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Background: Although the smoking rate among Japanese men has been the highest in developed countries, the epidemiological evidence about whether smoking cessation can extend their lifespan is not well established. Methods: A total of 1083 Japanese men aged $40 years were classified by their smoking status and followed up prospectively for 18 years (1988-2006). Results: Current smoking was a significant risk factor for all-cause death: the multivariate-adjusted HRs of all-cause death for current smokers of 1-19, 20-39 and $40 cigarettes per day were 1.61 (95% CI 1.16 to 2.22), 1.56 (95% CI 1.08 to 2.23) and 3.15 (95% CI 1.59 to 6.24), respectively. Former smokers did not have an increased risk of all-cause death compared with never smokers. The excess risk of all-cause death for current smokers tended to decrease within 5 years after smoking cessation, eventually reaching a level almost equivalent to that of never smokers. The risk of cancer death decreased by 53% in subjects who had quit smoking for $10 years, while the risk of cardiovascular death decreased by 56% in subjects with the cessation period of <10 years. Conclusions: Our findings suggest that even a modest smoking habit significantly increases the risk of death among Japanese men, and the risk of death diminishes soon after cessation of smoking. These results imply the importance of smoking cessation to extend life in Japanese men. [ABSTRACT FROM AUTHOR]

Abstract: The aim of the present study is to examine job role quality relating to intention to leave current facility and to leave profession among direct care workers in residential facilities for elderly in Japan. Direct care workers completed a paper questionnaire on October 2009. From 746 facilities in three prefectures (Tokyo, Shizuoka, and Yamagata) 6428 direct care workers with complete data were included in the analyses. The Job Role Quality (JRQ) scale was translated into Japanese language to assess job role quality. Hierarchical multiple regression analysis showed that intention to leave current facility was primarily associated with job role quality: poor skill discretion, high job demand, and poor relationship with supervisor. Intention to leave profession was primarily associated with poor skill discretion. The results of the present study imply the strategies to direct care worker retention for each facility and policy efforts. Each facility can implement specific strategies such as enhanced variety of work and opportunity for use of skills, adequate job allocation, and improvement of supervisor–employee relationship in work place. Policy efforts should enhance broader career opportunities in care working such as advanced specialization and authorized medical practice. [Copyright &y& Elsevier]

Background The slow progress of tobacco control policy in Japan reflects the tension among the interests of the Finance Ministry (which remains the majority shareholder of Japan Tobacco, Inc), the Health Ministry, tobacco growers and consumers. Methods We sought to examine regional disparities in compliance with national tobacco control legislation (the 2003 Health Promotion Law). Specifically, we sought to examine whether prefecture-level compliance with legislation was correlated with decreases in smoking prevalence, and decreases in lung cancer mortality rates. We also examined whether prefectural involvement in growing tobacco was associated with lower compliance with the law. Results From 2001 to 2007, higher prefectural compliance with tobacco control laws was associated with decreased prevalence of smoking. Decreased tobacco consumption was in turn associated with declining lung cancer mortality. Prefectures involved in growing tobacco exhibited lower levels of compliance with national tobacco control laws. The same prefectures also exhibited the worst improvement in smoking prevalence. Conclusions This study in Japan suggests that tobacco control policies are being unevenly implemented across prefectures, and that measures to counteract the influence of local tobacco culture are required to reduce the disparities in regional tobacco control outcomes in that country. [ABSTRACT FROM AUTHOR]

Purpose: To investigate speech-language pathologists' current perceptions, previous training experiences, resources, barriers, and training needs in terms of evidence-based practices (EBPs) in two Asian countries. Method: Their knowledge and attitudes about EBP were explored using an online questionnaire. A descriptive analysis was conducted with consideration of the effect of demographic variables on knowledge and attitudes about EBP. Result: Malaysian speech-language pathologists (n = 98) displayed more positive attitudes toward EBPs, with a significantly higher (t (143) = 5.91, p <.01) total mean score (Mean = 120.7, SD = 11) compared to the Japanese speech-language pathologists (n = 47, Mean = 107.8, SD = 13.5). Malaysian practitioners who were female, worked full-time, and worked in government settings reported higher motivation to develop EBP skills. Japanese practitioners who worked in private sectors reported higher EBPs training needs than those in government settings. In both countries, speech-language pathologists with higher education levels tended to express fewer perceived barriers towards EBP. Conclusion: Findings could help local governance and speech-language pathologist associations to understand the current practices and professional development needs of speech-language pathologists, leading to more effective training programs and educating employers and managers who can reinforce EBP among practitioners. [ABSTRACT FROM AUTHOR]

