[Need for livelihood support and relationship with community residents: A cross-sectional survey among older adults who do not use livelihood support in a rural area].

Objectives　In recent years, the Japanese government has promoted a livelihood support system based on residents-based mutual help in the community. This study aimed to examine the associations between the need for livelihood support and the relationship with community residents among older adults who do not use livelihood support in a rural area. We operationally defined livelihood support as helping older adults with daily problems so that they can continue to live in familiar neighborhoods.Methods　A self-administered questionnaire survey was conducted in Gejo Area of Tokamachi City, Niigata Prefecture in October 2018. The questionnaires were distributed to all 1,033 residents aged 65 years or over, excluding those certified with care levels 3-5 in the long-term care insurance system. The survey items included basic characteristics, health status, relationship with community residents, and need for 33 livelihood support items.Results　A total of 802 questionnaires were returned (response rate of 77.6%), and 653 community-dwelling individuals who had not used livelihood support were included in the analysis. Factor analysis grouped the 33 livelihood support items into four factors: temporary problems and troubles (53.4%), participation in events and gatherings (38.0%), daily household chores (31.7%), and small problems in daily life (27.7%). Logistic regression analysis showed that the need for assistance with temporary problems and troubles was related to "low trust in community residents," "willing to help community residents but have not yet done so," and "willing to help community residents and have already done so." The need for assistance with participation in events and gatherings was related to "willing to help community residents but have not yet done so," "willing to help community residents and have already done so," and "higher levels of sekentei." The need for assistance with daily household chores was related to "low trust in community residents" and "willing to help community residents and have already done so." Finally, the need for assistance with small problems in daily life was related to "willing to help community residents and have already done so."Conclusion　The need for livelihood support was related to relationships with community residents. To promote the livelihood support system in communities, the relationships between older adults and community residents should be considered.

Message framing effects on attitude and intention toward social participation in old age.

BACKGROUND: Message framing is frequently used to advocate health perceptions and behaviors. The effects of message framing on various health behaviors have been examined; however, its effects on social participation, a key determinant of healthy aging, are unclear. This study investigated the effects of message framing on older adults' attitudes and intentions toward social participation. METHODS: A questionnaire survey conducted in 2020 targeted community-dwelling people aged ≥ 65 years in two rural areas in Japan. Participants were randomly allocated to four groups according to the types of framed messages to promote social participation activities: "private gain-framed message," "private loss-framed message," "public gain-framed message," or "no message." Outcomes included attitudes and intentions toward social participation (impression, interest, and readiness for social participation activities). RESULTS: A total of 1,524 participants were analyzed (men: 46.3%; average age: 75.7 ± 7.9 years). Ordinal logistic regression analyses of individuals who engaged in any social participation activity showed no significant intergroup difference in the outcomes after adjusting for potential covariates. Among people who did not engage in any activity, the private loss-framed message was associated with a more favorable impression and higher interest and readiness than no message. The private gain-framed message was related to a higher interest in social participation. CONCLUSIONS: Private loss-framed messages are possibly most effective in reinforcing attitudes and intentions toward social participation, particularly among individuals without social participation experience. These findings highlight the possibility of using a message-framing approach to promote social participation in older adults.

[Characteristics of older people willing to offer lifestyle support to other community members living in rural areas with heavy snowfall].

