[Nihon koshu eisei zasshi] Japanese journal of public health

Objectives　This study investigated women's capacity to receive support and its relationship with negative support experiences during pregnancy through child-rearing using a mixed-methods approach. The study also sought to derive the practical implications of transforming negative support into positive support.Methods　An Internet-based survey was conducted in February 2020 targeting 4,700 mothers (aged 20-49 years) of infants and preschool-aged children across all 47 prefectures of Japan, with 100 respondents recruited from each prefecture. Quantitative data were analyzed using Poisson regression analysis, with the capacity to receive support as the dependent variable and experience of negative support as the independent variable. Covariates included demographic and socioeconomic attributes (mother's age, household income, educational background, employment status, marital status, child's age, and number of children), as well as mental health status. Qualitative data, consisting of open-ended descriptions of negative support experiences, were analyzed using qualitative content analysis. Subsequently, an integrated interpretation was conducted through joint displays using both quantitative and qualitative results.Results　In four of the five negative support questions, women who experienced negative support were significantly more likely to have a low capacity to receive support than those who did not experience negative support. The strongest association with the capacity to receive support was observed for negative support related to parenting support (Prevalence ratio [PR]＝1.65, 95% confidence interval [CI]: 1.50-1.82, P＜0.001). Compared to those with no negative support experiences, women who experienced one type of negative support had a PR of 1.42 (95% CI: 1.25-1.61, P＜0.001), and those who experienced two or more types had a PR of 2.11 (95% CI: 1.92-2.33, P＜0.001).　Through a joint display, an integrated interpretation was presented using qualitative case examples of negative support experiences among women with a low capacity to receive support. This analysis revealed part of the process by which women who were unable to obtain the support they sought gradually disengaged from seeking support.Conclusion　Health care and parenting support providers may need to raise awareness about the types of support that are perceived as negative and promote a shift toward providing more positive support.

Objectives　In contemporary society, attention is increasingly being directed toward individual and societal happiness and well-being. Numerous studies have examined the components of, and factors related to, happiness from various perspectives and have informed practical initiatives; however, most studies have focused on analyzing the factors that are associated with current happiness or life satisfaction. Few studies have explored how current perceptions relate to past levels of happiness or the future outlook. Therefore, this study aimed to 1) identify the factors that are associated with current life satisfaction and 2) examine the relationship between current factors and the anticipated future life satisfaction.Methods　Data from 3628 civil servants (2,070 men and 1,558 women, average age: 46.0 and 39.4 years, respectively) were analyzed. A total of 3,656 civil servants who participated in the sixth wave of the Japanese Civil Servant Study (response rate: 80.7%) were included in this analysis. Life satisfaction was used as an indicator of well-being. The sex- and age group-stratified distributions of current and future life satisfaction scores were evaluated using one-way analysis of variance. Furthermore, the differences between the current and future life satisfaction scores for each independent variable were examined using Welch's t-tests and one-way analysis of variance. Finally, multiple regression analyses were conducted to determine the predictive factors of current and future life satisfaction.Results　The univariate analysis revealed differences in life satisfaction scores for most variables that were used in both the current and future assessments. In multivariate analysis, even after adjusting for past life satisfaction, both individual factors, such as being unmarried and depressive symptoms, and environmental factors, such as dissatisfaction with the workplace environment and work- or family-related stress, showed associations with current life satisfaction in both men and women. In contrast, for future life satisfaction, even after adjusting for current life satisfaction, frequent feelings of loneliness and a compulsive work style were identified as commonly associated factors in both men and women.Conclusion　Although factors such as marital status and family conflict were strongly associated with current life satisfaction, they were not related to predictions of future life satisfaction. In contrast, frequent feelings of loneliness and a compulsive work style were identified as distinct factors that were strongly associated with the future outlook. Although further verification through longitudinal studies is necessary, the identification of factors that are associated with current and predicted future life satisfaction constitutes an important finding.

