[Developing scales to evaluate community practices among municipal public health nurses: content, perceptions of public health nurses, and organizational environment].

Objectives　This study aimed to develop scales for evaluating the level of implementation of community practices and explore the perception of public health nurses in municipalities regarding their community practices.Methods　Draft scales were developed based on a literature review and interviews with municipal public health nurses. Subsequently, a questionnaire survey was conducted with municipal public health nurses across Japan in response to these draft scales. Respondents were recruited based on the municipality population size. Questionnaires were distributed to 2,074 individuals from 52 municipalities ensuring representation from diverse municipalities. Exploratory factor analysis was performed to determine the number of factors, while confirmatory factor analysis was performed to determine the factor structure. The reliability of the scales was assessed by calculating Cronbach's alpha coefficients, and their validity was tested by examining correlations with existing scales, namely the Moral Competence Scale for Public Health Nurses and the Professional Identity Scale for Public Health Nurses, and years of experience as a public health nurse.Results　A total of 721 (34.8%) valid respondents were included in the analysis. Three scales, methods of community practices (three factors, nine items), perceptions of public health nurses toward community residents through community practices (three factors, 10 items), and organizational environment supporting community practices (two factors, 11 items) were developed as indicators of the implementation of public health nurses' community practices. Cronbach's alpha coefficients for the three scales were 0.896, 0.913, and 0.868, respectively. As hypothesized, each subfactor exhibited a positive correlation with the existing scales. However, certain subfactors did not demonstrate any correlation with years of experience.Conclusion　The three scales developed in this study were individually examined for reliability and validity. These scales can be used independently or in combination, allowing public health nurses to select the most suitable scale(s) based on their objective.　A notable contribution of this study is the establishment of concrete indicators for evaluating community practices, addressing the previously vague nature of this evaluation. By incorporating the scale items into daily health practices, we anticipate that these indicators can be employed to evaluate community practices at the organizational and individual levels.

Exposure to dogs and cats and risk of asthma: A retrospective study.

Findings on the relationship between pet exposure and asthma in western countries are inconsistent. This retrospective study examined the association of owning a dog or cat with the onset of asthma in Japanese people. We also investigated whether there is a critical window during which exposure to dogs and cats can reduce the risk of asthma by stratifying the analysis by the age at which pet ownership began. We analyzed data collected in an internet survey conducted by the Japan Pet Food Association in 2021. Valid data were obtained from 4290 participants for analysis of dog ownership and 4308 participants for analysis of cat ownership. In these respective groups, 41.2% had owned a dog and 26.5% had owned a cat. During the follow-up period, 5.7% of dog owners and 14.8% of non-dog owners developed asthma, as did 5.6% of cat owners and 13.5% of non-cat owners. On binomial logistic regression analysis, participants who had not owned a dog had an odds ratio (OR) of 2.01 (95% confidence interval (CI): 1.45-2.78) of developing asthma compared to those who had owned a dog after adjustment for sociodemographic characteristics. The corresponding OR of asthma onset among participants who had not owned a cat was 2.24 (95%CI: 1.56-3.23). Stratified analysis showed that while younger participants who had not owned a dog had higher ORs of developing asthma, those who had not owned a cat had similar ORs of asthma onset across all age categories. These results suggest that while there may be a critical window in early life during which exposure to dogs can prevent asthma onset, the protective effect of cat exposure is constant across all ages in Japan.

[Gaining consensus on key terms in community health activities: A national survey using the Delphi method].

Objectives　The purpose of this study was to define the terminology used in community health activities by systematically establishing agreement among public health nurses and related professionals, to aid them in effectively cooperating with other professionals.Methods　We extracted the major terms described in "Guidelines for Public Health Nurses' Activities in the Region," which was issued by the Director of Health Bureau, Ministry of Health, Labor and Welfare; and conducted 2 iterations on the proposed definition of the terms using the Delphi method. The survey targeted 800 stakeholders from the following 4 professions: public health nurses in managerial positions in local governments, clerical staff in local governments, public health nursing professors at educational institutions, and social welfare council staff. Respondents indicated their degree of agreement with the definition of the terms using a 4-point Likert scale. We tallied the answers indicating "I agree" or "Mostly agree." A 70% term agreement was considered "conformed." A free text box for each proposed definition was also available so that respondents could share their opinions and offer alternatives.Results　The first survey received 231 responses. The conformity of their definitions ranged from 83.9%-96.9% (mean=91.5%). Although all definitions exceeded the consensus level, we examined their adequacy with reference to the definitions and opinions from the free text. Various opinions were obtained from those engaged in each occupation. The second round included 117 consenting stakeholders from the first survey, yielding 90 responses. Their degree of conformity ranged from 86.7%-98.9% (mean=94.6%). Therefore, we determined the definitions had reached a robust agreement. We revised the definitions of some terms with reference to the opinions from the free texts and finalized the definitions. Finally, we defined 23 terms-such as region, community diagnosis, and policy.Conclusion　All terms had a conformity of more than 85%, thus bringing into alignment those community health terms that had varying interpretations among related occupations earlier. By including the opinions of those from the related occupations who collaborate with public health nurses, the definitions of these terms could be established and shared. These definitions can be used in public health nursing practice, education, service, and research-among those in involved these related occupations.