Objective　The increasing aging population has increased the number of older people who need lifestyle support because of their declining mental and physical health. In recent years, it has become necessary to increase the number of residents who can provide lifestyle support. It is highly expected that older people, as local residents, will be keen to offer lifestyle support. This study identified the characteristics of older people willing to offer lifestyle support to other members of the community living in rural areas with heavy snowfall.Methods　We surveyed 801 people, aged 65 years and above, who lived in Yoshijima, Kawanishi town, Yamagata Prefecture, and were not certified in nursing care levels 1-5. A questionnaire was distributed and collected by the president of the neighborhood association and the head of the neighboring group. Data were collected from June to July 2018. The survey included items on basic attributes, health status, social relations with neighbors, and willingness to offer lifestyle support (eight types). A logistic regression analysis was conducted for each support type, with basic attributes, health status, and social relations with neighbors as independent variables and willingness to offer lifestyle support as the dependent variable.Results　We analyzed the data of 586 participants (73.2% valid responses) and found that women were interested in "being a talking partner/consultant in cases of trouble," "helping with meal preparation/cleaning and laundry," and "inviting their neighbors to gatherings and events." However, they were uninterested in "performing outside work such as gardening or fieldwork" and "snow shoveling and removal." People who felt they were affluent were eager to perform "pick-ups and hospital visits," and the higher educated were more interested in "being a talking partner/consultant in cases of trouble" and "helping with meal preparation/cleaning and laundry." Those involved in highly instrumental activities were interested in "monitoring/safety confirmation," "inviting their neighbors to gatherings and events," "accompanying their neighbors for shopping or serving as a substitute," and "pick-up and hospital visits." Further, except "helping with meal preparation/cleaning and laundry" and "performing outside work such as gardening or fieldwork," people with close relationships with their neighbors were significantly more willing to offer support.Conclusion　The characteristics of older people willing to support others depended on the type of lifestyle support required. This finding could help in the recruitment and facilitation of older people willing to offer lifestyle support.

[Concept analysis of "Gojo" (mutual help)].

Objective　The purpose of this study is to redefine "Gojo" (mutual help) among residents and explore measures to develop it Gojo in the integrated community care system. In 2000, long-term care insurance accelerated Japan's movement toward an aging society, thus increasing the importance of Gojo. This study aims to clarify the conceptual definition it has come to acquire in recent years and explore ways it can be developed in comprehensive community systems.Methodology　Rodger's evolutionary concept analysis was utilized in the study. A keyword research was done using the term "Gojo" in the Japan Medical Abstracts Society (Ichushi Web) and CiNii Articles databases. The search period was from 2000 to 2016 (search date: August 30, 2016) and the database search formula was set to "Gojo/TA". Thirty documents were selected through random sampling and a total of 32 documents were selected for analysis, including landmark documents. A qualitative analysis was conducted on three frameworks: attributes (i.e., characteristics of Gojo), antecedents (i.e., factors affecting Gojo), and consequences (i.e., expected results for Gojo). These three frameworks represent how Gojo is used, the events occurring before it, and the events resulting from it, respectively.Results　The characteristics of Gojo were found to include "experiences of empathy toward residents' daily need for support," "awareness about the residents' efforts to support each other," and "interaction among residents who support other's daily needs." The factors affecting Gojo were identified to be "the need for daily life support beyond what self-help, social solidarity care, and governmental care can provide"; "interchange among residents"; "sharing needs for daily life support among residents"; and "a resident-led public system that promotes mutual support." Gojo's expected results were "a solution for residents' needs of daily support"; "promotion of self-help awareness"; "providing them with a role to enhance their purpose in life"; and "encouraging exchanges and relations between them."Conclusion　Gojo was defined as "the interaction between local residents who support their daily needs, have an empathic experience of the need for daily life support, and have the desire to support each other." In addition, the following points were suggested as measures necessary to expand Gojo. The residents must have sympathy for other residents who need daily life support, understand the benefits of supporting each other, and have a public support system, even if Gojo is led by the residents.

[Characteristics and challenges of health promotion volunteer organizations in Japan: Findings from a national municipality survey].

