Calculating a Prefecture-Level Well-Being Index in Japan: Applying the framework of the OECD's Better Life Index.

Objectives　Well-being serves as a crucial indicator of national governance and societal advancement. Consequently, the Better Life Index (BLI) developed by the Organisation for Economic Co-operation and Development (OECD) has emerged as a pivotal multidimensional measure of well-being, surpassing traditional indicators such as Gross Domestic Product (GDP). However, current well-being indicators predominantly focus on national measurements and do not effectively evaluate well-being in smaller regions such as states or prefectures. This study aimed to calculate a Regional Well-Being Index (RWI) tailored to localized areas in Japan.Methods　Japanese official statistics, publicly available as open data, were analyzed, focusing on 11 domains similar to those in the BLI: "Income," "Jobs," "Housing," "Health," "Work-Life Balance," "Education," "Community," "Civic Engagement," "Environment," "Safety," and "Life Satisfaction." The RWI scores were calculated for each prefecture in 2010, 2013, 2016, and 2019 using standard normalization techniques. To represent the overall well-being of each prefecture in each year, scores were aggregated across all domains; this aggregate is referred to as the Integrated RWI. The reliability and validity of RWI were assessed by examining time-series changes and Pearson's correlation coefficients.Results　Median Integrated RWI scores for Japanese prefectures remained relatively stable across the study period, with slight variations observed: median = 0.67 (Interquartile range [IQR]: -2.48-2.71) in 2010, median = 0.00 (IQR: -2.85-2.76) in 2013, median = 0.13 (IQR: -3.05-2.49) in 2016, and median = 0.19 (IQR: -2.75-3.06) in 2019. Geographical analysis showed lower scores in regions such as Western Kyushu and Shikoku, and higher scores in Chubu and Eastern Kinki. The RWI and the BLI demonstrated construct validity, with Pearson's correlation coefficients ranging from 0.58 to 0.99 across various domains.Conclusion　The RWI, based on the OECD's BLI, proved to be a reliable and valid tool for assessing comprehensive well-being at the regional level in Japan. It offers foundational data for identifying challenges to regional well-being and shaping targeted policies, thereby contributing to evidence-based policymaking. Moreover, this methodology has potential applicability in evaluating comprehensive well-being beyond GDP at the regional level in other countries using official statistics.

New Web-Based System for Recording Public Health Nursing Practices and Determining Best Practices: Protocol of an Exploratory Sequential Design.

BACKGROUND: Digitalization and information and communication technology (ICT) promote effective, efficient individual and community care. Clinical terminology or taxonomy and its framework visualize individual patients' and nursing interventions' classifications to improve their outcomes and care quality. Public health nurses (PHNs) provide lifelong individual care and community-based activities while developing projects to promote community health. The linkage between these practices and clinical assessment remains tacit. Owing to Japan's lagging digitalization, supervisory PHNs face difficulties in monitoring each department's activities and staff members' performances and competencies. Randomly selected prefectural or municipal PHNs collect data on daily activities and required hours every 3 years. No study has adopted these data for public health nursing care management. PHNs need ICTs to manage their work and improve care quality; it may help identify health needs and suggest best public health nursing practices. OBJECTIVE: We aim to develop and validate an electronic recording and management system for evaluating different public health nursing practice needs, including individual care, community-based activities, and project development, and for determining their best practices. METHODS: We used a 2-phase exploratory sequential design (in Japan) comprising 2 phases. In phase 1, we developed the system's architectural framework and a hypothetical algorithm to determine the need for practice review through a literature review and a panel discussion. We designed a cloud-based practice recording system, including a daily record system and a termly review system. The panels included 3 supervisors who were prior PHNs at the prefectural or municipal government, and 1 was the executive director of the Japanese Nursing Association. The panels agreed that the draft architectural framework and hypothetical algorithm were reasonable. The system was not linked to electronic nursing records to protect patient privacy. Phase 2 validated each item through interviews with supervisory PHNs using a web-based meeting system. A nationwide survey was distributed to supervisory and midcareer PHNs across local governments. RESULTS: This study was funded in March 2022 and approved by all ethics review boards from July to September and November 2022. Data collection was completed in January 2023. Five PHNs participated in the interviews. In the nationwide survey, responses were obtained from 177 local governments of supervisory PHNs and 196 midcareer ones. CONCLUSIONS: This study will reveal PHNs' tacit knowledge about their practices, assess needs for different approaches, and determine best practices. Additionally, this study will promote ICT-based practices in public health nursing. The system will enable PHNs to record their daily activities and share them with their supervisors to reflect on and improve their performance, and the quality of care to promote health equity in community settings. The system will support supervisory PHNs in creating performance benchmarks for their staff and departments to promote evidence-based human resource development and management. TRIAL REGISTRATION: UMIN-ICDR UMIN000049411; https://tinyurl.com/yfvxscfm. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/45342.