Aim: We investigated adverse events (AEs) in a Japanese intensive care unit (ICU) and evaluated the impact of cause‐specific AEs on mortality and length of stay. Design: A retrospective observational study in the ICU of an academic hospital. Methods: We reviewed medical records with the Global Trigger Tool. Results: Of the 246 patients, 126 (51%) experienced one or more AEs with an incidence of 201 per 1000 patient‐days and 115 per 100 admissions. A total of 294 AEs were detected with 119 (42%) adverse drug events, 67 (24%) procedural complications, 63 (22%) surgical complications, 26 (9%) nosocomial infections, 5 (2%) therapeutic errors and 4 (1%) diagnostic errors. Adverse event (AE) presence was associated with length of ICU stay (β = 2.85, 95% confidence interval [CI]: 1.09–4.61). Adverse drug events, procedural complications and nosocomial infections were strongly associated with length of ICU stay (β = 2.38, 95% CI: 0.77–3.98; β = 3.75, 95% CI: 2.03–5.48; β = 6.52, 95% CI: 4.07–8.97 respectively). [ABSTRACT FROM AUTHOR]

Aims: To investigate the number of bed transfers (patient transfers within the same ward) and their reasons in acute care wards of mid‐sized hospitals with multibed and private rooms. Background: Bed transfers, even when necessary, are burdensome for patients; however, the reasons for bed transfers in various types of rooms remain unclear. Methods: An observational study was conducted in seven wards in three hospitals in Japan. Nurses completed a questionnaire regarding each bed transfer, which elicited the reasons for the transfer. We classified transfer patterns based on the functions of the patients' rooms and the number of beds in each room and analysed scores. Results: Overall, 560 responses were analysed. The average number of bed transfers per day was 2.7. In total, 43% of bed transfers were conducted for patients aged over 70. The most frequent bed transfer pattern was 'transfer between patient rooms with the same number of beds', and the most frequent reason was 'patient did not need that bed'. Conclusions: Unnecessary bed transfers could be reduced by ward designs that reflect nurses' clinical judgement. Implications for nursing management: Monitoring data for the reason regarding bed transfer contributes to hospital planning and decreases unnecessary bed transfers. [ABSTRACT FROM AUTHOR]

This study examined differences in sociodemographic characteristics and the achievement of a good death between cancer patients who live alone and those who do not live alone prior to death in different settings. Secondary analysis of data collected across two cross‐sectional self‐reported questionnaire surveys was undertaken. The participants were bereaved family members of cancer patients who had died in palliative care units (PCUs), acute hospitals or homes. We stratified the data by the place of death and examined the differences in sociodemographic characteristics to determine the relationship between cancer patients achieving a "good death" and whether they were living alone. The data were collected through 15,949 surveys. On the Good Death Inventory, significantly higher total scores emerged for cancer patients who were living alone than for those who not living alone in PCUs (effect size [ES] = 0.11, Student's t‐test: p <.0001), but not in acute hospitals (ES = −0.03, p = 0.74) or home care services (ES = 0.02, p = 0.86). Cancer patients who were living alone were more likely to have been female, been older and have earned a lower annual income than those who were not living alone. Thus, among those who had received specialized palliative care, there was no difference in the quality of palliative care between cancer patients who were or were not living alone. [ABSTRACT FROM AUTHOR]