Objective　Various types of health promotion organizations exist in Japan, including volunteer organizations that promote healthy diets, health improvement, and maternal and child health. Health promotion volunteers, trained and recruited by municipalities, provide counseling and education on various health concerns to community members. A previous study on the effect of these activities and the organizational challenges demonstrated a decrease in the number of volunteer members. The present study aimed to identify the organizational characteristics and challenges of health promotion volunteer work in Japan to gain insight into volunteer recruitment and organizational management.Methods　A questionnaire was sent to 1,873 Japanese municipalities via e-mail or postal mail (excluding Tokyo's 23 wards). For cities of cabinet order, a questionnaire was sent to each borough in the municipality. Data were collected from February to March 2017. The survey was used to collect data on four types of health promotion volunteer organizations: healthy diet (organizations of volunteers who were shokuseikatsu kaizen suishinin), health improvement (organizations of volunteers who were kenkozukuri suishinin), and two types promoting maternal and child health (organizations of volunteers who were boshihoken suishinin and aiikuhan). We asked about the presence or absence of the organization type, year of establishment, number of members, the largest age group, recruitment methods, etc. Twelve organizational challenges were measured with a six-item Likert scale (from 1="strongly agree" to 6="strongly disagree"). Proportions of active members in the volunteer organization ranged from 0% to 10%.Results　Eight hundred eight municipalities responded to the survey (valid responses: 805, valid response rate: 43.1%). The presence or absence of the four types of volunteer organizations differed among the municipalities. The most common type was organizations of volunteers who were shokuseikatsu kaizen suishinin (84.7% municipalities), followed by kenkozukuri suishinin (64.3%), boshihoken suishinin (26.4%), and aiikuhan (10.1%). The total ratio of responses of "strongly agree," "agree," and "somewhat agree" about the organizational challenges, including "The organization cannot find new members easily" and "The participants are always the same people," was commonly more than 50% for the four types of volunteer organizations. The challenges, including "Many do not enjoy what they do," "For many volunteers, participation is limited due to work and family obligations," and "The goal of the activities is not widely shared among volunteers," were significantly correlated to the proportion of active members in the volunteer organization for all four types of organizations.Conclusion　This study revealed that organizational characteristics differed among the four types of health promotion volunteer organizations; however, many of the organizational challenges were found to be common throughout Japanese municipalities.

[Factors related to support provided by preschool personnel for parents rearing children with special needs: Focus on communicating about the child's developmental problems].

Objectives　Developmental disorders can hinder the acquisition of cognitive function, verbal ability, gross motor skills, and social skills. Therefore, it is necessary to detect them as soon as possible and to consider methods of providing support. Under these circumstances, preschool teachers are responsible for facilitating the support system. This study aimed to describe and classify the support provided by preschool personnel to parents of children with special needs, and to consider the measures necessary to promote support for such parents.Methods　Self-administered questionnaires were distributed to authorized preschool principals and teachers. The questionnaire for principals addressed facility factors within the preschool support system, and that for preschool teachers addressed the teaching factors related to their knowledge and attitude, collaboration among those inside and outside the facility, and support for parents of children with special needs. In addition, we examined the status of support provided to parents for each of the children with special needs picked up by a preschool teacher. To investigate the factors related to the implementation of support to parents, we conducted a multiple logistic regression analysis with the facility and preschool teaching factors as independent variables, and the presence or absence of preschool teachers' support for parents from as a dependent variable.Results　Overall, 10.8% of the children in the surveyed preschools had special needs. Among the surveyed principals and teachers, 73.4% responded that they provided support to parents by "developing a healthy relationship," while 39.5% reported that they provided support by "communicating about the child's developmental problems." In the generalized regression analysis on 535 children with special needs excluding missing values, factors associated with "communicating about the child's developmental problems" were "reflecting on the support that was offered in the teacher-parent conference," "collaborating with other professional staff to a high degree," and "being confident in providing support to parents."Conclusion　This study revealed factors related to providing support for parents of children of concern. The findings suggested that, to promote the provision of support for parents and to establish an early support system for children with developmental disorders, it is necessary to examine ways to conduct a support conference to review actions of preschool teachers retrospectively and to strengthen cooperation with other institutions. It might be effective to solve problems related to developmental disorders at the preschool level through the Community Association for Supporting Developmental Disorders.

[Development and effectiveness of care preventive supporter training programs based on a literature review].

