[Development and evaluation of the reliability and validity of the Japanese Version of the Positive Solitude Scale]

Objectives　Solitude is a state of being without social contact; it occurs when a person chooses not to interact with others, even when they are in the company of others. It is not necessarily accompanied by negative feelings. In contrast, loneliness, is a psychological state characterized by the feeling of needing the company of others. Most Japanese studies have regarded loneliness as an unpleasant and painful experience. In this study, focusing on solitude, we developed the Japanese version of the Positive Solitude Scale (JPSS) developed by Palgi et al. and evaluated its reliability and validity. This scale assesses the "conscious and voluntary decision to be alone as a positive experience."Methods　A self-administered, anonymous questionnaire survey was conducted between May and August 2023, with 700 men and women participants aged 20 years or older living in Ward A, Sapporo. The survey items comprised basic attributes, the JPSS, subjective sense of health, subjective sense of well-being, and depression to verify convergent validity and social network and loneliness to verify discriminant validity. Additionally, principal component and correlation analyses were performed.Results　A total of 245 questionnaires were collected, and 237 valid responses were obtained (valid response rate: 33.9%). The participants' mean age was 58.5±1.2 years and 111 (46.8%) were men; the Cronbach's alpha coefficient for the JPSS was 0.92. The principal component analysis revealed that all nine items had principal component loadings above 0.6, with a cumulative contribution of 62.3% to the overall scale. The total scale score was significantly positively correlated with subjective health (ρ=0.210, P=0.001), positive affect (ρ=0.302, P<0.001), and life satisfaction (ρ=0.241, P<0.001). There were no significant correlations among depression, negative affect, social networks, and loneliness.Conclusions　The JPSS is a reliable and valid instrument unaffected by social networks and other social relationships. It is expected to be a promising new scale that can measure perceptions of time as a positive emotion, distinct from loneliness.

Help-seeking preference in obtaining social support for older adults in depopulated areas

OBJECTIVE

To clarify the circumstances of help-seeking preference among older adults in depopulated areas and the relationship between help-seeking preference and social support.

METHODS

This was a cross-sectional study that included a sample of 271 men and women aged 65-79 years living in Japan. A questionnaire survey was conducted to assess help-seeking preference, social cohesion (community trust, norms of reciprocity and community attachment), socialising (interaction with neighbors and social network) and social support. Multiple regression analysis was performed with items that were found to be significantly associated with social support in the univariate analysis. Then, we examined the significance of the change in the coefficient of determination between a model that included help-seeking preference as an independent variable and a model that did not.

RESULTS

Social support was related to help-seeking preference, living arrangements, economic status, norms of reciprocity and social networks. There was a significant difference in the coefficient of determination between the models with and without help-seeking preference.

CONCLUSIONS

For older adults in depopulated areas to obtain social support, it is important to build trusting relationships with others and shows a willingness to seek and accept help.

Development of Older Adults' Perceptions on Community-based Connectedness with People Scale: Reliability and validity evaluation

AIM

We developed a self-assessment scale-Older Adults' Perceptions of Community-based Connectedness with People-to assess older adults' comprehensive perceptions of their connectedness with others in the community. A specific aim of this study is to evaluate the reliability and validity of this scale.

METHODS

Participants consisted of 1000 men and women aged 65 years or older, living in Sapporo, Hokkaido, Japan. Factorial validity was assessed using exploratory and confirmatory factor analysis, while concurrent validity was assessed using correlation analysis. Reliability was confirmed by Cronbach's α coefficient using the internal consistency method, and the stability coefficient was confirmed using the test-retest method.

RESULTS

Responses were received from 380 participants, and 358 participants who responded to all items were included in the analysis. The developed scale comprised 22 items with three factors: "Perception of Inclusion" (α = .947), "Perception of Reciprocity through Reception" (α = .937), and "Perception of Reciprocity through Provision" (α = .910). Correlation analyses indicated that concurrent scales were positively correlated with Ikigai and negatively correlated with loneliness on the total scale. The model fit was comparative fit index = 0.933, goodness-of-fit index = 0.854, adjusted goodness-of-fit index = 0.818, and root mean square of approximation = 0.081. The stability coefficient of the total scale scores was 0.875 (95% CI: [0.830, 0.908]).

CONCLUSIONS

The developed scale had adequate reliability and validity. The perceptions of connectedness measured using this scale can be used by public health and nursing care professionals to prevent loneliness and isolation among older adults living in the community.