Objectives　To assess whether articles indexed in the Ichushi-Web database that report online surveys using internet panels provide sufficient methodological information to facilitate appropriate interpretation and evaluate the overall quality of reporting.Methods　We operationally defined online surveys using internet panels as cross-sectional or longitudinal online surveys conducted among registered monitoring populations. Based on existing reporting guidelines, namely the Checklist for Reporting Results of Internet E-Surveys (CHERRIES) and the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement, we developed 17 evaluation items considered essential for reporting surveys using internet panels. A literature search for original articles published between 2020 and 2024 was conducted using Ichushi-Web, the online search service of the Japan Medical Abstracts Society. Two researchers independently screened titles and abstracts in the first stage, followed by full-text screening by four researchers to identify articles reporting online surveys using internet panels. Four researchers independently evaluated the included articles using predefined evaluation items, and the results were aggregated and analyzed.Results　In total, 165 articles were included in the analysis. General reporting items such as the study period, study population, and ethical approval were adequately reported in most articles. In contrast, only a few articles explicitly stated in the title or abstract that the survey was conducted using an internet panel. Moreover, the key items essential for evaluating reporting quality and transparency, including the participant selection flowchart and information on incentives, were not reported in most articles. The number of invited participants, the number of respondents, the response rate, and the sample size were evenly divided between generally appropriate and not reported. Although the names of survey companies were reported in some articles, the information necessary to assess representativeness, such as the characteristics of the internet panel or the eligibility criteria for panel registration, was rarely provided.Conclusion　Many articles identified through Ichushi-Web that reported online surveys using internet panels lacked critical information necessary to evaluate reporting quality and transparency, particularly regarding panel characteristics and potential sources of bias. This study provides an important foundation for organizing reporting items specific to surveys using internet panels and for the future development of reporting guidelines.

Objective　Strengthening local ordinances and regulations is considered an important strategy for preventing legionellosis associated with bathing facilities. However, no nationwide study has comprehensively examined the relationship between regulatory stringency and legionellosis occurrence. This study aimed to assess the association between the stringency of local ordinances and regulations governing public bath facilities, measured using an ordinance score, and the occurrence of legionellosis across Japan's 47 prefectures.Methods　The ordinance score comprised four domains: water quality testing, facility and equipment standards, hygiene management, and management systems. The score was developed from 31 items identified as relevant to legionellosis occurrence and extracted from Ministry of Health, Labour and Welfare guidelines for hygiene management of public bath facilities. Each item was assigned a score of 1 when prefectural requirements met or exceeded guideline standards and 0 otherwise. Ordinance scores were calculated using prefectural ordinances and regulations available on official websites as of February 2026. Publicly available data were used to calculate 5-year average values for all indicators. Reported legionellosis cases per 100,000 population and the proportion of the population aged ≥50 years were derived from annual data (2020-2024). The number of public bath facilities per 100,000 population, mean annual relative humidity, and annual precipitation were derived from fiscal data (2020-2024). Associations between ordinance scores and reported legionellosis cases per 100,000 population were evaluated using Spearman's rank correlation coefficient. Univariable and multivariable negative binomial regression analyses were conducted with adjustment for selected covariates.Results　A significant negative correlation was observed between ordinance scores and reported legionellosis cases per 100,000 population (Spearman's ρ = －0.33, P = 0.022). Higher ordinance scores were significantly associated with fewer reported legionellosis cases per 100,000 population in both univariable and multivariable negative binomial regression analyses. In the multivariable model, the incidence rate ratio was 0.80 (95% confidence interval, 0.70-0.93). None of the covariates showed a statistically significant association with reported legionellosis cases per 100,000 population.Conclusion　Prefectures with more stringent ordinances and regulations tended to report fewer legionellosis cases per 100,000 population, suggesting that stronger regulatory frameworks may help prevent legionellosis. This study provides the first nationwide evidence linking regulatory stringency with legionellosis occurrence in Japan. Although strengthening local ordinances and regulations may represent an effective public health strategy, its implementation should balance potential benefits against the operational burden imposed on facility operators.