Older adults' preference regarding where they want to spend their end‐of‐life (EOL) has been reported to be a significant predictor of the actual EOL location. Home‐care nurses have often been reported to try involving single older adults' neighbours in the support network of the older adults (community involvement activities) to allow them to stay at home. Hence, nurses' community involvement activities may be among the significant factors of older adults' preference to stay at home during EOL. Therefore, this study explored home‐care nurses' community involvement activities and its association with single older adults' EOL preference. A cross‐sectional questionnaire survey was conducted with older adults (aged 65 years or older) who lived alone and used home‐care nursing services for more than 6 months, their home‐care nurses, and managers of their home‐care nursing agencies. Questions included participants' characteristics, nurses' community involvement activities and older adults' preference to remain at home during EOL. We conducted multiple logistic regression analyses to explore the relationship between nurses' community involvement activities and older adults' preference to remain at home during EOL while controlling for their demographic variables. In total, 103 pairs of home‐care nurses and single older adults from 27 home‐care nursing agencies participated. Approximately 70% of older adults preferred to remain at home during EOL, and 50% of nurses implemented community involvement activities. Older adults' preference to remain at home during EOL was associated with implementation of community involvement activities (Odds Ratio [OR]: 3.4; 95% Confidence Interval [95%CI]:1.1–9.8), home‐care nurses' higher practical clinical ability (OR: 1.4, 95%CI:1.0–1.8), and older adult's longer use of home‐care nursing service (OR: 2.2, 95%CI:1.2–4.1). Community involvement activities may be essential in helping single older adults to stay at home as per their preference for EOL. [ABSTRACT FROM AUTHOR]

The purpose of this cross‐sectional study was to examine factors associated with nurses' resilience during the COVID‐19 pandemic. Data were collected in the latter half of 2020 from 904 nurses across Japan, Republic of Korea, Republic of Turkey, and the United States. The questionnaire included the Connor‐Davidson Resilience Scale 10, plus demographics and 20 questions about practice environment, workplace safety concerning infection control, COVID‐related experience, and organizational support. Fear of becoming infected, intention to leave nursing, and having had a positive COVID‐19 test were inversely associated with resilience (p < 0.05). Regression analysis indicated that U.S. nurses had significantly greater resilience than nurses in the other countries examined (p < 0.001). Nurses reporting organization support and those who participated in policy and procedure development had higher resilience scores (p < 0.01). Organizational support, involving nurses in policy development, and country of practice were found to be important resilience factors in our research, which aligns with other findings. Further research is recommended to determine the optimal practice environment to support nurse resilience. [ABSTRACT FROM AUTHOR]

Objectives: Ultrasonic scalers often cause an uncomfortable feeling to patients during the procedure. This study was conducted to compare patient complaint levels between magnetostrictive (M‐USSC) and piezoelectric ultrasonic scalers (P‐USSC) during supragingival scaling. Methods: This study enrolled 82 subjects who received supportive periodontal therapy for at least 2 years. At each recall visit, probing pocket depth (PPD), bleeding on probing (BOP) and O'Leary plaque control record (O'PCR) were recorded. Then, supragingival scaling was performed using P‐USSC (Varios or Petit Piezo) at the first visit and M‐USSC (Cavitron) at the second visit. After each treatment, a questionnaire survey was performed using the Wong‐Baker Faces Pain Scale for six items, which included the typical complaints occurring during ultrasonic scaling. Results: The scores for all the six items related to patient complaints were greater for P‐USSC than for M‐USSC (p < 0.001). Patient complaints such as discomfort, pain, sound, vibration, hyperesthesia and length of treatment time were ameliorated in 74%, 65%, 80%, 67%, 57% and 53% of subjects using M‐USSC, respectively. On the other hand, only <5% of subjects showed deterioration in terms of each complaint. Conclusion: This study suggested that M‐USSC causes fewer patient complaints during supragingival scaling than P‐USSC. M‐USSC may improve patient motivation and compliance and may contribute towards achieving successful treatment outcomes. However, this result could differ depending on the shape of the tip and the insert and treatment site. Further research will be required under various conditions. [ABSTRACT FROM AUTHOR]

