Published papers

Objectives　To understand the current conditions and challenges in the utilization and digitalization of information and communication technology (ICT) in public health nursing, using a nationwide survey of local government public health nurses. The study also seeks to provide recommendations for enhancing the utilization of ICT in public health nursing.Methods　An online, anonymous, and self-administered survey of public health nurses in supervisory positions across 47 prefectures and 1,741 municipalities was conducted. The survey collected information on the type of municipality (prefecture, government-designated city, city with health centers, or other municipalities). Additionally, data on the extent of the utilization of ICT in public health nursing activities, the status of current initiatives, and challenges in promoting ICT were collected. The survey was conducted between October 2023 and January 2024.Results　A total of 577 responses (response rate: 32.3%) were received, of which 524 were valid, with no missing items. Among the responding municipalities, 55.9% reported active promotion of ICT projects. However, only 26.7% reported that these projects were progressing smoothly. The most common ICT activity was conducting meetings via online calls (83.0%). The level of implementation of ICT varied depending on the initiative and the type of municipality. The most significant challenge identified by public health nurses was concern regarding the inclusion of cohorts facing difficulties in adapting to digital technologies (89.1%). This was followed by challenges in formulating a vision or policy for the utilization of ICT in public health nursing activities (86.1%) and difficulties in understanding procedures for promoting the utilization of ICT in their activities (82.8%). Each of these issues was recognized as a challenge by >80% of the municipalities surveyed. At the organizational level, the most commonly reported challenge was the difficulty of securing adequate budgets to facilitate utilization of ICT in public health nursing activities (52.7%). By municipality type, approximately 60% of prefectural governments reported that the internet environment available to public health nurses was inadequate. Similarly, approximately 60% of prefectural and government-designated city governments identified a shortage of accessible ICT devices for public health nurses as a challenge.Conclusion　Although many local governments actively promote the utilization of ICT in public health nursing activities, significant challenges remain. The progress and implementation of ICT initiatives varies by municipality. However, several challenges are common across regions. To promote the utilization of ICT in public health nursing, it is essential to enhance workforce development for the utilization of ICT for public health nurses, while also facilitating the sharing of good practices and expertise among municipalities.

Objectives: This study developed and psychometrically validated a new instrument – the Digital Health Competency Scale for Public Health Nurses (hereafter, DHCP) – to assess digital health competencies among public health nurses working in administrative agencies. Methods: DHCP was developed based on a literature review and expert interviews with four public health nurses (PHNs) and three researchers. A cross-sectional national survey was conducted with 1810 PHNs from stratified, randomly selected municipalities across Japan. Exploratory factor analysis (EFA) was used to identify the initial structure of DHCP, followed by confirmatory factor analysis (CFA) to assess construct validity. Internal consistency was calculated using Cronbach's alpha and criterion-related validity was examined by correlating DHCP scores with the eHealth Literacy Scale (eHEALS). Results: In total, 521 valid responses were obtained. The EFA applied an initial version of the scale with 28 items. The analysis identified a 12-item scale with a three-factor structure (motivation for digitalization, ethical-social assessment, and technical skills). The CFA supported the three-factor structure for DHCP, demonstrating a good model fit (GFI = 0.949, AGFI = 0.922, CFI = 0.960, RMSEA = 0.067). The Cronbach's alpha for the scale was 0.869. The total DHCP score was positively correlated with eHEALS (r = 0.444, 95 % confidence interval 0.372–0.511, p < 0.001), supporting criterion-related validity. Conclusions: DHCP is a novel instrument with good psychometric properties for assessing digital health competencies among PHNs. It has the potential to support digitalization efforts within municipal public health services.

This research focuses on the fact that information sharing in in-house care is often insufficient. After analysis of the factors obstructing information sharing, a new communication model is proposed and evaluated. The proposed model simultaneously allows for horizontal communications required for transparent information sharing and hierarchical access control by the service users which is imperative for sharing of privacy information. A system was developed to actualize this model and evaluated for validity. As a result it was proven that better information sharing in in-house care led to improved care service and a higher degree of satisfaction from the users.

