Influence of nurse work environment and psychological distress on resignation from hospitals: a prospective study

With the global nurse shortage, identifying nurse work environments that allow nurses to continue working is a common concern worldwide. This study examined whether a better nurse work environment (1) is associated with reducing nurses' psychological distress; (2) reduces nurse resignations; (3) weakens the influence of psychological distress on their resignation through interaction effect; and (4) whether psychological distress increases nurse turnover. Multilevel logistic regression analyses were performed using data obtained in 2014 from 2,123 staff nurses from a prospective longitudinal survey project of Japanese hospitals. The nurse work environment was measured by the Practice Environment Scale of the Nursing Work Index (PES-NWI) consisting of five subscales and a composite, and psychological distress by K6. All the PES-NWI subscales and composite (ORs 0.679-0.834) were related to K6, significantly. Regarding nurse turnover, K6 had a consistent effect (ORs 1.834-1.937), and only subscale 2 of the PES-NWI had a direct effect (OR 0.754), but there was no effect due to the interaction term. That is, (1) and (4) were validated, (2) was partly validated, but (3) was not. As better work environment reduces K6 and a lower K6 decreases nurses' resignation, high-level hospital managers need to continue improving the nurse work environment.

Associations Between Lifestyle Factors and Constipation Among Survivors After the Great East Japan Earthquake: A 9-year Follow-up Study

BACKGROUND

Disaster survivors experience deterioration in lifestyles and an increase in constipation. After the Great East Japan Earthquake in 2011, some survivors were evacuated for a long term, even after moving to temporary housing and public reconstruction housing. However, annual changes in constipation and the association between lifestyles and constipation among the survivors are still unknown.

METHODS

Overall, 9,234 survivors aged 18 years or older participated in this 9-year follow-up survey after the disaster. Information about the prevalence of constipation and lifestyle factors (diet, physical activity, and mental health) was collected using a self-reported questionnaire. Their dietary intake was categorized into the following two dietary patterns: prudent (fish and shellfish, soybean products, vegetables, fruits, and dairy products) and meat (meat and eggs). Odds ratios for constipation according to lifestyle factors were calculated using a generalized linear mixed model.

RESULTS

In women, the prevalence of constipation was the highest at baseline (8.7%) and remained around 5% afterward. In both men and women, older age, poor mental health, and poor physical activity were significantly associated with higher odds ratios of constipation. Moreover, a lower frequency of meals and a lower prudent dietary score were significantly associated with women's constipation.

CONCLUSION

The prevalence of constipation was the highest at baseline and remained around 5% in women. Lifestyle factors, such as poor mental health, physical inactivity, and low frequency of meals were associated with constipation. Our findings suggest continuous support for the survivors with constipation for medium- to long-term after disasters.

MRI of caval compression during left-lateral tilt in singleton and twin pregnancies: A prospective cohort study

BACKGROUND

It is unclear how different degrees of left-lateral tilt affect the volumes of the abdominal aorta and inferior vena cava (IVC) in pregnancy.

OBJECTIVE

To use magnetic resonance images to assess the volumes of the abdominal aorta and IVC in women with twin or singleton pregnancies in different degrees of left-lateral tilt.

DESIGN

Prospective cohort study.

SETTING

A single-centre university hospital.

PATIENTS

Women with singleton pregnancies (13) and twin pregnancies (13) at 32 to 38 weeks' gestation.

MAIN OUTCOME MEASURES

Comparison of abdominal aortic and IVC volumes measured by MRI in women with singleton and twin pregnancies while in the supine or left-lateral tilt position at 15°, 30° and 45°.

RESULTS

Supine, the mean aortic and IVC volumes were not significantly different between the women with singleton and twin pregnancies. In a left-lateral tilt position of 15 o compared with supine, the mean IVC volume was not increased in either group (singletons: 6.3 ± 6.6 ml, 95% CI, -2.4 to 0.4; P  = 0.174; twins: 3.9 ± 2.4 ml, 95% CI, -2.6 to 0.4; P  = 0.138). At tilt angles of 30° or 45°, the mean IVC volume significantly increased (singletons 30°: 9.7 ± 5.8 ml, 95% CI, -6.1 to -2.7; P  < .001; singleton 45°:13.8 ± 5.0 ml, 95% CI, -11.3 to -5.7; P  < .001; twins 30°: 5.7 ± 2.1 ml, 95% CI, -4.0 to -1.4; P  < .001; twins 45°: 12.8 ± 9.4 ml, 95% CI, -17.2 to -2.6; P  = 0.003). Aortic volume was not significantly increased in either group at any of the examined tilt angles compared with the supine.

CONCLUSION

IVC volume is significantly increased by 30° and 45° left-lateral tilt positions compared with supine in women with singleton and twin pregnancies.

TRIAL REGISTRATION

This study was registered in the University Hospital Medical Information Network (UMIN) clinical trial registration (# UMIN000031273).

Projections of maternal mortality ratios in Bangladesh

Background

The objective of this study was to predict when Bangladesh would achieve Sustainable Development Goal Target 3.1, which is to reduce the maternal mortality ratio (MMR) to less than 70 per 100 000 live births.

Methods

We used secondary data from the 1993 to 2017 Bangladesh Demographic and Health Surveys and other sources to project the MMR until 2060 under several scenario assumptions using an autoregressive moving average model with exogenous variables (ARMAX). Explanatory variables were selected based on the three delays model, and a reference forecast and four practical scenarios were simulated: Scenario 1 assumed a 4% annual increase in institutional deliveries, Scenario 2 followed the national goals, the reference forecast and Scenario 3 varied in terms of district-wise increase rates (Scenario 3 had a lower rate of increase), and Scenario 4 assumed minimal changes in institutional deliveries.

Results

Scenario 1 was the earliest, with an MMR of <70 per 100 000 live births in 2026. Scenario 2 would meet the target of <70 per 100 000 live births in 2029. The reference forecast had the third lowest MMR, with 69.78 per 100 000 live births (95% prediction intervals (PI) = 32.44 to 107.11) in 2049. Although the MMR for Scenario 3 decreased slowly, it would not reduce below 70 per 100 000 live births by 2060. Scenario 4, which had the highest MMR, also resulted in the MMR not reducing below 70 per 100 000 live births by 2060.

Conclusions

To increase the institutional delivery rate and reduce the MMR, as in Scenarios 1 and 2, it is necessary to improve the institutional delivery rate in regions with low institutional delivery rates. Additionally, health facilities need to provide appropriate quality medical care to increase the institutional delivery rate and contribute to a decrease in the MMR, as shown by the results of this study.

A randomized controlled trial on the effects of decision aids for choosing discharge destinations of older stroke patients

BACKGROUND

In Japanese medical practice, older stroke survivors are overwhelmed with information regarding their discharge locations, creating more decision-making challenges. A randomized controlled trial evaluated the influence of decision aids (DAs) for matching older stroke patients and their families' values concerning decisional conflict and participation in discharge destination decisions.

METHODS

Participants were randomly allocated to intervention and control groups. The intervention spanned two months, from admission to discharge, at which times participants were surveyed. DAs were provided to the intervention group, and brochures to the control group. The primary endpoint was decisional conflict, assessed using the Decisional Conflict Scale (DCS). The secondary endpoint decision-making participation was assessed using the Control Preference Scale (CPS) decision-making roles and a 10-point Visual Analog Scale for participation rate. An independent t-test analyzed decisional conflict scores and participation rates to examine between-group differences. The chi-square independence test evaluated roles in decision-making scores. Post hoc subgroup analyses were performed.

RESULTS

Ninety-nine participants (intervention group n = 51; control group n = 48) were included in the full analysis set, with a dropout rate of 38.4%. No significant group differences were found in decision-making conflict [t (99) = 0.69, p = 0.49, d = 0.14] and roles in decision-making scores [χ2 (5) = 3.65, p = 0.46]. However, a significant group difference was found in the participation rate [t (99) = 2.24, p = 0.03, d = 0.45]. DA tended to reduce uncertainty and promote participation rates, especially in participants living alone and unable to decide their discharge destination.

CONCLUSIONS

The use of DA with older stroke patients did not significantly decrease decisional conflicts. In addition, the participation rate in decision-making increased, but their active role did not. Further studies should be conducted to understand the methods of offering DA, their ideal durations, and identify their beneficiaries.

