[Comparison and clarification of public health and public health nursing competencies: A report of the Committee on Public Health Nursing (2017-2018)].

Objectives　The Committee on Public Health Nursing (2017-2018) of the Japanese Society of Public Health aimed to elucidate the competencies of public health and public health nursing to provide basic materials for public health, public health nursing education, practice, and research.Methods　We studied the core competencies of public health professionals and public health nursing in the United States and examined similarities to and differences from those in Japan.Results　The United States and Japan shared similar public health and public health nursing competencies in that they targeted populations, identified health problems, and clarified health challenges for effective actions. However, differences were noted in the understanding of target groups, perspectives for identifying health problems and overcoming health challenges, and conceptualization of individuals in populations. In public health, the target population practiced clear boundaries, such as residing in certain geographical areas and ethnic groups, among others. In health challenges, the top-down approach was employed to resolve health problems in certain populations. The individual was recognized as a part of a population composed of a certain group. In public health nursing, target population (e.g., from individuals/families to groups/communities/social groups) were understood in a continuous and multilayered manner. Individual/family health problems were associated with the characteristics of groups, communities, and social groups that encompass the continuum. Moreover, health challenges were addressed in a manner oriented toward the transformation of social groups as a whole. Public health nursing competencies in both countries, which share many similarities, were developed to achieve the objectives of public health. In the United States, the competencies and skills considered necessary, such as analytical/assessment and cultural competency skills, were clearly expressed and constructed in line with the core competencies of public health professionals. However, in Japan, skills and abilities necessary as competencies in public health nursing mentioned above were not specified.Conclusion　Elucidating the core competencies of public health professionals in Japan is essential to develop human resources that can contribute to effective practices in public health and public health nursing. Toward this end, skills and abilities necessary as competencies in public health nursing in Japan, which were not previously verbalized, should be described in detail.

Supporting elder persons in rural Japanese communities through preventive home visits by nursing students: A qualitative descriptive analysis of students' reports.

This article describes the evaluation of an innovative nursing education curriculum project, preventive home visiting practice, which began full implementation in 2015, in terms of students' learning outcomes. For the purpose of learning how elder persons live in community, all the 327 undergraduate nursing students, from freshmen to seniors, provided monthly or bi-monthly visits to home-dwelling elderly persons aged 75 or above in their home over 1 year period, in order to provide support for their independent living and to learn from them. The students' reports submitted at the end of the first academic year were qualitatively analyzed to evaluate what they learned. They acquired multiple perspectives for understanding elder persons, including a variety of individual and environmental aspects of wellness, prevention, and community life. They also acknowledged the importance of team practice through working and collaborating with different grade levels and generations. Overall, the observed learning contents were useful for future nursing education with elder persons and facilitating critical changes in nursing education systems to address the problems of aged society.

[Vitalizing public health activities through community assessment: A report of the Committee on Public Health Nursing 2014-2017].

Objectives　This report aims to present the community assessment model developed by the Committee on Public Health Nursing (6th term) of the Japanese Association of Public Health. This new model was designed such that it could be applied to a broad range of public health activities. It aims at theorizing public health nurses' practice-based knowledge and sharing it among other public health professionals.Methods　The model was developed during seven committee meetings held from October 2014 to September 2017. In the first step, we brainstormed the definition and methods of community assessment and constructed a framework for a literature review. In the second step, information on theories, research, and practice relevant to community assessment was reviewed based on this framework. In the third step, the community assessment model was developed based on the results of the literature review and the practice experience of the committee members. In the last step, we examined the applicability of this model to the practice of occupational health and public health administration.Project activities　We defined community assessment as the "skills and methods based on applied science that drive Plan-Do-Check-Action (PDCA) cycles in every activity that aims at achieving a better quality of life (QOL)." We further classified community assessment into two types; comprehensive assessment and targeted assessment. The model underlined that community assessment was a continuous and developmental process that occurs throughout every stage of the PDCA cycle, and that it was oriented toward improving the QOL of community residents. This model also purported that the empirical and scientific intuition, and ethical sensitivity of assessors were among the key determinants of assessment quality.Conclusion　The model on community assessment developed in the present study based on the empirical knowledge of public health nurses could be applied to all types of public health activities in communities.