Objective　Many preventive care supporter (e.g. kaigo-yobo supporter) training programs, conducted to train community residents, are developed by municipalities. However, it is not necessary that only municipalities can train people effectively or efficiently. In this paper, we initially reviewed the relevant literature and clarified the definitions of concepts like "program contents" and "evaluation indicators," while also planning our own training programs. Later, we developed a program based on the review and examined the results.Methods　The literature of the training program was examined, and the training program was developed based on the result. Four researchers and three public health nurses from a community general support center, in the Otsuchi Town of Iwate Prefecture, developed a training program from June to September 2017. The training program developed was then conducted from October to November 2017. To evaluate the participants' satisfaction with the program, a self-report survey was conducted. To evaluate the outcomes of the program, we measured their degree of comprehension of their community's challenges, before and after the program.Results　The training program was divided into two parts following the literature review. In the first part, the content of the supporters' activities following the program was determined (Type A), and, in the second, the same content was evaluated by the participants within the program (Type B). Type A consisted of various aspects including both concrete knowledge and skills needed to conduct care preventiveactivities after the program. In Type B, there were many aspects-including both lectures and exercises-that aimed to increase the participants' awareness of community challenges, as well as inspection to learn about pioneering activities which helped them consider concrete care preventive activities following the program. In Otsuchi Town, we found it to be imperative for participants to consider how to respond to various situations and accordingly plan the training program for use in Type B. To evaluate the results, 12 participants were analyzed. Participants included two men and ten women, with an average age of 71.4±10.0 years [range: 53-88]. Comprehension levels of community challenges (3.1→4.1, P=0.046), as well as the confidence to actively involve themselves in their own preventive care strategies (3.4→4.0, P=0.035), significantly increased after involvement in the program. However, their confidence to work for community preventive care support groups (3.1→3.5, P=0.227) did not increase significantly.Conclusion　We clarified certain viewpoints, such as the purpose, content, and evaluation indices of community care training programs, by reviewing the relevant literature. Based on the discovered viewpoints, we were then able to obtain certain results through implementing our own training programs, thereby significantly increasing participant comprehension and confidence levels.

Cultural Capital: A Concept Analysis.

OBJECTIVE: Harnessing community assets may help public health nurses address health inequalities. Cultural factor is one such asset, which is assumed to be capital in a community. Cultural capital is a key concept for understanding the causes of public health issues. This paper provided an in-depth analysis of "cultural capital" as a concept. DESIGN AND SAMPLE: Rodgers' evolutionary methodology was used for concept analysis. Forty-two studies published in English between 1998 and 2015 were retrieved from MEDLINE by searching for "cultural capital" in the title field. RESULTS: Antecedents of cultural capital included "educational environment," "belongingness in one's social group," "existing health/social inequalities," and "daily behavior." Cultural capital's identified attributes were "social cultivation," "reproductive rubric," "practical knowledge," and "autogenic ability." Cultural capital's consequences were "improving productivity," "reducing health/social inequality," and "enhancing well-being." CONCLUSIONS: Cultural capital is defined as capital characterized by cultivation, rubric, knowledge, and ability. These aspects of cultural capital are typically autogenic, and accumulate and reproduce through lifelong community membership. Cultural capital reduces inequality and ultimately enhances the well-being of individuals and the community through bonding, bridging, and linking economic and social capital.

Efficacy of a training program designed to help address challenges faced by health promotion volunteers.

Objective　To evaluate the effectiveness of a training program designed to address the following three challenges facing health promotion volunteers: lack of new volunteers, short tenure of volunteering, and failure to build a collaborative relationship with other civic organizations.Methods　Thirty-eight volunteer leaders representing 36 school districts (one from each district and two additional leaders) from southern parts of Shiga Prefecture participated in the training program. Four training sessions were conducted between July 2012 and January 2013. Each session lasted for 2 hours. The program included a lecture, group work, and role playing, all of which centered on the challenges experienced by the volunteers and possible solutions. Those who participated constituted the "training group," and other volunteers in the same area of Shiga, who did not take part in the program, made up the "non-training group." A third, control group consisted of health promotion volunteers based in City A, located outside the areas where the training occurred. To compare the three groups, we collected data before and after the training. The main evaluation index comprised the following three survey items: having confidence in recruiting new volunteers, having confidence in overcoming the difficulties or discouragement to continue to volunteer, and having confidence in explaining their activities to other local organizations to earn their cooperation. These questions were asked in a self-administered questionnaire using a 6-point Likert scale (1: strongly disagree, 6: strongly agree).Results　The data were compared among the training group (28 out of the 38 participants completed the survey), non-training group (n=293), and control group (n=107). On the question about recruiting new volunteers, the training group's mean score increased from 2.9 (standard deviation (SD)=1.3) to 3.3 (SD=1.0) following the training, and the improvement relative to the other two groups was statistically significant (P=0.008 for training vs. non-training, P<0.001 for training vs. control). On the question related to overcoming challenges and continuing volunteering, the training group's mean score went up from 3.3 (SD=1.1) to 3.5 (SD=0.9). The change was statistically significant compared to the non-training group (P=0.033), but not compared to the control group (P=0.401). No statistically significant change was found for the cooperation variable.Conclusion　Overall, this training program appears to be effective in addressing the challenges that health promotion volunteer organizations face.

