By 2060, approximately one in every 2.5 people in Japan is expected to be elderly, and there is an urgent need to establish a sustainable system of collaboration and cooperation based on human networks involving diverse stakeholders, organizations, and facilities, including local residents. However, many local governments still face challenges in establishing comprehensive community care systems, such as a shortage of people to support such systems and difficulties in providing services. The purpose of this study is to clarify the actual state and issues of collaborative partnerships in community-based integrated care systems. In particular, we focus on the roles of professionals and the nature of collaboration in urban and rural areas, and through a comparison of the two regions, we present insights that will contribute to the future operation of community-based integrated care systems. In Chapter 1, we conducted a literature review on the policy background and contemporary issues of the community-based integrated care system, clarifying the research questions and analytical perspectives of this study. In Chapter 2, we outlined the research methods and definitions of terms, and organized the research framework. In Chapter 3, we analyzed the narratives of professionals in urban and rural areas using text mining to clarify the actual state of collaboration and cooperation. In Chapter 4, we examined the operational challenges and future directions of the community-based integrated care system through a comparison of the two regions. The analysis revealed that urban areas faced issues such as a shortage of informal service providers, one-way communication due to the vertical structure of government, and a lack of facilities. Meanwhile, rural areas faced a combination of issues, including a shortage of professionals and social resources, poor transportation, a decline in community activities, and a lack of learning opportunities. Additionally, in rural areas, it became clear that many elderly people and their families desire long-term care in residential facilities due to the fragility of caregiving capacity. This means that in urban areas, there aren't enough professionals to handle the number of people who need their help, so they can't do their jobs properly. This shortage also leads to a vicious cycle where it's hard to keep up quality and hold training sessions and study groups to maintain standards. In rural areas, there are even fewer professionals to begin with, and there aren't enough offices, so each professional has to take on a wider range of responsibilities. In other words, it became clear that in urban areas, although systems and services exist, there is a problem in that human resources and operations are not keeping pace, while in rural areas, there is a lack of systems and social resources to begin with, and geographical and demographic barriers are significant obstacles to collaboration and cooperation.

In advance care planning (ACP), there are cases where it is difficult for patients to express their intentions for various reasons. In this study, we discussed the difficulties and countermeasures for the implementation of ACP in the cases of children and the elderly, involuntary hospitalization for psychiatric care, and the choice of end-of-life nutrition, as cases in which it is difficult for the patients to express their intentions. Internal difficulties caused by the individual, external difficulties such as non-provision of appropriate information and social difficulties such as the absence of significant others were considered to be the factors that make ACP implementation difficult. It is important for supporters to understand these difficulties and to implement ACP according to the individual patients. It is hoped that discussions on the promotion of ACP will be further enhanced in the future.

Excessive use of social networking services (SNS) is known to have a significant negative impact on mental health in university students. In this study, we conducted an online questionnaire survey of university students and analyzed 146 responses in order to clarify the relation between SNS addiction and self-compassion among university students. As a result, it was found that there was a significant negative relationship between SNS addiction and self-compassion in the university students. In addition, the subscales of "self-judgment," "isolation," and "over-identification" were significantly associated with SNS addiction. These results suggest that selfcompassion education may help reduce the deterioration of mental health caused by SNS addiction.

We developed a lifestyle reflection sheet for preventing and treating metabolic syndrome. Our tool aimed to help local residents identify their risk factors for metabolic syndrome, recognize areas for improvement in their lifestyle habits, and proactively engage in health promotion. We enrolled 1,146 patients, consisting of 715 men and 431 women, aged 18 to 92 years. Inclusion criteria were those who underwent health checkups at Mine City Hospital and answered a lifestyle questionnaire. We hypothesized that individuals with conditions related to metabolic syndrome have undesirable lifestyle habits. To test this hypothesis, we conducted logistic regression analysis to examine the probabilities of metabolic syndrome, hypertension, hyperglycemia, and dyslipidemia. The results were displayed as similarity percentages, reflecting how closely the daily behaviors of individuals with these conditions aligned with the behaviors of those who had these specific health issues. Eight specific behaviors were selected for preventing and improving metabolic syndrome: diet-related (eating behaviors that do not lead to obesity, avoid snacking, consume vegetables, reduce salt), physical activity-related (physical activity/ exercise, avoiding prolonged sitting), health-related (maintaining a sense of coherence), and alcohol-related (amount of alcohol consumed). The scores for these factors were calculated using a validated factor analysis. Each item was visualized by displaying a graph showing the standard deviation for all survey subjects. The lifestyle reflection sheet was printed on special paper and returned to individuals after their health check. The sheet served as a reference tool for health guidance. By utilizing this sheet, individuals could be individually notified of their risk of developing metabolic syndrome and the benefits of healthy behaviors. Behavioral changes for health were encouraged through a review of lifestyle habits.

The dissemination of knowledge and awareness regarding mental health promotion is an important issue in the mental health and welfare policies of local governments. In order to clarify the relationship between the social life situation of local residents and their mental health, we analyzed 1,139 people who underwent health checkups at Mine City Hospital and answered a lifestyle questionnaire about their psychological state (Kessler 6 Scale [K6]), social interaction (Lubben Social Network Scale-6 [LSNS6]), sleep (Athens Insomnia Scale [AIS]), economic situation, household composition, and residential area by sex and age group (youth: 20-39 years old, middle age: 40-64 years old, elderly: 65 years old or older). In men, K6 score decreased as the age group increased; however, there was no change in women across all age groups. Furthermore, when comparing by age group and sex, elderly men had the lowest K6 score. Analysis of the data for all subjects revealed that K6 score was negatively correlated with LSNS6 score (r = -0.219, P < 0.01) but had a significant positive correlation with AIS score (r = 0.495, P < 0.01). The "difficult" economic situation group had higher K6 scores than the "average" and "affordable" groups. These findings suggest that people with a poor psychological state have less human interaction and tend to suffer from insomnia and that improving one's subjective economic situation may contribute to a good psychological state.