Objectives: This study aimed to prospectively investigate the associations among obesity, physical activity, and short-term high medical expenditures in Japanese employees and their dependents. Methods: Participants were 245,044 employees and their dependents aged 40-74 years who underwent the Specific Health Checkup in fiscal year 2008. Health checkup and medical expenditure data for 2008-2010 were provided by health insurers. They were divided into 12 groups according to the combination of body mass index categories (normal, overweight, and obesity) and engagement in exercise and/or daily physical activity (inactive, daily physical activity only, exercise only, and active). The multivariable-adjusted odds ratios of the groups for high total medical expenditures in the next year compared to the inactive normal body mass index group were estimated. High medical expenditures were defined as the top 5% of total annual expenditures, consistent with prior literature identifying high-cost users. Similar analyses were performed by sex and age (<65 years, ≥65 years). Results: Of the participants, 61.8% were men (mean age, 52.1 years). Multivariable-adjusted odds ratios were significantly high only in the inactive groups with overweight or obesity in men and younger individuals. In women and older individuals, the odds ratios were significantly high only in inactive women with obesity; however, the odds ratios were high in women who exercised only and in active older individuals, both with obesity. Conclusions: Exercise or daily physical activity might attenuate the possibility of incurring high short-term medical expenditures in men and younger individuals with overweight or obesity. These findings suggest that physical activity recommendations may need to be tailored for women and older individuals with obesity, and further longitudinal research is warranted.

In Japan, where obesity prevalence is lower than in Western countries, few studies have examined the association between obesity and medical expenditures among patients with diabetes, distinguishing between overweight and obesity by sex. This study examined the association between obesity and medical expenditures among patients with diabetes in Japan. Data on medical expenditures and the Specific Health Checkups obtained from 12 municipal and six union insurers for fiscal years 2008 and 2009 were analyzed. Gamma regression and quantile regression were used to compare annual total, outpatient, and inpatient medical expenditures in fiscal year 2009 among three groups: normal/underweight (body mass index [BMI] < 25 kg/m2), overweight (BMI: 25-30 kg/m2), and obesity (BMI ≥ 30 kg/m2). The analyses were performed separately for men and women, adjusting for age, hypertension, hyper-low-density lipoprotein cholesterolemia, glycemic control, and smoking. Logistic regression was performed, adjusting for the same variables to assess the occurrence of annual total medical expenditures of ¥1 million (approximately US$10,600 in 2009) or more. Annual total medical expenditures were significantly higher in the obesity group than in the normal/underweight group among both men and women (exp(β) = 1.117 [95% confidence interval (CI): 1.023-1.221] among men and exp(β) = 1.157 [1.036-1.295] among women). Both men and women in the overweight and obesity groups had significantly higher outpatient expenditures than those in the normal/underweight group. The overweight and obesity groups had significantly higher medical expenditures than the normal/underweight group in most quantiles among men. The likelihood of annual total medical expenditures exceeding ¥1 million was higher among women with obesity than among those with normal/underweight (odds ratio = 1.546 [95% CI: 1.007-2.375], p = 0.047). These findings suggest that medical expenditures among patients with diabetes who have overweight or obesity are higher than those of normal/underweight patients.

ABSTRACT Oral diseases and masticatory dysfunction are more prevalent in hypertensive patients and may hinder blood pressure (BP) control during pharmacological treatment. However, the effect of the oral function on cardiovascular outcomes in patients with poorly controlled hypertension remains unclear. A total of 5 484 middle‐aged and older hypertensive patients receiving antihypertensive medications without prior cardiovascular diseases (CVD) (mean age: 67.5 ± 8.0 years) were followed to investigate incident CVD. Cox proportional hazards models were used to examine associations between the baseline oral status (number of remaining teeth and denture use) and the risk of developing CVD, stratified by BP control status. Poorly controlled BP was defined as systolic BP (SBP) ≥ 130 mmHg or diastolic BP ≥ 80 mmHg. Over a mean follow‐up period of 9.9 ± 2.7 years, 567 individuals (10.3%) experienced CVD events. In the poorly controlled BP group, tooth loss and non‐use of dentures were significantly associated with an increased risk of CVD; the hazard ratios (95% confidence intervals) were 1.79 (1.28–2.48) for 10–19 teeth, 1.37 (0.97–1.94) for 1–9 teeth with denture use, 1.56 (1.13–2.17) for no teeth with denture use, and 2.17 (1.30–3.64) for 0–9 teeth with non‐use of dentures, compared with ≥20 teeth. This association differed significantly between the poorly controlled and well‐controlled BP groups ( P for interaction = 0.016). In conclusion, tooth loss and non‐use of dentures are associated with a higher risk of CVD among adults with poorly controlled hypertension, suggesting that BP control status under treatment modifies this association.

