iPhone usage compared to older adults (odds ratio; 2.45, [95% confidence interval; 2.04–2.94]), as did women compared to men (1.47 [1.26–1.71]), those with a household income of ≥ 6 million JPY compared to those with lower income (1.39 [1.20–1.62]), and those with a college degree or higher compared to the others (1.17 [1.01–1.36]). Furthermore, those aged ≤ 64 years were more likely to provide step-count images than older adults (3.58 [2.17–5.90]), as were those with a college degree or higher compared to the others (1.71 [1.32–2.23]) and those with longer walking time compared to those with shorter walking time (1.66 [1.21–2.28]).

Conclusion　Age, sex, household income, and education were associated with iPhone use, whereas age, education, and physical activity level were associated with step-count screenshots. Possible biases must be considered among iPhone users and image providers in collecting and using step-count images in Internet surveys.

Objectives　Regional medical collaborations have become increasingly important in recent years. To facilitate such collaborations, it is necessary to promote reverse referrals from large hospitals to clinics. This study aimed to identify the factors that constitute patient preferences regarding reverse referrals and propose a new patient reverse referral preference scale based on the guidelines of the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN).

Methods　Seven specialists developed a pool of items that related to preferences for reverse referrals. Patients aged 20 years and older who had been hospitalized in university hospitals or other large hospitals (with 400 beds or more) within the past six months and who were currently receiving treatment for their condition were included in the study. The factor structure that constituted patient reverse referral preferences was determined using an online questionnaire and an exploratory factor analysis. A new scale for assessing patient reverse referral preferences was developed using the factors identified as subscales, and the reliability and validity of the scale were examined.

Results　Screening surveys were conducted on 23,000 registered members of an internet survey panel, of whom 374 met the criteria for this study and 293 responded to the survey. The factor analysis identified four factors related to patient preferences for reverse referrals: “evaluation of primary care physicians,” “reverse referral acceptability,” “treatment continuity,” and “disease assessment.” Based on these factors, we created a 19-item scale, “The 19-item Patient Preference Questionnaire Form for Reverse Referral (PQR-19).” Cronbach’s alpha coefficients for each subscale indicated sufficient reliability (0.76 to 0.87). In terms of validity, patients who accepted reverse referrals at physician recommendation had significantly higher scores on the PQR-19 total score (3.28 ± 0.69 vs. 2.96 ± 0.63, P = 0.044) and its subscale, treatment continuity (3.52 ± 0.76 vs. 3.05 ± 0.81, P = 0.012), and tended to have higher scores on other subscales, compared to those who did not accept reverse referrals.

Conclusion　This study identified four factors that constituted patient preferences for reverse referrals through a factor analysis and proposed a new scale, PQR-19. Some aspects of the scale’s reliability and validity have not yet been fully verified, which remains a topic for future research.

Objective　This study aimed to clarify the rate of dialysis initiation among the National Health Insurance (NHI) members and identify factors associated with individuals who underwent specific health checkups. These findings were shared with NHI insurers to help develop effective health services and reduce the incidence of chronic kidney disease (CKD).

Method　We analyzed individuals aged 40–74 years who were insured under the NHI in Ehime Prefecture in 2012, excluding those already on dialysis. Individual patient data were sourced from the National Health Insurance Database and Specified Health Examination Data Management System. The dependent variable was dialysis initiation, whereas the independent variables included various associated factors. A 4-year cumulative rate of dialysis initiation was calculated from 2013 to 2016 and stratified by age and participation in specific health checkups. Poisson regression analysis was performed to estimate the rate ratios adjusted for age, estimated glomerular filtration rate (eGFR), and urinary protein levels.

Results　The 4-year cumulative rate of dialysis initiation was 40.1 per 100,000 among those who underwent specific health checkups compared to 423.7 per 100,000 among those who did not. The rate of dialysis initiation was significantly higher among individuals with eGFR <45 and urinary protein ≥2+. Additionally，hypertension and diabetes mellitus were significant associated factors, with the rate ratios of 3.87 (95% CI: 1.37–10.9) and 7.51 (95% CI: 3.05–18.5), respectively.