Objectives　This study examined the availability and readiness of municipal data to assess participation in cancer screening among people with severe mental illness (SMI). In addition, we evaluated the feasibility of linking the Medical Payment for Services and Supports for Persons with Disabilities (MPSS) database and the municipal cancer screening database to calculate cancer screening uptake rates among individuals with schizophrenia spectrum disorder.Methods　A two-phase survey was conducted in municipalities in the Kinki, Chugoku, and Shikoku regions of Japan. In Phase 1, municipalities completed a questionnaire on the digitization status of relevant data items in municipal databases, including the MPSS, Mental Disability Certificate (MDC), and municipal cancer screening databases. In Phase 2, municipalities completed a questionnaire assessing the feasibility of generating aggregated data on cancer-screening participation using the MPSS and municipal cancer-screening databases.Results　Of the 429 municipalities surveyed, 67 (15.6%) responded to Phase 1. Of these, approximately 90% of the municipalities managed the MPSS and MDC databases as electronic data files; however, among those using electronic systems, primary diagnoses coded using the International Classification of Diseases, 10th Revision (ICD-10) were recorded in only 45% and 34% of the MPSS MDC databases, respectively. The municipal cancer screening database was electronically managed in over 95% of the participating municipalities. Primary screening results were recorded in 99% of patients, and attendance at follow-up examinations was recorded in ＞ 94% of patients. In the Phase 2 questionnaire, 13 municipalities (3.0%) successfully provided aggregated data by linking the MPSS and municipal cancer-screening databases, enabling the calculation of the municipal cancer-screening uptake rate among individuals with schizophrenia spectrum disorders. However, barriers included missing diagnostic information, technical difficulties in linking data across systems, privacy and data governance concerns, and limited human resources.Conclusion　Assessing cancer-screening uptake rates among people with SMI using the MPSS and municipal cancer-screening databases is technically feasible in a subset of municipalities. However, several challenges remain including limitations in data item completeness, structural barriers between information systems, and human resource constraints. Continued standardization of local government information systems and improvements in the administrative data infrastructure may enable the use of municipal data to design and evaluate cancer-screening policies that are responsive to the needs of people with SMI.

Objectives　The average daily vegetable intake of adults in Japan remains below recommended levels. As foods are primarily purchased at supermarkets (SMs), this study examined whether nudge interventions implemented in SMs are associated with increased vegetable purchases, using a quasi-experimental design.Methods　Among SMs operated by the same company within a single city, three medium-sized stores with similar customer numbers and vegetable sales trends that were located at least 3-km apart were non-randomly assigned to the intervention (stores A and B) or control (store C) condition. In the intervention stores, shopping baskets were equipped with flyers recommending vegetable purchases (Easy-Attractive nudge). Furthermore, Store B displayed a poster that visually presented 70-g portions of popular seasonal vegetables in the produce section (Attractive-Social-Timely nudge). Store C served as the control and received no intervention. The 1-month observation and intervention periods were October and November 2024, respectively. By comparing point-of-sale (POS) data from October to November 2024 with data from the corresponding period in the previous year, we calculated the year-on-year increase rates for daily vegetable sales (primary outcome) as well as non-vegetable and total sales (secondary outcomes), adjusted for relative changes in customer volume. During the final 2 days of the intervention, 50 customers per store were surveyed to obtain their basic demographics, socioeconomic status, awareness of the intervention materials, and impressions. Average treatment effects (ATEs) were estimated using a difference-in-differences approach that modeled outcomes, intervention status, and store and time indicators for the first and second halves of October and November. Store-specific analyses (A versus B) were also performed.Results　No significant differences were observed between stores regarding basic customer characteristics or socioeconomic status. The ATE for vegetable sales was ＋4.0 percentage points (95% confidence interval: 0.6-7.5), indicating a statistically significant increase. In contrast, no significant ATE was observed for non-vegetable sales (－4.4 percentage points: －14.2 to 5.5) or total sales (－3.6 percentage points: －13.0 to 5.9). Store-specific analyses revealed no additional differences between stores B and A. Awareness of shopping basket flyers was 95%. Among those aware, 24% reported purchasing vegetables, 51% expressed positive opinions, and 8% expressed negative opinions. The corresponding figures for the produce-section poster were 36%, 28%, 61%, and 0%, respectively.Conclusions　Easy-Attractive nudge flyers in shopping baskets were associated with increased vegetable purchases. This intervention potentially represents an effective strategy for promoting vegetable selection without increasing the overall customer spending.