Computed Tomography Renal Volumetry Better Predicts Postoperative Donor Renal Function in Live Kidney Donor Transplantation than Renal Scintigraphy: A Comparative Study

INTRODUCTION AND OBJECTIVES

Both computed tomography (CT) and renal scintigraphy (RS) have been used to assess vascular anatomy, renal status, and split renal function (SRF). In this study, we used a recently developed software that facilitates renal volumetric evaluations to compare RS and automated CT volumetry for assessing residual renal function and, thus, estimating postoperative renal function after donor nephrectomy.

METHODS

Fifty-one cases of donor nephrectomy were analyzed. Residual renal function was estimated based on RS and CT volumetry. The correlation between the postoperative estimated glomerular filtration rate (eGFR) and expected SRF, measured using RS and three types of CT volumetry data (ellipsoid, thin-slice, and 5-mm slice data), was determined.

RESULTS

The correlation coefficient between actual eGFR and expected SRF was significantly associated at each time point and modality (p < 0.0001). At any time point, the difference in correlation coefficient between RS and 5-mm volumetry was significant (p value: 0.003-0.018), whereas the differences in correlation coefficients between RS and the triaxial volume calculation, and the triaxial volume calculation and 5-mm volumetry, were generally statistically insignificant.

CONCLUSIONS

Expected SRF was estimated more accurately by CT volumetric calculations (especially 5-mm slice-based volumetry) than RS.

[Developing scales to evaluate community practices among municipal public health nurses: content, perceptions of public health nurses, and organizational environment]

Objectives　This study aimed to develop scales for evaluating the level of implementation of community practices and explore the perception of public health nurses in municipalities regarding their community practices.Methods　Draft scales were developed based on a literature review and interviews with municipal public health nurses. Subsequently, a questionnaire survey was conducted with municipal public health nurses across Japan in response to these draft scales. Respondents were recruited based on the municipality population size. Questionnaires were distributed to 2,074 individuals from 52 municipalities ensuring representation from diverse municipalities. Exploratory factor analysis was performed to determine the number of factors, while confirmatory factor analysis was performed to determine the factor structure. The reliability of the scales was assessed by calculating Cronbach's alpha coefficients, and their validity was tested by examining correlations with existing scales, namely the Moral Competence Scale for Public Health Nurses and the Professional Identity Scale for Public Health Nurses, and years of experience as a public health nurse.Results　A total of 721 (34.8%) valid respondents were included in the analysis. Three scales, methods of community practices (three factors, nine items), perceptions of public health nurses toward community residents through community practices (three factors, 10 items), and organizational environment supporting community practices (two factors, 11 items) were developed as indicators of the implementation of public health nurses' community practices. Cronbach's alpha coefficients for the three scales were 0.896, 0.913, and 0.868, respectively. As hypothesized, each subfactor exhibited a positive correlation with the existing scales. However, certain subfactors did not demonstrate any correlation with years of experience.Conclusion　The three scales developed in this study were individually examined for reliability and validity. These scales can be used independently or in combination, allowing public health nurses to select the most suitable scale(s) based on their objective.　A notable contribution of this study is the establishment of concrete indicators for evaluating community practices, addressing the previously vague nature of this evaluation. By incorporating the scale items into daily health practices, we anticipate that these indicators can be employed to evaluate community practices at the organizational and individual levels.

Rapid weight change as a predictor of disability among community-dwelling Japanese older adults

AIM

To fill the knowledge gap regarding weight change and the onset of disability in community-dwelling Japanese older adults, we investigated the potential effects of rapid weight change on disability risk as defined by Japan's long-term care insurance (LTCI) system.

METHODS

We analyzed data from a longitudinal study of 10 375 community-dwelling older Japanese adults (≥65 years) who were not LTCI needs certified at baseline and joined the study from 2002 to 2005. Weight change (percentage) was calculated by subtracting participants' weight in the previous year from that measured during a physical examination at study commencement. The five weight-change categories ranged from sizable weight loss (≤ -8.0%) to sizable weight gain (≥ +8.0%). Disability was defined according to LTCI certifications at follow-up. Hazard ratios (HRs) and 95% confidence intervals were calculated for new-onset disability using a Cox proportional hazards model that fitted the proportional subdistribution hazards regression model with weights for competing risks of death.

RESULTS

During the mean 10.5-year follow-up, 2994 participants developed a disability. Sizable weight loss (HR [95% confidence intervals], 1.41 [1.17-1.71]) and weight loss (1.20 [1.05-1.36]) were significant predictors of disability onset. Sizable weight gain (1.45 [1.07-1.97]) corresponded to severe disability. Stratified analyses by lifestyle and initial body mass index categories revealed more pronounced associations between weight change and disability risk in the unhealthy lifestyle and below initial normal body mass index groups.

CONCLUSIONS

Rapid and sizable weight gain could be additional criteria for disability risk in older adults. Geriatr Gerontol Int 2023; 23: 809-816.

The factors affecting implementing shared decision-making in clinical trials: a cross-sectional survey of clinical research coordinators' perceptions in Japan

BACKGROUND

The shared decision-making model has been proposed as the ideal treatment decision-making process in medical encounters. However, the decision to participate in clinical trials rarely involves shared decision-making. In this study, we investigated the perceptions of Japanese clinical research coordinators who routinely support the informed consent process.

METHODS

This study aimed to (1) identify clinical research coordinators' perceptions of the current status of shared decision-making implementation and its influencing factors, and (2) obtain suggestions to enhance the shared decision-making process in clinical trials. A cross-sectional survey was conducted using a web questionnaire based on the Theory of Planned behaviour. Invitations were sent to 1087 Japanese medical institutions, and responses from the participants were captured via the web. The shared decision-making process in clinical trials was defined according to the Shared Decision-Making Questionnaire for Doctors. The effect of the attitudes toward shared decision-making, clinical research coordinators' subjective norms towards its implementation, perceived barriers to autonomous decision-making, and the number of difficult steps in the shared decision-making process on the shared decision-making current status as the shared decision-making intention was assessed by multiple regression analysis.

RESULTS

In total, 373 clinical research coordinators responded to the questionnaire. Many believed that they were already implementing shared decision-making. Attitudes toward shared decision-making (t = 3.400, p < .001), clinical research coordinators' subjective norms towards its implementation (t = 2.239, p = .026), perceived barriers to autonomous decision-making (t = 3.957, p < .001), and the number of difficult steps in the shared decision-making process (t = 3.317, p = .001) were found to significantly influence current status (Adjusted R² = .123). However, results on perceived barriers to autonomous decision-making and the number of difficult steps in the shared decision-making process indicate a lack of knowledge of shared decision-making and decision-support skills among clinical research coordinators.

CONCLUSIONS

Clinical research coordinators might positively perceive shared decision-making based on normative beliefs without sufficient knowledge of it. Therefore, providing appropriate training on shared decision-making to clinical research coordinators and increasing awareness among stakeholders could enable its improvement.

TRIAL REGISTRATION

Not applicable.

The process of Transformative Learning in Dialog Café with Health Professionals and Citizens/Patients

INTRODUCTION

Dialogue Café, which is an inclusive process that provides a platform for the exchange of ideas or perspectives on certain issues, is a suitable approach to facilitating mutual understanding between health professionals and citizens/patients. However, little is known about the effects of the Dialogue Café on participants in the context of health communication. Previous studies suggest that transformative learning occurs after dialogue.

OBJECTIVES

This study aimed to clarify the process of the transformative learning process among participants of the Dialog Café and to evaluate whether their transformative learning would lead to an understanding of others' perspectives.

METHODS

We conducted a psychometric analysis of a web-based questionnaire consisting of 72 items for participants of Dialog Café held from 2011 to 2013 in Tokyo and studied the relationships between various concepts using structural equation modeling (SEM). To evaluate the validity and reliability of concept measurement, we conducted an exploratory factor analysis and a confirmatory factor analysis.

RESULTS

The questionnaire response rate was 39.5% (141/357), of which 80 (56.7%) respondents were health professionals and 61 (43.3%) respondents were citizens/patients. The SEM analysis revealed that transformative learning occurred in both groups. The process of transformative learning consisted of 2 types; one process leading directly to "perspective transformation" and the other leading to "perspective transformation" via "critical self-reflection" and "disorienting dilemmas." "Perspective transformation" was related to "understanding others" in both groups. Among health professionals, "perspective transformation" was related to "transformation of awareness toward patients/users."