Ki67 antigen contributes to the timely accumulation of protein phosphatase 1γ on anaphase chromosomes.

Ki67 is a protein widely used as cell-proliferation marker, with its cellular functions being hardly unveiled. In this paper, we present the direct interaction between Ki67 and PP1γ, a protein phosphatase showing characteristic accumulation on anaphase chromosomes via the canonical PP1-binding motif within Ki67. In cells depleted of Ki67, PP1γ is targeted to anaphase chromosomes less efficiently. Additionally, overexpression of Ki67, but not a mutant form without the ability to bind PP1γ, induced ectopic localization of PP1γ οn metaphase chromosomes. These observations demonstrate that Ki67 is one factor that defines the cellular behavior of PP1γ in anaphase. To explore the specific roles of the subset of PP1γ recruited on chromosome via its interaction with Ki67 (PP1γ-Ki67), endogenous Ki67 was replaced with a Ki67 mutant deficient in its ability to interact with PP1γ. Although no obvious defects in the progression of mitosis were observed, the timing of dephosphorylation of the mutant Ki67 in anaphase was delayed, indicating that Ki67 itself is one of the substrates of PP1γ-Ki67.

The effect of skill mix in non-nursing assistants on work engagements among home visiting nurses in Japan.

AIM: This study evaluated the effect of a skill-mix programme intervention on work engagement in home visiting nurses. BACKGROUND: A skill-mix programme in which home visiting nurses are assisted by non-nursing workers is assumed to foster home visiting nurses' work engagement. METHOD: Pre- and post-intervention evaluations of work engagement were conducted using self-administered questionnaires. A skill-mix programme was introduced in the intervention group of home visiting nurses. After 6 months, their pre- and post-intervention work engagement ratings were compared with those of a control group. RESULT: Baseline questionnaires were returned by 174 home visiting nurses (44 in the intervention group, 130 in the control group). Post-intervention questionnaires were returned by 38 and 97 home visiting nurses from each group. The intervention group's average work engagement scores were 2.2 at baseline and 2.3 at post-intervention; the control group's were 3.3 and 2.6. Generalised linear regression showed significant between-group differences in score changes. CONCLUSION: The skill-mix programme might foster home visiting nurses' work engagement by improving the quality of care for each client. Future research is needed to explain the exact mechanisms that underlie its effectiveness. IMPLICATIONS FOR NURSING MANAGEMENT: In order to improve the efficiency of services provided by home visiting nurses and foster their work engagement, skill-mix programmes might be beneficial.

[Mothers' difficulty in childrearing classified in terms of their children's behavioral characteristics].