Objectives　This study aimed to clarify the implementation status of support for fathers in maternal and child health (MCH) programs and programs primarily targeting fathers in municipalities in fiscal year 2022, examine differences by municipality type, and obtain evidence regarding implementation challenges and future directions.Methods　A self-administered postal questionnaire survey was conducted among municipalities' MCH departments between September and November 2023. Questionnaires from municipalities with responses from public health nurses and data required for analysis were analyzed. Support for fathers in municipal MCH programs through MCH handbook issuances, prenatal classes for parents, infant and child health checkups, and home visits was investigated, including information provision for fathers, assessment of living conditions, health screening, and consultation/guidance. For programs primarily targeting fathers, implementation, objectives, content, performance, perceived necessity, and reasons for non-implementation were examined. Differences by municipality type (special wards/cities vs. towns/villages) were examined using Chi-square or Mann-Whitney U tests.Results　Of the 1,741 municipalities surveyed, 588 returned the questionnaire. Among them, the analysis included 528. Concerning support for fathers in municipal MCH programs, the highest proportion of municipalities reporting no such support was observed for infant and child health checkups (24.6%). For all program types, this proportion was significantly higher in towns/villages than in special wards/cities. In postnatal services, assessment of fathers' health status and consultation/guidance provision were performed by approximately 20-30% of the municipalities. Programs primarily targeting fathers were implemented in 10.4% of municipalities, with a significantly higher proportion in special wards/cities. Of the 473 municipalities that had not implemented such programs, 75.1% recognized their necessity for implementation. The proportion citing "low priority for implementation because of regional characteristics" was significantly higher in towns/villages.Conclusion　Support for fathers in municipal MCH programs was observed. However, in postnatal services, municipalities reporting no such support were identified, and support primarily comprised information collection. Furthermore, only a few municipalities implemented programs that primarily targeted fathers. Differences by municipality type were observed in the implementation status in municipal MCH programs and perceived need for programs primarily targeting fathers, indicating that regional characteristics, workload, and human and financial constraints may influence implementation. Therefore, future efforts should strengthen support in municipal MCH programs to ensure that support continues seamlessly from pregnancy through the postnatal period, while considering program development tailored to regional characteristics.

Objectives　The growing number of foreign residents in Japan has increased linguistic and cultural diversity. Communication with individuals with limited Japanese proficiency has become an essential skill for health professionals; however, systematic educational approaches remain insufficient. This report aims to summarize the educational and training activities conducted by the authors and inform future evaluations and dissemination.Methods　Existing documents were reviewed to identify the advantages and challenges of communication methods for individuals with limited Japanese proficiency in health settings. Experiences from lectures and exercises on Plain Japanese (Yasashii Nihongo) were summarized by setting. A newly introduced practicum, the Multicultural Health Support Practicum, was described.Results　Six communication approaches were identified to support individuals with limited Japanese proficiency; medical interpretation, automatic translation, ad hoc interpretation by family members or others, translated documents, English language, and Yasashii Nihongo. Key challenges include the limited availability of medical interpreters, ethical and confidentiality concerns associated with ad hoc interpretation, and the limited role of English as a common language. Lectures and exercises on Yasashii Nihongo, conducted for 80-90 min, were implemented in multiple settings using public guidelines as teaching materials. After the introductory lecture, the participants rewrote words, short sentences, and longer texts individually or in groups, followed by presentations and peer feedback. Sessions were conducted with varying group sizes and delivered in-person and online. Additionally, a compulsory two-week Multicultural Health Support Practicum, involving hospital visits, roleplay exercises using simulated patients, visits to international centers with special lectures, community placements, and reflection sessions, was established for fourth-year nursing students, with preparatory lectures in the first and fourth years. Its components provide learning opportunities for health support within and outside medical institutions.Conclusion　For communication with individuals with limited Japanese proficiency in health settings, a balanced and appropriate strategy combining Yasashii Nihongo, automatic translation, and translated documents and using medical interpreters if necessary is required. Yasashii Nihongo lectures and exercises suggest that using publicly available materials, such training can be introduced with limited burden and implemented flexibly. Furthermore, the Multicultural Health Support Practicum presents an educational framework that enables stepwise learning through exposure to practices within and outside health settings. Collectively, these initiatives provide insights into educational approaches that will enhance learning in communication and health support skills and improve intercultural society.