Performance of the Large Language Model ChatGPT on the National Nurse Examinations in Japan: Evaluation Study.

BACKGROUND: ChatGPT, a large language model, has shown good performance on physician certification examinations and medical consultations. However, its performance has not been examined in languages other than English or on nursing examinations. OBJECTIVE: We aimed to evaluate the performance of ChatGPT on the Japanese National Nurse Examinations. METHODS: We evaluated the percentages of correct answers provided by ChatGPT (GPT-3.5) for all questions on the Japanese National Nurse Examinations from 2019 to 2023, excluding inappropriate questions and those containing images. Inappropriate questions were pointed out by a third-party organization and announced by the government to be excluded from scoring. Specifically, these include "questions with inappropriate question difficulty" and "questions with errors in the questions or choices." These examinations consist of 240 questions each year, divided into basic knowledge questions that test the basic issues of particular importance to nurses and general questions that test a wide range of specialized knowledge. Furthermore, the questions had 2 types of formats: simple-choice and situation-setup questions. Simple-choice questions are primarily knowledge-based and multiple-choice, whereas situation-setup questions entail the candidate reading a patient's and family situation's description, and selecting the nurse's action or patient's response. Hence, the questions were standardized using 2 types of prompts before requesting answers from ChatGPT. Chi-square tests were conducted to compare the percentage of correct answers for each year's examination format and specialty area related to the question. In addition, a Cochran-Armitage trend test was performed with the percentage of correct answers from 2019 to 2023. RESULTS: The 5-year average percentage of correct answers for ChatGPT was 75.1% (SD 3%) for basic knowledge questions and 64.5% (SD 5%) for general questions. The highest percentage of correct answers on the 2019 examination was 80% for basic knowledge questions and 71.2% for general questions. ChatGPT met the passing criteria for the 2019 Japanese National Nurse Examination and was close to passing the 2020-2023 examinations, with only a few more correct answers required to pass. ChatGPT had a lower percentage of correct answers in some areas, such as pharmacology, social welfare, related law and regulations, endocrinology/metabolism, and dermatology, and a higher percentage of correct answers in the areas of nutrition, pathology, hematology, ophthalmology, otolaryngology, dentistry and dental surgery, and nursing integration and practice. CONCLUSIONS: ChatGPT only passed the 2019 Japanese National Nursing Examination during the most recent 5 years. Although it did not pass the examinations from other years, it performed very close to the passing level, even in those containing questions related to psychology, communication, and nursing.

Predicting Smoking Prevalence in Japan Using Search Volumes in an Internet Search Engine: Infodemiology Study.

