Profile of Nagasaki Islands Study (NaIS): A Population-Based Prospective Cohort Study on Multi-disease.

In an aging society, it is important to visualize the conditions of people living with diseases or disabilities, such as frailty and sarcopenia, and determine the environmental and genetic factors underlying such conditions. Atherosclerosis and arterial stiffness are key conditions between these factors and noncommunicable diseases. In 2014, we launched a population-based prospective open-cohort study, the Nagasaki Islands Study (NaIS), which was conducted in Goto City, located in the remote islands of Nagasaki Prefecture, Japan, mostly involving middle-aged and older residents. We conducted our own health checkups along with the annual standardized checkups organized by the municipality; recruited study participants; and started to follow-up with them for vital status (death), migration, and occurrence of diseases such as myocardial infarction, stroke, fracture, and human T-cell leukemia virus type 1 (HTLV-1) -associated uveitis. Our checkups were conducted as baseline surveys in different areas of Goto City during the fiscal years 2014-2016, secondary surveys during 2017-2019, and tertiary surveys since 2021, consisting of medical interviews, physical examinations, blood and urine tests, body composition measurements, osteoporosis screening, arterial stiffness measurements, carotid ultrasonography, and dental examination. A total of 4,957 residents participated in either the baseline or secondary surveys and were followed-up; and 3,594 and 3,364 residents (aged 27-96 and 28-98 years) participated in the baseline and secondary surveys, respectively. In conclusion, the NaIS has been undertaken to reveal the influence of aging and risk factors of noncommunicable diseases and disabilities, with an aim to contribute towards better healthcare in the future.

Patient trust and positive attitudes maximize non-communicable diseases management in rural Tanzania.

The objectives of this study were to identify difficulties and their related contexts non-communicable disease (NCD) patients in rural Tanzania experienced, examine how patients managed the situation by seeking better treatment of the diseases, and propose a realistic approach for optimizing disease management with long-term perspectives in resource-limited settings, based on views of patients (PTs), health-care providers (HPs), and health volunteers (HVs). Nine focus group discussions were performed with 56 participants of PTs, HPs, and HVs in three district hospitals in the Dodoma region. Their views and self-care practices were extracted, and the verbatim data were analyzed to derive codes and categories. The types of NCDs reported by the PTs were hypertension (HT), diabetes mellitus (DM), and HT/DM comorbidity. Reported barriers to disease management included discontinuation of treatment due to various factors and a lack of positive messages regarding disease management in NCD care. The following points were addressed in relation to the improved management of NCDs: (i) positive attitudes and coping skills, (ii) support from family members, (iii) good communication between PTs and HPs, and (iv) trustworthy relationships with HVs. The findings suggest that to gain the trust of PTs in optimizing disease control in overstretched health-care systems, patient support systems should be strengthened by empowering positive attitudes.

Non-communicable diseases (NCDs) are the leading cause of death globally. NCDs are common in low- and middle-income countries and their prevalence has been growing more prominent. In Tanzania, one-third of all deaths are NCD-related. This study aims to identify the factors that may lead to the improved management of NCDs in rural Tanzania based on actual situations in patients' daily lives. We conducted focus group discussions with three different groups (patients with hypertension and/or diabetes mellitus [PTs], health volunteers [HVs], and health-care providers [HPs]). The results revealed that PTs faced various barriers such as treatment discontinuation and a lack of positive messages regarding disease management in NCD care. However, the following points were indicated by the participants for the improved management of NCDs: (i) positive attitudes and coping skills, (ii) support from family members, (iii) good communication between PTs and HPs, and (iv) trustworthy relationships with HVs. Thus, to gain the trust of PTs in optimizing disease control and complications in overstretched health-care systems, patient support systems need to be strengthened by adopting a community empowerment approach, delivering supportive messages, and building reliable relationships.

Association Between eHealth Literacy and Health Education Experiences and Confidence Regarding Online Health Information Among Nurses: A Cross-sectional Study.