The Importance of the Maternal/Self-Role Satisfaction for Reducing Anxiety: A Cross-Sectional Survey of Japanese Mothers.

Women who rear children have two types of roles: the maternal role and the self-role. Previous studies have suggested that maternal role satisfaction is related to anxiety, but the importance of self-role satisfaction in promoting the health of mothers has received less attention. The changing roles of women in society, especially in urban areas, have altered mothers' views of child-rearing. Our primary focus was on the relationship between maternal/self-role satisfaction and anxiety in mothers. To examine this, we conducted a cross-sectional survey using self-administered questionnaires that were distributed in 2011 to 2,342 mothers attending the 18-month health checkup of their children, in 7 cities of the Tokyo metropolitan area. A total of 881 responded (effective response rate = 38.0%). Multiple regression analysis revealed that maternal role satisfaction and self-role satisfaction were both significantly and negatively associated with anxiety. Thus, self-role satisfaction should be considered alongside maternal role satisfaction in evaluating and reducing anxiety. Health care professionals in community settings should conduct comprehensive assessments of maternal role satisfaction and self-role satisfaction.

Quality of nursing doctoral education in seven countries: survey of faculty and students/graduates.

AIMS: This study aimed to compare the findings of the quality of nursing doctoral education survey across seven countries and discuss the strategic directions for improving quality. BACKGROUND: No comparative evaluation of global quality of nursing doctoral education has been reported to date despite the rapid increase in the number of nursing doctoral programmes. DESIGN: A descriptive, cross-country, comparative design was employed. METHODS: Data were collected from 2007-2010 from nursing schools in seven countries: Australia, Japan, Korea, South Africa, Thailand, UK and USA. An online questionnaire was used to evaluate quality of nursing doctoral education except for Japan, where a paper version was used. Korea and South Africa used e-mails quality of nursing doctoral education was evaluated using four domains: Programme, Faculty (referring to academic staff), Resource and Evaluation. Descriptive statistics, correlational and ordinal logistic regression were employed. RESULTS: A total of 105 deans/schools, 414 faculty and 1149 students/graduates participated. The perceptions of faculty and students/graduates about the quality of nursing doctoral education across the seven countries were mostly favourable on all four domains. The faculty domain score had the largest estimated coefficient for relative importance. As the overall quality level of doctoral education rose from fair to good, the resource domain showed an increased effect. CONCLUSIONS: Both faculty and students/graduates groups rated the overall quality of nursing doctoral education favourably. The faculty domain had the greatest importance for quality, followed by the programme domain. However, the importance of the resource domain gained significance as the overall quality of nursing doctoral education increased, indicating the needs for more attention to resources if the quality of nursing doctoral education is to improve.

Identifying Residents' Health Issues Six Weeks after the Great East Japan Earthquake.

OBJECTIVE: The aim of this study was to identify the characteristics and health issues of residents in need of assistance in a town affected by the Great East Japan Earthquake, six weeks after the disaster, through an outreach initiative. DESIGN AND SAMPLE: A cross-sectional qualitative design was used. Public health nurses conducted comprehensive semi-structured interviews during home visits with residents. A total of 5,082 residents from the affected town. MEASURES: These included demographic information, public records of the extent of the damages, and qualitative interview data to determine the urgency of the necessary interventions. RESULTS: A total of 281 residents needed some kind of assistance and were identified as "requiring early intervention (within two weeks)" or "requiring assistance (within 12 weeks)." The most common health issue requiring early intervention was "interruption of treatment" (25.0%), followed by "need for mental care." The most frequent health issue requiring assistance within 12 weeks was the "need for mental health care" (39.7%), followed by "interruption of treatment," and "need for nursing care." CONCLUSIONS: During a disaster, it is imperative to identify cases requiring early intervention. Home-visit interviews were necessary to identify existing health concerns to prevent the development of more serious health problems.