BACKGROUND: Tobacco smoking is an important public health issue and a core indicator of public health policy worldwide. However, global pandemics and natural disasters have prevented surveys from being conducted. OBJECTIVE: The purpose of this study was to predict smoking prevalence by prefecture and sex in Japan using Internet search trends. METHODS: This study used the infodemiology approach. The outcome variable was smoking prevalence by prefecture, obtained from national surveys. The predictor variables were the search volumes on Yahoo! Japan Search. We collected the search volumes for queries related to terms from the thesaurus of the Japanese medical article database Ichu-shi. Predictor variables were converted to per capita values and standardized as z scores. For smoking prevalence, the values for 2016 and 2019 were used, and for search volume, the values for the April 1 to March 31 fiscal year (FY) 1 year prior to the survey (ie, FY 2015 and FY 2018) were used. Partial correlation coefficients, adjusted for data year, were calculated between smoking prevalence and search volume, and a regression analysis using a generalized linear mixed model with random effects was conducted for each prefecture. Several models were tested, including a model that included all search queries, a variable reduction method, and one that excluded cigarette product names. The best model was selected with the Akaike information criterion corrected (AICC) for small sample size and the Bayesian information criterion (BIC). We compared the predicted and actual smoking prevalence in 2016 and 2019 based on the best model and predicted the smoking prevalence in 2022. RESULTS: The partial correlation coefficients for men showed that 9 search queries had significant correlations with smoking prevalence, including cigarette (r=-0.417, P<.001), cigar in kanji (r=-0.412, P<.001), and cigar in katakana (r=-0.399, P<.001). For women, five search queries had significant correlations, including vape (r=0.335, P=.001), quitting smoking (r=0.288, P=.005), and cigar (r=0.286, P=.006). The models with all search queries were the best models for both AICC and BIC scores. Scatter plots of actual and estimated smoking prevalence in 2016 and 2019 confirmed a relatively high degree of agreement. The average estimated smoking prevalence in 2022 in the 47 prefectures for the total sample was 23.492% (95% CI 21.617%-25.367%), showing an increasing trend, with an average of 29.024% (95% CI 27.218%-30.830%) for men and 8.793% (95% CI 7.531%-10.054%) for women. CONCLUSIONS: This study suggests that the search volume of tobacco-related queries in internet search engines can predict smoking prevalence by prefecture and sex in Japan. These findings will enable the development of low-cost, timely, and crisis-resistant health indicators that will enable the evaluation of health measures and contribute to improved public health.

Changes in the Number of Public Health Nurses Employed in Local Governments in Japan During the Covid-19 Pandemic: A Cross-Sectional Study.

Introduction: Prefectural public health centers in Japan conducted epidemiological surveys of all COVID-19 patients, which subsequently increased their workload as the infection rate increased. The survey was conducted by public health nurses (PHNs); therefore, an increase in their workload was expected. However, changes in the number of PHNs have not yet been examined. This study focused on recruiting PHNs to local governments in Japan during the COVID-19 pandemic. Methods: This cross-sectional study of 150 local government public health centers was conducted from November to December 2021. The survey items included the number of full-time and part-time PHNs, number of PHNs who resigned or retired from the job, and number of PHNs recruitment examinations conducted between 2017 and 2021. For all variables, the mean, standard deviation, and minimum and maximum values for each municipality and year were calculated, and a one-way analysis of variance was performed. Conclusion: The response rate of the questionnaires was 54.0% (81/150). The change in the employment status of PHNs from 2019 to 2020 was not statistically significant in 2020, which was the COVID-19 outbreak year. However, the number of full-time PHNs increased by 2.6, while part-time PHNs almost doubled from 5.2 ± 8.3 to 10.8 ± 9.6 (p = .61) for prefectures, from 13.6 ± 13.1 to 21.5 ± 34.8 (p = .23) for cities, and from 16.8 ± 26.8 to 52.3 ± 132.5 (p = .70) for wards. The survey revealed that since the COVID-19 pandemic, the ratio of part-time to full-time PHNs significantly increased. Current status reports of public health centers will encourage political decisions and research on the factors necessary to balance the supply and demand of full-time PHNs.

Experience of annual events in the family and social adjustment of school-age children.

BACKGROUND: Parent-child relationships, the rearing attitudes of parents toward their children as well as the interactive relationships, such as play and cultural activities that parents and children enjoy together, serve as important factors in predicting a child's growth and development. These experiences of annual events celebrated with the family may be related to the school-age child's development. However, this relationship has not been investigated sufficiently. Therefore, this study aimed to identify the relationship between the experience of annual events observed in the family and a child's social adjustment. METHODS: In 2019, a self-administered questionnaire survey targeting fifth graders (ages 10-11) in Japan was conducted with children's parents. Major survey items included participants' characteristics (child's sex, family composition, siblings, household income, and parents' educational backgrounds), annual events observed in the family (Setsubun or the day before the start of spring, Mother's Day, Father's Day, the Tanabata or Weaver Festival, Respect for the Aged Day, Winter solstice, etc.), and the child's social adjustment (Strengths and Difficulties Questionnaire). A total of 653 children who met the criteria of not having any developmental disorders were included as participants for the analysis. RESULTS: The participants had celebrated an average of 15.47 (± 5.52) annual events with their families that year. The number of annual events celebrated was significantly related to family composition and the parents' educational backgrounds. We found that children who came from families with numerous experiences of annual events were more likely to have higher prosocial behavior and were less likely to have externalizing or internalizing problems. The same pattern was found even after adjusting for the family's socioeconomic background and other factors; that is, children who came from families having diverse experiences of annual events were more likely to show prosocial tendencies. CONCLUSIONS: Our findings suggest that the experience of annual events observed with family potentially enhances a child's prosocial behavior. Thus, celebrating and preserving cultural and personal events in the amily context may be an important developmental experience in terms of children's social adjustment.