Online health information searching and health literacy among middle-aged and older adults: A cross-sectional study

Given the rapid increase in health information available, health literacy is now more important than ever when searching for health information online. Furthermore, health literacy and online health information searching are reported to be associated with support from others. In this study, we examined the associations of health literacy and social support with online health information searching among individuals in their 50s and 60s. Between March and May 2022, an anonymous self-administered questionnaire was administered among 750 middle-aged and older adults (age 50-69) living in northern Japan. The questionnaire items included personal characteristics, frequency of online health information searching, health literacy domains, and social support. A total of 237 respondents answered all the items (response rate: 31.6%). Multiple logistic regression analysis revealed that communicative health literacy was significantly associated with searching for information about illnesses and health promotion, while critical health literacy was significantly associated with searching for information about medical institutions. Controlling for personal characteristics, health literacy, was associated with online health information searching, suggesting that improving health literacy is important in a digital and information society.

Older people's connectedness with people in the community in contemporary contexts: A concept analysis

AIM

This study aimed to clarify the concept of older people's connectedness with people in the community within the literature.

METHODS

This study was based on Walker and Avant's concept analysis method. We used PubMed, MEDLINE, CINAHL, and Web of Science databases and included peer-reviewed articles that were published in English between January 2010 and April 2023. After assessing eligibility and applying exclusion criteria, 25 articles were analyzed.

RESULTS

Attributes included sense of belonging to the community achieved through interactions and feeling of togetherness through interrelationships, which consequently led to the maintenance of healthy physical and mental states and independent living, the acquisition of the ability to overcome difficulties, and the creation of a sense of meaning in life through coexistence.

CONCLUSION

We identified the concept of older people's connectedness with people in the community in a contemporary context. Connectedness is a useful concept to consider in nursing care because it seems to evolve into comprehensive health, including the physical and psychosocial health of older adults.

Testing a frailty prevention program for older men during COVID-19: A 2-year mixed-methods pilot study

BACKGROUND

Frailty is a syndrome related to declining functioning attributed to aging. As a reversible, often improved condition, preventive measures for frailty can be effective.

OBJECTIVE

This study aimed to evaluate a frailty prevention program for older men comprising face-to-face meetings and an original social mobile application. We also examined the effect of COVID-19-associated social isolation on the implementation of this program.

METHODS

We conducted a mixed-methods pilot study featuring a single group before and after comparison of 11 man participants, ≥65 years, living in Japanese cities with a spouse or relatives. Program outcome measures included frailty, loneliness, grip strength, step count and mental health status. Process evaluation considered the experience of participants through a semi-structured interview.

RESULTS

The intervention period included an interval of self-isolation owing to the spread of COVID-19. Among the outcomes, grip strength decreased after intervention. No significant negative changes were observed in other items. Themes emerging from participant experiences with the program included 'Cooperation with researchers and contributing to research', 'Greater awareness of health', 'Interest in and experience of "newness"', 'Hesitation over active engagement', 'Casual ties with members' and 'Relationships that do not breach personal boundaries'.

CONCLUSIONS

Although the COVID-19 pandemic overlapped with the intervention, participants maintained their mental health. The program was a novel, stimulating experience for older men and demonstrated the usefulness of information and communication technology in supporting their social activities.

IMPLICATIONS FOR PRACTICE

As a community health nursing initiative for older people, we propose activities that combine group and online support. Frailty prevention programs for older men must contain content that stimulates their interests, such as 'health' and 'newness'.

Effects of a 'social activity program that encourages interaction' on rural older people's psychosocial health: Mixed-methods research

BACKGROUND

We developed a program that encourages interaction among older people living at home by combining face-to-face and online activities and examined its effects on older adults' psychosocial health.

METHODS

In this mixed-methods study, we recruited 11 women and 6 men (Mage = 79.5 ± 6.4 years), who lived in a rural community and participated in a senior citizen club. The intervention was conducted for 13 months, comprising monthly face-to-face group and social media activities. For the program process evaluation, we collected focus-group interview data on participants' perceptions of their personal lives, club membership, and community post-intervention. For the outcome evaluation, we collected six outcome measures pre- and post-intervention: loneliness, subjective health, subjective well-being, self-esteem, social support and social activity satisfaction. Finally, through the integration of the process-outcome evaluation, we inferred what effects the program had on participants' psychosocial health.

RESULTS

In the process evaluation, we identified four themes: 'Stimulation brought about by relationships with peers,' 'Realization as to where they feel they belong,' 'Rethinking of oneself in the community,' and 'Awareness of attachment to and coexistence with the community.' In the outcome evaluation, the outcome measures were maintained without significant decline post-intervention.

CONCLUSION

Through the integration of the process-outcome evaluation, we deduced three effects of the program on psychosocial health: (1) fulfilment of subjective health, (2) maintenance and assurance of moderate distance connectedness and (3) orientation toward aging in place.