This cross-sectional study examined nurses' eHealth literacy, health education experiences, and confidence in health education regarding online health information and explored their association. A self-administered questionnaire was distributed among 442 nurses in Japan from September 2020 to March 2021. The survey items were the Japanese version of the eHealth Literacy Scale, health education experiences and confidence in health education regarding online health information, and sociodemographic variables. The final analysis comprised 263 responses. Nurses' mean eHealth literacy was 21.89. Most nurses had never received questions regarding online health information in search (66.9%), evaluation (85.2%), and utilization (81.0%) from their patients. Further, most nurses lacked experience (84.0%-89.7%) and confidence (94.7%-97.3%) in health education regarding online health information. The factor associated with having health education experience regarding online health information was eHealth literacy (adjusted odds ratio, 1.08; 95% confidence interval, 1.02-1.15). Factors associated with having confidence in health education regarding online health information were eHealth literacy (adjusted odds ratio, 1.10; 95% confidence interval, 1.10-1.43) and having learning experiences regarding eHealth literacy (adjusted odds ratio, 7.36; 95% confidence interval, 2.06-26.39). Our findings suggest the importance of enhancing eHealth literacy among nurses and a proactive approach by nurses to improve patients' eHealth literacy.

Food store accessibility affects nutritional intake through shopping frequency and food intake in middle-aged to older adults in rural Nagasaki, Japan.

OBJECTIVES: The food environment is an important determinant of dietary and nutritional intake, but studies thus far have reported mixed results. We examined associations between food store accessibility and nutritional intake among middle-aged to older adults in rural Japan using data from a questionnaire survey of national health insurance enrollees. METHODS: The survey was conducted in Nagasaki, Japan, for individuals aged 40-74 years. Direct distances from home and food store density were estimated using a geographic information system (GIS). We focused on protein, vitamin D, and calcium intake for their preventive effects on frailty and sarcopenia. To examine the effects of food store accessibility on nutritional intake, we hypothesized a model with a chain of associations of food store accessibility, shopping frequency, food intake frequency, and nutritional intake. We performed a path analyses to explore the food items to be included in the models, associations between the variables, and fitness of the models. RESULTS: We obtained final models with satisfactory fit indices. The resultant models included significant associations between: 1) accessibility indicators and shopping frequency, 2) shopping frequency and intake frequency for two or four categories of food, and 3) intake frequency and nutritional intake. CONCLUSIONS: The results demonstrated that accessibility to food stores, assessed in terms of direct distance from home and food store density, can affect the intake of protein, vitamin D, and calcium through the effect on shopping frequency and intake frequency of some categories of food items, among middle-aged to older adults in Nagasaki, Japan.

Association between the dietary inflammatory index and disability in Japanese older people.

OBJECTIVES: To examine the demographic and lifestyle characteristics related to the dietary inflammatory index (DII™) score and to evaluate the association between DII score and disability among older people in Japan. DESIGN: Cross-sectional design. The DII score was calculated from nutrient intake information obtained from a FFQ. Disability was assessed using the Tokyo Metropolitan Institute of Gerontology Index of Competence questionnaire. Overall disability and disability in each component of everyday competence, that is, instrumental activities of daily living (IADL), intellectual activities and social participation, were assessed. Those with a deficit in one or more activities were defined as disabled. SETTING: Five non-urban areas in Japan. PARTICIPANTS: A total of 1642 Japanese older people aged 65 years or older. RESULTS: Women, residents of Oga-shi, and those with a higher education and greater frequency of shopping followed a more anti-inflammatory diet, while those living alone and residents of Minamiawaji-shi had higher dietary inflammation. A pro-inflammatory diet was associated with higher odds of overall disability and disability in each component of competence: overall disability, OR (95 % CI) = 1·26 (1·16, 1·36); IADL disability, OR (95 % CI) = 1·16 (1·07, 1·26); disability in intellectual activities, OR (95 % CI): 1·30 (1·20, 1·40); and disability in social participation, OR (95 % CI) = 1·20 (1·11, 1·29). CONCLUSIONS: Sex, living alone, education, frequency of shopping and area of residence were shown to be determinants of DII score in Japanese older people. DII score was positively associated with disability.

Interview survey of physical and mental changes and coping strategies among 13 Vietnamese female technical interns living in Japan.

