[Nihon koshu eisei zasshi] Japanese journal of public health最新文献

Objective　The transition of patients from specified pediatric chronic diseases (SPCD) to designated intractable diseases (DID) in Japan presents several challenges; however, few studies have addressed this issue. This study aimed to examine the status and challenges of the transition as perceived by local government officials and to compare transition rates between prefectures, with and without transitional care support centers (TCSCs).Methods　A web-based survey was conducted between September 25 and October 20, 2023, targeting 1,772 public health offices, health centers, and welfare offices across Japan. Data from personnel responsible for SPCD and DID programs, including their professional backgrounds, involvement in the programs, awareness of TCSCs, and the estimated percentage of patients who were unable to transition to the DID system in FY2022, were collected. Officials were also questioned on their perceptions of the challenges faced by patients who could not transition, and the status of support systems. The transition rates were compared between prefectures, with and without TCSCs.Results　A total of 1,026 responses were obtained (response rate: 58.0%). Among respondents, 18.9% were aware of TCSCs, while awareness in prefectures without TCSCs was notably lower at 12.4%. The estimated percentage of patients who did not transition to a DID was 53.0%. This was significantly higher in prefectures without TCSCs (54.8%) than in prefectures with TCSCs (49.7%) (t = 2.67, P = .008). The most frequently cited challenges included increased financial burden due to failure to transition (82.8%), difficulties in maintaining continuous care at adult medical institutions (71.5%), and insufficient support for autonomy and independence from medical, administrative, and educational systems (65.4%). These issues were recognized more frequently by medical professionals than by clerical staff.Conclusion　This study suggests that approximately 50% of patients with SPCDs may be unable to transition to a DID program, with a higher failure rate observed in prefectures without TCSCs. The presence of TCSCs may facilitate a smoother transition. However, awareness of these centers remains limited, particularly in areas without them. Raising awareness and promoting the establishment of TCSCs may assist in improving support during the transition period.

Objectives　In response to the coronavirus disease 2019 (COVID-19) pandemic, the usefulness of wastewater surveillance has been highlighted. Wastewater surveillance can detect pathogens that circulate throughout society, including asymptomatic infections, thereby allowing early outbreak warnings. However, several error factors must be considered when applying wastewater surveillance for COVID-19. This study examines the key error factors in COVID-19 wastewater surveillance and discusses their future applicability in Japan.Methods　A literature search was conducted using PubMed and Ichushi-Web to review the studies on wastewater surveillance for COVID-19. The search included combinations of the keywords "wastewater," "sewage," "COVID-19," "SARS-CoV-2," "fecal/urine," and "surveillance/survey/detection." A narrative review was conducted based on the search results.Results　A total of 2,108 articles were identified in PubMed, of which 19 were included in this review. In addition, six academic articles were retrieved from Google Scholar, and two government reports and guidelines were included in this review. The sampling methods and environmental factors such as wastewater temperature, transit time, and composition can be potential sources of error in wastewater surveillance. Furthermore, the standardization of these factors is difficult. The prevalence of COVID-19, population size, and population mobility in the target area also influence data interpretation. Additionally, because wastewater surveillance often lacks detailed patient background information such as age, sex, and exact locations of affected individuals, data interpretation can be more challenging than clinical testing-based surveillance, thus potentially limiting its applicability. However, compared to large-scale clinical screening, wastewater surveillance is significantly more cost-effective, rapid, and suitable for continuous monitoring. With regard to statistical analysis, sample normalization is crucial for accurate comparisons across samples, regions, and time periods. A low signal-to-noise ratio during COVID-19 wastewater surveillance requires significant smoothing procedures to extract meaningful signals.Conclusion　Wastewater surveillance for COVID-19 is subject to errors from several sources. Nevertheless, it offers advantages over clinical surveillance that include lower expected costs and capacity for continuous monitoring across broad geographic areas. In conclusion, it is essential to understand the advantages and limitations of both clinical and wastewater surveillance and appropriately integrate both approaches for optimal utilization.