IMPLICATIONS FOR PRACTICE

This study offers a promising opportunity for further development and research into community-based preventive nursing care intervention strategies to maintain the psychosocial health of homebound older people in communities with social activity groups.

Verification of the Effectiveness of a Communication Application in Improving Social Connectedness and Physical Health among Unacquainted Older Men: A Mixed-Methods Pilot Study

This study aimed to verify the effectiveness of an application (app) in establishing social connectedness among unacquainted older men, as well as improving their physical health. The nine participants were men aged 65 and older in the subarctic zone of Hokkaido, Japan. A mix of quantitative and qualitative methods were adopted as the study design. A questionnaire survey was completed before and after the intervention, and a semi-structured interview was conducted after the intervention. An app-installed smartphone was loaned to the participants, which allowed them to share pictures, voice recordings, and their step count. Quantitative data were analyzed using descriptive statistics and the Wilcoxon signed-rank test, and qualitative data were analyzed using qualitative descriptive analysis to generate categories. The average age of the participants was 77.7 years. The relationship between participants who were interacting for the first time through the app advanced as their understanding of each other's personalities deepened. The average step count during the third and fourth months was significantly higher than in the first two months. By using the app, older men were able to build relationships with one another. In addition, visualizing the number of steps on the app was effective in improving the number of steps.

Value of social activities and prerequisites for continued participation of rural older adults: A qualitative study

AIMS

To explore the value of social activities and the prerequisites for continuous participation among rural older adults based on their experiences.

DESIGN

Qualitative, descriptive design.

METHODS

Individual semi-structured interviews were conducted with 14 older adults from voluntary community salons in a rural area in Japan. Participants were selected through purposeful sampling. Data were analyzed using qualitative content analysis. The consolidated criteria for reporting qualitative research (COREQ) checklist were used.

RESULTS

Four values of social activities were identified: "Mutual benefit connectedness," "Preventing and coping with aging," "Making life brilliant 'now'," and "Building a safety net." Three prerequisites for activities were identified: "Do not overreach," "Do not infringe on personal territory," and "Do not go against community norms." Social activities provide rural older adults with reciprocity ties, coping with aging, enhanced daily lives, and a social safety net. Continued participation in rural social activities requires adherence to cultural norms and moderation of relationship distances. Community and public health nurses are expected to promote social activities that incorporate these values and adhere to these prerequisites.

Novice public health nurses' home-visit skills in Japan: A one-year longitudinal study

OBJECTIVE

This study aimed to clarify the status of novice public health nurses' home-visit skills during their first year of practice.

DESIGN AND SAMPLE

A one-year longitudinal observational study was conducted with 80 novice public health nurses. The participants were recruited from the four Japanese prefectures and their affiliated municipalities selected by using stratified sampling.

MEASUREMENTS

Self-administered questionnaires were distributed three times between April 2016 and March 2017, asking about home-visit experiences, understandings of the significance of home-visit, and the levels of home-visit skills. Data were analyzed with paired t-tests and Wilcoxon signed-rank tests.

RESULTS

All of twenty skills' self-ratings significantly increased between the fourth and eighth months; five skills continually increased between the eighth and twelfth months. Both of Physical Assessment and Relationship Development Skills improved to the "Can do, almost by myself" level at the twelfth month; other skills remained at the "Can do, with a little advice" level.

CONCLUSION

Although novice public health nurses improved to conducted home-visits independently, they didn't perceive themselves as being able to do so in their first year. Therefore, through preparing guideline, organizations should provide intentional support to assist their skill acquisition during their first, and even in their second year.

Older Rural People's Perception of Connectedness through Communication Application: A Qualitative Descriptive Study

Connectedness among older people is essential for healthy communities, especially among rural populations where limited social interaction and associated health effects may be cause for concern. In this qualitative descriptive study, we explored older rural people's perception of connectedness through a communication application. The study assessed 10 participants (mean age = 76.2 years) living in rural Japan who regularly participated in a senior citizens' club. From July 2019 to January 2020, the participants used a social media application developed by our research team to meet the needs of older people. Semi-structured interviews were conducted. Six themes representing older rural people's perception of connectedness were identified: (1) thoughtful consideration for members strengthened even without them meeting face-to-face, (2) encouragement received from familiar members, (3) joy in sharing daily routine with neighbors, (4) courage to advance through face-to-face interaction, (5) willingness to continue club membership, and (6) fear of disrupting club's harmony. Participants who used the application felt compensated for the lack of social interaction opportunities in rural settings and strengthened their existing relationships. This article is protected by copyright. All rights reserved.

Effectiveness of disaster preparedness education in helping older people prevent isolation

OBJECTIVE

This study intends to clarify the effect of regional disaster preparedness education on efforts to prevent the isolation of older people in the event of a disaster.