We conducted a case study to assess 1) physical and mental changes; 2) self-assessments of symptoms; 3) coping strategies; and 4) adaptation to physical and mental changes by semi-structured interview survey among Vietnamese female migrant workers working in Japan under the Technical Intern Training Program. We found they experienced female-specific physical changes, and some interns' symptoms worsened because they did not consult anyone about their symptoms. We propose increasing opportunities to learn about possible physical and mental changes caused by migration and to improve health literacy, including prevention, coping, help-seeking, and consultations about health concerns among female technical interns.

Knowledge, attitude, and preparedness toward IPV care provision among nurses and midwives in Tanzania.

BACKGROUND: With increasing recognition of intimate partner violence (IPV) as a public health challenge, nurses and midwives are recognized for their crucial role in providing front-line healthcare services for IPV. This study aimed to evaluate knowledge, attitude, and preparedness related to IPV care provision in health facilities among nurses and midwives in Tanzania. METHODS: A self-administered anonymous questionnaire survey was conducted among nurses and midwives working in health facilities in the Mbeya region between December 2018 and January 2019. The questionnaire consisted of questions on their perceived and actual knowledge, attitudes, and preparedness to provide care in relation to IPV. RESULTS: A total of 662 (50.1%) of 1321 nurses and midwives who worked in hospitals and/or health centers in the Mbeya region participated in this study, and 461 (69.6%) completed questionnaires were included in the analysis. The proportion of nurses and midwives with high scores in IPV perceived knowledge, actual knowledge, attitude, and preparedness to provide care was 59.9%, 53.1%, 54.2%, and 54.0%, respectively. Regardless of the type of facility, gender, educational level, and work experience, the use of IPV guidelines was significantly associated with high scores in IPV perceived knowledge (P < 0.001), actual knowledge (P = 0.004), and preparedness to provide care (P < 0.001), but not attitude, which was negatively associated (P = 0.048). Regardless of the type of facility, gender, educational level, and work experience, receiving preservice IPV training was associated with high scores in IPV perceived knowledge (P < 0.001), actual knowledge (P = 0.049), and preparedness to provide care (P = 0.002), but not attitude (P = 0.192). Regardless of the type of facility, gender, educational level, and work experience, in-service IPV training was associated with high scores in IPV perceived knowledge (P < 0.001), actual knowledge (P = 0.043), and preparedness to provide care (P = 0.001), but not attitude (P = 0.063). CONCLUSIONS: Although guidelines and training could improve nurses' and midwives' knowledge and preparedness to provide care regarding IPV, attitudes against IPV care are a challenge. To improve attitudes regarding IPV among front-line nurses and midwives, it is necessary to address concepts of IPV care and sympathy with potential and actual victims of IPV in pre- and in-service training in addition to providing recall-level knowledge.

Perceived eHealth Literacy and Learning Experiences Among Japanese Undergraduate Nursing Students: A Cross-sectional Study.

This study aimed to describe undergraduate nursing students' perceived eHealth literacy and learning experiences of eHealth literacy in Japan and to clarify the relationship between these factors. We conducted a self-administered online questionnaire survey using a convenience sample of 353 Japanese undergraduate nursing students selected from three universities. Participants completed the eHealth Literacy Scale and questionnaires on learning experiences of eHealth literacy and some demographic factors. Participants had moderate perceived eHealth (mean [SD], 24.52 [5.20]). More than half the participants responded that they had no learning experiences of health or science literacy. We observed a positive correlation between the total mean eHealth literacy and learning experiences scores. Undergraduate nursing students in Japan had slightly lower perceived eHealth literacy than nursing students in other countries, hospital nurses, and even patients. Of the 353 participants in this study, 69.4% did not know "where to find helpful health resources on the Internet," 80.2% of those lacked the skills "to evaluate health resources," and 68.9% could not "differentiate the quality of health resources on the Internet"; few of the participants perceived themselves as having any experience in learning the six domains of eHealth literacy. Very few reported learning about health (43.3%) and scientific (21.8%) literacy. The low perceived eHealth literacy among participants might reflect lack of knowledge and confidence in eHealth literacy as well as their own low level of health-promoting behaviors; this might influence the quality of health education of clients and their families. Nursing educators should address the lack of eHealth literacy among undergraduate nursing students.