CONCLUSION

Dialog Café can facilitate the process of transformative learning among participants, and transformative learning may lead to mutual understanding between health professionals and citizens/patients.

Psychological Distress in Responders and Nonresponders in a 5-year Follow-up Health Survey: The RIAS Study

BACKGROUND

People with poor health or mental conditions are generally unwilling to participate in the health examinations, and no studies have directly examined the relationship of psychological distress among disaster survivors with participation status to date. The present study thus examined psychosocial differences according to the respondent status in a 5-year follow-up survey among participants in the prospective health surveys on survivors of the Great East Japan Earthquake and Tsunami Disaster study in Iwate Prefecture, Japan.

METHODS

We analyzed data from 10,203 Japanese survivors aged ≥18 years (mean age, 65.6 years; 38.0% men) and who underwent health examinations at baseline in 2011. Participants were classified into responders and nonresponders according to their 2015 health examination participation status. Psychological distress was evaluated using the Kessler 6 scale and categorized as none, mild, and severe. Multinominal logistic regression was used to examine the risk of psychological distress in relation to participation status.

RESULTS

In the 2015 survey, 6,334 of 6,492 responders and 1,686 of 3,356 nonresponders were analyzed. The most common reasons for nonparticipation in the survey were participated in other health examinations, examined at a hospital, and did not have time to participate. Nonresponse in males was associated only with mild psychological stress, whereas nonresponse in females was associated with mild and severe psychological distress.

CONCLUSION

Nonresponders in the follow-up survey had a higher risk of psychological distress than responders. Continuous monitoring of the health of nonresponders and responders may help to prevent future health deterioration.

Associations between health literacy and information-evaluation and decision-making skills in Japanese adults

Background

Health literacy among Japanese is often low, making it difficult for them to evaluate health information and make informed decisions. However, the health literacy scales applied measure the perceived difficulty of health-related tasks; they do not directly assess the specific skills needed to perform the tasks: the skills to judge the reliability of diverse information using evaluation criteria and implement rational decision-making. Therefore, the study objectives were to investigate the following issues using a nationwide survey in Japan. (1) When obtaining information, to what extent do people apply criteria for evaluating information to confirm its reliability; when making decisions, to what extent do they seek out available options and compare pros and cons based on their own values? (2) How strongly are such skills associated with health literacy and demographic characteristics? (3) What opportunities are available to learn these skills?

Methods

We conducted an online questionnaire survey using a Japanese Internet research company; 3,914 valid responses were received. The measures comprised health literacy (European Health Literacy Survey Questionnaire), five items on information evaluation, four items on decision-making, and items on the availability and location of learning opportunities. We calculated Pearson correlations to explore the association of health literacy with information-evaluation and decision-making skills. Multivariate analyses were also conducted using these factors as dependent variables.

Results

Fewer than half (30%–50%) of respondents reported always or often evaluating information and engaging in decision-making. Health literacy was significantly and positively correlated with the specific skills of information evaluation and decision-making (r = .26 and .30, respectively) as were multivariate analyses (beta = .15 and .22, respectively).

Over 40% of respondents had never learned those skills. The most common resources for learning the skills were the Internet and television; less-used resources were schools and workplaces.

Conclusions

Both information-evaluation and decision-making skills were associated with health literacy. However, these skills are not sufficiently widespread in Japan because there are few opportunities to acquire them. More research is needed to raise awareness of the importance of such skills for improving health literacy and providing learning opportunities.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13892-5.

Pilot Study of Evaluating Attitudes toward Childhood Immunization among Healthcare Workers in Japan

Providing appropriate immunization information during the perinatal period is important for improving immunization rates among infants and children; however, the distribution of immunization information by healthcare workers (HCWs) is not standardized in Japan. We investigated HCWs’ attitudes toward childhood immunization and factors related to vaccine hesitancy. We conducted a cross-sectional descriptive survey of HCWs involved in childhood immunization in Niigata City, Japan, from November 2017 to January 2018. We assessed contextual, individual and group, and vaccine/vaccination-specific influences. Of 290 HCWs, 139 (47.9%) returned completed questionnaires. Most HCWs (87/139, 64.9%) reported providing immunization information verbally to parents; 51/87 (58.6%) spent fewer than five minutes doing so. Pediatricians provided vaccines based on the parents’ best interest, whereas public health nurses and midwives emphasized government policy. Nurses had greater hesitancy related to personal perceptions and social/peer factors than pediatricians (p < 0.001). Nurses were significantly more likely than pediatricians to suggest that children receive more shots than necessary (p < 0.01). Nurses tended to have more negative attitudes toward vaccination and little awareness of immunization promotion compared to pediatricians. Thus, all HCWs involved in childhood immunization should receive sufficient information to provide timely and appropriate immunization to infants and children.

Healthcare providers' perception of advance care planning for patients with critical illnesses in acute-care hospitals: a cross-sectional study

Background

In acute-care hospitals, patients treated in an ICU for surgical reasons or sudden deterioration are treated in an outpatient ward, ICU, and other multiple departments. It is unclear how healthcare providers are initiating advance care planning (ACP) for such patients and assisting them with it. The purpose of this study is to clarify healthcare providers’ perceptions of the ACP support provided to patients receiving critical care in acute-care hospitals.

Methods

A cross-sectional study was conducted using questionnaires. In this study, 400 acute-care hospitals with ICUs in Japan were randomly selected, and 1490 subjects, including intensivists, surgeons, ICU nurses, surgical floor nurses, and surgical outpatient nurses, participated. Survey items examined whether ICU patients received ACP support, the participants’ degree of confidence in providing ACP support, the patients’ treatment preferences, and the decision-making process, and whether any discussion was conducted on change of values.

Results

Responses were obtained from 598 participants from 157 hospitals, 41.4% of which reportedly supported ACP provision to ICU patients. The subjects with the highest level of ACP understanding were surgeons (45.8%), and differences in understanding were observed across specialties (P < 0.001). Among the respondents, physicians and nurses expressed high levels of confidence in providing ACP support to patients requiring critical care. However, 15.2% of all the subjects mentioned that they would not attempt to resuscitate the patients. In addition, 25.7% of the participants handed over patients’ values to other departments or hospitals, whereas 25.3% handed over the decision-making process.

Conclusions

Among the participating hospitals, 40% provided ACP support to patients receiving critical care. The low number is possibly because support providers lack understanding of the content of patients’ ACP or about how to support and use ACP. Second, it is sometimes too late to start providing ACP support after ICU admission. Third, healthcare providers differ in their perception of ACP, widely considered an ambiguous concept. Finally, in acute-care hospitals with different healthcare settings, it is necessary to confirm and integrate the changes in feelings and thoughts of patients.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12904-021-00900-5.

Association between Covid-19 preventive behaviors and health literacy, information-evaluation, and decision-making skills in Japanese adults

Background

Health literacy is important for the prevention of COVID-19 transmission. Research in Japan shows that health literacy is related to skills in evaluating information and decision-making (skills that are not necessarily limited to information about health). Such basic skills are important, particularly when individuals encounter new health issues for which there is insufficient evidence.

Objective

We aimed to determine the extent to which COVID-19 preventive behaviors were associated with health literacy and skills in evaluating information and making decisions.

Methods

A web-based questionnaire survey was conducted using a Japanese internet research company. The measures comprised 8 items on COVID-19 preventive behaviors, health literacy items (European Health Literacy Survey Questionnaire), 5 items on information evaluation, and 4 items on decision-making process. Pearson correlations between these variables were calculated. Multivariable analyses were also conducted using the COVID-19 preventive behavior score as a dependent variable.

Results

A total of 3914 valid responses were received.COVID-19 preventive behaviors were significantly correlated with health literacy (r=0.23), information evaluation (r=0.24), and decision-making process (r=0.30). Standardized regression coefficients (health literacy: β=.11; information evaluation: β=.13; decision-making: β=.18) showed that decision-making process contributed the most.

Conclusions

Although comprehensive health literacy is necessary for COVID-19 preventive behaviors, the skills to evaluate a wide range of information and to make appropriate decisions are no less important. Opportunities for people to acquire these skills should be available at all times.

Developing the nursing practice environment scale for home health care: A trial study in Japan

AIM

To develop the nursing practice environment scale in home health care (NPES-HHC), which measures the attractiveness of nursing practice environments in Japan.

DESIGN

Cross-sectional study.