Conclusion　These findings highlight an urgent need to improve health check-up participation rates to identify high-risk individuals and to prevent disease progression. This study also underscores the importance of addressing diabetes and other associated factors in CKD management, which may lead to the development of targeted health initiatives by NHI insurers.

Objectives　Urinary cotinine concentration is widely used as a reliable biomarker to objectively evaluate smoking status. High-precision methods, such as liquid chromatography-mass spectrometry (LC-MS) and gas chromatography-mass spectrometry (GC-MS), are mainly used for measuring cotinine concentrations. However, these techniques require expensive equipment and specialized analytical techniques; therefore, they are not suitable for large-scale surveys. Conversely, enzyme-linked immunosorbent assay (ELISA), which is simple and low-cost and has a precision comparable to that of LC-MS and GC-MS, has attracted attention. ELISA has been shown to be useful for evaluating urinary cotinine levels in combustible cigarette smokers; however, its application to heated tobacco product (HTP) users has not yet been examined. Thus, in this study, we aimed to measure urinary cotinine concentrations in HTP users and ascertain whether ELISA is as effective as LC-MS for such measurements.

Methods　Urine samples were collected from workers at a certain workplace during lunch breaks on weekdays. In total, 33 participants were analyzed: 11 nonsmokers, 13 cigarette-only smokers, and 9 HTP-only users. Urinary cotinine concentrations were measured using LC-MS and ELISA. The correlation between the measurements obtained using these methods was evaluated using Pearson’s correlation coefficient; the agreement was examined using the Bland–Altman analysis.

Results　The ELISA and LC-MS results showed a high correlation (cigarette-only smokers: r ＝ 0.84, P ＜ 0.001; HTP-only users: r ＝ 0.96, P ＜ 0.001). The Bland–Altman plot showed a high degree of agreement, with 90.9% of the data between both methods falling within the limits of agreement.

Conclusion　ELISA was useful for evaluating urinary cotinine levels in cigarette smokers and HTP users. Because of its convenience and low cost, ELISA is expected to be utilized for large-scale epidemiological surveys and promoting smoking control in workplaces.

Objectives　In Japan, public health centers (PHCs) have been crucial in managing health crises during the coronavirus disease (COVID-19) pandemic. This study aimed to provide insight into future crisis management measures by identifying the support that PHC directors received and found useful while performing their duties during the pandemic.

Methods　A questionnaire survey targeting PHC directors from 468 PHCs nationwide was conducted between September and October 2022. The survey items included the support received by directors in performing their roles and duties during the pandemic, type of support (medical duties, medical coordination, coordination work, and management duties), and support they found useful. Descriptive statistics were performed.

Results　Valid responses were obtained from 189 PHC directors (40.4%), most of which were doctors. The highest proportion of support the directors received was from public health nurses/clerical staff at PHCs and head offices (73.0%), followed by from infectious disease specialists and Disaster Medical Assistance Teams. This support from public health nurses/clerical staff had the highest proportion of which the directors found useful (60.9%). Regarding communication, 48.1% of the directors found it useful to obtain an understanding from the administration heads, whereas < 40% found it useful to exchange information with other PHC directors or head offices. The type of support differed depending on whether the directors received it or with whom they exchanged information.

Conclusions　During the COVID-19 pandemic, PHC directors mainly received human support from various occupations led by public health nurses/clerical staff and found the support useful. The type of support differed depending on who they received support from. The directors found it useful to obtain an understanding from the administration heads and were less likely to exchange information with other PHC directors or head offices. Two-way communication may not have been established in this case. Human support, appropriate placement, and two-way communication are important for the management of future health crises.