We examined the effect of sex on the relationship between obesity and hypertension among Japanese people, who generally have a lower prevalence of obesity than Westerners. We analyzed the results of specific health checkups for Japanese aged 40–74 years (688,306 men and 891,191 women) obtained in 2011. The participants were divided into four age groups (40–49, 50–59, 60–69, and 70–74 years) and five body mass index (BMI) categories (≤ 24.9 [non-overweight/obesity], 25.0–26.9 and 27.0–29.9 [overweight], 30.0–34.9 and ≥ 35.0 kg/m2 [obesity]). The odds ratio for hypertension in each BMI category was calculated using normal weight as the reference. The prevalence of hypertension was 26.8%–65.5% for men and 17.6%–53.6% for women in the overweight or obesity categories in the 40–49 age group, and 72.0%–88.7% for men and 70.1%–90.6% for women in the 70–74 age group. In women aged 40–49, the prevalence of hypertension in each BMI category was approximately 10% lower than that in men, but there was almost no difference between men and women in the 70–74 age group. On the other hand, the odds ratio for hypertension was higher in women than in men across all BMI categories and age groups. A stronger relationship between obesity and hypertension was observed in women than in men in all age groups. Japanese women have not been the target of studies for obesity, but more attention should be paid to Japanese women with obesity.

Introduction With staffing shortages, retaining healthcare professionals working in home healthcare is one of the key strategies. Easier tools are needed to capture the work environment characteristics associated with their retention. This study aims to develop a shortened version of the Practice Environment Scale for Home Healthcare, capable of measuring the attractiveness to healthcare professionals. Methods A mail survey with anonymous self-administered questionnaires was distributed to healthcare professionals working at 153 (rate of intention to participate: 7.7%) home-visit nursing agencies in Japan (July-October 2023). The questions included 37 items from the original version of the Practice Environment Scale for Home Healthcare, which comprises seven factors, including job satisfaction, quality of care, and intention to remain. Confirmatory factor analysis was conducted on 21 items from 380 (rate of valid responses: 31.4%) mail surveys. The relationships between the subscale and composite scores of the 21 items for the home healthcare practice environment scale and participants' job satisfaction, quality of care, and intention to remain at the agencies were assessed. Results A seven-dimensional model with 21 items was supported by a confirmatory factor analysis. The Cronbach's alpha of the seven subscales and the composite was 0.80-0.91. The scores on the Practice Environment Scale for Home Healthcare were positively associated with participants' job satisfaction, quality of care, and intention to remain. Conclusion A shortened Practice Environment Scale for Home Healthcare, comprising 21 items, is a valid and reliable measurement that effectively assesses attractive practice environments for healthcare professionals. Improving the characteristics of the work environment, as indicated in the shortened scale, will aid managers and policymakers in securing healthcare professionals in home healthcare settings.

