[Nihon koshu eisei zasshi] Japanese journal of public health

Objective　To investigate the causes of the sharp increase in pertussis cases, by comparing the trends in pertussis incidence in Kanagawa Prefecture before and after the COVID-19 pandemic.Methods　Epidemiological data of pertussis cases reported in Kanagawa Prefecture from epidemiological week 1 of 2018 to week 33 of 2025 were examined based on infectious disease surveillance. Since changes in pertussis trends may have been influenced by behavioral changes that were implemented during the COVID-19 pandemic, such as droplet infection prevention and social distancing, the study period was divided into two sections: before and after the pandemic. The number of cases was compared across variables, including age group, vaccination history, symptoms, and diagnostic methods.Results　A pertussis outbreak was observed between 2018 and 2020, and a large-scale outbreak starting in 2024 continued to persist as of week 33 of 2025. Comparing the periods before and after the COVID-19 pandemic, the age group with the highest number of case reports shifted from children aged 5-10 years to those aged 10-15 years. Moreover, the number of reported cases has decreased in infants under 6 months of age, who are at the highest risk of severe complications from pertussis. Regarding vaccination history, in both time frames, the proportion of cases with "four doses received" was the highest; after the COVID-19 pandemic, an increase in the number of cases for those with four doses of DPT or DPT-IPV vaccines was observed in the 7-15 age group. Regarding symptoms, the percentage of patients with nocturnal cough, dyspnea, staccato, whoop, vomiting, apnea, cyanosis, and leukocytosis decreased. In terms of diagnostic methods, the frequency of genetic testing and rapid diagnostic tests increased compared to serological techniques.Conclusion　Factors contributing to the sharp increase in pertussis cases included the accumulation of susceptible individuals due to droplet and contact infection control measures and behavioral restrictions during the COVID-19 pandemic, waning immunity due to the time elapsed following pertussis vaccination, a possible increase in the number of reported cases due to an expanded set of diagnostic methods, and an increase in macrolide-resistant Bordetella pertussis strains. Advancing the starting age of routine vaccinations to 2 months contributed to the prevention of infant pertussis. However, additional DPT vaccinations at the ages of 5-7 and 11-12 years, as recommended by the Japanese Pediatric Society, are considered necessary.

Objectives　Few studies have examined the weight-loss behaviors (i.e., dieting behaviors) among pregnant women who were not obese before pregnancy or explored the association between dieting behaviors during pregnancy and previous dieting experiences. Therefore, in this study, we aimed to identify the weight-loss behaviors practiced by pregnant women during pregnancy and to examine their associations with adherence to gestational weight gain guidelines of the Japan Society of Obstetrics and Gynecology, and as well as with past dieting behaviors.Methods　We included 601 pregnant women from Takatsuki City, Osaka Prefecture, Japan. After excluding participants with missing questionnaire responses, 529 participants were analyzed. Participants completed self-administered questionnaires during antenatal and one-month postpartum health examinations. Information regarding dieting behaviors during adolescence, the year before pregnancy, and pregnancy, including gestational weight gain, was collected. For the 496 participants with recorded pregnancy weight gain values, the odds ratios for achieving the recommended weight gain were calculated for "appropriate" and "inappropriate dieting behaviors." Furthermore, logistic regression analysis was used to calculate age- and pre-pregnancy body mass index-adjusted odds ratios (95% confidence intervals) for participants who engaged in dieting behaviors during their teenage years and the year before pregnancy and who subsequently engaged in "dietary restriction" or "inappropriate behaviors" during pregnancy.Results　Of all participants, 39.9% engaged in dieting behaviors during pregnancy. Among pregnant women with available gestational weight gain data, 33.5% achieved the recommended weight gain, whereas only 18.8% of women who were underweight before pregnancy met the guideline. The adjusted odds ratio for achieving weight gain compared to no dieting behavior was 1.0 (0.6-1.5) for "appropriate behaviors" and 1.0 (0.5-2.0) for "inappropriate behaviors," showing no significant association in either case. "Dietary restriction" during pregnancy and "inappropriate behaviors" were associated with "dietary restriction" in the year before pregnancy [6.4 (3.2-12.6), 6.1 (3.1-12.0)] and "inappropriate dieting" [6.0 (3.1-11.7), 6.4 (3.3-12.3)].Conclusions　Approximately 40% of non-obese pregnant women engaged in dieting behaviors during pregnancy. Moreover, those who engaged in "dietary restriction" or "inappropriate behaviors" in the year before pregnancy may continue such behaviors during pregnancy. Thus, antenatal checkups and nutritional guidance are required for guiding appropriate weight gain and screening previous dieting experiences. Furthermore, preconception care is necessary to ensure appropriate weight management.