Whole grains, which retain the bran and germ layers, are rich in nutrients and more nourishing than refined grains, with a globally acclaimed potential to prevent non-communicable diseases. The World Health Organization and Food and Agriculture Organization of the United Nations recommend whole grains as part of a healthy and sustainable diet, and several countries explicitly include them in their national dietary guidelines. In contrast, Japan lacks a clear definition or intake recommendation for whole grains and consumption levels remain notably low. This article reviews international evidence on the public health and health economic impact of whole-grain consumption, focusing on brown rice, a representative whole grain in Japan. Although brown rice intake has been associated with a reduced risk of type 2 diabetes, its consumption remains limited in Japan owing to barriers such as taste preferences, preparation efforts, and limited availability. Partial substitution of white rice with brown rice may help prevent type 2 diabetes and reduce national healthcare expenditure. Promoting the intake of whole grains, including brown rice, through multifaceted strategies, such as enhanced nutrition and health education, collaboration with food industry stakeholders, and incorporation into school and workplace meals, may support long-term improvements in population health and the containment of social security costs.

Objective　The study aim was to clarify the effects and driving factors of digital transformation (DX) on COVID-19 countermeasures.

Methods　The Obihiro Public Health Center promoted the use of DX to cope with the increased workload caused by the COVID-19 pandemic. Before August 3, 2022 (early phase), the center devised measures using questionnaires; however, we had to print and file an epidemiological investigation form and questionnaire for each patient. From August 4 to November 16, 2022 (middle phase), we created a database that consolidated all the information on a sheet of paper and printed it automatically. After November 17, 2022 (later phase), the workflow was reviewed to completely digitize the operations, and personal records were handed over within an electronic folder. Quantitative indicators included the percentage of groups adopting DX, and paper usage was compared for the three phases. The number of days required from notification acceptance to recuperation began, and the questionnaire response time was analyzed using the Mann-Whitney U-test. Questionnaire response rates were compared using the chi-square (χ²) test. Qualitative data were coded based on the reflections of the staff involved in the DX promotion. Subcategories were created from commonalities among the codes, and categories were generated through increasing levels of abstraction.

Results　As the phases progressed, the percentage of groups adopting DX increased and paper usage decreased. The number of days required was shorter in the later phase (0.4 days) than in the middle phase (0.6 days, P < 0.05). The questionnaire response time was shorter in the later phase (72.3 minutes) than in the middle phase (97.5 minutes, P < 0.01). The questionnaire response rate increased from 4.9% in the middle phase to 11.4% in the later phase (P < 0.01). Seven [categories] of DX driving factors were extracted from the qualitative data. The middle phase included [a need to review the support system because of the rapid spread of infection] and [concrete proposals to introduce DX and decisions by management]. During the later phase, the workflow became paperless as it was completed electronically. Furthermore, we promoted our efforts while providing [technical support to enhance the understanding and adaptation to the DX promotion]. We also sought to [understand individual values and encourage improved awareness].

Conclusion　DX efforts reduced paper usage and the time spent on administrative tasks. The driving factors for DX were motivation from social situations, actions, decision-making to solve issues, and support for organizations and individuals. The promotion of DX across departments has led to labor-saving improvements and greater efficiency in operations.

Objectives　This study evaluated the long-term effects of exercise classes for middle-aged and older people with reduced medical care expenditures. Participants who had previously been compared with regards to medical costs through a retrospective cohort study were further followed up for eight years using the Kokuho database, comparing medical care expenditures, long-term care (LTC) costs, survival rates, and independence rates.

Methods　A total of 416 matched pairs (832 individuals) of exercise-class participants and non-participants were followed between April 1, 2015 and March 31, 2023. For the survival and independence analyses, 410 pairs (820 individuals) were included, excluding those certified as requiring Level 2 nursing care or higher by March 31, 2015. To compare medical and LTC costs, 345 pairs (690 individuals) insured under the National Health Insurance or Late-Stage Senior Citizen’s Health Insurance until March 31, 2023, were analyzed. Descriptive statistics were calculated for medical and LTC costs and paired t-tests were performed to compare expenditures between the participating and the non-participating groups. McNemar’s test was used to compare the recipients of medical treatment. Kaplan–Meier curves were generated to calculate the eight-year survival and independence rates for both groups. In addition, stratified log-rank tests were performed for survival time analysis. Statistical significance set at P＜0.05.