AIM:Specific Health Checkups (SHCs) and Specific Health Guidance (SHG) were launched in 2008, but the factors related to their effectiveness have not been clarified. We examined the mean reduction in body weight (BW) and waist circumference (WC) of participants eligible for active support under SHG. Body size was considered, as well as the number of support points given during SHG, which indicates the amount of support they received. METHODS:A dataset of participants (aged 40-64) who were eligible for SHG and had SHC results collected between 2011 and 2012 was analyzed (n = 76,565). The mean changes in BW and WC between 2011 and 2012 were compared among participants based on their participation status (did not participate, dropped out, finished) and the number of support points for those who finished. Participants were also stratified by sex and BMI (kg/m2): normal weight, overweight, and obese. RESULTS:The mean BW change (95% CI) for those who did not participate and finished SHG was -0.45 kg (-0.47, -0.43) and -1.32 kg (-1.39, -1.25) in men, and -0.66 kg (-0.72, -0.60) and -1.68 kg (-1.87, -1.49) in women, respectively. Higher support points and larger body sizes correlated with greater reductions in BW in men (P＜0.001), but the associations were not significant in women. The reduction in WC was greater in women with normal weight than in obese women. CONCLUSION:Sex differences were observed in the association between BW/WC reduction and body size or the amount of support given during SHG.

BACKGROUND:As global populations age, dementia poses a major public health challenge, necessitating community-based interventions to improve awareness and understanding. Dialogue Cafés, where healthcare professionals engage with local residents, offer a promising approach to enhancing public understanding and health literacy related to dementia. This study evaluates the effectiveness of Dialogue Café sessions in improving attitudes toward dementia and health literacy related to dementia comprehension among community citizens and healthcare/social professionals. METHODS:From October 2015 to February 2016, Dialogue Café sessions on dementia were conducted in six Japanese municipalities, involving 224 participants (217 completed questionnaires). These community-based educational cafés provided structured group discussions between healthcare professionals and citizens using the Dialogue Café approach. Attitude toward dementia and health literacy were measured at three time points: before (T1), immediately after (T2), and one month later (T3). RESULTS:The study included 202 participants (112 health professionals, 90 citizens). Health professionals' Attitude Toward Dementia scale (AD) scores increased from 46.14 (±5.99) at T1 to 47.53 (±5.43) at T2 but slightly declined at T3 (46.74 ±5.56). Citizens showed a greater increase from 42.09 (±7.07) at T1 to 45.35 (±6.40) at T2, with a slight decrease at T3 (44.86 ±5.43). Health literacy improved in both groups, with sustained gains for citizens. Attitude changes were influenced by time, dementia course participation, and caregiving experience. CONCLUSION:Dialogue Cafés effectively enhance dementia awareness and health literacy, particularly among the general public, supporting their broader application in community-based dementia education.

Introduction Securing patient safety is a global concern. Unsafe care can cause preventable adverse events. Nurses play a key role through two types of patient safety behaviors: compliance (mandatory adherence to safety protocols) and participation (voluntary efforts to improve safety). While value congruence with supervisors promotes positive work behaviors, its influence on patient safety behaviors remains unclear. Moreover, a clear link between psychological safety and patient safety outcomes is yet to be established. To fill this gap, the present study examines whether psychological safety moderates the relationships between value congruence regarding patient safety and patient safety behaviors. Objectives To examine the associations between nurses' value congruence with their managers regarding patient safety and both patient safety compliance and participation, and to assess the moderating role of psychological safety in these relationships. Design A cross-sectional, multicenter, self-administered questionnaire survey. Materials and methods The survey was conducted from April to May 2025 among registered nurses working in hospitals across Japan with more than 200 beds. Multivariate regression analyses were employed to examine the relationships among patient safety behaviors, value congruence, and psychological safety. This study was conducted in accordance with the STROBE (STrengthening the Reporting of OBservational Studies in Epidemiology) guidelines. Results In total, 509 nurses at six hospitals were included in the study. Value congruence was associated with patient safety compliance (β=0.347, p<0.001) and participation (β=0.341, p<0.001). The interaction effect of value congruence and psychological safety on patient safety compliance and participation yielded β=0.020 (p<0.630) and β=0.081 (p=0.047), respectively. Conclusions This study introduced the novel concept of value congruence as a contributor to patient safety. Our findings suggest that sharing values and goals related to patient safety can promote both types of patient safety behaviors, and psychological safety plays a key role in fostering voluntary engagement in patient safety practices.