Objectives　In 2023, the Kobe City Public Health Management Center (KCPHMC) conducted an extraordinary on-site inspection based on the Medical Care Act and provided administrative guidance after a whistleblower report regarding Hospital A. However, owing to repeated legal violations, the KCPHMC eventually issued an improvement measure. In this study, we evaluated the various steps of the interventions implemented by the KCPHMC to establish a patient safety management system (PSMS), clarified the role of a public health management center, and identified the remaining unresolved issues.Methods　A factual overview is provided based on the relevant documents in this case. Subsequently, the KCPHMC-induced interventions were divided into four verification items, including the processes of extraordinary on-site inspections under the Medical Care Act, fact-finding and guidance, evaluation of improvements, and decision making, and analyzed retrospectively. We evaluated the validity of the inspection methods following the detection of the case and its legitimacy, the impact of the identification of root causes and providing guidance, and the utility of the methods used by KCPHMC to evaluate improvements and the decision-making processes.Results　The application of Article 25(2) of the Medical Care Act for on-site inspections was found to be valid. The process-from the selection of investigation targets and fact-finding processes for the determination of legal violations to the issuance of an improvement order-was appropriate. Identifying the organizational background as the root cause led to fundamental improvements. In addition to the guidance of the KCPHMC, expert advice regarding the PSMS enabled Hospital A to incorporate advanced measures into the improvement plans. The check system to evaluate PSMS improvement, using improvement-verification tables that were cross-verified by the KCPHMC and Hospital A, promoted PSMS activities and the establishment of a PSMS culture. As the concern strongly affected the regional medical system, discussions and policy decisions were made by departments other than the KCPHMC in Kobe City, depending on the nature of the case.Conclusions　In case of a dysfunctional PSMS, the hospital faces difficulties in self-correction. KCPHMC-instituted interventions, including extraordinary inspections, fact-finding, improvement orders, root-cause analysis, formulation of fundamental improvement plans, and subsequent evaluations, were crucial for the reconstruction of the PSMS. In such cases, where there is a potential threat to citizens' lives and an impact on the regional medical system, proactive intervention by the health center is important. Simultaneously, we noticed a shortage of expertise and human resources in this process. Further knowledge regarding effective interventions and guidance by health centers is required.

Objectives　A previous study reported that future long-term care (LTC) costs differ according to risk assessment scores for incident functional disability. This study uses extended long-term follow-up data to examine cumulative LTC cost differences across various follow-up periods.Methods　As part of the Japan Gerontological Evaluation Study (JAGES), a baseline survey was conducted in August 2010 and January 2011 among individuals aged ≥ 65 years in five Japanese municipalities (response rate: 63.7%). These individuals were not certified as requiring public LTC insurance benefits. Using public LTC claim records, LTC service costs were tracked for 21,626 individuals aged over 12 years following the baseline survey. The risk assessment scale for incident functional disability (0-48) comprises 12 items including sex and age. An ordinary linear regression model, Tobit regression model, and a linear regression model with multiple imputation for missing values were applied.Results　During the follow-up period, 9,368 (43.3%) participants were certified as requiring LTC or support, and 7,137 (33.0%) died. Even at the 12-year follow-up, the higher-risk group (risk score ≥17) was positively associated with the cumulative cost of LTC services per person, duration of LTC service use, and the proportion of people certified as requiring LTC or support. Compared with the difference between high- and low-scoring groups at the 1-year follow-up, the magnitude of the difference increased exponentially: a 59.7-fold increase at 6 years, a 120.2-fold increase at 9 years, and a 185.6-fold increase at 12 years. After adjusting for confounders, the 12-year cumulative LTC cost increased by approximately 80,900 yen (95% confidence interval [CI]: 68.6-93.2) per 1-point increase in the risk score. The corresponding estimates were 63,000 yen (95%CI: 49.3-76.6) in the low-score group (risk score ≤16) and 110,400 yen (95%CI: 80.6-140.2) in the high-score group (risk score ≥17). Total expenditure increased with longer observation periods, although the increase plateaued after approximately 10 years in the high-score group. The major results and trends were generally consistent across the different model specifications.Conclusion　The baseline risk assessment scale for incident functional disability can be used to estimate the subsequent occurrence of LTC certification and cumulative LTC expenditure over a 12-year follow-up.

Objectives　In Japan, in accordance with their public health responsibilities to promote the early detection and treatment of osteoporosis, municipal governments are legally encouraged to implement osteoporosis screening. However, the proportion of municipalities that conduct such screenings plateaued at approximately 60%, with substantial intermunicipal disparities. In this study, we aimed to identify the factors that are associated with the implementation of osteoporosis screening across all municipalities in Japan.Methods　This ecological study included all municipalities in Japan. Based on the 2022 Community Health and Health Promotion Project Report, public data on fiscal factors, population characteristics, and medical resources were analyzed to ascertain the implementation status of osteoporosis screening. The community environmental indicators included the habitable population density, area-deprivation index, and rurality index. Modified Poisson regression was used to estimate prevalence differences (PDs) with 95% confidence intervals (CIs). The multivariable model comprised all explanatory variables, except the number of orthopedic surgeons and the rurality index which were excluded owing to their strong correlations with the other variables.Results　Among 1,735 municipalities, 1,094 (63.1%) implemented osteoporosis screening. In the unadjusted model, a 0.1-unit increase in the fiscal capacity index was associated with a 1.2 percentage-point higher implementation rate (PD＝0.012, 95% CI [0.004-0.020], P＝0.003). In contrast, a 1% increase in the proportion of residents aged ≥75 years was associated with a 0.6 percentage-point lower implementation rate (PD ＝－0.006, 95% CI [－0.011 to －0.002], P＝0.004), and a one-unit increase in the area-deprivation index was associated with a 3.7 percentage-point lower rate (PD＝－0.037, 95% CI [－0.072 to －0.003], P＝0.032). In the multivariable model, the fiscal capacity index remained positively associated with osteoporosis screening implementation, with a 0.1-unit increase corresponding to a 1.7-percentage point higher implementation rate (PD＝0.017; 95% CI [0.003-0.030], P＝0.014). In contrast, a 10% increase in the habitable population density was associated with a 0.4-percentage point decrease in the implementation rate (PD＝－0.004, 95% CI [－0.006 to －0.001], P＝0.005).Conclusion　A greater fiscal capacity and a higher habitable population density were associated with higher and lower implementation rates of osteoporosis screening, respectively. Thus, local socioeconomic and geographic characteristics may influence municipal-level screening practices; these findings provide evidence for developing strategies to promote the implementation of osteoporosis screening and reduce disparities among municipalities.