Few studies of depression have examined older inpatients with fracture and preexisting cognitive impairment. The current study sought to confirm whether depression affects the condition of older inpatients with fracture who also have cognitive impairment, and to investigate the extent to which depression affects activities of daily living. This was a retrospective cross-sectional study. The subjects were older inpatients with fracture and preexisting cognitive impairment. We examined data within 1 week of hospitalization, obtained from medical records. The data included demographic information, the motor Functional Independence Measure, Charlson Comorbidity Index, Mini-Mental State Examination, Geriatric Depression Scale 15, Geriatric Nutritional Risk Index, Skeletal Muscle Index and maximum grip strength test. These variables were compared between the two groups (with and without depression), and multiple regression analysis was performed with the motor Functional Independence Measure as the dependent variable. The subjects were 68 patients. Only the motor Functional Independence Measure was significantly lower in the depression group than the non-depression group. Multiple regression analysis confirmed that depression strongly affected activities of daily living. In considering the recovery of older inpatients with fracture and preexisting cognitive impairment, it is important to take the effects of depression into account. The number of older fracture inpatients with cognitive impairment is predicted to increase, and such patients have a high prevalence of depression. Depression strongly affected Activities of Daily Living in older inpatients with fracture and pre-existing cognitive impairment. Focusing on depression assessment and intervention is important for rehabilitation of older fracture inpatients with cognitive impairment. [ABSTRACT FROM AUTHOR]

Background: Disability weights (DWs) are weight factors that reflect the severity of health states for estimates of disability-adjusted life years. A new set of global DWs was published for the Global Burden of Diseases and Injuries (GBD) 2013 study, which relied on sampling from various world regions, but included little data for countries in East Asia. This study aimed to measure DWs in Japan using comparable methods, and compare the results with previous estimates from the GBD 2013 DW study. Methods: We conducted a web-based survey in 2019 to estimate DWs for 231 health states for the Japanese population. The survey included five new health states but otherwise followed the method of the GBD DW measurement study. The survey consisted of 15 paired comparison (PC) questions and 3 population health equivalence questions (PHE) per respondent. We analyzed PC data using probit regression and rescaled results to DW units between 0 (equivalent to full health) and 1 (equivalent to death). Findings: We considered 37,318 nationally representative respondents. The values of the resulting DWs ranged from 0.707 (95% uncertainty interval (UI) 0.527–0.842) for spinal cord injury at neck level (untreated) to 0.004 (UI 0.001–0.009) for mild anemia. High correlation between Japanese DW and GBD 2013 DW was observed, but there was considerable disagreement. Out of 226 comparable health states, 55 (24.3%) showed more than a factor-of-two difference, of which 41 (74.6%) had a higher value in Japanese DW. Many of the health states with higher DW in the Japan study were injuries, including amputation and fracture, and hearing and vision loss, while mental, behavioral, and substance use disorders generally tended to be lower. Conclusions: This study has created an empirical basis for assessment of Japanese DWs of health status. The findings from this study based on the Japanese population suggest that there might be contextual differences in rating the severity of health states compared to previous surveys conducted elsewhere. [ABSTRACT FROM AUTHOR]

Aim: To determine the employment factors associated with daily time management in working people with type 2 diabetics. Methods: A questionnaire survey was administered to 277 working people with type 2 diabetes. It included a daily time management scale, and questions about age, gender, hemoglobin A1c levels, shift work, managerial position, and average working hours. Multiple regression analysis was used to assess the relationship between daily time management and each factor, adjusted for age, gender, and hemoglobin A1c. Results: Responses were obtained from 220 individuals. Daily time management was associated with managerial position (being a manager) and working hours. Shift work was associated with "adjustment of life rhythms" and managerial position was associated with "adjustment of work" and "goal setting and behaviors consistent with personal values". Hours of work were associated with "adjustment of life rhythms" and "time control". Conclusion: When providing support on time management to working people with type 2 diabetes mellitus, any assessment should consider the availability of shift work, whether they are in a managerial position and working hours. [ABSTRACT FROM AUTHOR]