Factors associated with social support in child-rearing among mothers in post-disaster communities.

BACKGROUND: Natural disasters have long-term negative impacts on the health and socioenvironmental conditions of a population, affecting the physical environment as well as the relationships within the community, including social networks. Mothers in post-disaster communities may have difficulty receiving social support not only from family members and relatives but also from members of their community, such as people in their neighborhoods. This study focused on mothers with infants and preschool-aged children in post-disaster communities. The associations of social support with sociodemographic characteristics and socioenvironmental conditions related to child-rearing among mothers in post-disaster communities were assessed. METHODS: An anonymous self-administered questionnaire survey was conducted in October 2015 in 988 households in areas affected by the Great East Japan Earthquake and Tsunami. The data collected on sociodemographic and socioenvironmental characteristics included the presence of pre-disaster acquaintances in the neighborhood and social support for child-rearing. The associations of sociodemographic and socioenvironmental characteristics with social support were examined. RESULTS: We analyzed 215 completed questionnaires from mothers living in different houses from those they lived in before the disaster to reflect continuous relationships with people from the pre-disaster communities. Social support was significantly associated with infant sex, extended family, support obtained from relatives not living together, pre-disaster acquaintances, use of child support resources, and no perceived difficulties in child-rearing. In addition, the presence of pre-disaster acquaintances was associated with categories of mental/physical place of comfort and child-rearing support, with adjusted odds ratios of 1.88 (95% CI 1.03-3.44) and 2.84 (95% CI 1.46-5.52) compared with mothers who did not have any pre-disaster acquaintances. CONCLUSIONS: Factors associated with the obtainment of social support in child-rearing among mothers in post-disaster communities were attributed not only to mothers themselves and family members but also to socioenvironmental factors such as the presence of pre-disaster acquaintances. The presence of pre-disaster acquaintances promoted rich social support in child-rearing in post-disaster communities. When reconstructing a community following changes in residence location after a disaster, the pre-disaster relationships among the community dwellers should be considered from the viewpoint of child-rearing support.

Feasibility of the Pharmacy DOTS System in Nagasaki Prefecture.

Objective This study aimed to investigate the preparedness of pharmacies to provide DOTS in Nagasaki Prefecture, Japan, and to analyze the feasibility of this system with a view toward providing a basis for future administrative studies to consider its adoption.Methods A self-administered mail questionnaire survey was conducted, involving the owners (mostly pharmacists) of 533 pharmacies belonging to designated medical institutions for tuberculosis treatment in Nagasaki Prefecture, seeking information on the following: 1) respondent attributes, 2) pharmacy-related information, 3) experience of participating in tuberculosis-related academic meetings, 4) recognition of DOTS and desire to cooperate with the pharmacy DOTS system and participate in related workshops, and 5) challenges and requirements of the provision of DOTS at pharmacies. Responses were analyzed using the chi-square test, focusing on factors related to the respondents' desire to cooperate with the pharmacy DOTS system and participate in related workshops. The significance level was set at P<0.05.Results On analyzing 212 valid responses (valid response rate: 39.8%), "participating in academic meetings or related workshops", "supporting patients with tuberculosis", "recognizing DOTS", "recognizing the pharmacy DOTS system", "calculating additional medical fees for standard dispensing", and "establishing community liaison systems" were significantly correlated with "wishing to cooperate with the pharmacy DOTS system". Furthermore, age under 50, in addition to "participating in academic meetings or related workshops", "supporting patients with tuberculosis", "recognizing DOTS", "recognizing the pharmacy DOTS system", "calculating additional medical fees for standard dispensing", and "establishing community liaison systems" were significantly correlated with "wishing to participate in related workshops". More than 60% and 50% of the respondents mentioned "tuberculosis-related knowledge and information" and "pharmacy manpower", respectively, as requirements for the provision of DOTS at pharmacies.Conclusion Pharmacies interested in "calculating additional medical fees for standard dispensing" and "establishing community liaison systems", as well as pharmacy owners younger than 50 who actively participate in tuberculosis-related academic meetings or similar activities are likely to cooperate with the pharmacy DOTS system in the future. It was also suggested that sufficient preparation for the adoption of this system, such as promoting collaboration between administrative offices and medical institutions and holding workshops on tuberculosis and the system, would contribute to its feasibility in Nagasaki Prefecture.