Factors affecting subjective health of child-rearing-aged Japanese adults, considering the effect of healthy life expectancy: A cross-sectional study.

OBJECTIVES: The extension of healthy life expectancy is an important policy issue in Japan. This study aimed to clarify the association between subjective health and healthy life expectancy and identify the factors that improve subjective health of child-rearing-aged adults in Japan. METHODS: A cross-sectional study was conducted. We used data from 2718 participants of the Japanese General Social Survey 2009 Life Course Study. The mean age was 35.5 ± 4.10 years, and 56% were female. Multivariate logistic regression analysis was performed on subjective health, which was treated as a binary variable when calculating healthy life expectancy as an objective variable. The predictors were gender, age, marital status, number of family members living in the home, household income, mental health score, age of youngest child, and the person from whom one seeks help. The prefecture where the participants resided was treated as a control variable. RESULTS: There was no association between individual subjective health and healthy life expectancy. Mental health score (measured by the Mental Health Inventory-5, MHI-5) was significantly associated with subjective health. With a MHI-5 score of ⩽ 10 points as the reference criterion, as the score increased, the odds ratio of subjective health increased, and for MHI-5 scores ⩾ 16 points, odds ratio was 14.14 (confidence interval: 7.57-26.38). CONCLUSION: Among the child-rearing-aged adults, prefectural healthy life expectancy was not associated with individual subjective health. Mental health was significantly associated with subjective health and may be underestimated in calculating healthy life expectancy.

Prediction of Age-Adjusted Mortality From Stroke in Japanese Prefectures: Ecological Study Using Search Engine Queries.

BACKGROUND: Stroke is a major cause of death and the need for nursing care in Japan, with large regional disparities. OBJECTIVE: The purpose of this study was to clarify the association between stroke-related information retrieval behavior and age-adjusted mortality in each prefecture in Japan. METHODS: Age-adjusted mortality from stroke and aging rates were obtained from publicly available Japanese government statistics. A total of 9476 abstracts of Japanese articles related to symptoms and signs of stroke were identified in Ichushi-Web, a Japanese web-based database of biomedical articles, and 100 highly frequent words (hereafter referred to as the Stroke 100) were extracted. Using data from 2014 to 2019, a random forest analysis was carried out using the age-adjusted mortality from stroke in 47 prefectures as the outcome variable and the standardized retrieval numbers of the Stroke 100 words in the log data of Yahoo! JAPAN Search as predictive variables. Regression analysis was performed using a generalized linear mixed model (GLMM) with the number of standardized searches for Stroke 100 words with high importance scores in the random forest model as the predictive variable. In the GLMM, the aging rate and data year were used as control variables, and the random slope of data year and random intercept were calculated by prefecture. RESULTS: The mean age-adjusted mortality from stroke was 28.07 (SD 4.55) deaths per 100,000 for all prefectures in all data years. The accuracy score of the random forest analysis was 89.94%, the average error was 2.79 degrees, and the mean squared error was 13.57 degrees. The following 9 variables with high importance scores in the random forest analysis were selected as predictive variables for the regression analysis: male, age, hospitalization, enforcement, progress, stroke, abnormal, use, and change. As a result of the regression analysis with GLMM, the standardized partial regression coefficients (ß) and 95% confidence intervals showed that the following internet search terms were significantly associated with age-adjusted mortality from stroke: male (ß=-5.83, 95% CI -8.67 to -3.29), age (ß=-5.83, 95% CI -8.67 to -3.29), hospitalization (ß=-5.83, 95% CI -8.67 to -3.29), and abnormal (ß=3.83, 95% CI 1.14 to 6.56). CONCLUSIONS: Stroke-related search behavior was associated with age-adjusted mortality from stroke in each prefecture in Japan. Query terms that were strongly associated with age-adjusted mortality rates of stroke suggested the possibility that individual characteristics, such as sex and age, have an impact on stroke-associated mortality and that it is important to receive medical care early after stroke onset. Further studies on the criteria and timing of alerting are needed by monitoring information-seeking behavior to identify queries that are strongly associated with stroke mortality.