This paper focuses on the 1.5 shelters (mid-term shelters) established as temporary accommodation facilities for wide-area secondary evacuation during the Noto Peninsula Earthquake in January 2024. After an overview of the managing body, support provided, management methods, and changes in the number of residents, we report on two operational issues, namely, the management of evacuation centers by the prefectural government and the sharing of care-related information, to provide insight into the management of shelters in future disasters.

保健師活動におけるICT(Information and Communication Technology)活用の推進へ向け、本邦の地方自治体における保健師活動へのICT活用の促進要因と阻害要因を整理することを目的に、医学中央雑誌Web版を用いて、情報通信技術に関する国および地方公共団体の責務について定めた法律である高度情報通信ネットワーク社会形成基本法が制定された2000年から2023年3月の文献を対象に検索を行い、得られた9件を分析した。その結果、保健師活動におけるICT活用の促進要因として、保健師個人の要因では「業務の効率化」「住民の健康管理・健康増進」が、保健師が所属する組織の要因では「目的が明確化できていること」「必要性が認識されていること」「ICT専門職を含めた連携体制」に加え「国や制度によるデジタル推進の流れ」が挙げられた。ここから、保健師活動におけるICT活用の推進へ向け、組織内での合意形成とともに、事務職やICT専門職等との連携・協力体制構築の必要性が示された。ICT活用の阻害要因では、保健師個人の要因である「ICTへの無関心さ」「苦手意識」「ネガティブな認識」「ICTの活用状況やスキルの差」などが、保健師が所属する組織の要因として「職場のICT環境の不十分さ」「予算・マンパワーの課題」などが挙げられていたほか、電子記録システム自体の整備や標準化も課題として挙げられていた。

INTRODUCTION: The incidence of severe natural disasters has been increasing worldwide. The residents of long-term care facilities (LTCFs) are particularly vulnerable to such events. Therefore, promoting disaster preparedness among LTCF stakeholders is urgent. However, the optimal preparedness process remains unclear. To close this gap, we use a realist review (RR) to promote an understanding of under what circumstances and what works for promoting the disaster preparedness among LTCF stakeholders and develop theories for the process. METHODS AND ANALYSIS: RR will be guided by the Realist and Meta-Narrative Evidence Synthesis: Evolving Standard. The following five steps will be employed: (1) literature review and search for evidence, (2) study selection, (3) data extraction, (4) data synthesis and (5) development of the initial programme theory (IPT). Evidence will be searched using MEDLINE, CINAHL, PsycINFO, Web of Science, Cochrane Library, Scopus and ICHUSHI (a Japanese database). Grey literature and citation tracking will also be used. Documents of any design or publication type will be included. The study selection, coding and synthesis will be conducted independently by two authors. An IPT will be developed in the Context-Mechanism-Outcome configuration to understand how to promote disaster preparedness among LTCF stakeholders. The developed IPT will be verified by experts or stakeholders to enhance its validity. ETHICS AND DISSEMINATION: Ethical approval will not be required because this is a review of published literature. The results will be disseminated at scientific conferences and peer-reviewed journals. The developed IPT will be used in subsequent research and iteratively tested or refined to better explain under what circumstances and what works for promoting disaster preparedness among LTCF stakeholders. REGISTRATION DETAILS: This protocol has been registered at the Open Science Framework https://doi.org/10.17605/OSF.IO/J4TU6.