Results　When comparing hospitalization expenditures, the participating group incurred significantly lower hospitalization costs (P＝0.009) and higher outpatient and pharmacy expenses than the non-participating group (P＝0.019). For LTC costs, the facility and total service scores were higher in the non-participating group; however, these differences were not significant. The non-participating group was significantly more likely to receive inpatient treatment (P＝0.032), whereas the participating group was significantly more likely to receive outpatient care (P＝0.004). Survival analysis revealed significantly lower survival and independence rates in the non-participating group (P＝0.031 and P＝0.003, respectively).

Conclusion　The participating group had significantly lower mortality, loss of independence, hospital admissions, and hospitalization expenditures. These findings indicate that regular participation in exercise classes assists in maintaining quality of life and extending healthy life expectancy in middle-aged and older people.

Objective　Public transport is less developed in regional cities than in metropolitan areas. Consequently, older adults in these cities often face difficulties in securing alternative means of transportation after surrendering their driver’s licenses, which can lead to reduced outings. Understanding the relationship between possessing a driver’s license by an older adult and the purpose of outings in regional cities can provide fundamental information for designing appropriate support measures. This study aimed to examine the association between driver’s license possession and outings for personal errands among older adults living in regional cities, while focusing on sex-specific patterns and differences between early- and late-stage older adults.

Methods　A cross-sectional study was conducted using data from 9,463 individuals aged 65–84 years who responded to the third Higashi-Surugawan metropolitan area person trip survey, which was carried out in Shizuoka Prefecture in December 2015 and February 2016. Outing purposes were classified into categories such as “routine household chores and shopping,” “non-routine shopping,” “social activities, meetings, recreation, dining,” “pick-up and drop-off,” “medical visits,” “tourism and leisure,” and “other personal purposes.” Logistic regression analyses were performed separately by sex and by early- and late-stage older adults, with the presence or absence of outings for each purpose as the dependent variable and driver’s license possession as the independent variable.

Results　The findings indicated a significant positive association between driver’s license possession and outings for certain purposes. Among early-stage older men, possessing a license was associated with outings for “non-routine shopping,” “pick-up and drop-off,” and “tourism and leisure,” whereas among late-stage older men, it was associated with outings for “routine household chores and shopping” and “pick-up and drop-off.” Among early stage older women, possessing a license was associated with outings for “social activities, meetings, recreation, dining,” “pick-up and drop-off,” “medical visits,” “tourism and leisure,” and “other personal purposes,” whereas among late-stage older women, it was associated with outings for “social activities, meetings, recreation, dining,” “pick-up and drop-off,” “tourism and leisure,” and “other personal purposes.”

Conclusion　Drivers’ license possession among older adults living in regional cities is associated with outings for several personal purposes, such as household chores, shopping, social activities, and medical visits.

Objectives　The Health Japan 21 initiative (third term) requires establishing an environment that allows people of all ages to lead healthy lives without excessive exertion. Such environments should be created by local governments, in collaboration with multiple stakeholders. Such initiatives carry the potential for collective impact, wherein multiple stakeholders with varying perspectives work together to solve societal challenges. However, research institutions rarely join backbone organizations to direct such collective impacts in Japan. Herein, we describe the first year (2023) of the health community development initiatives conducted by the Department of Community Building for Well-being, jointly established by the Center for Preventive Medical Sciences of Chiba University and Iwabuchi Pharmaceutical Co. in Yotsukaido City (Chiba Prefecture), and aim to demonstrate their results, achievements, challenges, and future prospects, in line with the concept of collective impact.