Predicting the Number of Suicides in Japan Using Internet Search Queries: Vector Autoregression Time Series Model.

BACKGROUND: The number of suicides in Japan increased during the COVID-19 pandemic. Predicting the number of suicides is important to take timely preventive measures. OBJECTIVE: This study aims to clarify whether the number of suicides can be predicted by suicide-related search queries used before searching for the keyword "suicide." METHODS: This study uses the infoveillance approach for suicide in Japan by search trends in search engines. The monthly number of suicides by gender, collected and published by the National Police Agency, was used as an outcome variable. The number of searches by gender with queries associated with "suicide" on "Yahoo! JAPAN Search" from January 2016 to December 2020 was used as a predictive variable. The following five phrases highly relevant to suicide were used as search terms before searching for the keyword "suicide" and extracted and used for analyses: "abuse"; "work, don't want to go"; "company, want to quit"; "divorce"; and "no money." The augmented Dickey-Fuller and Johansen tests were performed for the original series and to verify the existence of unit roots and cointegration for each variable, respectively. The vector autoregression model was applied to predict the number of suicides. The Breusch-Godfrey Lagrangian multiplier (BG-LM) test, autoregressive conditional heteroskedasticity Lagrangian multiplier (ARCH-LM) test, and Jarque-Bera (JB) test were used to confirm model convergence. In addition, a Granger causality test was performed for each predictive variable. RESULTS: In the original series, unit roots were found in the trend model, whereas in the first-order difference series, both men (minimum tau 3: -9.24; max tau 3: -5.38) and women (minimum tau 3: -9.24; max tau 3: -5.38) had no unit roots for all variables. In the Johansen test, a cointegration relationship was observed among several variables. The queries used in the converged models were "divorce" for men (BG-LM test: P=.55; ARCH-LM test: P=.63; JB test: P=.66) and "no money" for women (BG-LM test: P=.17; ARCH-LM test: P=.15; JB test: P=.10). In the Granger causality test for each variable, "divorce" was significant for both men (F104=3.29; P=.04) and women (F104=3.23; P=.04). CONCLUSIONS: The number of suicides can be predicted by search queries related to the keyword "suicide." Previous studies have reported that financial poverty and divorce are associated with suicide. The results of this study, in which search queries on "no money" and "divorce" predicted suicide, support the findings of previous studies. Further research on the economic poverty of women and those with complex problems is necessary.

Model Comparisons of the Cost Effectiveness of Rubella Vaccination Method in Japanese Adults.

The number of rubella cases has increased in Japan, especially among adults. Rubella infection in pregnant females can lead to congenital rubella syndrome (CRS). The Japanese government is promoting vaccination to prevent CRS. This study performs a cost-effectiveness analysis of the following four methods: (1) females who wished to become pregnant and partners, with an antibody-titer test; (2) females only, with an antibody-titer test; (3) females and males, without an antibody-titer test; (4) females only, without an antibody-titer test. A decision tree model with a hypothetical cohort of 500 males and 500 females was used for the analysis, and the parameters were obtained from previous studies. The number of avoidances of CRS was defined as the effect. Compared to the case where methods were not implemented, the number of CRS cases that can be prevented by implementing the methods was 0.0115589 by (1) and (3) and 0.0147891 by (2) and (4). The cost effectiveness of (1) to (4) was 287,413,677 JPY, 135,050,529 JPY, 388,524,974 JPY, and 197,744,219 JPY, respectively (1 JPY = 0.00963247 USD). Method (2) was the most cost-effective and did not change by sensitivity analysis. We conclude that the vaccination for females only with an antibody-titer test is recommended.

Comparing the differences in three measures of healthy life expectancy among prefectures in Japan.