This study evaluated the impact of a public medical interpreter on the follow-up clinic attendance rate of foreign-born people with HIV who live in Japan. Participants were patients who visited Nagoya Medical Center from 2009 to 2016. Lost to follow-up was defined as an absence from follow-up visits for more than six months without any notification. A log-rank test was conducted to compare the lost-to-follow-up rates by patients' nation of origin and medical interpreter use. Of the 931 participants, 114 were foreign patients, whose overall attendance rate at 5 years was 75.5%, which was significantly lower than that of Japanese patients (94.1%, p < 0.001). There was no significant difference in regular attendance with respect to medical interpreter use (p = 0.09). Social support in addition to a medical interpreter may be needed to improve attendance rates in the study population. [ABSTRACT FROM AUTHOR]

This study examined the degree to which goals perceived by occupational therapists (OTs) matched those perceived by their clients. A total of 100 clients and 79 OTs were recruited from seven subacute rehabilitation wards in Japan. Matched pairs of OTs and their clients were independently asked for their perception about the clients' occupational therapy goals through semi-structured interviews. Collectively, the OTs reported 239 goals, while the clients reported 161 goals. While both the OTs and the clients reported a high level of client engagement in the goal setting process, 79% of the goal statements were mismatched between pairs of OTs and their clients. Goal matching was slightly better for goals about activities of daily living or participation than for goals about body structure or body function. Although most OTs and their clients perceived that they engaged in goal-setting together, only 21% of reported goals actually matched between OTs and clients. It would also be worth investigating whether there is any correlation between the content of goals, patient engagement in goal setting, degree of goal matching, and health outcomes achieved by clients following discharge from rehabilitation services. Although most occupational therapists (OTs) and their clients perceived that they engaged in goal-setting together, 79% of the goals independently reported by OTs and their clients did not match in seven post-acute rehabilitation wards across Japan. Goals were slightly more likely to match if the topic of the goals related to instrumental activities of daily living or participation (30.3%) or basic activities of daily living (24.7%) than if the topic of the goals were about body structure or body function (11.2%); however, the overall rate of goal matching was low. Japanese OTs need to develop more effective methods for recording or communicating goals in ways that clients can understand; this may be the same for other countries. [ABSTRACT FROM AUTHOR]

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Aim: The present study aimed to analyze the use of machine learning in ultrasound (US)‐based fecal retention assessment. Methods: The accuracy of deep learning techniques and conventional US methods for the evaluation of fecal properties was compared. The presence or absence of rectal feces was analyzed in 42 patients. Eleven patients without rectal fecal retention on US images were excluded from the analysis; thus, fecal properties were analyzed in 31 patients. Deep learning was used to classify the transverse US images into three types: absence of feces, hyperechoic area, and strong hyperechoic area in the rectum. Results: Of the 42 patients, 31 tested positive for the presence of rectal feces, zero were false positive, zero were false negative, and 11 were negative, indicating a sensitivity of 100% and a specificity of 100% for the detection of rectal feces in the rectum. Of the 31 positive patients, 14 had hard stools and 17 had other types. Hard stool was detected by US findings in 100% of the patients (14/14), whereas deep learning‐based classification detected hard stool in 85.7% of the patients (12/14). Other stool types were detected by US findings in 88.2% of the patients (15/17), while deep learning‐based classification also detected other stool types in 88.2% of the patients (15/17). Conclusions: The results showed that US findings and deep learning‐based classification can detect rectal fecal retention in older adult patients and distinguish between the types of fecal retention. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