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.

The tsunami's impact on mortality in a town severely damaged by the 2011 Great East Japan Earthquake.

This study identifies the relationship between tsunami damage and mortality through a demographic pyramid of a town severely damaged by the tsunami following the Great East Japan Earthquake of 11 March 2011. It uses cross-sectional data collection. Volunteers visited all households, including shelters, and asked residents about the whereabouts of family members and neighbours. The information was collated with lists of evacuees and the dead to confirm the whereabouts of all residents about 50 days after the disaster. Demographic pyramids for the whole population based on pre- and post-disaster data were drawn. In all, 1,412 (8.8 per cent) were dead or missing, 60.2 per cent of whom were aged 65 and over and 37.5 per cent aged 75 and over, suggesting that the very old should be located beyond the reach of tsunamis. The mortality rate of children was lower than that in other studies, which may indicate the efficacy of disaster evacuation drills.

Relationship between plasma total homocysteine level and dietary caffeine and vitamin B6 intakes in pregnant women.

A high total homocysteine (tHcy) level during pregnancy is a risk factor for adverse perinatal outcomes, such as fetal growth restriction and preeclampsia. Caffeine is assumed to increase tHcy levels by acting as a vitamin B6 antagonist. The objective of this study was to examine a relationship between circulating tHcy levels and dietary caffeine and vitamin B6 intakes in pregnant Japanese women. A total of 321 healthy women with singleton pregnancies were recruited in metropolitan Tokyo, from June to December 2008, resulting in the final number included in the study as 254. Dietary caffeine intakes did not correlate with plasma tHcy levels. When we analyzed the data according to caffeinated beverages, caffeinated tea consumption was positively associated with plasma tHcy levels only among the women with a high intake of vitamin B6 , after controlling for confounding factors (P = 0.029). No correlation between coffee consumption and plasma tHcy levels was found. Pregnant Japanese women might need to cut down the consumption of caffeinated tea as well as take sufficient vitamin B6 in order to prevent the tHcy levels from increasing.

[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.

Perinatal immunization education improves immunization rates and knowledge: a randomized controlled trial.

OBJECTIVES: To determine if providing perinatal immunization education positively changes the immunization status of infants, influences the infant immunization knowledge, attitudes and beliefs of mothers and affects the intent to vaccinate children in Japan where immunization education is limited. METHODS: Pregnant women were recruited from three sites in Tokyo, Japan and were assigned to two intervention (pre- or postnatal education) groups and a control group. The immunization status of infants was assessed and a written survey was performed before and after the intervention. RESULTS: Among 119 study participants, 106 subjects replied to the post-survey. The intervention groups (34.3%) had higher immunization rates in infants at three months of age than the control group (8.3%) (P=0.005); however, no differences were observed between the prenatal (29.4%) and postnatal groups (38.9%) (P=0.40). The percentage of women intended to vaccinate their infants was higher in the intervention groups (61.4%) compared to the control group (33.3%) (P=0.01). The improvement in score for basic knowledge was higher in the intervention groups, particularly in the prenatal group (mean±S.D.: 3.4±1.8) compared to the control (1.9±1.9) (P=0.003). CONCLUSIONS: Perinatal immunization education improved the immunization status of infants, increased the women's knowledge on immunization and intention to vaccinate their infants.

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.

[Difficulties and solutions related to the experience of developing a new project by Japanese municipal public health nurses according to their seniority].