Objectives: A high dietary sodium/potassium ratio with low potassium and high sodium intake, which is a risk factor for hypertension, is a characteristic of diets in East Asia, such as Japan. To promote prevention of hypertension among Japanese workers, knowledge of the antihypertensive effects of potassium, which is not limited to vegetables and fruits and include various potassium-rich foods, such as milk, is important. Thus, we investigated the knowledge of workers on the associations of potassium and milk intake with blood pressure and effective methods for communicating this association. Methods: The participants were 130 Japanese workers, most of whom were under 50 years old and were not using medication for hypertension. After distributing only free dairy products for 3 weeks, leaflets and stickers were distributed with the dairy products to communicate the knowledge about the hypotensive effect of potassium and milk for 3 weeks. At baseline, after distributing only free dairy products, and after providing knowledge, the participants responded to the same questionnaires on the association of potassium and milk intake with blood pressure. Questionnaire responses were analyzed using Cochran’s Q test and multiple comparison analysis. Results: The percentage of the correct answers on the association of potassium and milk intake significantly improved with the knowledge intervention (35.4% at baseline, 50.8% after distributing only the dairy products, and 90.0% after distributing the knowledge regarding potassium). Conclusions: The participants had limited knowledge about the association between potassium and milk intake and blood pressure. Our intervention methods might be effective for improving knowledge of the association.

AIM:To examine the relationship between nurse managers' empowering leadership, nurses' resilience and organisational learning from incidents. DESIGN:Cross-sectional observational study. METHODS:Secondary data from a study conducted in June-July 2022 was used. The sample included 1049 nurses working in three special-functioning hospitals. The self-administered questionnaires assessed nurse managers' empowering behaviours, nurses' resilience and attitudes and behaviours fostering organisational learning from incidents. The analysis employed multilevel analysis with hierarchical linear modelling. RESULTS:Nurse managers' empowering behaviours and nurses' resilience were significantly positively associated with attitudes and behaviours fostering organisational learning from the following incident subscales: make efforts to identify the problem, discuss safety in the workplace, identify and give feedback to address the at-risk behaviour. The interaction of empowering behaviours and resilience was not significant. CONCLUSION:Nurse managers' empowering behaviours and nurses' resilience can contribute to attitudes and behaviours that foster organisational learning, even when nurses face stressful incidents. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE:Fostering empowering leadership in nurse managers and resilience in nurses enhances organisational learning and improves safety and care quality. REPORTING METHOD:The reporting is based on the STROBE guidelines. PATIENT OR PUBLIC CONTRIBUTION:This study did not include patient or public involvement in its design, conduct or reporting.

Background/Objectives: High nurse turnover has economic implications for healthcare organizations and impacts the quality of care. Individual, job-related, and organizational factors determine nurse turnover. This study, thus, aimed to investigate the impact of nurses' resilience and the quality of the relationship between staff nurses and nurse managers, defined as leader-member exchange (LMX), on actual nurse turnover. Methods: A prospective study was conducted from June to July 2022, targeting nurses from three advanced treatment hospitals in Japan. Data were collected through a self-administered questionnaire investigating the participants' actual turnover in April 2023. The data of 1130 nurses were analyzed in this study. A binary logistic regression analysis was performed using actual turnover as the dependent variable and nurse resilience and LMX as independent variables. Results: The results revealed that while LMX influenced actual turnover, nurse resilience had no statistically significant relationship with turnover. Conclusions: The findings show that LMX needs to be improved if actual turnover is to be curbed.