METHODS

The answers of 1,050 mail surveys conducted for nurses at 421 home-visit nursing agencies in Japan were analysed. Exploratory and confirmatory factor analyses of the NPES-HHC's candidate items were performed. Relationships between the newly developed NPES-HHC and participants' intention to remain at the workplace, job satisfaction and quality of care were also tested.

RESULTS

A seven-dimensional model with 37 items was obtained by exploratory factor analysis (Cronbach's alpha: 0.77-0.92). Confirmatory factor analysis supported this model. NPES-HHC scores had significant positive relations with participants' intention to remain at the workplace, job satisfaction and quality of care (p < .01). The NPES-HHC is a reliable and valid instrument to assess the attractiveness of the practice environment for home-visit nursing agencies.

Association between Milk Intake and Incident Stroke among Japanese Community Dwellers: The Iwate-KENCO Study

We aimed to evaluate the association between the milk consumption and incident stroke in a Japanese population, where milk consumption is lower than that of Western countries. In total, 14,121 participants (4253 men and 9868 women) aged 40–69 years, free from cardiovascular diseases (CVD) were prospectively followed for 10.7 years. Participants were categorized into four groups according to the milk intake frequency obtained from a brief-type self-administered diet questionnaire. The adjusted HRs of total stroke, ischemic stroke and haemorrhagic stroke associated with milk intake frequency were calculated using the Cox proportional hazards model. During the follow-up, 478 stroke cases were detected (208 men and 270 women). Compared to women with a milk intake of <2 cups/week, those with an intake of 7 to <12 cups/week had a significantly low risk of ischemic stroke in a model adjusting CVD risk factors; the HR (95% CI) was 0.53 (0.32–0.88). No significant associations were found in men. This study suggested that milk intake of 7 to <12 cups/week decreased the risk of ischemic stroke in Japanese women. Milk intake of about 1 to <2 cups/day may be effective in the primary prevention of ischemic stroke in a population with low milk intake.

Work environment for hospital nurses in Japan: The relationships between nurses' perceptions of their work environment and nursing outcomes

AIM

To investigate nurses' perceptions of their work environment and to investigate the relationships between variables measuring the work environment (WE) and nursing outcomes (NOs ).

DESIGN

A 2-year prospective longitudinal survey (2013-2015).

METHOD(S)

Descriptive statistics of nurse demographics, organizational WE and NOs were calculated by position. The associations between Practice Environment Scale of the Nursing Work Index (PES-NWI) and NOs were examined for each unit.

RESULTS

The participants were 2,992 staff nurses, 137 nurse managers (NMs), and 8 chief nursing officers in Phase 1 and 7,849, 371 and 23 in Phase 2, respectively. The higher the job position, the better the WE was rated. The higher the PES-NWI scores, the better the outcomes. Descriptive statistics about organizational WEs and NOs and the statistically significant associations between the two were identified.

Low educational level increases functional disability risk subsequent to heart failure in Japan: On behalf of the Iwate KENCO study group

Objectives

The risk factors that contribute to future functional disability after heart failure (HF) are poorly understood. The aim of this study was to determine potential risk factors to future functional disability after HF in the general older adult population in Japan.

Methods

The subjects who were community-dwelling older adults aged 65 or older without a history of cardiovascular diseases and functional disability were followed in this prospective study for 11 years. Two case groups were determined from the 4,644 subjects: no long-term care insurance (LTCI) after HF (n = 52) and LTCI after HF (n = 44). We selected the controls by randomly matching each case of HF with three of the remaining 4,548 subjects who were event-free during the period: those with no LTCI and no HF with age +/-1 years and of the same sex, control for the no LTCI after HF group (n = 156), and control for the LTCI after HF group (n = 132). HF was diagnosed according to the Framingham diagnostic criteria. Individuals with a functional disability were those who had been newly certified by the LTCI during the observation period. Objective data including blood samples and several socioeconomic items in the baseline survey were assessed using a self-reported questionnaire.

Results

Significantly associated risk factors were lower educational levels (odds ratio (OR) [95% confidence interval (CI)]: 3.72 [1.63–8.48]) in the LTCI after HF group and hypertension (2.20 [1.10–4.43]) in no LTCI after HF group. Regular alcohol consumption and unmarried status were marginally significantly associated with LTCI after HF (OR [95% CI]; drinker = 2.69 [0.95–7.66]; P = 0.063; unmarried status = 2.54 [0.91–7.15]; P = 0.076).

Conclusion

Preventive measures must be taken to protect older adults with unfavorable social factors from disability after HF via a multidisciplinary approach.

Arthroscopic Bankart Repair and Open Bristow Procedure in the Treatment of Anterior Shoulder Instability With Osseous Glenoid Lesions in Collision Athletes

Background:

Traumatic anterior shoulder instability in collision sports athletes often involves osseous glenoid lesions, which make surgical treatment challenging. High redislocation rates have been seen in collision sports athletes treated using arthroscopic Bankart repair.

Purpose:

To investigate the effectiveness of a combined arthroscopic Bankart repair and open Bristow procedure for the treatment of traumatic anterior shoulder instability in collision sports athletes, with a focus on osseous glenoid lesions.

Study Design:

Case series; Level of evidence, 4.

Methods:

We reviewed 149 shoulders in 141 competitive collision sports athletes (mean ± standard deviation age, 20.1 ± 4.1 years; 8 bilateral cases) who underwent a combined arthroscopic Bankart repair and open Bristow procedure with minimum 2 years of follow-up. Osseous Bankart lesions were arthroscopically reduced and fixed using a coracoid graft.

Results:

Clinical outcomes as indicated by mean Rowe score improved significantly from 50.0 preoperatively to 98.9 postoperatively (P < .001) at a median follow-up of 3.4 years (range, 2.5-7 years). There were 2 recurrent dislocations (1.3%), both of which had nonunion of the transferred coracoid. Osseous Bankart lesions were observed in 85 shoulders, and osseous glenoid lesions ≥10% of the diameter of the nonoperative side were found in 58 shoulders, including 24 off-track cases. Clinical outcomes were not significantly different between patients with a glenoid defect ≥10% and <10%. Nonunion of the transferred coracoid was observed in 16 shoulders (10.7%), which had inferior Rowe scores; however, we could not define any risk factors for nonunion, including patient characteristics or bone morphology. Postoperative computed tomography performed in 29 patients >1 year after surgery showed successful repair of the osseous glenoid lesions, with a restored glenoid articular surface in all cases. Significant pre- to postoperative increases were seen in glenoid diameter (mean, 13.1% [95% CI, 9.9%-16.3%]; P < .001) and area (mean, 10.6% [95% CI, 8.5%-12.7%]; P < .001).

Conclusion:

A combined arthroscopic Bankart repair and open Bristow procedure improved bone morphology and was a reliable surgical method for treating collision sports athletes with traumatic anterior shoulder instability involving osseous glenoid lesions.

Intervention and efficacy of advance care planning for patients in intensive care units and their families: a scoping review protocol

AIM

This scoping review aims to elucidate the effectiveness of advance care planning interventions for patients entering the intensive care unit and their families.

DESIGN

Scoping review of relevant literature from January 2000-March 2020.

METHODS

This review includes studies undertaken in intensive care units that focus on patients older than 18 years or their families. The review will be conducted in accordance with the PRISMA-P guideline. The PubMed, EMBASE, CINAHL, BNI, PsycINFO and ICHUSHI databases and the Cochrane Library will be searched for both published and unpublished articles. Two independent reviewers will examine the list of remaining titles and summarize and identify articles that meet the inclusion criteria.

RESULTS

It has long been taboo to consider end-of-life care when in intensive care unit. However, promoting advance care planning, even in patients who are in the intensive care unit, is important and it may help support the patient's need for autonomy.

Advance Care Planning for Intensive Care Patients During the Perioperative Period: A Qualitative Study

INTRODUCTION

Patients in intensive care units (ICUs) may transition into an end-of-life phase during treatment. Advance care planning (ACP) for this population has not been studied comprehensively, and support for its implementation is insufficient.

OBJECTIVE

This study aims to clarify the ACP support needs among critical perioperative patients.

METHODS

In this qualitative descriptive study, semistructured interviews were conducted with patients previously admitted to the ICU. The survey was conducted from September to November 2019. Participants comprised 13 individuals, who were admitted to the ICU for a period of 3 months to 2 years after surgery.

