Rumi Seko

OBJECTIVES: To compare the characteristic competencies of public health nurses working for the older adult's health and welfare in public administration ("PA") with those at community general support centers ("CGSC") in Japan. METHODS: We conducted a questionnaire survey by mail for PA and CGSC public health nurses. A competency list that was developed to compare three groups (PA, CGSC experts with ≥5 years of experience, and CGSC newcomers with ≤2 years of experience) was used. The following characteristics were examined: (1) competencies acquired early after arriving at the CGSC, (2) competencies acquired through a certain amount of CGSC experience, (3) common competencies, (4) competencies that even experts lacked, and (5) competencies that the newcomers lacked. RESULTS: We examined the responses of 171 PA nurses, 185 CGSC expert public health nurses, and 165 CGSC newcomer public health nurses. The results of comparison of the three groups showed that (1) had no applicable items; (2) had nine items for individual support associated with preventive care management; (3) had 14 items including teamwork among three professionals (social workers, senior care manager, public health nurse)/other professionals and self-improvement; (4) had three items for community development, (5) had two items for individual support and 16 items for community development. CONCLUSION: Initiatives for preventive care and coordination of care teams should be supported and suggested as characteristic competencies for CGSC public health nurses.

OBJECTIVES: Employment support for working age people with disease is important. We investigated the intention to work among outpatients with malignant neoplasms, ischemic heart disease, and cerebrovascular disease. METHODS: We used anonymous data from the 2007, 2010, and 2013 Comprehensive Survey of Living Conditions in Japan, a self-administered nationwide questionnaire survey. Data for 154,445 participants (76,059 men and 78,386 women) aged 20-64 years were analyzed using logistic regression models adjusted for covariates. RESULTS: The number of outpatients with malignant neoplasms, ischemic heart disease, and cerebrovascular disease was 851, 1,037, and 716, respectively. The adjusted odds ratio for not working in people with the intention to work was significantly higher among outpatients with the three diseases than among non-outpatients, for both men and women. The adjusted odds ratio for intention to seek permanent work in unemployed people with the intention to work was lower among outpatients with cerebrovascular disease than among non-outpatients for men (p=0.093), and was significantly higher among outpatients with malignant neoplasms than among non-outpatients for women (p=0.007). CONCLUSIONS: This study identified a high proportion of unemployed people with the intention to work among outpatients with these three diseases, and suggests that there are disease-associated differences in employment type sought.

<p> Taking action in response to health examination results is important to stay healthy. We aimed to investigate the associations between occupation, employment type and company size, and having a health examination and taking action in response to the results among Japanese employees. We focused on three particular actions by employees in response to health examination results: paying attention to one's health, receiving health guidance, and visiting a medical institution. We used anonymous data from the 2010 Comprehensive Survey of Living Conditions of Japan, a self-administered nationwide questionnaire survey. The data of 23,963 employees (12,938 male and 11,025 female) aged 20–64 yr were analyzed using logistic regression models adjusted by covariates. There were significant changes in odds ratios for receiving a health examination by occupation, employment type and company size. We found significant odds ratios for receiving health guidance by occupation and company size, but there was almost no significant association with paying attention to one's health and visiting a medical institution. These results confirmed that receiving a health examination was associated with occupational factors, and suggested that receiving health guidance after health examination results was associated with occupation and company size.</p>

<p>Objectives: The aim of this study was to investigate changes in health university students' attitudes toward community service before and after a community-oriented education program using team-based learning (TBL). </p><p>Methods: A community-oriented educational program using TBL was carried out with a total of 529 3rd- and 4th-year students in seven faculties of two departments at Fujita Health University, and a questionnaire survey was conducted before and after the program. There were eight questions on students' attitude toward community service.</p><p>Results: Responses with no missing information from 431 students were used in the analysis. There were significant increases in the number of positive responses to three questions after TBL. The item "I think there are things that university students can do as members of the community" increased from 81.9% before TBL to 86.5% after, "I can form specific images of activities that benefit the community" increased from 46.0% before to 70.3% after, and "In the future I want to participate in activities that benefit the community" increased from 74.7% before to 80.3% after.</p><p>Conclusion: The results suggest that this community-oriented educational program using TBL raised the motivation of university students in medical and health science programs to practice community health care.</p>

Objectives: We examined whether selected factors were associated with activity limitation used to calculate the healthy life expectancy in accordance with the target of Health Japan 21 (the second term). <br>Methods: Data for 6251 subjects were obtained from the Comprehensive Survey of Living Conditions and the National Health and Nutrition Survey, both of which were conducted by the Ministry of Health, Labour and Welfare of Japan in 2010. The age-adjusted odds ratios (AOR) of limitation of activity for the assessed factors were estimated using a logistic model.<br>Results:, The percentage of persons with activity limitation was 12.1% of men and 15.6% of women. For men, low body mass index (BMI) (AOR: 2.02, p=0.008), high blood pressure (AOR: 1.53, p=0.021), high hemoglobin A1c (HbA1c) (AOR: 1.99, p=0.000), a small number of steps (AOR: 1.68, p=0.002), and high intake of salt (AOR: 0.69, p=0.010) were significantly associated with limitation of activity. For women, high BMI (AOR: 1.49, p=0.003), a small number of steps (AOR: 1.48, p=0.009), and high intake of salt (AOR: 0.77, p=0.017) were significantly associated with activity limitation. <br>Conclusion: We identified several factors that were associated with activity limitation. Our results from cross-sectional data require careful interpretation before concluding whether these relationships are causal