Objective　In the fourth phase of Specific Health Checkups and Specific Health Guidance, outcome evaluation was introduced with a 2-cm reduction in abdominal circumference and a 2-kg reduction in body weight as the main achievement goals. This study aimed to clarify the health guidance methods that public health nurses and registered dietitians (health guidance practitioners) from various health insurance providers consider effective for achieving outcome evaluations from two perspectives: implementation methods for health guidance and methods for conducting interviews.Method　This qualitative descriptive study used focus group interviews. The participants were health guidance practitioners who were recruited using snowball sampling. Twenty-four participants were selected by including two groups of six from each job category. A descriptive qualitative analysis was conducted. Results　For implementation methods, 95 codes were extracted, generating 18 subcategories and five categories: utilizing tailored information and communication technology, prioritizing the initial interview in health guidance, preventing interruptions and dropouts, collaborating with other professions/organizations, and improving and standardizing health guidance quality. With regard to the methods of conducting interviews, 79 codes were extracted, generating 16 subcategories and four categories: using motivational expressions and approaches, providing theoretical explanations of current conditions and future prognoses, prioritizing trust building with participants, and enhancing awareness of outcome evaluation.Conclusion　Health guidance practitioners from various health insurance providers identified the following methods as effective approaches for implementing health guidance: combining face-to-face and online guidance, utilizing apps, providing guidance on the day of health checkups, collaborating with health management initiatives, and improving the food environment. Methods for conducting interviews included devising approaches to engage individuals receiving health guidance for the first time, conducting multifaceted assessments of daily life, building trust, setting goals tailored to an individual's readiness, and self-monitoring of weight and other factors. However, further interventional studies are required to validate these findings.

Objectives　Insufficient vegetable intake in children poses a public health challenge. This study investigated the frequency of vegetable consumption at breakfast and examined its association with vegetable consumption at breakfast among parents using longitudinal data from Japan.Methods　Longitudinal data were obtained from infant health checkups, including parental questionnaires, conducted at four months, one and a half years, and three years of age in Obu City, Aichi Prefecture, Japan. Among 1,053 children who underwent all three health checkups between 2019 and 2023, 896 children who provided valid responses were included in the analysis. These analyses determined vegetable consumption frequency at breakfast at three years of age for high (≥4 days/week) and low (≤3 days/week) frequency consumption groups. The exposure variable was vegetable consumption frequency at breakfast for the parents at each time point. Parental responses were divided into high- and low-frequency groups, and four trends were defined; maintained high frequency, decreased, increased, and maintained low frequency. Poisson regression analyses were conducted to calculate the prevalence ratios (PR) of parental trends associated with children's high-frequency consumption at three years after adjusting for potential confounding factors. Separate analyses were conducted for the parents.Results　Among the 896 children, 23.2% exhibited high-frequency consumption at three years of age and, a decrease from 47.8% at one and a half years. The proportions of mothers and fathers exhibiting high consumption were 30.0% and 19.5% (four months), 26.2% and 21.8% (one and a half years), and 25.4% and 19.0% (three years), respectively. Poisson regression analysis revealed that for mothers, compared with low frequency maintenance, high frequency maintenance (adjusted PR [95% confidence interval]; 4.49 [3.25-6.22]) and increased (4.91 [3.47-6.93]) trends were associated with high frequency consumption by children at three years. Similar associations were observed for high frequency maintenance (2.77 [2.10-3.65]) and increased (3.06 [2.29-4.09]) trends among fathers.Conclusion　Vegetable consumption frequency at breakfast among 3-year-old children decreased significantly from consumption at 1.5 years of age and was associated with mothers' vegetable consumption. As age three marks the completion of weaning and transition toward typical home-provided meals; promoting improvements in mothers' dietary habits before weaning could improve breakfast vegetable intake among children.