OBJECTIVE: An ecological study using secondary open data from Japanese government statistics was conducted. The study aimed to verify differences in three measures of healthy life expectancy (HLE); namely, disability-free life expectancy without activity limitation (DFLE-AL), life expectancy with self-perceived health (LE-SH), and disability-free life expectancy without care need (DFLE-CN). RESULTS: Each HLE from 47 prefectures in 2010, 2013, and 2016 was extended over time. There were strong Cronbach's coefficient alpha (α) between DFLE-AL and LE-SH (Minimum α; 0.80, Maximum α; 0.90) as well as between LE and DFLE-CN (Minimum α; 0.92, Maximum α; 0.99) in both sexes in every data year. However, the other pairs had weaker associations. In regression analysis with each HLE as a dependent variable and aging rate, mortality, the proportion of unhealthy people as independent variables, the subjective unhealthy rate had significant standardized partial regression coefficients (ß) in models with DFLE-AL and LE-SH as dependent variables (Minimum ß; - 0.56, Maximum ß; - 0.34). Therefore, DFLE-CN tended to differ from the other HLEs. The subjective unhealthy rate had a significant influence on DFLE-AL and LE-SH.

Comparing Medical Term Usage Patterns of Professionals and Search Engine and Community Question Answering Service Users in Japan: Log Analysis.

BACKGROUND: Despite increasing opportunities for acquiring health information online, discussion of the specific words used in searches has been limited. OBJECTIVE: The aim of this study was to clarify the medical information gap between medical professionals and the general public in Japan through health information-seeking activities on the internet. METHODS: Search and posting data were analyzed from one of the most popular domestic search engines in Japan (Yahoo! JAPAN Search) and the most popular Japanese community question answering service (Yahoo! Chiebukuro). We compared the frequency of 100 clinical words appearing in the clinical case reports of medical professionals (clinical frequency) with their frequency in Yahoo! JAPAN Search (search frequency) logs and questions posted to Yahoo! Chiebukuro (question frequency). The Spearman correlation coefficient was used to quantify association patterns among the three information sources. Additionally, user information (gender and age) in the search frequency associated with each registered user was extracted. RESULTS: Significant correlations were observed between clinical and search frequencies (r=0.29, P=.003), clinical and question frequencies (r=0.34, P=.001), and search and question frequencies (r=0.57, P<.001). Low-frequency words in clinical frequency (eg, "hypothyroidism," "ulcerative colitis") highly ranked in search frequency. Similarly, "pain," "slight fever," and "numbness" were highly ranked only in question frequency. The weighted average of ages was 34.5 (SD 2.7) years, and the weighted average of gender (man -1, woman +1) was 0.1 (SD 0.1) in search frequency. Some words were specifically extracted from the search frequency of certain age groups, including "abdominal pain" (10-20 years), "plasma cells" and "inflammatory findings" (20-30 years), "DM" (diabetes mellitus; 30-40 years), "abnormal shadow" and "inflammatory findings" (40-50 years), "hypertension" and "abnormal shadow" (50-60 years), and "lung cancer" and "gastric cancer" (60-70 years). CONCLUSIONS: Search and question frequencies showed similar tendencies, whereas search and clinical frequencies showed discrepancy. Low-clinical frequency words related to diseases such as "hypothyroidism" and "ulcerative colitis" had high search frequencies, whereas those related to symptoms such as "pain," "slight fever," and "numbness" had high question frequencies. Moreover, high search frequency words included designated intractable diseases such as "ulcerative colitis," which has an incidence of less than 0.1% in the Japanese population. Therefore, it is generally worthwhile to pay attention not only to major diseases but also to minor diseases that users frequently seek information on, and more words will need to be analyzed in the future. Some characteristic words for certain age groups were observed (eg, 20-40 years: "cancer"; 40-60 years: diagnoses and diseases identified in health examinations; 60-70 years: diseases with late adulthood onset and "death"). Overall, this analysis demonstrates that medical professionals as information providers should be aware of clinical frequency, and medical information gaps between professionals and the general public should be bridged.

[Regional Comparison on Recognition of Tasks for a Home Care System-Analysis of Medical Plans of 47 Prefectures by Text Mining and GIS].

