論文

目的　本研究の目的は，地方自治体の統括保健師等を対象にした全国調査により，保健師活動におけるICT活用やデジタル化（以下，ICT活用）の実態や課題等を把握し，今後の保健師活動におけるICT活用推進にむけた示唆を得ることである。方法　47都道府県および1,741市区町村に勤務する統括保健師およびそれに準じる立場の保健師を対象に，オンライン無記名自記式調査を実施した。調査内容は，自治体種別（都道府県・政令指定都市・保健所設置市区・その他市町村），保健師活動におけるICT活用の積極度・順調度，実際の取組状況，進める上での課題等であった。調査期間は2023年10月から2024年1月であった。結果　本調査の回収数は577件（回収率32.3%）であり，524件を有効回答とした。積極度・順調度について，回答した自治体の55.9%が積極的に推進しているとの認識を示した一方で，順調に進んでいるとの認識は26.7%に留まった。実際の取組状況について，最も高い割合で実施されていたのは「オンライン通話による会議の実施」83.0%であった。取組の内容や自治体種別によって，実施状況は異なっていた。保健師の課題について「保健師活動の対象のうち，デジタルへの対応が難しい対象者への懸念がある」89.1%が最も多く，「保健師活動におけるICT活用に関するビジョン・方針を定めることが難しい」86.1%，「保健師活動におけるICT活用を推進する手順がわからない」82.8%のいずれも8割を超える自治体が課題と認識していた。組織の課題について「保健師活動におけるICT活用を進めるための予算確保が難しい」52.7%が最も多く，自治体種別にみると「保健師が活用できるインターネット環境が十分でない」では都道府県の約6割，「保健師が利用可能なICT機器が不足している」では都道府県・政令指定都市等において約6割が課題と認識していた。結論　多くの自治体が積極的にICT活用を推進する一方，その進捗については順調ではないとの認識であることが明らかになった。また自治体種別によって進捗状況や取組内容は異なっていたが，課題は共通するものもあった。ICT活用の推進に向けては，保健師のICT活用にむけた人材育成を進めるとともに，自治体間での事例やノウハウの共有が必要である。

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.

本研究では在宅介護サービスの提供者、利用者相互の情報流通が不十分である問題に着目し、その阻害要因の分析に基づき、情報流通を円滑化するためのコミュニケーションモデルの提案と評価を行った。このモデルは、情報の透明性を高めるための水平型コミュニケーションモデル及びサービス利用者本人が主体的に情報流通を制御できるヒエラルキ型のアクセスコントロールモデルを組み合わせることにより、介護に必要なプライバシ情報の効率的な共有と、適正な保護を両立させるものである。このモデルの実用可能性を検証するために、プロトタイプシステムによる実証実験を行い、在宅介護コミュニティにおける情報流通の円滑化が、サービス提供の効率化と利用者の満足度の向上につながることを示唆する結果を得た。

本稿では，2024年1月に発生した令和6 年能登半島地震において，広域2次避難のための一時滞在施設として設置された1.5次避難所に焦点を当てる。運営主体，提供された支援，運営方法，入所者の推移について概観した上で，県による避難所運営の課題，および，ケア関連情報の共有の課題という2 つの運営上の課題について報告し，今後の災害における1.5次避難所の運営にかかる知見を提供する。

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.

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.

本論文では，事業型NPOにおけるサービスの利用を促進させるツールとして，電子コミュニティ通貨を利用する際のサービスモデルおよびモデルを実現するために必要な各システムの機能要件を示す．事業型NPOを中心として形成されるサービス受給者コミュニティのメンバーがサービスの授受によってコミュニティ通貨を蓄積し，それを別のサービスを利用するために使うという流通モデルを提案し，このモデルをネットワーク上で安全に実現するための機能要件を示す．