Objective　Municipal public health nurses (PHNs) provide diverse community health services, including the planning, implementation, and evaluation of local health policies. A well-planned and continuous recruitment system is essential for performing these duties effectively and efficiently; however, many municipalities face difficulties in securing adequate full-time PHNs amid increasing workloads, and establishing sustainable recruitment measures remains a challenge. In this context, supervisory PHNs are expected to possess the ability to establish systems for recruiting and training local government PHNs and are considered to play a crucial role in these processes. However, a quantitative evaluation of the relationship between assignment of supervisory PHNs and number of PHN recruits has not been conducted. This study aimed to clarify this association.Methods　This cross-sectional study was conducted by analyzing the data of 1,733 municipalities in the fiscal year 2020. Data on the presence of supervisory PHNs, number of full-time PHNs, annual PHN recruits, and the total population of each municipality were obtained from the Ministry of Health, Labour and Welfare's Survey on Public Health Nurse Activities by Area of Work and the Ministry of Internal Affairs and Communications' Population Census, and other official statistics. The outcome was the annual number of PHN recruits, and the main explanatory variable was the presence of a supervisory PHN. Multivariable negative binomial regression analysis was used to calculate incidence rate ratios and 95% confidence intervals (CIs), with adjustments for variables related to regional characteristics.Results　Of the 1,733 municipalities analyzed, 865 (49.9%) had a supervisory PHN. After adjusting for municipality size, retirements, and other covariates, municipalities with a supervisory PHN had 1.167 times more PHN recruits than those without a supervisory PHN (95% CI: 1.040-1.310).Conclusions　Municipalities with supervisory PHNs tended to have more PHN recruits than those without supervisory PHNs. This suggests that supervisory PHNs play a crucial role in securing PHN personnel through their involvement in recruitment planning, enhancing workplace attractiveness, and promoting strategic recruitment activities. This result may have important implications for the development of stable and continuous recruitment strategies for municipal PHNs.

Objectives　Community gathering places have emerged as a key population-level approach for frailty prevention in Japan. Although these activities are expected to support health maintenance and long-term care prevention among older adults, evidence regarding their association with frailty remains limited because few studies have adequately addressed potential confounding and reverse causation. This study aimed to examine the association between participation in community gathering places and frailty using large-scale three-wave panel data.Methods　Data were obtained from the 2016, 2019, and 2022 waves of the Japan Gerontological Evaluation Study (JAGES). The analytic sample comprised 41,245 community-dwelling older adults aged ≥65 years from 25 municipalities. Frailty status in 2022 was the outcome, and participation in community gathering places in 2019 was the primary exposure. Thirteen covariates measured in 2016 were included: sex, age, baseline frailty status, urbanicity, equivalent household income, educational attainment, marital status, household composition, employment status, social participation, social support, depressive symptoms, and current medical treatment. Modified Poisson regression models were used to estimate risk ratios. Subgroup analyses stratified by demographic and socioeconomic characteristics were also performed.Results　Older adults who participated in community gathering places at least once monthly had a lower risk of frailty in 2022 than nonparticipants (risk ratio: 0.93, 95% confidence interval: 0.88-0.97). Subgroup analyses showed that the association was generally consistent across sex and age categories. Similar findings were observed among individuals with lower socioeconomic status, indicating that the potential benefits of participation may extend across diverse population groups.Conclusion　Participation in community gathering places was associated with a reduced risk of frailty, suggesting that these community-based activities may contribute to frailty prevention. These findings highlight the importance of strengthening and expanding such programs as part of broader population strategies to promote healthy longevity among older adults.