DESIGN AND SAMPLE

This quasi-experimental study involved participants aged 65 and above. The intervention group (n = 35) and the comparison group (n = 61) were compared in the first survey and another one month later.

MEASUREMENTS

The survey items assessed aspects such as awareness of and actions related to isolation preparedness, and awareness of support needed by others in the event of a disaster. The results were compared between the two groups.

INTERVENTION

The educational program was based on the transtheoretical model of health behavior change and focused on preventing isolation in the event of a disaster, by connecting vulnerable people with their neighbors. Puppet shows and group work were used as part of the program.

RESULTS

A month after the program implementation, the intervention group had significantly higher awareness of and actions related to isolation preparedness than the comparison group.

CONCLUSIONS

Disaster preparedness education invokes a responsibility toward the prevention of isolation in the disaster and perceives it as a community issue and encourages individuals to support others.

Ovarian reserve may influence the outcome of bone mineral density in patients with long-term use of dienogest

Objective:

Long-term administration of dienogest, which is known to have effect on bone mineral density, is frequently done in patients with endometriosis and adenomyosis, but a few studies focused on the bone mineral density changes after finishing the long-term therapy. This study aimed to reveal the factors that adversely affect lumbar bone mineral density.

Method:

Fifty-seven premenopausal women who visited our hospital were diagnosed as either endometriosis or adenomyosis, and they were treated by dienogest for more than 115 weeks (26.5 months). Based on a previous report, bone mineral density changes less than 2% was categorized as the osteopenic group ( n = 30), and the others were assigned to the unchanged group ( n = 27). Bone mineral density was measured at the lumbar spine using dual-energy X-ray absorptiometry. A representative ovarian reserve marker, endogenous estradiol levels, and follicle-stimulating hormone levels were measured over time and were compared between the osteopenic and unchanged groups.

Result:

Duration of dienogest intake was 59.5 months (osteopenic group) versus 57.5 months (unchanged group). These patients experienced ovarian surgeries in a similar frequency, but the ovarian reserve in osteopenic group was impaired as suggested by the decline of endogenous estradiol level during intake of dienogest compared to that of unchanged group ( p = 0.0146). Endogenous follicle-stimulating hormone level between osteopenic group and unchanged group did not reach statistically significant difference, although the osteopenic group showed relatively higher level.

Conclusion:

This study might suggest that decreased ovarian reserve as judged by endogenous estradiol level is a factor that negatively affect bone mineral density, and measurement of endogenous estradiol level during intake of dienogest could have a predictive meaning of future decreased bone mineral density level.

Overcoming the ceiling effects of experts' motor expertise through active haptic training

One of the most challenging issues among experts is how to improve motor skills that have already been highly trained. Recent studies have proposed importance of both genetic predisposition and accumulated amount of practice for standing at the top of fields of sports and performing arts. In contrast to the two factors, what is unexplored is how one practices impacts on experts' expertise. Here, we show that training of active somatosensory function (active haptic training) enhances precise force control in the keystrokes and somatosensory functions specifically of expert pianists, but not of untrained individuals. By contrast, training that merely repeats the task with provision of error feedback, which is a typical training method, failed to improve the force control in the experts, but not in the untrained. These findings provide evidence that the limit of highly trained motor skills could be overcome by optimizing training methods.

Development of a social activities scale for community-dwelling older people requiring support

Aim

This study aims to develop the Social Activities Scale for Community‐Dwelling Older People Requiring Support (SASOS).

Design

This study is a cross‐sectional investigation.

Methods

The participants were healthy older people (HOP; N = 140) and those requiring support (OPRS; N = 250). An anonymous questionnaire included items on SASOS, subjective health and ikigai (Japanese well‐being concept). Criterion‐related validity was examined using the Social Activity Index for Elderly People (SAI‐E).

Results

Seventy‐five HOP and 157 OPRS provided effective responses. The scale (α = 0.805) had three subscales: "interactions with friends and neighbors (F1),” "close relationships with family (F2)” and "interactions with others through activity programs (F3).” SASOS and SAI‐E scores were correlated (r = .558, p < .01), indicating criterion‐related validity. In known‐groups validity analysis, F1 were significantly higher among HOP and F3 were significantly higher among OPRS. Total scores correlated with perceived health (r = .240, p < .01) and ikigai (r = .419, p < .01).

Processes that enable public health professionals to organize preventive care support groups

OBJECTIVES

This study examines the structure of the process that public health professionals (PHPs) use to organize preventive care groups for older adults and the elements that strengthen this process.