Methods　The results, achievements, and challenges related to the initiatives were organized in alignment with the five conditions of collective success: backbone support organizations, continuous communication, mutually-reinforcing activities, common agendas, and shared measurement systems.

Results　We established a joint research department in April 2023, and hosted a commemorative symposium to establish it. We then organized 15 lectures focused on health community development. We collaborated with several companies, Yotsukaido City, local residents, and community organizations. We ultimately launched the “Yotsuba Project” through the various initiatives undertaken in 2023. This project emphasizes collaboration between multiple stakeholders.

Conclusion　Through our activities in 2023, we established an operational structure with the main team from Chiba University and Iwabuchi Pharmaceutical Co. as the backbone support organizations. Through continuous communication, a network was established between multiple stakeholders, including Yotsukaido City. Various examples of collaboration between stakeholders took place that exemplified the principles of mutually-reinforcing activities. The major challenges related to the project include the way it is run, the large number of people involved, the common agenda of promoting the concept of the “Yotsuba Project,” and the need to share measurement systems. Through our efforts, we hope to promote the creation of health and well-being communities for people of all ages, contribute to realizing the “Healthy Japan 21 (third term)” vision, and create a robust model that can be applied by other local governments as well.

Objective　We broadly assessed how open residents in rural and remote areas are to using telemedicine, and whether an association exists between openness to telemedicine use and resident demographics including clinical visit status and advance care planning.

Methods　A self-administered survey was disseminated via mail between October 2022 and January 2023. Participants included 3,767 residents of nine districts with remote and rural medical care services in Shunan City, Yamaguchi Prefecture aged ≥20 years. We selected participants using stratified random sampling by district, sex, and age. The survey comprised questions regarding willingness to use telemedicine services including online medical care and medication counseling, resident characteristics, clinical visit status, and willingness to accept long-term and terminal care. Multivariate logistic regression analysis was used to assess potential factors associated with willingness or unwillingness to use telemedicine. We also analyzed the specific reasons given in the responses of those who did not want to use telemedicine.

Results　A total of 1,540 respondents were included in the final analyses (valid response rate: 40.9%). Regarding telemedicine use, 43.0% and 48.1% of respondents were willing to use online medical care in their family clinics and in their own houses, respectively. Additionally, 53.5% expressed a desire to use medication counseling clinics. Willingness to use telemedicine associated significantly with smartphone users and responders aged ≤50 years of age. Notably, hospital visitors and remote island residents were unwilling to use online medical care services. Time required to visit a hospital/clinic, residents living alone, and resident’s desire to receive terminal care at home did not correlate significantly. The most common reasons given by those who did not want to use telemedicine were “easier to talk to someone in person (45.2–56.0%),” “never experienced it before (36.6–41.2%),” and “difficult to hear explanations (12.5–14.3%).” Other reasons (free responses) included “Don’t know/don’t need it (27.8–42.4%), “No problem with current hospital visit/pharmacy care (13.6–21.5%),” and “Concerns regarding equipment operation (10.4–18.2%).

Conclusions　We identified factors associated with positive and negative attitudes toward telemedicine among residents of rural and remote areas. Our findings underscore the importance of promoting residents’ understanding of the convenience and necessity of telemedicine by increasing their opportunities to experience it.

Objectives　The use of multiple medicines that increase frailty and functional disability among older adults is a significant public health concern. However, no study has analyzed whether the intake of multiple medicines increases functional disability according to age. The number and severity of diseases and frailty that are positively correlated with medicines have not been considered. In this longitudinal study, we aimed to investigate whether multiple medicines increased functional disability incidence according to age groups (65–74 and ≥75 years) after adjusting for disease status and frailty.