Evaluating the Efficacy of Double-Filtration Plasmapheresis in Treating Five Patients With Drug-Resistant Pemphigus.

Double-filtration plasmapheresis is an effective and safe treatment for pemphigus. We retrospectively evaluated the decrease in autoantibody titer and pemphigus disease area index following double-filtration plasmapheresis in five patients with moderate to severe pemphigus, who were physically and/or serologically unresponsive to 1.0 mg/kg per day of prednisolone and other supportive drugs and ointments. The percentage reduction in autoantibodies 85.6 ± 14.4% (P = 0.00014), and that in pemphigus disease area index was 75.4 ± 24.3% (P = 0.0023). No side-effects were observed. All patients exhibited clinical improvement after undergoing double-filtration plasmapheresis, and the prednisolone dose was reduced by 41 ± 8.9 mg (P = 0.0005) approximately 3 months after double-filtration plasmapheresis. To our knowledge, this is the first report evaluating the efficacy of double-filtration plasmapheresis with pemphigus disease area index, and it demonstrated that double-filtration plasmapheresis is a safe "subtracting" treatment for patients with drug-resistant pemphigus.

Errata: Developing a scale to measure "attachment to the local community" in late middle aged individuals.

Nihon Koshu Eisei Zasshi(JAPANESE JOURNAL OF PUBLIC HEALTH), Vol. 63 (2016) No. 11 p. 664-674: p668(Table 2).

Developing a scale to measure "attachment to the local community" in late middle aged individuals.

Objectives This study was conducted to develop a scale for measuring "attachment to the local community" for its use in health services. The scale is also intended to nurture new social relationships in late middle-aged individuals.Methods Thirty items were initially planned to be included in the scale to measure "attachment to the local community", according to a previous study that identified the concept. The study subjects were late middle-aged residents of City B in Prefecture A, located in Tokyo suburbs. From the basic resident register data, 1,000 individuals (local residents in the 50-69 year age group) were selected by a multi-stage random sampling technique, on the basis of their residential area, age, and sex (while maintaining the male to female ratio). An unsigned self-administered questionnaire was distributed to the subjects, and the responses were collected by postal mail. The collected data was analyzed using psychometric study of scale.Results Valid responses were obtained from 583 subjects, and the response rate was 58.3%. In an item analysis, none of the items were rejected. In a subsequent factor analysis, 7 items were eliminated. These items included 2 items with a factor loading of <0.40, 3 items loading on multiple factors and showing a factor loading of ≥0.40, and 2 items with a low factor correlation (0.04-0.16). These items included factors that related to only these 2 items. Consequently, 23 items in the following 4-factor structure were selected as the scale items: "Source of vitality to live life," "Intention to cherish ties with people," "Place where one can be oneself," and "Pride of being a resident." Cronbach's coefficient α for the entire scale of "attachment to the local community" was 0.95, demonstrating internal consistency. We then examined the correlation with an existing scale to measure social support; the results revealed a statistically significant correlation and confirmed criterion-related validity (P<0.001). In addition, the fit indices in a covariance structure analysis showed adequate values.Conclusions The developed scale was considered reliable and appropriate for measuring "attachment to the local community."

Moral competence questionnaire for public health nurses in Japan: scale development and psychometric validation.

AIM: To develop a valid and reliable self-assessment questionnaire that can be easily used by public health nurses in Japan to measure their moral competence. METHODS: A self-administered questionnaire that included the preliminary Moral Competence Questionnaire for Public Health Nurses and demographics was distributed to public health nurses who worked at local governments in Japan. RESULTS: Exploratory factor analysis for the Moral Competence Questionnaire for Public Health Nurses from 3493 responses (31.9%) revealed 15 items loading on three factors: (1i) judgment based on the values of community members; (ii) strong will to face difficult situations; and (iii) cooperating with relevant people/organizations. Confirmatory factor analysis indicated that this model has a reasonable fit to the data. Cronbach's alphas ranged 0.85-0.91. CONCLUSION: The construct validity and internal consistency reliability of the Moral Competence Questionnaire for Public Health Nurses were supported. This questionnaire reflected the characteristics of Japan's public health nursing practice and it may be used to assess current moral practice and need for continuing education. However, this questionnaire needs additional internal validity testing and possible item development. Additional research is needed to refine this scale and increase the possibility of generalizability.

Ethical issues in practice: a survey of home-visiting nurses in Japan.