Objectives An earlier study using the data from the Japanese Long-term Care Insurance (LTCI) system reported a scenario for achieving the target of Health Japan 21 (the second term): future gains in health expectancy from 2011 to 2020 must be larger than gains in expectancy. According to this scenario (the Healthy Life Expectancy Extension Scenario), the proportion of disability (cases≥Care Level 2 in LTCI disability certification) will gradually decrease by 1% per year from 2011. The purpose of this study was to estimate the cost savings in long-term care and medical care if the Healthy Life Expectancy Extension Scenario is achieved.<br/>Methods We used data from Japanese national statistics and a survey conducted in Osaki city, Miyagi. The natural course of disability cases (≥Care Level 2) was estimated under the assumption that the future population composition would be equal to the population projections for Japan and the future proportion of disabilities for each age grade would be equal to that of 2010. Then, the decrease in the number of disabilities based on the Healthy Life Expectancy Extension Scenario was calculated. Finally, the cost savings in long-term care and medical care associated with the assumed decrease in the number of disability cases was calculated.<br/>Results When the disability cases (≥Care Level 2) were shifted to "no disability certification (not requiring care)," a total estimated cost reduction of 5,291 billion yen was achieved from 2011 to 2020. Furthermore, a total estimated reduction of 2,491 billion yen was achieved for the same period when all disability shifts to "Care Level 1" were accounted for.<br/>Conclusion As a rough calculation, if the Health Japan 21 (second term) target is achieved, approximately 2,500–5,300 billion yen will be saved in the cost of long-term care and medical care.

Objectives&emsp;We attempted to predict health expectancy in Japan for the period between 2011 and 2020, considering the target of Health Japan 21 (the second term) that future gains in health expectancy be larger than in life expectancy.<br/>Methods&emsp;We used data from Japanese national statistics. Health expectancy between 2011 and 2020 was predicted using the Sullivan method under the assumption that future mortality was equal to the estimate in Population Projections for Japan (January 2012), and under three scenarios of future prevalence of bad health status.<br/>Results&emsp;The numbers of expected years without activity limitation at birth for males and females in 2020 were predicted as 71.2 and 74.3, respectively, under the scenario that prevalence of activity limitation was constant since 2010; 71.4 and 74.5 under the scenario that the prevalence followed the recent trend; and 71.7 and 74.9 under the scenario that the prevalence decreased with such a rate that future gains in health expectancy were equal to in life expectancy. The rate of decrease in the prevalence in 2010&ndash;2020 in the last scenario was estimated to be 0.95 in males and 0.96 in females. The numbers of expected years with subjective well-being at birth in 2020 predicted under above three scenarios were between 69.5 and 71.2 in males and between 72.9 and 74.6 in females. The rate of decrease in the last scenario was estimated to be 0.96 in males and 0.97 in females. The numbers of expected years without care needs at age 65 in 2020 predicted under above three scenarios were between 18.0&ndash;18.2 in males and between 21.2&ndash;21.5 in females. The rate of decrease in the last scenario was estimated to be 0.90 in males and 0.91 in females.<br/>Conclusion&emsp;The health expectancy in 2011&ndash;2020 was predicted under some scenarios of future prevalence of bad health status. The rate of decrease in the future prevalence of bad health status was estimated with a view to the accomplishment of the target of Health Japan 21 (the second term).

We studied the probability of fatty liver (FL) onset by subjecting FL risk factors to logistic regression analysis and clarifying the probability of FL disappearance due to weight loss. Subjects were 611 people with an average age of 50.6&plusmn;9 years who underwent thorough medical checkups. Of risk factors for FL, we analyzed BMI, HDL cholesterol (HDL), triglyceride (TG), HbA₁c (A₁c), and uric acid (UA) to investigate FL onset probability. Results indicated that probability in terms of the average risk factor score for people without FL was estimated at 15% for men and 1% for women. At a A₁c of 6.5%, probability was 75.5% for men and 22% for women. At a TG of 200 mg/dl, probability was almost 100% for men and 85% for women. Regarding the effects of weight loss from a multiple risk syndrome state, the probability of FL onset at a BMI of 26 kg/m², A₁c of 5.8%, UA of 7.0 mg/dl, TG of 150 mg/dl, and HDL of 39 mg/dl was 88% for men and 46% for women. With weight loss of 1 kg/m² of BMI, the probability decreased to 59% for men and 9.3% for women, and with weight loss of 2 kg/m² of BMI, it decreased to 20% for men and 7.6% for women. These findings suggest that weight loss of approximately 10% for men and 5% for women is sufficient for reducing the FL risk.