OBJECTIVES: Mothers who experience difficulty in childrearing are becoming increasingly more prevalent in Japan. This study described and classified mothers' childrearing difficulty in terms of their children's behavioral characteristics and related factors. METHODS: Self-administered questionnaires were distributed to 818 mothers at their children's 3-year-old health checkup in eight suburban cities in Japan. The questionnaire consisted of items assessing the mother's experience of difficulty in childrearing for the child undergoing the checkup. The subjects were classified into four groups according to their children's behavioral characteristics: "low needs," "internalizing behavior," "externalizing behavior," and "comorbid internalizing-externalizing behavior." Multiple regression analysis was performed to examine the relationships between mothers' difficulty in childrearing and related factors. RESULTS: A total of 775 respondents were divided as follows: 332 mothers had children with low needs, 104 had those with internalizing behavior, 230 had those with externalizing behavior, and 109 had those with comorbid internalizing-externalizing behavior. Mothers in the low needs group showed less childrearing difficulty than did mothers in the other groups. Childrearing difficulty increased by group in the following order: internalizing, externalizing, and comorbid internalizing-externalizing. In all four groups, mothers with low self-efficacy and less appraisal support from their family encountered greater childrearing difficulty. In the low needs group, experiencing childrearing difficulty with another child was related experiencing childrearing difficulty with the child undergoing the checkup. In the internalizing behavior group, mothers who had experienced greater difficulty in childrearing were more likely to be housewives and of younger age, and were more likely to have had boys as the child undergoing the checkup. In the externalizing behavior group, mothers with more difficulty in childrearing were more likely to be younger and less healthy, have less appraisal support from their friends, and live in apartments. In the comorbid internalizing-externalizing group, if the mothers were housewives, they were more likely to have difficulty in caring for their other children, receive less appraisal support from their friends, and experience more difficulty in childrearing. CONCLUSION: The results showed that mothers' difficulty in childrearing and the factors related to this difficulty differed according to their children's behavioral characteristics. Public health nurses could provide more effective care and support to mothers by considering children's behavioral characteristics.

Mental health and current issues of migrant workers in Japan: A cross-sectional study of Vietnamese workers.

BACKGROUND: Over the past 5 years, the number of Vietnamese migrant workers in Japan has grown rapidly to become the largest group of migrant workers in the country. They hold various statuses of residence and are subjected to multifactorial stressors. AIMS: The current study's aim is to investigate the association between psychological distress experienced by Vietnamese workers and their work environment. Another aim is to discuss issues involving migrant workers by comparing the characteristics of workers in the major statuses of residence. METHODS: The study applied a cross-sectional design, and included a nationwide self-administered online questionnaire that was conducted in Vietnamese in 2022. The questionnaire included the Kessler Psychological Distress Scale (K10), workplace interpersonal factors as well as factors related to work and health. A multiple logistic regression analysis was conducted to investigate factors associated with psychological distress. RESULTS: Of 933 Vietnamese workers, 37% were grouped as distressed under the K10 cutoff. Fewer opportunities to speak with Japanese co-workers, lower welfare and workload ratings, and the visa statuses including 'Technical Intern Training' were significantly associated with psychological distress. Unexpectedly, those in 'Engineer/Specialist in Humanities/International Services (ESI)' category who are deemed to hold better conditions demonstrated the highest amounts of distress. CONCLUSION: Outside of unsatisfactory working environments, differing situations depending on status of residence could produce various sources of distress. The difficult aspects of Japan's distinct culture seem to contribute to their distress, especially for those who have more interactions with Japanese co-workers. A push for a multicultural society, where migrant workers can pursue proactive life designs of their own choosing, is warranted.

Exploring the ideal combination of activity satisfaction and burden among health promotion volunteers: a cross-sectional study in Japan.

BACKGROUND: Health promotion volunteers (HPVs) who are expected to function as leaders in promoting community health in Japan feel both satisfaction and burden associated with their community engagement activities. The purposes of this study were 1) to describe the prevalence of volunteers with differing levels of activity satisfaction and burden; 2) to examine the association between satisfaction and burden with activity involvement and persistence, and life satisfaction; and 3) to explore associated factors by satisfaction/burden levels among Japanese HPVs. The research question for this study was as follows: What is the relationship between activity satisfaction and burden among HPV? METHODS: A mail-in self-administered questionnaire survey was distributed to 604 HPVs in the cities of Konan and Koka, Shiga Prefecture, central Japan, in September 2005. Questions encompassed demographic data, variables regarding HPV activity such as organizational environment, social support, and the relationship with the neighborhood association, and overall satisfaction and burden related to the activity. RESULTS: The analyzed sample comprised 422 HPVs. Those with high satisfaction/low burden represented the largest number of study participants (group A; 38.4%). HPVs with high satisfaction/high burden (group B), low satisfaction/low burden (group C), and low satisfaction/high burden (group D) represented 23.0%, 11.1%, and 27.5% of participants, respectively. HPVs in groups A and B reported a greater total number of activities undertaken than those in group C. However, HPVs in group A had higher life satisfaction than those in groups C and D. Multinomial logistic regression analysis used to explore group differences showed that HPVs in group B had lower initial motivation and received less social support from colleagues, and those in group C felt the head of the neighborhood association was uncooperative. Those in group D had lower initial motivation, rated their organizational climate as worse, and considered the head of the neighborhood association uncooperative compared with group A. CONCLUSIONS: We found that feeling satisfied and lightly burdened facilitated HPVs' active participation in community-based activities. Findings suggest the importance of improving activity environments surrounding HPVs.