DESIGN AND SAMPLE

The study was conducted using a quantitative descriptive design. Anonymous self-administered questionnaires were distributed by mail to 919 PHPs, including nurses and social workers employed by local governments in a Japanese prefecture, who facilitated recreational groups for older adults for the purposes of preventive care. Measures Items related to the process and the awareness of support were based on previous research. The process structure was examined using exploratory factor analysis, while multiple logistic regression analysis was used to study strengthening elements.

RESULTS

The process yielded six factors (encouraging clarity with respect to the group's activity policy; creating connections with other resources; fostering independence; encouraging activity evaluation; creating relationships with group members; understanding the strengths and weaknesses of communities and individuals) with a total of 23 items. Two of three indicators of awareness of support were significantly related to the process.

CONCLUSIONS

Understanding the importance of strengthening elements might improve support groups for older adults.

Development of a Scale for Assessing the Meaning of Participation in Care Prevention Group Activities Provided by Local Governments in Japan

The meaning of participation in care prevention group activities may encourage continuous participation, making older adults active and healthy throughout their lives. This study developed a scale to assess the meaning of participation in care prevention group activities. It involved 427 participants in care prevention group activities (CPGAs) in Japan who filled out a self-administered questionnaire between October 2017 and February 2018. The meaning of participation was assessed using 15 items. In total, there were 379 valid responses. A factor analysis yielded two factors: "promotion of self-growth" and "enrichment of daily life". The goodness of fit index (GFI), comparative fit index (CFI), and root mean square error of approximation (RMSEA) were satisfactory (GFI = 0.923; CFI = 0.960; RMSEA = 0.073). Cronbach's α was 0.939 for the entire scale. The scale scores were significantly correlated with scores of the social activity-related daily life satisfaction scale and Ikigai-9. The scale's reliability and validity were confirmed, indicating its usability for promoting care prevention efforts.

Developing a comprehensive career development scale for public health nurses in Japan

OBJECTIVES

This study aims to develop a scale that can comprehensively measure public health nurses'(PHNs) career development and to verify the validity and reliability of that scale.

DESIGN AND SAMPLES

This study is a cross-sectional investigation. The participants were 1,009 PHNs working in a government facility in Japan. A total of 586 participants who had been working for more than 3 years as PHNs were analyzed.

MEASUREMENTS

Anonymous self-response questionnaires included items on professional awareness, practical competency, and job satisfaction. We conducted exploratory factor analysis and confirmatory factor analysis to clarify the construct validity of the scale. The reliability was examined by the Cronbach's α coefficient. The validity was examined by an external reference relevant validity and the known-group method.

RESULTS

The scale was structured with 32 items covering three factors: "community activities, policy, and management," "PHN identity," and "foundations as a PHN." The Cronbach's α coefficients were all greater than 0.9. In confirmatory factor analysis, the scale showed acceptable goodness of fit.

CONCLUSIONS

The comprehensive career development scale for PHNs proved its reliability and validity. This scale may be useful to promote PHN identity and competency comprehensively in basic education and in-charge education.

Mothers' challenges with the parental control of 3-year-old children in Japan: A qualitative study

BACKGROUND

Parents often struggle against the negativism of 3-year-old children in exerting parental control. Although most research on parental control is from western cultures, Japanese mothers may face unique challenges because of their sociocultural background. We therefore explored mothers' challenges in exerting parental control over 3-year-old children in Japan.

METHODS

A descriptive qualitative approach was adopted. The participants were 10 Japanese mothers with children aged 3-4 years. We conducted individual semistructured interviews and analysed the data via qualitative content analysis.

RESULTS

We found four categories and a structure of the challenges mothers faced in exerting parental control. Mothers' control attempts had four main intentions, each with a different subject (i.e., the children, themselves, the family, and society). Most challenges with parental control stemmed from mothers' "consciousness of parental responsibility." In confronting the child in their attempts to exert parental control, mothers perceived a "struggle with the child's negativism," which led them to recognize that they could not find a correct method of discipline. Furthermore, in the face of conflicting roles, mothers experienced "confusion in seeking the righteous answer as a parent." Some mothers began to feel that they were discovering their maternal role in their own way rather than finding a correct answer, which formed a "conviction that my own parenting is not incorrect."

CONCLUSIONS

The challenges mothers faced in exerting parental control over their 3-year-old children served as a turning point for them to reflect on themselves as parents. However, due to societal monitoring of parents and mothers' multiple roles in the family, it can be difficult for mothers to fully overcome the challenges of parental control. It is necessary to foster social capital in the community to which the mother belongs and to create an atmosphere in which community members can watch over parents warmly.