A medical plan reflectsthe current state of a region. The purpose of thisres earch isto analyze medical plansby text mining and examine geographical features using a geographic information system. From the medical plans of 47 prefectures, nationwide, 6 regional divisions', and four age groups' text fileswere prepared. Further, wordswere extracted and subsequently, their relevance wasanalyzed. Additionally, we examined the geographical featuresus ing a color-dividing Japanese map by the word appearance rate of"Mitori"(end-of-life care), which is an important task. In the aggregate nationwide text files, 214,716 words were extracted. The top frequent words were medical care, home, support, nursing care, visit, medical treatment, and cooperation. In the co-occurrence network, medical care- home- nursing care- cooperation were connected with organization- construction. There was a link between human resources- training in Kanto and Kinki."Mitori"frequently occurred in areaswith a high aging rate, and there wasa human resources- training- securing connection in areas with a low aging rate. The frequency of"Mitori"was high in western Japan. The results suggested that collaboration between medical care and nursing care is emphasized in medical planning. Further,"Mitori"was emphasized in western Japan or areas with a high aging rate while human resourcesdevelopment wasemphas ized in areaswith a low aging rate.

[Investigation of the actual conditions of users of a home-visiting bathing service based on the long-term care insurance care ranking and factors affecting the judgment of bathing possibility].

AIM: In home-visiting bathing services (HVBs), a nurse's role is to evaluate the vital signs, judge bathing possibilities and provide treatment before/after bathing. There are no guidelines regarding specific physical criteria for judging the bathing possibility. However, the body condition of HVB users during bathing has not been investigated. Thus, the present study aimed to clarify users' actual conditions and the factors related to the judgment of the possibility of bathing. METHODS: An anonymous self-administered questionnaire survey of HVBs users was conducted by Company-A, which provides HVBs. Six hundred sixty responses were collected (response rate: 40.1%).We described the conditions of HVB users and used chi-squared tests and logistic regression analyses to confirm the factors, including the certified Long-term Care Insurance (LTCI) care rank, past medical history and physical conditions that were associated with aborted HVB experiences. RESULTS: The mean age of the care-recipients was 82.1±12.1 and 93.3% of the recipients had severe conditions, including conditions necessitation the use of medical equipment, pressure ulcers, and contracture. The logistic regression analysis showed that the LTCI-certified-care-rank, the presence of pain, and the need for treatment before bathing were significant factors. CONCLUSIONS: This study showed that users of HVBs not only had high LTCI-certified-care ranks, but that they also required pain management and pre-bathing treatment.

[A Study of Job Retention among Nurses Engaged in Home-Visit Bathing Services].

It is necessary to include a nurse as staff in"Home Visit Bathing Long-Term Care"because nurses provide medical care such as vital sign measurement. However, the shortage of nurses is serious. A questionnaire survey was administered to nurses of E company, and findings showed that more than 50% of nurses felt physical fatigue. Correlation analysis showed that there was a significant correlation between"the intentions to continue working"and"good relationship between nurses and staff" (r=0.398, p<0.001), and there was a negative correlation with"low payment"(r=-0.232, p<0.01)and"physical fatigue" (r=-0.272, p<0.01). Although physical fatigue and low payment are factors that inhibit the intentions to continue working, the most important factor is human relationships. It was suggested that maintaining good human relationships enhances the intentions of nurses to continue working.

Adaptation of Pseudomonas sp. strain 7-6 to quaternary ammonium compounds and their degradation via dual pathways.

Pseudomonas sp. strain 7-6, isolated from active sludge obtained from a wastewater facility, utilized a quaternary ammonium surfactant, n-dodecyltrimethylammonium chloride (DTAC), as its sole carbon, nitrogen, and energy source. When initially grown in the presence of 10 mM DTAC medium, the isolate was unable to degrade DTAC. The strain was cultivated in gradually increasing concentrations of the surfactant until continuous exposure led to high tolerance and biodegradation of the compound. Based on the identification of five metabolites by gas chromatography-mass spectrometry analysis, two possible pathways for DTAC metabolism were proposed. In pathway 1, DTAC is converted to lauric acid via n-dodecanal with the release of trimethylamine; in pathway 2, DTAC is converted to lauric acid via n-dodecyldimethylamine and then n-dodecanal with the release of dimethylamine. Among the identified metabolites, the strain precultivated on DTAC medium could utilize n-dodecanal and lauric acid as sole carbon sources and trimethylamine and dimethylamine as sole nitrogen sources, but it could not efficiently utilize n-dodecyldimethylamine. These results indicated pathway 1 is the main pathway for the degradation of DTAC.