The strategies of Japanese public health nurses in medication support for high-risk tuberculosis patients.

OBJECTIVE: The purpose of this study was to describe the support provided by Japanese public health nurses (PHNs) to high-risk tuberculosis (TB) patients, focusing specifically on the support aimed at preventing interruptions in treatment. DESIGN AND SAMPLE: A qualitative descriptive approach was used with a convenience sample of 11 PHNs in Japan who cared for TB patients at highest risk for medication adherence problems. MEASURES: Semi-structured interviews were conducted to learn the scope and practice of PHNs with high-risk TB patients. Data were analyzed using a qualitative descriptive analysis process. RESULTS: One main theme was identified: "Supporting the patients in overcoming tuberculosis, regaining health, and living a healthier life." Three categories with five subcategories described the nurses' activities: (1) empathetic and reliable support, (2) motivational strategies for medication adherence, and (3) developing a foundation for healthier life. CONCLUSIONS: The nurses interviewed described creative and extraordinary strategies used to promote medication adherence and facilitate development of a healthy posttreatment lifestyle. Their approach was patient-centered and culturally congruent. Findings may be transferrable to PHN practice in other regions as care for this economically disadvantaged and marginalized population is a critical need.

[Loneliness and social relations among mothers with infants].

OBJECTIVES: To provide support for child-rearing mothers under circumstances in which they are likely to experience loneliness by studying the status of their social network (contact frequency) and social support as well as the relationship of these variables with loneliness. METHODS: An anonymous questionnaire was distributed to 978 mothers who visited 4 health care centers in Ward A in Tokyo for medical check-ups of their infants aged 3-4 months between August and November 2008. Examined parameters were the revised UCLA Loneliness Scale; basic attributes of mothers and infants; child-rearing environment; presence/absence of a husband (partner), biological parents, friends who were also mothers (''mother friends''), and other friends; presence/absence of an active social network (contact frequency); and social support. Contact frequency was counted and classified according to face-to-face contacts and other contacts. The first multiple regression analysis was performed with loneliness score as the dependent variable and presence/absence of a husband (partner), biological parents, mother friends, and friends as independent variables. The second multiple regression analysis used the loneliness score as a dependent variable to examine relationships among loneliness, social support, and contact frequency with a husband (partner), biological parents, mother friends, and friends. Those with no contact person or supporter or with a missing value were excluded. Therefore, a sub-analysis among mothers with no mother friends was performed. RESULTS: In total, 432 questionnaires were completed and 417 had effective responses (effective response rate, 43.3%). The mean Loneliness Scale score was 34.4±9.0 points. Multiple regression analysis showed that the Loneliness Scale score was higher in those with no mother friend or friends. Mothers with all types of contact persons and supporters had higher loneliness scores if they had longer conversations with husband (partner), less frequent face-to-face contact with mother friends and friends, and less social support from biological parents, mother friends, and friends. However, having supporters and contact persons without mother friends had no apparent relationship with contact frequency, social support, or the loneliness score, but correlated with interpersonal attitudes and mother's awareness. CONCLUSION: To prevent and mitigate the loneliness of mothers engaged in child care, it is important to assess the presence/absence of mother friends and friends; relationships with biological parents, mother friends, and friends; and interpersonal attitudes and awareness of mothers, and then take actions to enhance positive images of maternal roles, provide opportunities for face-to-face contact with mother friends and friends, and obtain social support from biological parents, mother friends, and friends.

[Home care and place of death for elderly people living in the remote islands of Japan. An examination on the presence of inpatient facilities].