RESULTS

The average age of the participants was 63.8 years. The average mechanical ventilation duration following surgery was 24.5 h. The interviews focused on the ACP needs from the preoperative period to discharge. About 90% of the patients thought about the possibility of death before surgery and considered giving advance orders (e.g., "I don't want life-sustaining treatment"). The participants discussed inheritance, work-related matters, and household issues with their families but rarely spoke about treatment and care. Although they examined the content of the advance directives, the medical staff was not informed about them. Patients revealed that they wanted to understand the distinction between life-prolonging and life-saving treatments and discuss it with the medical staff, apart from being educated on ACP. Many patients previously admitted to the ICU are unclear about the difference between life-prolonging and life-saving treatments; this is also true for medical staff.

CONCLUSION

Patients who had been admitted to the ICU after high-risk surgery thought they needed help with ACP before surgery. Therefore, patients have the right to know about treatment risks; however, medical staff believes that this is difficult to communicate. Thus, medical staff should consider ways to communicate clearly with patients, including discussing the risks associated with surgery.

Increase in Body Weight Following Residential Displacement: 5-year Follow-up After the 2011 Great East Japan Earthquake and Tsunami

BACKGROUND

Previous studies have linked residential displacement as a result of the 2011 East Japan Earthquake to increases in body weight. However, no study has examined longer-term trajectories of body weight among displaced survivors. We compared body weight change between survivors relocated to temporary housing (TH) group versus other types of accommodation for up to 5 years after the Great East Japan Earthquake.

METHODS

Longitudinal follow-up was conducted from 2011 to 2015 in a cohort of 9,909 residents of 42,831. We compared trends in body weight in the TH group (n = 3,169) and the non-TH group (n = 6,740) using a mixed linear regression model stratified by sex (mean age, 61.0 years old; male, 38.9%).

RESULTS

In age-adjusted analysis, the body weight in the 2011 survey was not significantly different between two groups for either sex. In men, the TH group significantly increased body weight compared to the non-TH group since 2012. In women, body weight sharply increased in the TH group while body weight did not change in the non-TH group during survey time points. The interaction of living conditions and survey years was statistically significant in both sexes (men; F-value, 6.958; P < 0.001: women; F-value, 19.127; P < 0.001).

CONCLUSION

Survivors relocated to temporary housing had an increased risk of weight gain. The weight gain in this group is a potential risk factor for metabolic syndrome in the post-disaster period.

Reliability and validity of the Multidimensional Measure of Leader-Member Exchange Japanese version for staff nurses

AIM

To verify the reliability and validity of Multidimensional Measure of Leader-Member Exchange Japanese version (LMX-MDM-J) for staff nurses.

BACKGROUND

Staff nurses who have a high-quality relationship with nurse managers tend to have low turnover intention. However, the validity and reliability of LMX-MDM Japanese version have not been confirmed.

METHODS

Staff nurses (n = 870) working in wards of four Japanese hospitals were surveyed using self-administered questionnaires. Reliability was tested by internal consistency. Validity was tested by the confirmatory factor analysis for construct validity and relationships with external criteria for criterion-related validity.

RESULTS

There were 450 valid responses. Cronbach's α coefficients of the overall scale and each dimension were 0.97 and 0.86-0.95, respectively. The goodness-of-fit indices of the confirmatory factor analysis showed CFI = 0.981 and RMSEA = 0.076. Correlation coefficients with external criteria were 0.57 for job satisfaction, 0.80 for relationship satisfaction with the nurse manager and -0.36 for turnover intention (all p < .001).

CONCLUSION

The reliability and validity of LMX-MDM-J were determined to be adequate for staff nurses.

IMPLICATIONS FOR NURSING MANAGEMENT

LMX-MDM-J can accurately measure the quality of the dyadic relationship between nurse managers and staff nurses. This measurement indicates whether nurse managers are providing leadership.

Poor self-rated health predicts the incidence of functional disability in elderly community dwellers in Japan: a prospective cohort study

BACKGROUND

Although previous large population studies showed elderly with poor self-rated health (SRH) to be at a high risk of functional disability in Western countries, there have been few studies in which the association between SRH and functional disability was investigated in Japanese community dwellers. The association between SRH and functional disability, defined as certification of the long-term care insurance (LTCI) system, in Japanese elderly community dwellers was examined in this study.

METHODS

A total of 10,690 individuals (39.5% men, mean age of 71.4 years) who were 65 years of age or more who did not have a history of cardiovascular disease or LTCI certification were followed in this prospective study for 10.5 years. SRH was classified into four categories: good, rather good, neither good nor poor, and poor. A Cox proportional-hazards model was used to determine the hazard ratios (HRs) for the incidence of functional disability among the SRH groups for each sex.

RESULTS

The number of individuals with functional disability was 3377. Men who rated poor for SRH scored significantly higher for functional disability (HR [95% confidence interval]: poor = 1.74 [1.42, 2.14]) while women who rated rather good, neither good nor poor, and poor scored significantly higher for functional disability (rather good =1.12 [1.00, 1.25], neither good nor poor = 1.29 [1.13, 1.48], poor = 1.92 [1.65, 2.24]: p for trend < 0.001 in both sexes).

CONCLUSION

Self-rated health, therefore, might be a useful predictor of functional disability in elderly people.

Increased incidence of metabolic syndrome among older survivors relocated to temporary housing after the 2011 Great East Japan earthquake & tsunami

Background

Beyond the immediate toll of injuries and deaths, major disasters are often associated with long-term increased risks of chronic disease. We sought to investigate the incidence of metabolic syndrome (MetS) among survivors of the 2011 Great East Japan Earthquake and tsunami.

Methods

Subjects aged ≥18 years from the tsunami-stricken area participated in a prospective cohort study of disaster survivors (the RIAS Study) from 2011 to 2015. After excluding subjects who were previously diagnosed with MetS, we observed the cumulative incidence of MetS across four annual examinations among 7318 subjects (mean age, 59.8 years; 43.5% men). We defined MetS using the International Diabetes Foundation criteria.

Results

The 4-year cumulative incidence of MetS was 18.0% in the overall sample. The incidence was significantly higher among older women survivors relocated to prefabricated temporary housing (40.9%, 95% confidence interval, 36.4-44.6), and other types of housing (36.2%, 95% CI: 32.3-40.6) compared to those who were not relocated (34.1%, 95% CI: 30.9-37.4). An increase in incidence of MetS was not observed for older men, or younger survivors aged ≤64 years.

Conclusion

Relocation to prefabricated temporary housing was a risk factor for increased incidence of MetS in older women.

Development and validation of Nurse Managers' Empowering Behavioral Scale for staff nurses

Aim

In this study, we developed and verified the Nurse Managers' Empowering Behavioral Scale for Staff Nurses (NMEB-SN).

Design

A cross-sectional survey.

Methods

The NMEB-SN was developed based on the staff nurses' perspectives. Nurses working in 10 hospitals in Japan were surveyed using a questionnaire to test the scale's validity using construct and criterion-related validity and reliability using internal consistency and test-retest method. There were 1,146 eligible participants included in the process.

Results

The scale items resulted in five subscales comprising of 48 items altogether. The goodness-of-fit indices for confirmatory factor analysis were CFI = 0.903 and RMSEA = 0.076. The correlation with external criteria for criterion-related validity was near the expected standard. Further, Cronbach's α coefficient was 0.95-0.97 for each subscale and 0.99 for the overall scale. The reliability and validity of the developed NMEB-SN were verified for staff nurses in Japan.