AIM: The purposes of this study were to identify specific components and frequencies of ethical issues that home-visiting nurses encountered in their practice, relationships between ethical issues and demographic data, and experience of ethics education and workplace environment. METHODS: A self-administered questionnaire was distributed to home-visiting nurses in Japan. Usable data (1961) were analyzed. RESULTS: Item and exploratory factor analysis for the frequency of encountering ethical issues revealed: (i) concern about respecting client or relationships with relevant professionals; (ii) differences in treatment or care-taking views among home-visiting nurse and client and family, or relevant professionals; and (iii) discrepancy of intention between family and client or home-visiting nurse. All factors were significantly positively related to the current position, duration of working experience as a home-visiting nurse, and type of nursing education; age was significantly negatively related. Home-visiting nurses noted that programmed continuing education systems and staff-training programs were not sufficiently available. CONCLUSION: The findings of this study indicated the characteristics of ethical issues that home-visiting nurses encountered in their practice and insufficient continuing education system including ethics education. Ethics education programs tailored to home-visiting nurses ethical concerns and traits and continuing education systems are needed.

Development and psychometric evaluation of the Moral Competence Scale for Home Care Nurses in Japan.

PURPOSE: The purpose of this study was to evaluate the validity and reliability of the Moral Competence Scale for Home Care Nurses (MCSHCN). METHODS: A self-administered questionnaire that included the preliminary MCSHCN (90 items) was distributed to home care nurses (HCNs) in Japan. Usable data (from 1,961 questionnaires) were analyzed. RESULTS: Item and exploratory factor analysis for the MCSHCN revealed 45 items that loaded on 5 factors. This 5-factor model showed reasonable fit to the data by confirmatory factor analysis (root mean square error of approximation [RMSEA] = 0.070). Thus, the model closely corresponded to the theoretical components of moral competence. Cronbach's alpha ranged from .78 to .93. CONCLUSIONS: The construct validity and internal consistency reliability were supported. Further research is needed to refine this scale to increase the generalizability.

Ethical issues in practice: a survey of public health nurses in Japan.

OBJECTIVES: The purposes of this study were to identify specific components and frequencies of ethical issues that public health nurses (PHNs) encountered in their practice, relationships between ethical issues and demographic data, and ethics education and workplace environment. DESIGN AND SAMPLE: Cross-sectional survey for PHNs at local governmental agencies in Japan. Usable data were 3,409. MEASURES: Public health nurses completed the frequency of ethical issues, experience of ethics education, workplace environment, and demographics. RESULTS: Item and exploratory factor analysis for the frequency of encountering ethical issues revealed: (1) discrepancy of intention between client and his/her family on treatment or care; (2) differences in views between PHNs and their organization's administrators regarding providing services; and (3) discrepancy of caretaking views between PHNs and various professionals. All factors were related to work experience and one factor was specifically related to the type of local government employing PHNs. Only 11.1% of PHNs received ethics education via continuing education programs. PHNs reported that programmed continuing education systems were not sufficiently available. CONCLUSIONS: Systematic continuing ethics education programs for PHNs need developing, tailored to the specific characteristics associated with PHNs' ethical concerns, such as nurses' working experience and the type of employing local government.

[A framework for assessing essential public health nursing skills and achievement levels required for students graduating from schools that provide education for obtaining a license as a public health nurse in Japan].

PURPOSES: This study aimed to develop a framework for essential skills and the achievement levels necessary for students graduating from schools that provide education for obtaining a license as a public health nurse (PHN) in Japan. METHODS: Two rounds of questionnaire-based investigations using the Delphi methodology were conducted. Subjects were 197 PHNs from municipalities or companies and 146 nurse educators from universities, colleges, junior colleges, or technical nursing schools. RESULTS: (1) The essential skills framework consisted of three (macro, intermediate and micro) levels. Macro-level items were based on the principle of justice, a primary pillar of health care: (A) community assessment to identify health problems; (B) solving and improving particular health problems in collaboration with people to enable them to promote their own health; (C) promoting equitable access and distribution of community resources for health and daily living. Micro-level items had four achievement levels: (I) independent; (II) instructor-guided; (III) laboratory exercise; (IV) theoretical understanding. Micro-level items for A and B had two domains for achievement: individual/family and group/community. (2) In the first round over 70% of respondents said "very important," "important" or "acceptable" for all micro-level items. In the second round, over 90% said all micro-level items fit within macro and intermediate-level items. (3) In the second round, micro-level items attained 70% consensus among PHNs and nurse educators were 71 of 93 (76.3%). Micro-level expression was used for adjustment and the final framework of essential skills yielded 3 macro, 8 intermediate and 59 micro-level items and 95 levels of achievement. (4) In the final framework, the level of achievement for "individual/family" (Macro-level A and B) was almost level I, and for "group/community" almost II or III. The number of micro-level items at level IV for C was 14 of 21 (66.7%). (5) Compared with PHNs, educators generally assigned a more advanced achievement level for the same skill. CONCLUSIONS: This framework offers more clarity to the content and competency of practice and thus should be useful for basic and continuing PHN education. The assumption driving this study was the necessity to improve the nursing educational system, and develop an appropriate curriculum for the PHN national licensure.