This research investigated patterns of the use of dietary supplement and doping awareness among high-ranked judoists from 2 countries. Korean (70 men and 31 women) and Japanese (37 men and 34 women) national judo team members were divided into 2 groups (high and low competitive performance levels) according to their international and national rankings. Fifty-nine percent of Korean and 61% of Japanese judoists consumed dietary supplements. Eighty-eight percent of high- and 51% of low-competitive-performance-level Korean judoists consumed dietary supplements. Sixty-eight percent of high- and 57% of low-competitiveperformance- level Japanese judoists consumed dietary supplements. Oriental supplements (34%), vitamins (23%), and protein powder (12%) were the most commonly consumed dietary supplements in Korean judoists. Vitamins (45%), protein powder (33%), and minerals (15%) were the most commonly consumed dietary supplements in Japanese judoists. Thirty-eight percent of judoists from both countries had not received any proper education about antidoping, and 44% of judoists from both countries had not received knowledge of antidoping legislation. There was a significant difference in education about antidoping between high and low competitive-performance levels of Korean judoists (p < .001). Korean judoists received significantly less antidoping education than Japanese judoists (p < .001). The associations for antidoping education and knowledge of antidoping legislation with the use of dietary supplements were 3.46 (95% CI = 1.31-9.12) and 1.63 (95% CI = 0.71-3.76), respectively. Our findings showed that use of dietary supplements in judoists from both countries was increased after experiencing antidoping education. [ABSTRACT FROM AUTHOR]

Background: The dietary variety score (DVS), a simple dietary survey method for older adults, investigates the weekly frequency of consumption of the 10 food groups in Japan. The DVS is also associated with nutritional status. The original scoring method applied only to community‐dwelling older adults, not to older patients receiving home care, who have little dietary variety. Aim: Using three different scoring methods for the DVS, we examined which method was most likely to reflect the nutritional status of older patients receiving home care. Methods: This cross‐sectional study was carried out on older patients receiving home care. Participant characteristics, the DVS (evaluated using three different scoring methods), and the Mini Nutritional Assessment‐Short Form (MNA®‐SF) survey were researched. A receiver operating characteristic (ROC) analysis was performed to find the cut‐off value for the DVS. Multivariate analysis was performed, with malnutrition as the outcome, to investigate the extent to which the DVS is associated with malnutrition. Results: We studied 317 participants. The DVS could produce significant ROC curves using modified scoring methods A and B (p =.028 and.042) with nutritional status as the outcome. Cut‐off value, sensitivity and specificity were 30 points, 60.9% and 55.9% in modified scoring method A and 5 points, 79.1%, and 35.6% in modified scoring method B. Results of the multivariate logistic regression analysis, in Model 1 dysphagia (odds ratio [95% confidence interval]: 3.85 [1.70–8.71]) and the DVS of modified scoring method A (2.00 [1.11–3.62]) were significant independent factors. In Model 2, dysphagia (3.57 [1.58–8.07]) and the DVS based on modified scoring method B (2.36 [1.24–4.47]) were significant independent factors. Conclusions: Modified scoring method B was found to be most suitable for the dietary assessment of older patients receiving home care. Implications for practice: Even in the absence of registered dietitians, any care staff member who is involved in providing nursing services during home‐visits is capable of administering a dietary survey, when using the easy DVS scoring method. [ABSTRACT FROM AUTHOR]

Background: Foot care knowledge and practices among nurses and care workers in the community greatly impact foot health maintenance and prevention of foot-related problems among older people. This study aimed to explore and examine the current foot care knowledge, practices, and perceptions among nurses and care workers at home care and adult day service center, along with their demographic characteristics and daily care for clients. Methods: This study analyzed 232 randomly selected front-line nurses and care workers working at home care or adult day service center in one of the selected cities, Aichi Prefecture, Japan. Data were obtained using questionnaires and subsequently analyzed using descriptive statistics, t-tests, Chi-square tests, Wilcoxon rank-sum tests, and Spearman's rank correlation tests. Results: Among the 305 surveyed, 232 (62 nurses; 170 care workers) provided data. Although 57 nurses (91.9%) and 142 care workers (83.5%) showed interest in foot care, 33 nurses (53.2%) and 133 care workers (78.2%) stated that foot care education was insufficient. Knowledge and practice scores were associated with working status. Higher accuracy differences in the early detection of foot problems and skin tears on lower limbs in knowledge category were observed between nurses and care workers. The nurses as well as the care workers had low accuracy rates of knowledge questions regarding the use of shoes and socks subscale. For practice, both nurses and care workers had low mean scores for checking client's shoes (2.0/5.0 and 2.1/5.0, respectively), method for reducing ingrown nail pain (2.6/5.0 and 1.9/5.0, respectively), and opportunity for discussing foot care with others (2.7/5.0 and 2.2/5.0, respectively). A significant correlation between knowledge and practice scores was observed among nurses (0.331, p < 0.05) and care workers (0.339, p < 0.001). Conclusions: Despite the presence of several barriers toward enhanced care delivery to clients needing it most, nurses and care workers clearly understood the importance of foot care. These findings indicate that foot care should be focused by nurses and care workers to improve the knowledge and practice of foot care and to suggest future implications that efficient and understandable tools are needed considering their current working situation. [ABSTRACT FROM AUTHOR]