Perspectives of persons in charge regarding support for the health and daily lives of female technical intern trainees who migrate to Japan: a qualitative study.

Objectives: Migrant technical intern trainees who migrate to Japan have become essential to the Japanese labour force, especially in rural areas. Persons in charge of supervising organisations and training coordinators both support the trainees' health and daily lives during their stay in Japan. This support is significant for trainees as it helps them access and interact with Japanese society. This study explored the perspectives of persons in charge of female technical trainees regarding support for the latter's health and daily lives. Materials and Methods: Semi-structured interviews were conducted with 14 persons in charge of female technical trainees, followed by a thematic analysis of the interview data to extract key themes. Results: Four primary themes emerged: fostered beliefs and roles, cultural considerations and health support, language considerations, and concerns about female trainees in relationships. These considerations and support developed solely through experience of persons in charge of female trainees. Additionally, those in charge expressed concerns about trainees being involved in a relationship. However, no specific measures, such as providing female trainees with information, have been taken. Conclusion: Persons in charge of female technical intern trainees need to be provided opportunities to learn about cultural considerations and providing health support for their trainees. Furthermore, the cooperation of health professionals with supervising organisations and training facilities is essential to promote the healthy lives of technical intern trainees. These insights can contribute to the development of an integrated community-based approach to support the health and daily lives of female trainees.

Service provision conditions for foreign residents in municipalities in Japan.

Objectives: This study examined the actual conditions of service provision to foreign residents (FRs) addressing prevention of lifestyle-related diseases (LRDs) and disaster preparedness/disaster responses (DPRs) in Japanese municipalities. Materials and Methods: A cross-sectional study was performed using a self-administered questionnaire with representatives of public health nurses in each municipality in Japan from December 2021 to January 2022. Results: Services considering FRs are more likely to be implemented in cities than in towns, and in municipalities where FRs account for ≥2.2% of the population (proportion of FRs in the Japanese population at the time of the study) than in those with fewer FRs. Cities have larger populations and greater financial resources than towns. Factors associated with the implementation of services and measures necessary for providing services to FRs were the classification of the municipality as a city, a high percentage of FRs, and large variation in corresponding nationalities/countries of origin. Conclusions: Cross-disciplinary efforts and collaborations need to be strengthened to share available resources within local governments and experiences in providing services for FRs in other divisions/sections, rather than considering only how to provide services for FRs in the public health division/section.

Sociocultural factors that reduce risks of homicide in Dar es Salaam: a case control study.

OBJECTIVES: This study was performed to examine the potential contributions of sociocultural activities to reduce risks of death by homicide. METHODS: This study was designed as a case control study. Relatives of 90 adult homicide victims in Dar es Salaam Region, Tanzania, in 2005 were interviewed. As controls, 211 participants matched for sex and 5-year age group were randomly selected from the same region and interviewed regarding the same contents. RESULTS: Bivariate analysis revealed significant differences between victims and controls regarding educational status, occupation, family structure, frequent heavy drinking, hard drug use and religious attendance. Conditional logistic regression analysis indicated that the following factors were significantly related to not becoming victims of homicide: being in employment (unskilled labour: OR=0.04, skilled labour: OR=0.07, others: OR=0.04), higher educational status (OR=0.02), residence in Dar es Salaam after becoming an adult (compared with those who have resided in Dar es Salaam since birth: OR=3.95), living with another person (OR=0.07), not drinking alcohol frequently (OR=0.15) and frequent religious service attendance (OR=0.12). CONCLUSIONS: Frequent religious service attendance, living in the same place for a long time and living with another person were shown to be factors that contribute to preventing death by homicide, regardless of place of residence and neighbourhood environment. Existing non-structural community resources and social cohesive networks strengthen individual and community resilience against violence.

Factors associated with failure to undergo health check-ups in Nagasaki Prefecture, Japan.