Objective　To identify barriers to psychological safety in long-term care insurance facilities through a qualitative descriptive analysis of verbatim transcripts obtained from facility directors.Methods　Directors of long-term care insurance facilities in the Kinki region of Japan were recruited using snowball sampling. Semi-structured interviews were conducted between August and September 2023. Verbatim transcripts were analyzed qualitatively and inductively to generate codes representing statements that impede psychological safety. Codes were iteratively grouped to increase abstraction, forming subcategories and higher-order categories. Findings were further organized according to three antecedent domains: individual, structural/system, and interpersonal factors, to examine how these barriers manifest within facilities.Results　A total of 11 directors participated (9 male; age distribution: 40s, n=5; 50s, n=5). Mean age was 50.0 years (SD=6.44), and mean tenure in the current role was 10.4 years (SD=5.12). Three categories of individual factors were identified: "Position of new employees and junior employees," "Trait of being overly conscious of others and defensive of oneself," and "Difficult work performance among employees suspected of having psychological issues." Three structural/system categories were identified: "Limited understanding and capability regarding managerial duties," "Difficulties in managing, supporting, and training staff," and "Burden due to staff shortages and challenges in appropriate staffing." Five interpersonal categories were identified: "Self-centered and dismissive behavior toward others," "Self-righteous and pressure-generating behavior from superiors," "Intolerance and low flexibility associated with excessive righteousness," "Misunderstandings and concerns arising from insufficient ethical knowledge and rumors," and "Emotionally complex relationships that are difficult to reconcile." Interpersonal factors were prominent and interacted with individual factors. The findings suggested that the lack of effective organizational and workplace structures and systems to address these issues hinders psychological safety in long-term care facilities.Conclusion　Individual, interpersonal, and structural/system factors directly and indirectly inhibit open work-related communication among employees in long-term care insurance facilities. Persistent staffing shortages in Japan further exacerbate these barriers. Enhancing psychological safety requires targeted interventions addressing structural/system factors, particularly leadership practices within management.

Abstract　In rapidly aging Japan, supporting older adults in maintaining meaningful social roles is an important public health priority for extending healthy life expectancy and preventing the need for long-term care. In response, the Work-like Activity (Shuro-teki Katsudo) Support Coordinator Placement Program was introduced in 2020 to promote role-based social participation among older adults. Within this policy framework, this paper clarifies the concepts of work-like activities and work-like activity support. By reviewing diverse definitions and practices and examining their alignment with documents issued by the Ministry of Health, Labour and Welfare, we identify key conceptual issues related to work-like activities and emphasize their significance as meaningful forms of social participation, particularly regarding paid activities outside formal employment. Two central perspectives on work-like activity support are highlighted: (1) aligning activities with older adults' preferences and functional conditions and (2) developing and expanding opportunities that accommodate diverse health and functional states. This conceptual framework may support the planning and implementation of municipal programs while providing a common foundation for future research on the prevalence and effects of work-like activities.

Objectives　Insomnia is prevalent among older adults, individuals with depression, and women. It has been linked to hypertension and diabetes mellitus onset and increased risk of dementia, making it a major public health concern. It also affects quality of life and has broader social consequences, such as traffic accidents. The aim of this study was to identify the factors influencing insomnia among community-dwelling older adults using longitudinal data and provide insights to facilitate better sleep and inform future preventive measures.Methods　A self-administered questionnaire was mailed to 3,417 individuals selected from older adults living in 11 areas within Ward A of K City, Kanagawa Prefecture, where the proportion of people aged 65 years and older is relatively high. A similar survey was conducted among 1,755 individuals who agreed to participate in a follow-up survey two years later. The Athens Insomnia Scale (AIS) was used to measure the severity of sleep disorders. Multiple regression analysis (forced entry method) was performed using the AIS score as the dependent variable in the follow-up survey. The independent variables included sex, social network, instrumental independence, back pain, knee or joint pain, self-rated health, role at home, financial situation, and household status.Results　From participants with follow-up data, 917 were included in the analysis after excluding those who had died, were hospitalized, or had an AIS score of 6 or higher at baseline. The characteristics of the participants were as follows: mean age, 75.0 (SD＝5.7) years; 459 males (50.1%); mean social network score, 17.1 (SD＝5.9); median instrumental independence, 5; lower back/back pain, 257 individuals (28.0%); knee/joint pain, 200 (21.8%); self-rated poor health, 72 (7.9%); no role at home, 83 (9.1%); financial hardship, 55 (6.0%); living alone, 141 (15.4%). Multiple regression analysis (forced entry method) was conducted to examine the factors influencing the AIS scores at follow-up. The results showed significant associations of the AIS score with having a small social network and being female. The adjusted coefficient of determination (R2) was 0.312.Conclusion　Increasing social interactions and developing strategies that incorporate sex differences may help reduce insomnia in community-dwelling older adults.