ICRP Publication 140: Radiological Protection in Therapy with Radiopharmaceuticals

Radiopharmaceuticals are increasingly used for the treatment of various cancers with novel radionuclides, compounds, tracer molecules, and administration techniques. The goal of radiation therapy, including therapy with radiopharmaceuticals, is to optimise the relationship between tumour control probability and potential complications in normal organs and tissues. Essential to this optimisation is the ability to quantify the radiation doses delivered to both tumours and normal tissues. This publication provides an overview of therapeutic procedures and a framework for calculating radiation doses for various treatment approaches. In radiopharmaceutical therapy, the absorbed dose to an organ or tissue is governed by radiopharmaceutical uptake, retention in and clearance from the various organs and tissues of the body, together with radionuclide physical half-life. Biokinetic parameters are determined by direct measurements made using techniques that vary in complexity. For treatment planning, absorbed dose calculations are usually performed prior to therapy using a trace-labelled diagnostic administration, or retrospective dosimetry may be performed on the basis of the activity already administered following each therapeutic administration. Uncertainty analyses provide additional information about sources of bias and random variation and their magnitudes; these analyses show the reliability and quality of absorbed dose calculations. Effective dose can provide an approximate measure of lifetime risk of detriment attributable to the stochastic effects of radiation exposure, principally cancer, but effective dose does not predict future cancer incidence for an individual and does not apply to short-term deterministic effects associated with radiopharmaceutical therapy. Accident prevention in radiation therapy should be an integral part of the design of facilities, equipment, and administration procedures. Minimisation of staff exposures includes consideration of equipment design, proper shielding and handling of sources, and personal protective equipment and tools, as well as education and training to promote awareness and engagement in radiological protection. The decision to hold or release a patient after radiopharmaceutical therapy should account for potential radiation dose to members of the public and carers that may result from residual radioactivity in the patient. In these situations, specific radiological protection guidance should be provided to patients and carers.

Reliability and validity of a 12-item medication adherence scale for patients with chronic disease in Japan

BACKGROUND

To improve and support medication adherence among patients with chronic diseases, especially for long-term medication, it is important to consider both their relationship with healthcare providers and their lifestyle. We tested the reliability and validity of a modified 12-item Medication Adherence Scale.

METHODS

We revised a 14-item measure of medication adherence, created in 2009, to a more concise and clear 12-item version, and we verified the reliability and validity of the 12-item scale. We included 328 patients with chronic diseases participating in the Chronic Disease Self-Management Program in Japan from 2011 to 2014. Confirmatory factor analysis was used to assess whether the four factors assessed were the same as the previous 14-item Medication Adherence Scale. Cronbach's coefficient alpha was used to assess internal consistency reliability, and the relationships between patient demographic characteristics and medication adherence were compared with previous studies.

RESULTS

The 12 items were categorized into the four factors "medication compliance", "collaboration with healthcare providers", "willingness to access and use information about medication", and "acceptance to take medication and how taking medication fits patient's lifestyle". Confirmatory factor analysis showed χ2/df = 2.6, CFI = 0.94, and RMSEA = 0.069. Cronbach's alpha for the 12-item scale was 0.78. Cronbach's alpha for the four subscales was 0.74, 0.81, 0.67, and 0.45. Higher medication adherence was significantly associated with being a female patient, living with someone else, and age 40-49 years versus age 20-29 years. These relationships were the same as in previous studies.

CONCLUSIONS

We modified our original 14-item scale to a 12-item Medication Adherence Scale for patients with chronic diseases, which considers their relationship with healthcare providers and lifestyle. Refinement might be needed because of the relatively low reliability of subscales. However, the modified scale is expected to contribute to more effective self-management of medication and to improving medication adherence, particularly among patients with chronic diseases who require long-term medication not only in Japan but also in other countries.

Social Capital and Dietary Intakes Following the 2011 Great East Japan Earthquake and Tsunami

Background

Previous studies have identified poor dietary intake as a health risk affecting survivors of the 2011 Great East Japan Earthquake and Tsunami. We examined the association between different social factors (eg, living conditions and perceptions of community social capital) and dietary intakes among disaster-affected survivors.

Methods

We studied 6,724 survivors in four municipalities of Iwate Prefecture 3 years after the disaster. Social capital was assessed via four items inquiring about respondents’ perceptions of social cohesion in their communities. Good dietary intake was defined according to the following criteria: intake of staple food ≥three times a day; intake of meat, fish and shellfish eggs, or soybean products ≥twice a day; vegetable intake ≥twice a day; and intake of fruit or dairy products ≥once a day. An individual who did not meet any of these criteria was defined as having poor dietary intake. We adjusted for covariates, including socioeconomic status, marital status, and residential area.

Results

Poor dietary intake was reported by 31.6% of respondents. Poisson regression analyses revealed that the following factors were related to poor dietary intake: age <65 years (men: prevalence ratio [PR] 1.48; 95% confidence interval [CI], 1.29–1.71 and women: PR 1.55; 95% CI, 1.36–1.77), difficulties in living conditions (men: PR 1.18; 95% CI, 1.00–1.39 and women: PR 1.19; 95% CI, 1.01–1.40), and low perceptions of community social capital (women: PR 1.20; 95% CI, 1.04–1.38).

Conclusions

Our findings suggest that social capital plays a role in promoting healthy dietary intake among women in disaster-affected areas.

Reliability and validity of the practice environment scale of the nursing work index for Japanese hospital nurses

AIMS

The aim of this study was to examine the reliability and validity of the Practice Environment Scale of the Nursing Work Index (PES-NWI) for hospital nurses in Japan.

DESIGN

A cross-sectional mail survey.

METHODS

Participants in this study were 1,219 full-time ward nurses from 27 hospitals in Japan, using 31 items of the Japanese version of the PES-NWI questionnaire, from December 2008-March 2009. Construct validity, criterion-related validity and internal consistency of the PES-NWI were tested.

RESULTS

The PES-NWI showed reliable internal consistency. The five-factor structure was supported by confirmatory factor analysis. The PES-NWI correlated significantly with job satisfaction, burnout and the nurses' intention to stay on the job, supporting criterion-related validity.

Association between health risks and frailty in relation to the degree of housing damage among elderly survivors of the great East Japan earthquake

Background

Many survivors of the Great East Japan Earthquake that occurred in 2011 were at risk of deteriorating health, especially elderly people living in disaster-stricken areas. The objectives of this prospective study were: a) to clarify the different lifestyle and psychosocial factors associated with frailty by sex among the non-disabled elderly survivors, and b) to describe the differences in characteristics stratified by the degree of disaster-related housing damage.

Methods

We followed 2261 Japanese survivors aged ≥65 years (45.3% male; mean age, 71.7 years) without disability or frailty who completed a self-administered questionnaire at baseline. All participants completed a baseline questionnaire in 2011 and at least one identical follow-up questionnaire between 2012 and 2015 regarding lifestyle (smoking status, alcohol intake, physical activity, sedentary lifestyle, and dietary intake) and psychosocial factors (self-rated health, standard of living, psychological distress, and social networks). Frailty was defined as a score of ≥5 on the Kihon Checklist, which is used by the Japanese government to certify the need for long-term care insurance. Adjusted odds ratios and 95% confidence intervals with frailty as the dichotomous dependent variable and health factors as the independent variables were calculated using a multilevel model for repeated measures by sex, followed by stratification analyses by the degree of housing damage.

Results

Over the 4-year study period, 510 participants (22.6%) developed frailty. In the post-disaster setting, many of the psychosocial factors remained more prevalent 4 years later among survivors with extensive housing damage. The presence of risk factors regarding the development of frailty differed by the degree of housing damage. Among men, psychological distress, in parallel with a poor social network, was related to frailty among only the participants with extensive housing damage and those living in temporary housing, whereas among women, worsening psychological distress was associated only with no damage and no displaced survivors. Among women with extensive damage and displacement, health outcomes such as overweight and diabetes and poor social networks were strongly related to frailty.

Conclusions

Lifestyle and psychosocial factors associated with the risk of frailty differ by sex and the degree of housing damage.

Electronic supplementary material

The online version of this article (10.1186/s12877-018-0828-x) contains supplementary material, which is available to authorized users.

Factors associated with deaths in 'Elderly Housing with Care Services' in Japan: a cross-sectional study

BACKGROUND

Although the Japanese government has expanded its 'Elderly Housing with Care Services' (EHCS) to ensure sufficient places of death for the elderly, resident deaths have occurred in less than 30% of the facilities. Our purpose was to identify the factors associated with residents' deaths in the EHCS, especially within the areas that are expected to have a large increase in the number of deaths.

METHODS

Our cross-sectional study involved all EHCS (N = 412) in Japan's Tokyo, Kanagawa prefecture and used self-administered questionnaire data that the EHCS directors completed. In addition, we accessed the national statistics related to the municipal characteristics of the cities where the EHCS were located. These sources provided information about health care provision for the residents as well as facility/resident/regional characteristics that could potentially be associated with residents' deaths in the EHCS. Based on this information, a sequential multiple logistic regression analysis was performed. First, we included in-facility health care provision (presence of nursing staff) and facility/residents/regional characteristics in Model 1. Next, visiting nurse agency's care provision was included in Model 2. Finally, we included community hospitals or clinical care provision in Model 3.