Objective: Municipal National Health Insurance (NHI) in Nagasaki Prefecture in Japan struggles with poor attendance of health check-ups, which was only 39.6% in 2018. This study aimed to evaluate factors that encourage healthy behaviors, including opting for health check-ups, and the characteristics of middle-aged and older individuals who did not undergo health check-ups. Materials and Methods: This cross-sectional study, using a self-administered questionnaire, was conducted in August 2020 in three municipalities of Nagasaki Prefecture. In addition to questions regarding sociodemographic information, such as sex, age, educational status, self-rated economic status, and family structure, the questionnaire included questions on daily lifestyle habits such as alcohol intake and exercise, current medical treatment, self-rated health, and information related to health check-ups. Of the 18,710 questionnaires distributed in the three municipalities, 8,756 (46.8%) were collected by the end of December 2020, of which 7,840 were valid for analysis. The compliance rate for health check-ups was obtained from the Public Health and Welfare Bureau of Nagasaki Prefecture. Statistical analyses were performed according to two age groups: 40-59 and 60-74 years. Results: Among the respondents who did not undergo health check-ups in the year prior to this study, "lack of time" and being "too bothersome" were the most popular reasons for not attending health check-ups. "Living alone" and "low self-rated economic status" were negative factors for receiving health check-ups regardless of age group. Conclusions: Vulnerable middle-aged and older persons, such as those living alone and with low economic status, were less likely to undergo health check-ups. Emphasis on home visits by public health nurses may also be needed to increase awareness of individual health conditions, especially for people living alone and those who are socioeconomically disadvantaged.

Utilization of bar and izakaya-pub establishments among middle-aged and elderly Japanese men to mitigate stress.

Japanese suicide rate is one of the highest among industrialized nations, especially following the economic crisis of the 1990s, with more than 30000 suicides every year since 1998. Previous studies have pointed out to relationships between overwork and/or job stress, and death and other health risks, and suggested several possible avenues for releasing stress and emotional burden, including suicidal ideation, through talking with intimate friends, family, and specialists, such as counselors and physicians. The present study was performed to explore the potential role of owners and managers of bars and izakaya-pub establishments in mitigating stress of middle-aged and elderly Japanese men by having informal conversations with them. A self-administered questionnaire was posted to all bars and izakaya-pubs registered in Ohmura-city, Nagasaki prefecture, in December 2009. Among 260 bars and izakaya-pubs, a total of 103 owners and managers completed the questionnaire. More than half of the respondents experienced engaging in conversations with their customers regarding customers' various personal and private issues. The most frequently talked about problem was that regarding work (56.3%). Regardless of sex and age of the respondents, those with longer working experience in bar and izakaya-pub establishments were more likely to have had customers confiding in them financial problems including debts/loans (adjusted odds ratio: 5.48, p = 0.033). Owners and managers of bars and izakaya-pubs may be in a position to act as "listeners", to whom middle-aged and elderly men can talk about their personal problems casually and without having to worry about conflict of interests, and direct those in need to professional counseling.

Curricular Limitations and Recommendations for Training Health Care Providers to Respond to Intimate Partner Violence: An Integrative Literature Review.

BACKGROUND: Intimate partner violence (IPV) is a well-known public health problem occurring worldwide. With a multisectoral approach being emphasized in addressing IPV, the health sector has a key role to play due to many IPV victims who appear in health facilities without their needs being met. A well-designed and implemented IPV curriculum is necessary for effectively training health care professionals to provide quality IPV care and related services. This integrative review was conducted to establish evidence for existing curricular limitations and recommendations for training health care providers to respond to IPV. METHODS: A systematic literature search was conducted for studies published from 2000 to 2020 in five databases (PubMed, Science Direct, Cochrane Library, Google, and Scholar). As a criterion, studies that reported curricular limitations in training health care providers/professionals to address IPV were included. A total of 198 studies were identified for screening, with 16 studies meeting the inclusion criteria and included in the review. FINDINGS: Curricular limitations for IPV response training for health care providers were reported in the following areas (themes): time allocated for the training, amount of content in the existing curricula, institutional endorsement for the content, IPV response teachers/facilitators, teaching and learning strategies, and funding to support curricular implementation. Various recommendations to improving IPV response training were provided including guaranteeing the training in all courses, increasing academic capability to teach the content, allocation of funding to improve infrastructure for curriculum development and implementation, comprehensive approaches to teaching, and continuing education for health care providers.