Aim: Nurses are expected to have a role in the transition of care from pediatric to adult medical practices for adolescents and young adults with childhood‐onset chronic diseases. This study compares the experience, knowledge, and perceptions regarding the ideal care among adult unit and pediatric nurses regarding the transition to adult care for those with childhood‐onset chronic diseases. Methods: A cross‐sectional study using self‐report questionnaires was conducted with nurses in a tertiary hospital in Tokyo. Questions were generated based on a literature review and expert discussion. Data from 1,064 participants were analyzed (adult unit nurses: n = 959, 90.1%; pediatric nurses: n = 105, 9.9%). Results: Among 623 adult unit nurses who had care experience for adult patients with a childhood‐onset chronic disease, 458 nurses (73.6%) were unaware of the concept of transitional care. As the obstructive factors for transition, pediatric nurses recognized problems in healthcare providers' attitudes and lack of transitional care coordinators, while the adult unit nurses emphasized the patients' wishes to continue to receive pediatric healthcare. Most adult unit nurses expected pediatric nurses to function as transitional care coordinators. Conclusion: Adult unit and pediatric nurses had different perceptions of the barriers in transitioning children with chronic diseases to adult care. It is important to have educational programs focusing on transitional care for all nurses, both to enable pediatric nurses to improve transition readiness of children with chronic diseases and to offer adult patients with a childhood‐onset chronic disease continuing support through adult unit nurses. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to develop an objective method to assess the degree of bristle splaying of used manual toothbrushes and to investigate their plaque removal efficacy. Methods: A randomized controlled trial targeting Hiroshima University students was performed to assess the plaque removal efficacy of polybutylene terephthalate (PBT) manual toothbrushes. Participants were randomly assigned to the soft toothbrush group (n = 40) or the medium toothbrush group (n = 40). A small number of participants discontinued the intervention for personal reasons in both the medium (n = 6) and soft (n = 2) toothbrush groups. Toothbrushes were collected immediately after first use (T0: baseline), after 1 month of use (T1: month 1), after 2 months of use (T2: month 3) and after 3 months of use (T3: month 6), following the allocation of a new toothbrush. The bristle surface area was measured using digital software. Results: The surface area of the bristles was significantly greater at T1, T2 and T3 than at T0 in the medium toothbrush group (n = 34) and soft toothbrush group (n = 38) (P <.001). Importantly, plaque removal efficacy, calculated from a modified plaque control record score and modified patient hygiene performance score, was significantly lower at T2 than at T0 in both groups. Conclusions: Our method for evaluation of bristle splaying is considered to be reliable and reproducible. PBT toothbrushes may become less effective after two months of use. [ABSTRACT FROM AUTHOR]