Background/Objectives: Reducing sodium (Na) and increasing potassium (K) intake are important for lowering blood pressure (BP). Practical measures to decrease the dietary Na/K ratio are needed. A crossover design intervention study serving lunches prepared using K-enriched (low-Na/K) seasonings and dairy at an employee cafeteria was conducted. Methods: Participants consumed lunches containing low-Na/K seasonings and dairy as intervention meals and regular lunches as control meals for four weeks each, and we examined the changes in BP and urinary Na/K ratios. The Na and K contents of the meals were also measured. Results: A total of 166 employees (17.5% of whom were hypertensive, while 42.2% were women; mean age of 44.3 years) who regularly use the cafeteria completed the whole survey. The intervention meals contained less Na (66.4 vs. 74.2 mmol/serving) and more K (15.1 vs. 9.9 mmol/serving) than the control meals, and the average Na/K ratio was significantly lower (4.6 vs. 8.2, p < 0.001). The average urinary Na/K ratio was significantly lower in the intervention period than in the control (3.69 vs. 4.10, p = 0.008), but there was no difference in the average BP. Participants rated both the intervention and the control meals to be similarly good; 69.5% and 73.7% reported that the taste was fine, respectively, with no significant difference. Conclusions: Employing low-Na/K seasonings and habitual dairy consumption at lunchtime were effective in reducing urinary Na/K in a healthy working population. This may be a practical measure for sustainably decreasing dietary Na/K and controlling age-related increases in BP. UMIN-CTR registration: UMIN000050876.

Objectives:To 1) design an online training program for Japanese healthcare professionals (HCPs) on the development and use of patient decision aids (PtDAs); 2) assess the acceptability of the program, participants' satisfaction with it, and their intention to develop and implement PtDAs, and 3) obtain suggestions from participants to improve the program. Methods:A user-centered approach was used to design an online training program for Japanese HCPs on the development and use of PtDAs. HCPs (physicians, nurses, midwives, psychologists, etc.) were recruited to evaluate the training. A total of 40 HCPs completed questionnaires regarding the acceptability of the program, their satisfaction with it, intentions to develop and use PtDAs, and suggestions for improving the program. Results:Acceptability ratings for the program were high, with over 90 % of participants finding it useful and easy to understand. Thirty-nine of the 40 participants watched all the videos at least once. Ninety percent of the sample were satisfied with the program, and 95 % (n = 38) intended to use PtDAs in the future, although only 65 % (n = 26) planned to develop such tools. Conclusion:Our online training program for Japanese HCPs on the development and use of PtDAs was acceptable and useful, and most professionals indicated their intentions to use such tools. Innovation:There is a lack of resources on PtDAs in Japan. Our online training program is an innovative resource for HCPs that fills an important gap in facilitating shared decision-making.

BACKGROUND:In Japanese medical practice, older stroke survivors are overwhelmed with information regarding their discharge locations, creating more decision-making challenges. A randomized controlled trial evaluated the influence of decision aids (DAs) for matching older stroke patients and their families' values concerning decisional conflict and participation in discharge destination decisions. METHODS:Participants were randomly allocated to intervention and control groups. The intervention spanned two months, from admission to discharge, at which times participants were surveyed. DAs were provided to the intervention group, and brochures to the control group. The primary endpoint was decisional conflict, assessed using the Decisional Conflict Scale (DCS). The secondary endpoint decision-making participation was assessed using the Control Preference Scale (CPS) decision-making roles and a 10-point Visual Analog Scale for participation rate. An independent t-test analyzed decisional conflict scores and participation rates to examine between-group differences. The chi-square independence test evaluated roles in decision-making scores. Post hoc subgroup analyses were performed. RESULTS:Ninety-nine participants (intervention group n = 51; control group n = 48) were included in the full analysis set, with a dropout rate of 38.4%. No significant group differences were found in decision-making conflict [t (99) = 0.69, p = 0.49, d = 0.14] and roles in decision-making scores [χ2 (5) = 3.65, p = 0.46]. However, a significant group difference was found in the participation rate [t (99) = 2.24, p = 0.03, d = 0.45]. DA tended to reduce uncertainty and promote participation rates, especially in participants living alone and unable to decide their discharge destination. CONCLUSIONS:The use of DA with older stroke patients did not significantly decrease decisional conflicts. In addition, the participation rate in decision-making increased, but their active role did not. Further studies should be conducted to understand the methods of offering DA, their ideal durations, and identify their beneficiaries.