Cerebral Mitochondrial Microangiopathy Leads to Leukoencephalopathy in Mitochondrial Neurogastrointestinal Encephalopathy

BACKGROUND AND PURPOSE

Mitochondrial neurogastrointestinal encephalopathy is a rare disorder due to recessive mutations in the thymidine phosphorylase gene, encoding thymidine phosphorylase protein required for mitochondrial DNA replication. Clinical manifestations include gastrointestinal dysmotility and diffuse asymptomatic leukoencephalopathy. This study aimed to elucidate the mechanisms underlying brain leukoencephalopathy in patients with mitochondrial neurogastrointestinal encephalopathy by correlating multimodal neuroradiologic features to postmortem pathology.

MATERIALS AND METHODS

Seven patients underwent brain MR imaging, including single-voxel proton MR spectroscopy and diffusion imaging. Absolute concentrations of metabolites calculated by acquiring unsuppressed water spectra at multiple TEs, along with diffusion metrics based on the tensor model, were compared with those of healthy controls using unpaired t tests in multiple white matters regions. Brain postmortem histologic, immunohistochemical, and molecular analyses were performed in 1 patient.

RESULTS

All patients showed bilateral and nearly symmetric cerebral white matter hyperintensities on T2-weighted images, extending to the cerebellar white matter and brain stem in 4. White matter, N-acetylaspartate, creatine, and choline concentrations were significantly reduced compared with those in controls, with a prominent increase in the radial water diffusivity component. At postmortem examination, severe fibrosis of brain vessel smooth muscle was evident, along with mitochondrial DNA replication depletion in brain and vascular smooth-muscle and endothelial cells, without neuronal loss, myelin damage, or gliosis. Prominent periependymal cytochrome C oxidase deficiency was also observed.

CONCLUSIONS

Vascular functional and histologic alterations account for leukoencephalopathy in mitochondrial neurogastrointestinal encephalopathy. Thymidine toxicity and mitochondrial DNA replication depletion may induce microangiopathy and blood-brain-barrier dysfunction, leading to increased water content in the white matter. Periependymal cytochrome C oxidase deficiency could explain prominent periventricular impairment.

Social activities of older men who require daily support and the purpose of such activities

Objectives The purpose of this study was to analyze the social activities of older men who require daily support, and to clarify the purpose of such activities, in order to develop effective living support and preventive long-term care service, suitable for this population.Methods Individual, semi-structured interviews were conducted with 17 older men. Data were analyzed using inductive and qualitative methods.Results Four categories of social activities were identified, and four categories of purposes of these social activities were extracted. The following were the identified social activities: maintenance of "comfortable relationships with others," including family, relatives, friends, and neighbors; "participation and use of services and programs with clear objectives and relationships with others," such as long-term care insurance system services, clubs for the elderly, and hobby groups; maintenance of "relationships with former colleagues, depending on their experience of working with them," where some individuals actively participated in gatherings with former colleagues, while others did not keep in touch at all; and participation in "activities to enrich their feelings and quality of life within their living space," such as reading, watching TV, and doing household chores. The purposes of the observed social activities were to build "relationships with society through communication with other people" and to have a "sense of security by spending time with people of the same age and with those older than them." Hence, participants engaged in clubs for the elderly, as well as in hobby groups. In addition, participants made time for exercising regularly, which maintained their cognitive function and was intended for the "maintenance and activation of their physical functions by continuing to exercise," and "continuing to learn by thinking." Furthermore, participants engaged in the exercise or hobby groups that they were interested in, in order to "utilize their time in a meaningful way" that lead to pleasure and enjoyment.Conclusion The following were the characteristics of the observed social activities: (1) the activities helped participants to maintain relationships with their coworkers, (2) participants had comfortable relationships with others, with these relationships exhibiting different levels (i.e. intimate relationships or casual), and (3) participants actively followed current events. They have clear purpose join and participate in social activities. In addition, it is suggested that this population engage in social activities to enrich physical function and overall quality of life.

Examination of Visceral Perception and Gastric Tone by Gastric Stimulation Using Air Inflation during Endoscopy

This study investigated the assessment of visceral perception and gastric tone using insufflation during endoscopy. The intragastric pressure was measured during insufflation in 16 patients with gastro-oesophageal reflux disease, 25 patients with functional dyspepsia and 24 normal controls, using a pressure transducer inserted through the forceps aperture until gastric symptoms appeared. The intragastric pressure at the visceral perception threshold, the time to threshold and the time-pressure curve gradient were measured. The visceral perception threshold was significantly reduced in the functional dyspepsia group compared with the normal controls. Balloons were also inserted into the duodenal bulbs of 10 normal controls to investigate the effect of efflux of air into the duodenum; the measured parameters were not influenced by inflation and deflation. These results suggest that it is possible to assess visceral perception and gastric tone by measuring changes in intragastric pressure, using gastric stimulation by insufflation during endoscopy.