Objectives　Rising heat stress due to climate change has increased the urgency of developing resilient long-term care systems for older adults. This study examined preparedness for heat-related risks in Japanese nursing homes.Methods　This qualitative descriptive study used semi-structured interviews with eight nursing home managers across four regions of Japan: Tohoku, Kanto, Chubu, and Kyushu. Interviews addressed six domains: recognition of extreme heat as a crisis and its impact on care delivery; heat stroke prevention strategies; implementation challenges; essential prevention requirements; gaps in current practices; and concerns about future risks from heat and other disasters. Data were analyzed through text mining using KH Coder (version 3.02).Results　Co-occurrence network analysis identified 10 semantic subgraphs, categorized into three domains. (1) Heat perception included "limitations on outdoor activities" as a measure and "risk of heat-related illness" as a challenge. (2) Living environment management included "indoor temperature management," "ensuring airflow," and "maintenance of air conditioning system" as measures, and "managing localized temperature variations" and "increased electricity consumption and risk of power outages" as challenges. (3) Workload burden included "providing hydration to residents" and "differences in temperature perception between older adult residents and caregivers" as challenges.Conclusion　Preventive measures, including temperature control and adequate hydration, are implemented but increase caregiver workload as temperatures rise. Sustaining long-term care services under these conditions requires strategies that reduce routine staff burden.

Objective　Focusing on novice public health nurses with prior work experience, this study aimed to identify the characteristics of human resource development systems related to career development, and to examine the importance of achievement levels in home visits within such systems.Methods　A web-based survey was conducted targeting all public health nurses newly employed by prefectural and municipal governments across Japan in fiscal years 2023 and 2024. In this study, we analyzed data from individuals with prior work experience. The survey items included demographic characteristics, the Comprehensive Career Development Scale for public health nurses (career score), the human resource development system, and levels of achievement during home visits for basic cases (home-visit achievement). Using hierarchical multiple regression, the career score was set as the dependent variable. In Model 1, all independent variables except home-visit achievement were entered; in Model 2, home-visit achievement was added. The adjusted coefficient of determination (R2) and its change were calculated to examine the contribution of home-visit achievement.Results　A total of 1,679 questionnaires were returned, of which 1,572 were valid, and 734 respondents had prior work experience. In the hierarchical multiple regression analysis, the adjusted R2 values were 0.095 for Model 1 and 0.114 for Model 2, indicating a significant increase of 0.02. In Model 2, variables significantly associated with the career score were workplace consultation (β＝0.19), experience in presenting at academic conferences (β＝0.08), reading journals/books purchased by the workplace (β＝0.14), self-purchased journals/books (β＝0.08), and home-visit achievement (β＝0.15).Conclusion　The adjusted R2 of Model 2 was 0.114, indicating that the career development of novice public health nurses with prior work experience could not be explained sufficiently by the variables examined in this study alone. However, workplace consultation, presentation experience, journal and book reading, and home-visit achievements were significantly associated with career score, with the inclusion of home-visit achievements further improving the explanatory power of the model. These findings suggest that, even for novice public health nurses with prior work experience, human resource development that provides systematic instruction and ensures achievement levels during home visits, together with well-developed consultation systems and learning opportunities, is important for supporting career development during the initial employment period.