BACKGROUND:Disaster survivors experience deterioration in lifestyles and an increase in constipation. After the Great East Japan Earthquake in 2011, some survivors were evacuated for a long term, even after moving to temporary housing and public reconstruction housing. However, annual changes in constipation and the association between lifestyles and constipation among the survivors are still unknown.METHODS:Overall, 9,234 survivors aged 18 years or older participated in this 9-year follow-up survey after the disaster. Information about the prevalence of constipation and lifestyle factors (diet, physical activity, and mental health) was collected using a self-reported questionnaire. Their dietary intake was categorized into the following two dietary patterns: prudent (fish and shellfish, soybean products, vegetables, fruits, and dairy products) and meat (meat and eggs). Odds ratios for constipation according to lifestyle factors were calculated using a generalized linear mixed model.RESULTS:In women, the prevalence of constipation was the highest at baseline (8.7%) and remained around 5% afterward. In both men and women, older age, poor mental health, and poor physical activity were significantly associated with higher odds ratios of constipation. Moreover, a lower frequency of meals and a lower prudent dietary score were significantly associated with women's constipation.CONCLUSION:The prevalence of constipation was the highest at baseline and remained around 5% in women. Lifestyle factors, such as poor mental health, physical inactivity, and low frequency of meals were associated with constipation. Our findings suggest continuous support for the survivors with constipation for medium- to long-term after disasters.

The excessive intake of sodium (Na) and insufficient intake of potassium (K) are major concerns in the prevention of hypertension. Using low-Na/K seasonings (reducing 25% of the NaCl and adding K salt) may improve the dietary Na/K ratio and help prevent hypertension. To devise an intervention study using low-Na/K seasonings at a company cafeteria, we calculated the Na and K contents of the meals served at the cafeteria and estimated changes in the intakes when suitable low-Na/K seasonings were used. We also considered using milk as a good source of K. We used an ingredient list of a company cafeteria and calculated Na and K contents in each dish. The average amounts of NaCl and K per use were 5.04 g and 718 mg, respectively. Seasonings contributed 70.9% of the NaCl. With the use of low-Na/K seasonings, an estimated reduction in NaCl of 0.8 g/day and an estimated increase in K of 308 mg/day was achieved. With an additional serving (200 mL) of milk, NaCl was reduced by 0.57 g/day and K was increased by 610 mg/day, with an overall decrease in the dietary Na/K ratio from 3.20 to 2.40. The use of low-Na/K seasonings and dairy may improve the dietary Na/K ratio among cafeteria users and help prevent hypertension.

Background The objective of this study was to predict when Bangladesh would achieve Sustainable Development Goal Target 3.1, which is to reduce the maternal mortality ratio (MMR) to less than 70 per 100 000 live births. Methods We used secondary data from the 1993 to 2017 Bangladesh Demographic and Health Surveys and other sources to project the MMR until 2060 under several scenario assumptions using an autoregressive moving average model with exogenous variables (ARMAX). Explanatory variables were selected based on the three delays model, and a reference forecast and four practical scenarios were simulated: Scenario 1 assumed a 4% annual increase in institutional deliveries, Scenario 2 followed the national goals, the reference forecast and Scenario 3 varied in terms of district-wise increase rates (Scenario 3 had a lower rate of increase), and Scenario 4 assumed minimal changes in institutional deliveries. Results Scenario 1 was the earliest, with an MMR of <70 per 100 000 live births in 2026. Scenario 2 would meet the target of <70 per 100 000 live births in 2029. The reference forecast had the third lowest MMR, with 69.78 per 100 000 live births (95% prediction intervals (PI) = 32.44 to 107.11) in 2049. Although the MMR for Scenario 3 decreased slowly, it would not reduce below 70 per 100 000 live births by 2060. Scenario 4, which had the highest MMR, also resulted in the MMR not reducing below 70 per 100 000 live births by 2060. Conclusions To increase the institutional delivery rate and reduce the MMR, as in Scenarios 1 and 2, it is necessary to improve the institutional delivery rate in regions with low institutional delivery rates. Additionally, health facilities need to provide appropriate quality medical care to increase the institutional delivery rate and contribute to a decrease in the MMR, as shown by the results of this study.