Methods　Data from the 2013 Japan Gerontological Evaluation Study (JAGES)—collected during a follow-up period of approximately six years—were used. Individuals aged ≥65 years who were activities of daily living (ADL) dependent, using an unknown number of medicines, and experiencing functional disabilities at the time of response were excluded. A total of 12,752 functionally independent older adults from 14 municipalities were included in this study. The outcome variable was whether the participants had functional disabilities. The explanatory variable was the intake of multiple medicines (reference group, no medicines; exposure group, 1–2, 3–4, or ≥5 medicines). As covariates, 12 variables were considered potential confounding factors between the intake of multiple medicines and functional disabilities. A survival analysis (Cox’s proportional hazards model) was used to calculate the hazard ratio (HR), 95% confidence interval (CI), and p-value (5% significance level). After confirming the association between multiple medicines and age groups (65–74 and ≥75 years), participants were analyzed according to age groups. Multiple imputation methods were used for the missing variables.

Results　Among the 65–74 and ≥75 years age groups, the incidence of functional disabilities was 10.3% and 37.6%, respectively. The interaction between multiple medicines and age was significant (P < 0.05). During the follow-up period, the HR (95% CI, P-value) for functional disability incidence with the intake of multiple medicines was higher compared to that of the reference group, as follows: for 3–4 and ≥5 medicines among individuals aged 65–74 years, 1.31 (1.01–1.69, 0.042) and 1.89 (1.44–2.49, <0.001), respectively; and for ≥5 medicines among individuals aged ≥75 years, 1.43 (1.19–1.72, <0.001).

Conclusion　The study findings indicate that multiple medicines administered to community-dwelling older adults increase their susceptibility to functional disabilities. However, individuals aged 65–74 years with a lower disease status and frailty percentages may be attentive when using multiple medicines. Guidelines for appropriate medicine use among older adults emphasize the importance of healthcare workers in medical institutions and community pharmacies. These workers should also address the issue of multiple medicines among individuals aged 65–74 years.

Objectives　To understand the current conditions and challenges in the utilization and digitalization of information and communication technology (ICT) in public health nursing, using a nationwide survey of local government public health nurses. The study also seeks to provide recommendations for enhancing the utilization of ICT in public health nursing.

Methods　An online, anonymous, and self-administered survey of public health nurses in supervisory positions across 47 prefectures and 1,741 municipalities was conducted. The survey collected information on the type of municipality (prefecture, government-designated city, city with health centers, or other municipalities). Additionally, data on the extent of the utilization of ICT in public health nursing activities, the status of current initiatives, and challenges in promoting ICT were collected. The survey was conducted between October 2023 and January 2024.

Results　A total of 577 responses (response rate: 32.3%) were received, of which 524 were valid, with no missing items. Among the responding municipalities, 55.9% reported active promotion of ICT projects. However, only 26.7% reported that these projects were progressing smoothly. The most common ICT activity was conducting meetings via online calls (83.0%). The level of implementation of ICT varied depending on the initiative and the type of municipality. The most significant challenge identified by public health nurses was concern regarding the inclusion of cohorts facing difficulties in adapting to digital technologies (89.1%). This was followed by challenges in formulating a vision or policy for the utilization of ICT in public health nursing activities (86.1%) and difficulties in understanding procedures for promoting the utilization of ICT in their activities (82.8%). Each of these issues was recognized as a challenge by >80% of the municipalities surveyed. At the organizational level, the most commonly reported challenge was the difficulty of securing adequate budgets to facilitate utilization of ICT in public health nursing activities (52.7%). By municipality type, approximately 60% of prefectural governments reported that the internet environment available to public health nurses was inadequate. Similarly, approximately 60% of prefectural and government-designated city governments identified a shortage of accessible ICT devices for public health nurses as a challenge.

Conclusion　Although many local governments actively promote the utilization of ICT in public health nursing activities, significant challenges remain. The progress and implementation of ICT initiatives varies by municipality. However, several challenges are common across regions. To promote the utilization of ICT in public health nursing, it is essential to enhance workforce development for the utilization of ICT for public health nurses, while also facilitating the sharing of good practices and expertise among municipalities.