OBJECTIVES: Public health nurses (PHNs) have to regularly develop new projects that actively solve community health problems. The purpose of this study was to clarify the difficulties encountered by PHNs while developing a new project and their solutions for them. We also aimed to examine the effect of experience of Japanese PHNs in developing new projects, according to their seniority. METHODS: Using random sampling, we chose 374 of 1871 municipalities that could not be consolidated with neighbouring municipalities in 2005, and 305 municipalities responded to questionnaires. The self-administered questionnaires were mailed to 2306 Japanese PHNs working within the municipalities. The questionnaire included items on the following: (1) PHN-related variables; (2) whether the PHN had experience in project development; (3) open-ended description of the difficulties and solutions related to the development of new projects by the PHN; (4) the reasons why the PHN could not create new services. We used content analysis to categorize the descriptions based on commonalities. We divided PHNs into 4 groups according to their seniority: Novice, Lower middle-level, Upper middle-level, and Expert. We performed the chi2 test (Fisher's exact test) to examine the relationship between experience and parameters such as "the difficulties" and "the solutions" in each group. RESULTS: Among the 1270 respondents, 340 PHNs were in the Novice group, 347 in the Lower middle-level group, 329 in the Upper middle-level group, and 254 in the Expert group. The chi2 test (Fisher's exact test) revealed that there was a significant difference between difficulties and having experience in all 4 groups: 'Facing a busy schedule.' In these 4 groups, the following 7 solutions were statistically related with experience: 'Deepening the understanding of the PHNs' work of supervisors and colleagues,' 'Explaining the need for creating a new system with evidence,' 'Sharing information for creating a new service on a daily basis, 'Organizing the evidence to demonstrate the need for developing a new project,' 'Making a practical project plan,' 'Cooperating with persons concerned and facilitating consensus-building among them,' 'Coping with the cost of a new program. CONCLUSION: In order to overcome difficulties encountered by PNHs while developing new projects, our findings suggest that the work done by PHNs' should be better understood by supervisors and colleagues. Further, evidence should be used to explain the need for creating a new system, and a consensus should be built at carefully. Moreover, the budget of the new program should be carefully managed.

[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.

Longitudinal comparison study of pelvic floor function between women with and without stress urinary incontinence after vaginal delivery.

PURPOSE: To compare the pelvic floor function between women with and without stress urinary incontinence after vaginal delivery. METHODS: Seventeen women (age 35.5 ± 3.5) were prospectively studied at about 6 weeks, 3 months, and 6 months after vaginal delivery. Urinary incontinence was assessed by the International Consultation on Incontinence Questionnaire - Short Form. Pelvic floor function was assessed by antero-posterior diameter of the levator hiatus using transperineal ultrasound. RESULTS: Five of 17 women experienced postpartum stress urinary incontinence. The antero-posterior diameter of the levator hiatus at rest was significantly longer in stress urinary incontinent women than in continent women until 3 months after delivery (p < 0.01), though shortening of the antero-posterior diameter of the levator hiatus was not significantly different between continent women and stress urinary incontinent women. Regardless of urinary incontinence, the antero-posterior diameter of the levator hiatus at rest shortened at 6 months postpartum, compared to 6 weeks postpartum (p < 0.001). The antero-posterior diameter of the levator hiatus during contraction had shortened only in continent women by 6 months postpartum (p = 0.02). CONCLUSION: The extended pelvic floor may be a cause of stress urinary incontinence in the postpartum period. Therefore, treatment to improve the extended pelvic floor should be developed for the prevention of stress urinary incontinence.

Validity and reproducibility of folate and vitamin B(12) intakes estimated from a self-administered diet history questionnaire in Japanese pregnant women.

BACKGROUND: No validated dietary questionnaire for assessing folate and vitamin B(12) intakes during pregnancy is available in Japan. We evaluated the validity and reproducibility of intakes of folate and vitamin B(12) estimated from a self-administered diet history questionnaire (DHQ) in Japanese pregnant women. METHODS: A sample of 167 healthy subjects with singleton pregnancies in the second trimester was recruited at a private obstetric hospital in metropolitan Tokyo from June to October 2008 (n = 76), and at a university hospital in Tokyo from June 2010 to June 2011 (n = 91). The dietary intakes of folate and vitamin B(12) were assessed using the DHQ. The serum concentrations of folate and vitamin B(12) were measured as reference values in the validation study. To assess the reproducibility of the results, 58 pregnant women completed the DHQ twice within 4-5 week interval. RESULTS: Significantly positive correlations were found between energy-adjusted intakes and serum concentrations of folate and vitamin B(12) (r = 0.286, p < 0.001 and r = 0.222, p = 0.004, respectively). After excluding the participants with nausea (n = 121), the correlation coefficient for vitamin B(12) increased to 0.313 (p = 0.001). When participants were classified into quintiles based on intakes and serum concentrations of folate and vitamin B(12), approximately 60% were classified in the same or adjacent quintile. The intraclass correlation coefficients of the two-time DHQ were 0.725 for folate and 0.512 for vitamin B(12). CONCLUSION: The present study indicated that the DHQ had acceptable validity and reproducibility for assessing folate and vitamin B(12) intakes in Japanese pregnant women.