RESULTS

One hundred and fifty-four facilities answered the questionnaire (response rate: 37.4%). A total of 114 facilities were analysed. In-facility residents' deaths occurred in more than half (54.4%) of the facilities. After adjusting for all variables (Model 3), end-of-life (EOL) care provision from community hospitals or clinics, the number of years since establishment and the number of residents were significantly associated with residents' deaths. In Model 2, visiting nurse's EOL care provision was significantly associated with residents' death.

CONCLUSION

Our results suggest that in order to accommodate residents' deaths, the government or the facility's directors should promote the cooperation between EHCS facilities and community hospitals or clinics for in-residents' EOL care. Furthermore, as the results suggest that community nurses contribute to the occurrences of death by collaborating with the physician, promoting cooperation with visiting nurse agencies may be also needed.

Combined associations of physical activity and dietary intake with health status among survivors of the Great East Japan Earthquake

BACKGROUND AND OBJECTIVES

Each of the effects of physical activity and dietary intake on health is well known, but combined associations of physical activity and dietary intake on health has not been reported yet. Physical activity and dietary intake are key factors for maintaining health of survivors of the Great East Japan Earthquake in 2011. This study aimed to examine combined associations of physical activity and dietary intake with survivors' health status.

METHODS AND STUDY DESIGN

We used data from 6668 participants of a cross-sectional survey taken 3 years (2013) after the disaster. To evaluate combined associations of physical activity and dietary intake, answers to questions regarding these two variables were categorized into four groups: poor physical activity and poor dietary intake (Group 1), poor physical activity and good dietary intake (Group 2), good physical activity and poor dietary intake (Group 3), and good physical activity and good dietary intake (Group 4). Multiple logistic regression analyses were performed by sex, with good self-rated health and good mental health as dependent variables, and age, place of residence, living conditions and physical activity/dietary intake group (with Group 1 as the reference category) as independent variables.

RESULTS

Good self-rated health was associated with age in both sexes, and Groups 3 (male: odds ratios (ORs) 1.84 (95% confidence intervals (95% CIs) 1.32-2.57), female: OR 1.82 (95% CI 1.32-2.51)) and 4 (male: OR 1.96 (95% CI 1.39-2.76), female: OR 1.94 (95% CI 1.42-2.64)). Good mental health was associated with Groups 3 (OR 1.48 (95% CI 1.10-1.97)) and 4 (OR 1.86 (95% CI 1.37-1.97)) for male respondents; and living place (other than temporary housing) (OR 1.45 (95% CI 1.26-1.68)) was associated with Group 4 (OR 1.42 (95% CI 1.09-1.85)) for female respondents.

CONCLUSIONS

Good physical activity alone or combined with good dietary intake was associated with good self-rated health and good mental health. Further interventions regarding physical activity and dietary intake are needed to improve the health status of survivors.

Risk of stroke and heart failure attributable to atrial fibrillation in middle-aged and elderly people: Results from a five-year prospective cohort study of Japanese community dwellers

Background

The relative and absolute risks of stroke and heart failure attributable to atrial fibrillation (AF) have not been sufficiently examined.

Methods

A prospective study of 23,731 community-dwelling Japanese individuals was conducted. Participants were divided into two groups based on the presence or absence of prevalent AF (n = 338 and n = 23,393, respectively). Excess events (EE) due to AF and relative risks (RRs) determined using the non-AF group as the reference for incident stroke and heart failure were estimated using Poisson regression stratified by age groups (middle-aged: 40–69 years old; elderly: 70 years of age or older) after adjustment for sex and age.

Results

There were 611 cases of stroke and 98 cases of heart failure during the observation period (131,088 person-years). AF contributed to a higher risk of stroke both in middle-aged individuals (EE 10.4 per 1000 person-years; RR 4.88; 95% confidence interval [CI], 2.88–8.29) and elderly individuals (EE 18.3 per 1000 person-years; RR 3.05; 95% CI, 2.05–4.54). AF also contributed to a higher risk of heart failure in middle-aged individuals (EE 3.7 per 1000 person-years; RR 8.18; 95% CI, 2.41–27.8) and elderly individuals (EE 15.4 per 1000 person-years; RR 7.82; 95% CI, 4.11–14.9). Results obtained from multivariate-adjusted analysis were similar (stroke: EE 8.9 per 1000 person-years; RR 4.40; 95% CI, 2.57–7.55 in middle-aged and EE 17.4 per 1000 person-years; RR 2.97; 95% CI, 1.99–4.43 in elderly individuals; heart failure: EE 3.1 per 1000 person-years; RR 7.22; 95% CI, 2.06–25.3 in middle-aged and EE 14.1 per 1000 person-years; RR 7.41; 95% CI, 3.86–14.2 in elderly individuals).

Conclusions

AF increased the risk of stroke by the same magnitude as that reported previously in Western countries. AF increased the RR of heart failure more than that in Western populations.

•

Incidence rates for stroke and HF were estimated in Japanese community dwellers.

•

Subjects were divided into AF and non-AF groups separately by age (40–69 and ≥70).

•

AF increased the risk of stroke by the same magnitude as in Western populations.

•

AF increased the risk of HF more than that in Western populations.

•

The absolute risk differences of outcomes were larger in the elderly individuals.

Weight Gain in Survivors Living in Temporary Housing in the Tsunami-Stricken Area during the Recovery Phase following the Great East Japan Earthquake and Tsunami

Introduction

Survivors who lost their homes in the Great East Japan Earthquake and Tsunami were forced to live in difficult conditions in temporary housing several months after the disaster. Body weights of survivors living in temporary housing for a long period might increase due to changes in their life style and psychosocial state during the medium-term and long-term recovery phases. The aim of this study was to determine whether there were differences between body weight changes of people living in temporary housing and those not living in temporary housing in a tsunami-stricken area during the medium-term and long-term recovery phases.

Materials and methods

Health check-ups were performed about 7 months after the disaster (in 2011) and about 18 months after the disaster (in 2012) for people living in a tsunami-stricken area (n = 6,601, mean age = 62.3 y). We compared the changes in body weight in people living in temporary housing (TH group, n = 2,002) and those not living in temporary housing (NTH group, n = 4,599) using a multiple linear regression model.

Results

While there was no significant difference between body weights in the TH and NTH groups in the 2011 survey, there was a significant difference between the mean changes in body weight in both sexes. We found that the changes in body weight were significantly greater in the TH group than in the NTH group in both sexes. The partial regression coefficients of mean change in body weight were +0.52 kg (P-value < 0.001) in males in the TH group and +0.56 kg (P-value < 0.001) in females in the TH group (reference: NTH group).

Conclusion

Analysis after adjustment for life style, psychosocial factors and cardiovascular risk factors found that people living in temporary housing in the tsunami- stricken area had a significant increase in body weight.

Association between relocation and changes in cardiometabolic risk factors: a longitudinal study in tsunami survivors of the 2011 Great East Japan Earthquake

OBJECTIVES

The aim of this study is to determine changes in atherosclerotic cardiovascular risk factors with and without serious disaster-related mental and socioeconomic problems represented by relocation (REL).

DESIGN

A longitudinal survey.

SETTING

Multiphasic health check-ups for the general population affected by the 2011 Great East Japan Earthquake and Tsunami.

PARTICIPANTS

A total 6528 disaster survivors in heavily tsunami-damaged municipalities were recruited. Two sequential surveys were conducted and the data were analysed.

MAIN OUTCOME MEASURES

Multiphasic health check-ups including investigation of lifestyle and psychological and socioeconomic measures were performed in two sequential phases (8 and 18 months) after the disaster for tsunami survivors with REL (n=3160) and without REL (n=3368). Longitudinal changes in cardiometabolic risk factors between the two phases were compared in the REL and non-REL groups.

RESULTS

In sex/age-adjusted analysis, we found increases in body weight and waist circumference between the two phases that were significantly greater in the REL group than in the non-REL group (body weight:+0.31 (0.23∼0.39) versus -0.24 (-0.32∼-0.16) kg, p<0.001; waist circumference:+0.58 (0.48∼0.68) versus+0.05 (-0.05∼0.15) cm, p<0.001)). A decrease in serum HDLC levels was found and again was significantly greater in the REL group than in the non-REL group (-0.65 (-0.96∼-0.34) versus -0.09 (-0.39∼0.21) mg/dL, p=0.009). In addition, deterioration in physical activity, mental health and socioeconomic status was more prevalent in the REL group than in the non-REL group (all p<0.001).