[Implementation of stress assessments by occupational health nurses working in occupational health agencies and their confidence in conducting such assessments]

OBJECTIVE

Stress assessments are due to be conducted in December 2015. It is expected that there will be an increase in the number of private health agencies that provide stress assessment services and mental health care. This study aimed to clarify the current situation of and the factors related to stress assessments conducted by nurses in occupational health agencies.

METHODS

Nurses working full time were randomly selected from 60 organizations that were members of the National Federation of Industrial Health Organization. Self-administered questionnaires were sent out between November 2013 and January 2014. The questionnaire included the personal attributes of the participants, training programs, job contents, and how practical mental health care, including stress assessment, is. The study was approved by the ethics committees in the respective organizations.

RESULTS

Out of the 162 questionnaires that were distributed, 89 (54.9%) were returned and 85 (53.1%) were valid for analysis. Stress assessments were conducted by 38.8% of the participants. With reference to their confidence in conducting stress assessments, "confidence and" 70.6%, respectively. The groups that conducted and did not conduct the stress assessments did not show any differences in the findings or other attributes. Further, the implementation of stress assessment was not associated with occupational health nurse (OHN) training, education, position, age, years of experience, attendance of lectures on mental health, etc. However, the confidence in conducting the assessment was related to age when dealing with cases on confidence stress assessment consultation in follow-up to the implementation of screening, such as stress, persons at high risk, and so on.

CONCLUSION

Approximately 40% of the nurses were already conducting stress assessments, but most of them conducted such assessments about once a year and were not deeply involved in them. Approximately 70% of the nurses were confident in implementing stress assessments. Further, they reported that they were confident to do so even if OHNs were not involved. We found that to encourage OHNs in occupational health agencies to provide mental health care and stress assessments, practical training programs are required. Such programs should include a series of stress assessments and help foster cooperation with superiors, colleagues, and occupational health staff such that the OHNs obtain experience and confidence.

Liposome chaperon in cell-free membrane protein synthesis: one-step preparation of KcsA-integrated liposomes and electrophysiological analysis by the planar bilayer method

Chaperoning functions of liposomes were investigated using cell-free membrane protein synthesis.

Cytochemical studies of nuclear DNA and RNA in normal and abnormal keratinizing tissues

The distribution patterns of nuclear DNA and RNA in normal and abnormal keratinizing tissues of human skin were examined by electron microscopy, using an enzyme digestion technique. We found that the distribution of nucleic acids in the nuclei of epidermal cells during keratinization changes gradually. In the hair cells, particularly in the cells of hair cortex and Henle's layer of inner root sheath, essentially similar findings were observed. On the other hand, the distribution patterns observed in the tumor cells of calcifying epithelioma and the parakeratotic cells of psoriasis were different from each other and different from the distribution patterns of normal keratinizing tissue, hair, and epidermis. It seems that a similar pattern of reorganization of nucleic acids occurs in the nucleic of normal keratinizing cells as the cells keratinize. However, in abnormal tissue, it seems that the reorganization pattern of nucleic acids in the nuclei is different in each case.

Pharmacokinetics of everolimus when combined with cyclosporine in Japanese de novo renal transplant recipients

BACKGROUND

Currently, there are no published data on pharmacokinetics (PK) of everolimus in combination with cyclosporine in Japanese renal transplant patients. We evaluated the PK of everolimus in Japanese de novo renal transplant patients who received everolimus in combination with cyclosporine.

METHODS

In this phase 3, multicenter, randomized, open-label study, patients were randomized (1:1) to 1 of the 2 groups: everolimus 1.5 mg (targeted C0 of 3-8 ng/mL) plus reduced-dose cyclosporine or mycophenolate mofetil 2 g/d plus standard-dose cyclosporine. PK assessments for everolimus were performed on day 28 (month 1) in the PK subpopulation.

RESULTS

A total of 11 patients (7 men), mean age 47.5 ± 11.21 years, were enrolled for PK analysis of everolimus. Starting at 1.5 mg (0.75 mg twice a day), the mean dose over a period of 28 days was 0.705 ± 0.1011 mg. Everolimus mean trough concentration was 4.307 ± 1.2459 ng/mL and mean peak concentration was 13.539 ± 3.5330 ng/mL, which peaked at 1 to 2 hours postdose. The average concentration was 7.558 ± 1.4723 ng/mL, area under the concentration-time curve was 90.70 ± 17.667 ng·h/mL, and peak-trough fluctuation was 122.6%. The PK parameters of everolimus were comparable to those in the earlier phase 3 studies (A2306 and A2307). The mean everolimus trough levels were within the target ranges at all time points ranging from 3.4 to 5.5 ng/mL (everolimus 0.75 mg twice a day, safety population). The majority of patients (>85% from day 7 onward) were maintained within the targeted everolimus trough blood levels (safety population). These data were similar to a non-Japanese study (A2309).