The effects of an intervention program for promoting interorganizational network building between multidisciplinary agencies and community-based organizations: a cluster trial in Japan.

BACKGROUND: Strengthening interorganizational relationships in the community has become an increasingly valued strategy for improving public health in recent years. However, no intervention strategy to foster an interorganizational network in the community has yet been devised. The purpose of this study was to examine the effects on members of an organization of an intervention program designed to promote interorganizational network building between multidisciplinary agencies and community-based organizations (CBOs). METHODS: The program was conducted in Setagaya and Suginami wards, Tokyo, Japan, for staff of community comprehensive support centers (CCSCs), which are multidisciplinary organizations responsible for the support of the elderly. A cluster non-randomized design with a CCSC as a cluster unit (N = 47) was used. The intervention group comprised 20 centers and the control group 27 centers. Those 27 centers declined to participate in program sessions, but did participate through completing pre- and post-intervention surveys. In total, 158 staff members were eligible to participate in this study, 73 from the intervention group and 85 from the control group. Of the 73 members in the intervention group, 19 participated in the monthly program sessions, over a period of 10 months. Attendees participated in group discussions during the sessions. The effects of the intervention were examined by comparing three groups (attendees and non-attendees of the program from the intervention group, and the control group) and between two groups (intervention group and control group). RESULTS: We found no significant difference in any outcome between the intervention group and the control group. However, among the three groups, a significant effect was found in the recognition of knowledge and skills for building networks with CBOs. Recognition of knowledge and skills increased significantly among the attendees compared to non-attendees in the intervention group and the control group. In addition, there was a significant effect, particularly on those with relatively low baseline scores, for the recognition of knowledge and skills. CONCLUSIONS: The tested intervention proved effective for attendees regarding their recognition of knowledge and skills for promoting interorganizational network building with CBOs.

Expansion of discharge planning system in Japan: Comparison of results of a nationwide survey between 2001 and 2010.

BACKGROUND: In response to the rapid aging of the population in Japan, many care systems have been created in quick succession. Establishment of discharge planning departments (DPDs) in hospitals is one of them. In this study, we compared the distribution and characteristics of DPDs and the characteristics of the hospitals that have DPDs between 2001 and 2010 in Japan. METHODS: We mailed a questionnaire about the characteristics of hospitals and existence and situation of DPDs to all general hospitals with 100 or more general beds in 2001 and in 2010. RESULTS: In 2001, of the 3,268 hospitals queried, 1,568 (48.0%) responded and 1,357 (41.5%) were selected for data analysis. In 2010, among 2,600 hospitals, 940 hospitals (36.1%) responded and 913 (35.1%) met the inclusion criteria. The percentage of hospitals with DPDs increased from 30% to more than 70% between the two surveys. More departments were under the direct control of the hospital director and more physicians participated in discharge planning activities in 2010 than in 2001. In 2001, private hospitals and hospitals with an affiliated institution or agency tended to have a DPD; however, the relationship between these factors and the presence of a DPD had disappeared in 2010. Larger hospitals and hospitals with more nurses per patient tended to have a DPD both in 2001 and 2010. CONCLUSIONS: Since 2008, the establishment of a DPD has been directly connected to medical fees so hospital administrators might have recognized the DPD as a "necessary and paid for" department. Having a DPD was the majority's policy in Japan, and we must recognize the importance of quality assurance through DPDs from now on, especially in small hospitals.