Fecal incontinence (FI), which can arise from various pathogenic mechanisms, has attracted considerable attention worldwide. Despite its importance, the reproduction of the defecatory system to study the mechanisms of FI remains limited, largely because of social stigma and being considered inappropriate. Inspired by the rectum’s functionalities, we developed a soft robotic system that includes a power supply, pressure sensors, data acquisition systems, a flushing mechanism, stages, and a rectal module. Specifically, the innovative soft rectal module includes actuators inspired by sphincter muscles, both soft and rigid covers, and a soft rectum mold. The rectal mold, which was fabricated from materials that mimic human rectal tissue, was produced using a mold replication fabrication method. Both the soft and rigid components of the mold were created using three-dimensional (3D) printing technology. In addition, the sphincter muscle-inspired actuators featured double-layer pouch structures that were modeled and optimized based on multilayer perceptron methods to obtain a high contraction ratio (100%), generate high pressure (9.8 kPa), and have a short recovery time (3 s). Upon assembly, this defecation robot could smoothly expel liquid feces, perform controlled solid fecal cutting, and defecate extremely solid long feces, thus closely replicating the functions of the human rectum and anal canal. This defecation robot has the potential to facilitate human understanding of the complex defecation system and contribute to the development of improved quality-of-life devices related to defecation. (Figure presented.)

We developed a simulator to practice the digital disimpaction technique, a kind of excretory care that is commonly performed by home-care nurses in Japan. The key point of this study is that the requirements for creating a simulation model were not known in advance, so we adopted a rapid prototyping method, in which product development is carried out by repeatedly creating and testing simple prototypes and a user-participatory design method, where feedback is obtained directly from users. We proceeded with the development of the simulator and the definition of requirements simultaneously, repeating the process of creation, trial use, and feedback from interviews with skilled nurses. Digital disimpaction is a complex procedure involving interaction with a living body, in which a finger stimulates the rectum and facilitates the excretion of feces leveraging the rectum's natural biological response. Digital disimpaction is performed primarily by a nurse. Since digital disimpaction is an embarrassing and sometimes painful procedure for the patient, a smooth and comfortable technique is desirable. On the other hand, only a limited set of circumstances are provided to learn the digital disimpaction technique. The requirement for a "procedure requiring non-visible interaction," such as digital disimpaction, is hard to acquire through a simple interview because it is performed based on subjective sensation. Further, while the movement of the finger within the body is crucial, it is essentially impossible to learn through observation of a skilled nurse as it is not visible from the outside. For this reason, we created a simple rectal model as a first prototype. We improved the model by extracting requirements from observations and feedback on actual trial use by skilled nurses. From the first user experience of the simple 3D printed model, requirements were extracted regarding the texture of the rectum, the interaction between finger movement and rectal response, and the characteristics of the feces. A rectal model with a mucosal structure and a fecal model was created based on the obtained requirements. Through the second user experience, the process was repeated, where requirements were again extracted regarding the shape of the rectal model, the characteristics of the mucosa, and the rectal response with the finger movement. We redesigned the model to meet these refined requirements and developed a buttock model covering the rectal model.The results of the third user experience confirmed that the simulator mostly reproduced the intestinal setting as perceived by the nurses during the actual digital disimpaction procedure. This study suggests that the combination of rapid prototyping and user-participatory design can be used to systemize subjects for which requirements are hard to define in advance, such as care procedures based on tacit knowledge.

Soft robots have found extensive applications in the medical field, particularly in rehabilitation exercises, assisted grasping, and artificial organs. Despite significant advancements in simulating various components of the digestive system, the rectum has been largely neglected due to societal stigma. This study seeks to address this gap by developing soft circular muscle actuators (CMAs) and rectum models to replicate the defecation process. Using soft materials, both the rectum and the actuators were fabricated to enable seamless integration and attachment. We designed, fabricated, and tested three types of CMAs and compared them to the simulated results. A pneumatic system was employed to control the actuators, and simulated stool was synthesized using sodium alginate and calcium chloride. Experimental results indicated that the third type of actuator exhibited superior performance in pressure generation, enabling the area contraction to reach a maximum value of 1. The successful simulation of the defecation process highlights the potential of these soft actuators in biomedical applications, providing a foundation for further research and development in the field of soft robotics.

This letter describes the social needs and research trends of soft robots for pressure ulcer prevention, and our current work on the robotization of soft gel cushions.

We propose a service model and system functions for service promotion in business oriented NPOs using e-community currency. We propose a currency distribution model such that service users and providers save the community currency through the exchange services, and they can use the community currency for receiving other services. Then, we describe the system functions to securely implement the model on the Internet secure.