OBJECTIVES: The purpose of this study was to clarify the actual status of end-of-life care for elderly people living in the remote islands of Japan, and whether the presence of inpatient facilities was related to the place of death, so as to obtain suggestions for constructing a system of end-of-life care. METHODS: The survey targeted caregivers (85 people) who cared for elderly people (aged 65 and over), who had been legally certified for long-term care, and who had died between April 2009 and July 2011 in five islands of Japan. Islands were selected from a list of remote islands specified in the Remote Islands Development Act and related laws. Using a mixed method embedded design, we conducted semi-structured interviews using a questionnaire that assessed the place and cause of the elderly patient's death, age at death, gender, and whether the patient or family members had requested that the patient be allowed to die at home. RESULTS: The proportion of elderly people who died at home in the group living on remote islands with no inpatient facilities was 39.0% (16 of 41 people), compared with 18.2% (8 of 44 people) living on islands with inpatient facilities. The difference was significant (P=0.029). Among the 24 elderly people who died at home, 6 died of cancer. Terminally ill cancer patients were released to die at home under three conditions: the caregivers could provide sufficient care, the visiting physician was present, and pain control was provided. It was also possible for elderly cancer patients to receive end-of-life care in remote islands that did not have inpatient facilities. In addition, among the elderly people who died at home in the remote islands, home care had been recommended by medical staff. CONCLUSION: It is important for professionals coordinating home care to understand the characteristics of diseases, perform early assessment of caregiver situations, and collaborate with medical staff.

Age Group Differences in Daily Life Changes among Community Residents during the COVID-19 Pandemic: A Pilot Study on Intergenerational Comparison.

This study investigated lifestyle changes and the self-reported mental health status of Japanese community residents during the COVID-19 pandemic. Differences in demography, daily lifestyle changes, and approaches to problem solving were analyzed in two age cohorts (<60 vs ≥60 years). The prevalence of moderate/increased psychological distress was 31.7%, with no significant difference between the cohorts. Compared with the pre-COVID-19 era, more than 80% of the participants stopped eating out and spent more time at home, and more than 70% used public transport less frequently. There were significant differences between the cohorts for the time spent at home, opportunities to eat meals outside of home, and shopping in stores. Participants aged under 60 years were less likely to use television and newspapers or to consult a family doctor. Those aged over 60 years were less likely to consult friends/colleagues or to use the Internet/social networking services. Identifying the risk factors for psychological distress is warranted for implementing measures to maintain and improve the physical and mental health of residents.

Potential motivators affecting parental intention in COVID-19 vaccination for children aged 6 months to 4 years: Implications for targeted vaccine interventions in Japan.

Although COVID-19 vaccination was approved for younger children in Japan in October 2022, uptake rates remain critically low. This study aimed to investigate Japanese parents' intentions, hesitators' probability of positive intention change, and factors that motivate COVID-19 vaccination. Parents with a 6-month to 4-year-old child living in Japan participated in this internet-based, cross-sectional survey conducted from December 19, 2022, to January 4, 2023. The modified Poisson regression analysis was used to assess the probabilities of changing intention by each motivator when comparing the degree of hesitancy among hesitators, and the Poisson generalized estimating equations were used to compare the probabilities of changing intentions by potential motivators within hesitant individuals. Among 12,502 participants, 10,008 (80.1%) were hesitators. Parents with lower hesitancy levels were more likely to be motivated to vaccinate their children through potential motivators. Vaccine hesitators were motivated to vaccinate their children, particularly by proven vaccine effectiveness (including "protecting children from getting sick" with a probability ratio [PR] of 3.7 [95% confidence interval (CI) 3.5-3.9] and "less likely to infect adults" with a PR of 2.9 [95% CI 2.8-3.1]), as well as vaccine safety (including "safe vaccination of millions of children" with a PR of 3.1 [95% CI 3.0-3.3]) compared to injunctive norm (including "community leader recommendation"). Therefore, initially addressing parents with low hesitancy levels is an effective strategy that motivates COVID-19 vaccination. Also, providing evidence-based information about COVID-19 vaccine efficacy and safety that is consistent with parents' needs is crucial.