Reaching Patients With Noncommunicable Diseases in Rural Tanzania Using Mobile Devices and Community Trust: Qualitative Study.

BACKGROUND: A health service using mobile devices, mobile health (mHealth), has been widely applied to programs focusing on maternal and child health and communicable diseases in sub-Saharan African countries. However, mHealth apps for noncommunicable disease (NCD) services remain limited. OBJECTIVE: This study aimed to explore the acceptability and potential usability of SMS text messaging for patients and health care providers for the management of NCDs as part of an implementation research in rural Tanzania. METHODS: Nine focus group discussions were conducted with 56 participants (21 community health workers [CHWs], 17 patients, and 18 health care professionals [HPs]) in 3 districts in the Dodoma region, Tanzania. The interview guides were prepared in Swahili, and each session was recorded, transcribed, and translated into English. The focus group discussions consisted of the following topics: (1) perceptions of the participants about the possible use of mobile devices and SMS text messages as an mHealth platform in community health services; and (2) experiences of mobile device use in health activities or receiving health services via a mobile phone in the past. RESULTS: CHWs and HPs reported having familiarity using mobile devices to provide health services, especially for reaching or tracing patients in remote settings; however, patients with NCDs were less familiar with the use of mobile devices compared with the other groups. Hesitation to receive health services via SMS text messaging was seen in the patient group, as they wondered who would send health advice to them. Some patients expected services beyond what mHealth could do, such as aiding in recovery from a disease or sending notifications about the availability of prescription medications. CHWs showed interest in using text messaging to provide health services in the community; however, the concerns raised by CHWs included the cost of using their own mobile devices. Moreover, they demanded training about NCD management before engaging in such an activity. CONCLUSIONS: This study explored views and experiences regarding the possible installation of an mHealth intervention for managing NCDs in rural Tanzania. Although HPs and CHWs had experience using mobile devices to provide health services in non-NCD projects, only a few patients (3/17, 17%) had heard about the use of mobile devices to receive health services. To improve the suitability and acceptability of the intervention design for patients with NCDs, their trust must be earned. Involving CHWs in the intervention is recommended because they have already been appointed in the community and already know how to communicate effectively with patients in the area.

Knowledge, experience, and potential risks of dating violence among Japanese university students: a cross-sectional study.

BACKGROUND: The Domestic Violence Prevention Act came into effect in Japan in 2001, but covers only marriage partner violence and post-divorce partner violence, and does not recognize intimate partner violence (IPV). The present study was performed to determine the experience of harassment, both toward and from an intimate partner, and recognition of harassment as IPV among Japanese university students. METHODS: A self-administered questionnaire survey regarding the experience of harassment involving an intimate partner was conducted as a cross-sectional study among freshman students in a prefectural capital city in Japan. RESULTS: A total of 274 students participated in the present study. About half of the subjects (both male and female students) had experience of at least one episode of harassment toward or had been the recipient of harassment from an intimate partner. However, the study participants did not recognize verbal harassment, controlling activities of an intimate partner, and unprotected sexual intercourse as violence. Experience of attending a lecture/seminar about domestic violence and dating violence did not contribute to appropriate help-seeking behavior. CONCLUSIONS: An educational program regarding harassment and violence prevention and appropriate help-seeking behavior should be provided in early adolescence to avoid IPV among youth.

Reduction of health-related risks among female commercial sex workers: learning from their life and working experiences.

We performed this study to determine both positive and negative impacts on the health of sex workers working on the street. We conducted this study using key informant and focus group interviews in bars and streets in Mozambique. The interviewed sex workers were aware about the risks and protection against sexually transmitted infections (STIs), and they consistently used condoms. Most suffered from harmful behavior, including violence and assault by both customers and other commercial sex workers. We found that sex workers' own skills and knowledge acquired through experience potentially could be developed into life skills that could save and protect their lives.