CONCLUSIONS

This study suggests that relocation after the devastating tsunami was related to weight gain and decreasing HDLC among survivors, and this change was associated with prolonged psychological distress and socioeconomic problems after the disaster.

Radiological protection in ion beam radiotherapy: practical guidance for clinical use of new technology

Recently introduced technologies in radiotherapy have significantly improved the clinical outcome for patients. Ion beam radiotherapy, involving proton and carbon ion beams, provides excellent dose distributions in targeted tumours, with reduced doses to the surrounding normal tissues. However, careful treatment planning is required in order to maximise the treatment efficiency and minimise the dose to normal tissues. Radiation exposure from secondary neutrons and photons, particle fragments, and photons from activated materials should also be considered for radiological protection of the patient and medical staff. Appropriate maintenance is needed for the equipment and air in the treatment room, which may be activated by the particle beam and its secondary radiation. This new treatment requires complex procedures and careful adjustment of parameters for each patient. Therefore, education and training for the personnel involved in the procedure are essential for both effective treatment and patient protection. The International Commission on Radiological Protection (ICRP) has provided recommendations for radiological protection in ion beam radiotherapy in Publication 127 Medical staff should be aware of the possible risks resulting from inappropriate use and control of the equipment. They should also consider the necessary procedures for patient protection when new technologies are introduced into clinical practice.

[Nationally representative score of the Japanese language version of the 13-item 7-point sense of coherence scale]

OBJECTIVES

The amount of research relating to evaluation of intervention programs with regard to sense of coherence, a concept of salutogenic stressor coping capacity, is increasing in Japan. However, a nationally representative score of the Japanese version of the sense of coherence scale has not yet been reported. The aim of this study was to describe the 13-item, 7-point Japanese sense of coherence scale (SOC-13), with scoring by sex and age group, and to examine the relationships between the score and locality and city size.

METHODS

Four thousand Japanese men and women were selected by stratified random sampling, and a cross-sectional, self-administered questionnaire survey was conducted using the placement method. Responses were obtained from 2,067 individuals (response rate: 51.7%). This study analyzed 956 men and 1,107 women (mean age [standard deviation]: 50.0 [14.3]).

RESULTS

The mean score on the SOC-13 was 59.0 (12.2) in all participants, 59.1 (11.8) in men, and 58.9 (12.5) in women. No significant difference was found between men and women (P=0.784). ANOVA and multiple comparison for age difference showed a clear relationship (P<0.05) between higher age and a higher SOC-13 score. Moreover, the results of main and interaction effects in ANCOVA, with independent variables for locality (11 segments) and city size (four segments), were not significant when controlled for age.

CONCLUSION

A nationally representative score for the Japanese SOC-13 was acquired. In future research, application of the SOC-13 in Japan for clinical studies is anticipated based on the nationally representative score.

Standardized Prevalence Ratios for Atrial Fibrillation in Adult Dialysis Patients in Japan

Background

While it is assumed that dialysis patients in Japan have a higher prevalence of atrial fibrillation (AF) than the general population, the magnitude of this difference is not known.

Methods

Standardized prevalence ratios (SPRs) for AF in dialysis patients (n = 1510) were calculated compared to data from the general population (n = 26 454) living in the same area.

Results

The prevalences of AF were 3.8% and 1.6% in dialysis patients and the general population, respectively. In male subjects, these respective values were 4.9% and 3.3%, and in female subjects they were 1.6% and 0.6%. The SPRs for AF were 2.53 (95% confidence interval [CI], 1.88–3.19) in all dialysis patients, 1.80 (95% CI, 1.30–2.29) in male dialysis patients, and 2.13 (95% CI, 0.66–3.61) in female dialysis patients.

Conclusions

The prevalence of AF in dialysis patients was twice that in the population-based controls. Since AF strongly contributes to a higher risk of cardiovascular mortality and morbidity in the general population, further longitudinal studies should be conducted regarding the risk of several outcomes attributable to AF among Japanese dialysis patients.

A Japanese version of the Pearlin and Schooler's Sense of Mastery Scale

The aims of this research were to develop a Japanese version of Pearlin and Schooler’s Sense of Mastery Scale (SOMS) and evaluate its reliability and validity. This survey targeted 4,000 men and women aged 25–74 living in Japan as of January 1, 2014, categorized them according to the region and size of the city in which they lived, randomly extracted 200 municipalities, and randomly extracted individuals after categorizing for sex and age based on the resident registries of each municipality. 2,067 survey responses were collected (response rate 51.7%). We used weighted 7-item (SOMS-7) and 5-item (SOMS-5) versions that excludes two reverse items (item6 and 7) from SOMS-7 of the SOMS. From the item analysis, the item-total correlation coefficients of the two reverse items (items 6 and 7) were .03 and .34. The Cronbach’s alpha coefficient was also .69 in SOM-7 and .77 in SOMS-5. The partial correlation coefficients between SOMS and the sense of coherence, mental health inventory, self-rated health, and life satisfaction were all significant (p < 0.001). The SOMS showed high construct validity. SOMS-5 has sufficient reliability.

Comprehensive health literacy in Japan is lower than in Europe: a validated Japanese-language assessment of health literacy

BACKGROUND

Health literacy, or the ability to access, understand, appraise and apply health information, is central to individuals' health and well-being. A comprehensive, concept-based measure of most dimensions of health literacy has been developed for the general population in Europe, which enables comparisons within and between countries. This study seeks to validate this tool for use in Japan, and to use a Japanese translation to compare health literacy levels in Japan and Europe.

METHODS

A total of 1054 Japanese adults recruited through an Internet research service company, completed a Japanese-language version of the 47-item European Health Literacy Survey Questionnaire (HLS-EU-Q47). The survey was administered via an online questionnaire, and participant demographics were closely matched to those of the most recent Japanese national census. Survey results were compared with those previously reported in an eight-country European study of health literacy.

RESULTS

Internal consistency for the translated questionnaire was valid across multiple metrics. Construct validity was checked using confirmatory factor analyses. The questionnaire correlated well with existing scales measuring health literacy and mental health status. In general, health literacy in the Japanese population was lower than in Europe, with Japanese respondents rating all test items as more difficult than European respondents. The largest difference (51.5 %) was in the number of respondents finding it difficult to know where to get professional help when they are ill.

CONCLUSIONS

This study translated a comprehensive health literacy questionnaire into Japanese and confirmed its reliability and validity. Comparative results suggest that Japanese health literacy is lower than that of Europeans. This discrepancy may be partly caused by inefficiency in the Japanese primary health care system. It is also difficult to access reliable and understandable health information in Japan, as there is no comprehensive national online platform. Japanese respondents found it more difficult to judge and apply health information, which suggests that there are difficulties in health decision-making in Japan. Numerous issues may be linked to lower levels health literacy in Japan, and further studies are needed to improve this by developing individual competencies and building supportive environments.

ICRP Publication 127: Radiological Protection in Ion Beam Radiotherapy

The goal of external-beam radiotherapy is to provide precise dose localisation in the treatment volume of the target with minimal damage to the surrounding normal tissue. Ion beams, such as protons and carbon ions, provide excellent dose distributions due primarily to their finite range, allowing a significant reduction of undesired exposure of normal tissue. Careful treatment planning is required for the given type and localisation of the tumour to be treated in order to maximise treatment efficiency and minimise the dose to normal tissue. Radiation exposure in out-of-field volumes arises from secondary neutrons and photons, particle fragments, and photons from activated materials. These unavoidable doses should be considered from the standpoint of radiological protection of the patient. Radiological protection of medical staff at ion beam radiotherapy facilities requires special attention. Appropriate management and control are required for the therapeutic equipment and the air in the treatment room that can be activated by the particle beam and its secondaries. Radiological protection and safety management should always conform with regulatory requirements. The current regulations for occupational exposures in photon radiotherapy are applicable to ion beam radiotherapy with protons or carbon ions. However, ion beam radiotherapy requires a more complex treatment system than conventional radiotherapy, and appropriate training of staff and suitable quality assurance programmes are recommended to avoid possible accidental exposure of patients, to minimise unnecessary doses to normal tissue, and to minimise radiation exposure of staff.