Objective　Traditionally, families and households have served as stable sources of support and the primary settings of daily life; however, their roles have changed significantly in recent years. This study defined "intra-household isolation" as a state in which individuals live with family members or housemates yet experience markedly limited interactions within the household. We examined the association between intra-household isolation and psychological health among community-dwelling middle-aged and older adults.Methods　Data were collected through a mail-in questionnaire as part of the baseline survey of the Wako Cohort Study conducted in 2023, targeting the residents of Wako City, Saitama Prefecture. The mail-in questionnaire comprised two separate surveys for individuals aged 40-64 years and those aged ≥65 years, yielding 2,395 and 6,429 valid responses, respectively, for a total of 8,824 responses. Intra-household isolation was defined as cohabitation with others but spending ＜15 minutes daily conversing with them and being alone at home for most of the time on weekdays, weekends, and holidays. Psychological health outcomes included self-rated health, depression, well-being, and loneliness. We conducted modified Poisson regression and multiple regression analyses, adjusting for demographic factors, socioeconomic status, health behaviors, health status, and social networks outside the household.Results　Among the respondents, 44.7% were male, and the average age was 70.0 years (standard deviation: 12.7). The prevalence of intra-household isolation was 4.7% for all participants (3.2% in those aged 40-64 years and 5.3% in those aged ≥65 years) and 5.8% for cohabiting participants (3.7% in those aged 40-64 years and 6.7% in those aged ≥65 years). The proportion of intra-household isolation was higher in the older age group, and across nearly all age groups, men were more likely to experience intra-household isolation than women. Multivariate analyses revealed that, even after adjusting for social networks outside the household and other covariates, individuals experiencing intra-household isolation had poorer self-rated health, greater depression, lower well-being, and stronger feelings of loneliness than those who lived alone or were not isolated within the household. After examining the interaction terms, we found that the association between intra-household isolation and depression was strong among individuals aged ≥65 years. In contrast, this association was weak among those with strong neighborhood ties and those who frequently interacted with non-cohabiting individuals.Conclusion　The findings suggest that even when cohabiting with others, limited interactions within a household may increase the risk of psychological health deterioration. It is essential to carefully assess not only social interactions outside the household, but also isolation within it.

Objective　Patients with high treatment satisfaction are known to have better treatment compliance and persistence, and the Treatment Satisfaction Questionnaire for Medication (TSQM) is a questionnaire widely used to assess treatment satisfaction. A Japanese version of this questionnaire is available; however, its application is limited. In this study, we aimed to culturally adapt and assess the psychometric properties of a newly developed Japanese version of the TSQM in patients with diabetes or migraine who were prescribed oral and injectable medications in Japan.Methods　The study included two phases; phase I, retranslation and cultural adaptation of the Japanese TSQM, and phase II, psychometric validation of the updated Japanese TSQM. Japanese patients with diabetes or migraine receiving oral and/or injection treatment were involved in the cognitive debriefing interview and psychometric validation. The retranslation and cultural adaptation of the Japanese TSQM were conducted following the process recommended by the ISPOR Task Force. The updated Japanese TSQM, finalized after amendments based on cognitive debriefing interviews, was distributed to patients for psychometric validation. The psychometric properties of the finalized Japanese TSQM were assessed using classical test and Rasch measurement theories.Results　Minor modifications were made to the Japanese TSQM after cognitive debriefing interviews with eight patients. In total, 512 patients completed the final version of the Japanese TSQM. All versions of the Japanese TSQM had moderate reliability, with Cronbach's alpha ranging 0.6-0.9 for each domain and intraclass correlation coefficients for test-retest reliability between 0.5 and 0.6 for most domains. High item-convergent and item-discriminant validity were observed, in which all items had higher correlations with their respective domains than with other domains of the Japanese TSQM. The Rasch measurement theory added additional support to the reliability and validity of the measures as they fit the Rasch models. Additionally, high internal consistency reliability, unidimensionality of the domains, and scale invariance were supported by the values of the person separation index, Chi-square value of each domain, and differential item functioning across patient subgroups, respectively.Conclusion　The Japanese TSQM was successfully updated by revising the complex wording and removing wording specific to oral medications, making it usable for patients regardless of medication type. The updated Japanese TSQM had sufficient reliability and validity and could be used regardless of the disease and mode of administration of medication.

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.

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.

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.

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　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.

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.