Objectives　As the number of older workers increase, the proportion of occupational accidents among them has increased. To prevent such accidents, it is crucial to understand the characteristics of age-related decline in physical and psychological function from middle to old age. This study aimed to elucidate these characteristics and discuss occupational health issues in middle to old age.

Methods　This study was part of the National Institute for Longevity Sciences - Longitudinal Study of Aging, involving 1,153 men and 1,117 women Japanese community-dwelling participants aged 40–84 years during the seventh wave (2010–2012). Hearing function, visual function, postural balance, motor fitness, gait function, cognitive function, mental health, and bone mineral density were measured using a survey. Descriptive statistics and z-scores (based on the age groups; 40–44, 45–54, 55–64, 65–74, and 75–84) were calculated based on sex and age group. Statistical significance was set at P < 0.05 (z-score; ≥ ±1.96).

Results　Compared to those aged 40–44 years, those aged 75–84 showed significantly lower z-scores for hearing function (z-score for air-conduction pure-tone threshold at 8,000 Hz; +4.78 for men, +4.91 for women), near visual acuity (+4.42 for men), information processing ability (−3.94 for women), and muscular endurance (z-score for upper body raising; −2.73 for men, −2.38 for women). Conversely, age differences were relatively small (−0.5 < z-score < 0.5 in all ages) in gait pace, depression scores, and life satisfaction in both sexes.

Conclusion　Hearing function (especially at high frequencies) scores were significantly lower in older age groups, followed by near visual acuity, information processing ability, and muscular endurance in both sexes. However, there were no clear age-related differences in the gait pace, psychological health, or life satisfaction. Occupational health check-ups must be implemented based on an understanding of the characteristics of changes in physical and psychological functions with aging.

Objective　Green-slow mobility (electric-powered carts), with travel speeds below 20 km/h on public roads, is expected to promote outings and social participation, potentially reducing the risk of functional disabilities. When electric-powered cart operations stop in a community, outings and social connections may decrease, thereby increasing the risk of functional disability. This study investigated whether the risk of functional disability increased among users after electric-powered cart operation ended.

Methods　This longitudinal study employed a natural experimental design and analyzed three waves of data: before electric-powered carts were introduced, during operation/immediately after operation stopped, and sometime later (post-stoppage). For each wave, data were gathered through a self-administered survey. After operation stopped, secondary analyses were conducted. Electric-powered carts remained out of service for four months following the demonstration project’s conclusion. Participants included 78 adults over age 65 residing in Nitto, Taishi, and Kawachinagano. They completed all three surveys and reported using electric-powered carts at least once monthly during operation. The primary outcome variable was the risk assessment scale, which predicts the likelihood of requiring long-term care within three years (range: 0–48, with higher scores indicating a greater risk). The primary explanatory variables were survey waves (preoperative, during the operation/immediately after operations stopped, and post-stoppage). Covariates included baseline characteristics, such as sex, education, marital status, employment, economic hardship, and living alone. A linear mixed-effects model was used to analyze the data, reporting coefficients (B), 95% confidence intervals (CI), and P values. Additional analyses stratified the participants by cart usage frequency (at least once weekly vs. 1–3 times monthly).

Result　Among people who used carts at least once weekly (n = 31, 39.7%), the mean risk scores were the lowest during operation/immediately after operation stopped (20.0) and the highest post-stoppage (21.8). The coefficient of the association between survey timing and risk scores was 0.01 (−0.78–0.81, P = 0.975) during operation/immediately after operation stopped, and 0.49 (−0.31–1.28, P = 0.231) after post-stoppage. For people using carts at least once/week, the association was 0.71 (−0.75–2.17, P = 0.341) pre- and 1.77 (0.31–3.24, P = 0.017) post-stoppage. No significant associations were found for those using carts 1–3 times monthly.

Conclusion　Stopping electric-powered cart operations may increase the risk of long-term care, particularly for [at least] once weekly users. Sustained cart usage is vital for healthy aging among older adults.