CONCLUSIONS

The pharmacokinetic characteristics of everolimus in Japanese de novo renal transplant patients did not differ from those previously observed in non-Japanese patients, hence the same dosage of everolimus may be acceptable in Japanese patients.

Development of a Social Activities Scale for Community-Dwelling Older Women Requiring Support in Japan: A Preliminary Study

OBJECTIVE

The purpose of this study was to develop a scale for measuring the social activities of community-dwelling older women requiring support in Japan.

DESIGN AND SAMPLE

A methodological study was performed of 118 older women (>65 years old) requiring support and residing in region A of Japan.

MEASURES

An anonymous questionnaire was administered through individual interviews, and valid responses were obtained from 110 people. The construct validity of the resulting scale was assessed by exploratory factor analysis. Criterion-related validity was tested by calculating Spearman's rank correlation coefficient between the resulting scale and the existing Social Activity Index for Elderly People (SAI-E). Reliability was tested by Cronbach's alpha coefficient.

RESULTS

The Social Activity Scale for Community-Dwelling Older Women Requiring Support (SASOWS) was created. This scale comprised the following three subscales: "interactions with familiar people," "consulting with care service providers," and "performing proactive creative activities at home". Correlation of SASOWS with the existing SAI-E resulted in a correlation coefficient of .521 (p < .01). Cronbach's alpha for the entire scale was .772, and internal consistency was observed.

CONCLUSIONS

SASOWS appears to be a reliable, valid, and useful scale to measure social activities specific for older women requiring support. Future studies should continue to examine the items and usefulness of this scale.

1306-km 20x124.8-Gb/s PM-64QAM transmission over PSCF with net SEDP 11,300 (b ∙ km)/s/Hz using 1.15 samp/symb DAC

We demonstrated the transmission of a Nyquist-WDM signal based on PM-64QAM modulation in an EDFA-only submarine configuration composed of 54.4 km-long fiber spans: 20 channels at 124.8-Gb/s were propagated over 1306 km of low-loss pure-silica-core fiber (PSCF). Thanks to an aggressive digital spectral shaping, we achieved a raw spectral efficiency (SE) of 10.4 b/s/Hz, corresponding to 8.67 b/s/Hz net SE when considering a 20% FEC overhead. Transmitter DACs are operated at a record-low 1.15 samples/symbol, enabled by the insertion of advanced anti-alias filters. The achieved SE-times-distance product was 11,327 (b ∙ km)/(s ∙ Hz), the highest reported so far for PM-64QAM. Combining the experimental results with the performance predictions obtained using an analytical model of nonlinear propagation in uncompensated coherent optical systems (the so-called "GN-model"), we show that PM-64QAM is a realistic option for ultra-high capacity systems in the 1,000 km range, carrying up 40 Tb/s in the C-band.

In not only vertebroplasty but also kyphoplasty, the resolution of vertebral deformities depends on vertebral mobility

BACKGROUND AND PURPOSE

It has not been clarified whether the postoperative resolution of vertebral deformities achieved by KP are superior to those achieved by VP. We compared the outcomes of KP and VP, taking into account the presence of vertebral mobility, to determine whether the balloon inflation in KP may contribute to postoperative resolution of the vertebral deformities in patients with VCFs.

MATERIALS AND METHODS

The subjects had 34 vertebral bodies treated by VP, and 43 vertebral bodies treated by KP. In all patients, preoperative dynamic imaging was performed to assess the presence of vertebral mobility. First, the vertebral height restoration and kyphotic change were compared between the VP and KP groups. Then, the patients were further divided into 2 groups on the basis of the presence of vertebral mobility, and they were compared within and between the VP and KP groups in relation to the presence of vertebral mobility.

RESULTS

Overall, no significant differences were observed in either the vertebral height restoration or kyphotic change between the VP and KP groups (P > .20). Preoperative dynamic imaging identified 19 vertebral bodies each with vertebral mobility in the VP (56%) and KP groups (44%) (P = .21). Within the VP and KP groups, the vertebral height restoration and kyphotic changes were significantly better in patients with vertebral mobility than in those without (P < .01). There were no significant differences between the 2 treatment groups after adjustment for the presence of vertebral mobility (P > .30).

CONCLUSIONS

In both the VP and KP groups, the vertebral height restoration and kyphotic change largely depended on the preoperative vertebral mobility. The use of the balloon itself contributed little to resolution of the vertebral deformities.