Aim: Critical thinking is vital in implementing evidence‐based practice. However, little is known about factors related to critical thinking among nurses in Japan. This study aims to comprehensively explore the organizational and personal factors related to critical thinking disposition among hospital nurses in Japan. Methods: We conducted a cross‐sectional, self‐administered questionnaire survey. Critical thinking was measured using the 33‐item Japanese Critical Thinking Disposition Scale. We asked nurse managers about organizational characteristics of hospitals/units and about their critical thinking disposition. We questioned staff nurses regarding personal characteristics, cultural construal of self, self‐esteem, perception of their work environment and workload, experiences of nursing research, and critical thinking disposition. We conducted multiple regression analysis to identify factors associated with staff nurses' critical thinking. Results: We analyzed data from 68 nurse managers and 986 staff nurses. The staff nurses' mean age was 37.6 years and 91% of the participants were female. Factors related to higher critical thinking were working in an emergency unit (β =.07, p =.040); having a bachelor's degree or higher qualification (β =.07, p =.030); having higher independent view of self (β =.22, p <.001), self‐esteem (β =.24, p <.001), and perceived workload (β =.10, p =.002); and training experience of nursing research in post‐licensure education (β =.15, p <.001). Conclusions: The factors influencing critical thinking disposition are mainly related to personal characteristics or experiences. Providing research training for nurses may contribute to fostering critical thinking. [ABSTRACT FROM AUTHOR]

Background: Attachment theory shows that childhood experiences influence the parenting style that the child shows later, as a parent. Nevertheless, at present there are no instruments to efficiently quantify the emotions associated with parents' early attachment. Objective: This study aims to develop a cognitive scale that measures both the positive and negative emotions reflecting the early attachment experience of Japanese mothers now nurturing their own preschool‐age children. Design: A Parental Attachment Recognition Scale is developed in three phases that include concept analysis, item pool development and validity analysis, and investigation of the scale's statistical features, factor structure, validity, and reliability. Measurements and Sample: The scale development is based on a self‐administered questionnaire survey, answered by 639 mothers. Results: The scale consists of 27 items, grouped by factor analysis into three subordinate scales, named: (1) Parent–child contact; (2) Emotional bond; and (3) Parental impressions. Conclusions: The study proposes a new scale to measure the recognition of early childhood attachment experiences among mothers raising their own preschool children. The instrument has a considerable degree of validity and reliability. The scale is expected to be useful in helping public health nurses assess mothers in need of childrearing support. [ABSTRACT FROM AUTHOR]

Aims and objectives: To clarify the characteristics and practice of discharge planning nurses in acute care hospitals and to elucidate the relationship between subjective difficulty perceived in practice and reflection. Background: The importance of discharge planning for an effective transition from the hospital to a care facility is increasing. In acute care hospitals, however, it is not clear what discharge planning nurses are doing for patients who are highly dependent on medical treatment, the subjective difficulties they perceive in practical activities, and whether reflection by nurses can be expected to mitigate those difficulties. Design: Cross‐sectional survey. Methods: This survey was conducted in 2,379 acute care hospitals in Japan from 1 June–30 June 2018. The survey of discharge planning practice activities examined nine factors. A nurse who answered that he/she did reflect on his/her practices was defined as a self‐reflecting nurse. The STROBE statement checklists were completed. Results: Questionnaires were collected from 760 respondents (response rate = 32.1%). The discharge planning nurses had fewer than 36 months of experience with discharge planning. Among the nurses who had been involved in hospital discharge support for 13 months or more, the self‐reflecting nurses had fewer perceived difficulties in their practice activities than the non‐self‐reflecting nurses did. Conclusions: It was shown that discharge planning nurses with 13 months or more of experience and who practiced reflection on their practical activities perceived less subjective difficulty. Reflection in daily practice may mitigate the subjective difficulty of practical activities experienced by discharge planning nurses, and the establishment of an effective training method that promotes such reflection is required. Relevance to clinical practice: In the future, it will be necessary to construct and evaluate an effective education programme for discharge planning nurses that includes self‐reflection on practice cases. [ABSTRACT FROM AUTHOR]

Objectives: In this study, we examined Japanese older adults’ health habits (healthy diet, exercise, and nonsmoking) using 4 models: sensitive period, pathway, social mobility, and cumulative effects. Methods: A representative cross-sectional survey of people 65 years and older, living in Tokyo, produced 739 effective respondents. Health habits in social networks over the life course, at junior high school, age 20, and age 40, were measured through retrospective recall questions. Ordinary regression and logistic regression were used separately to analyze healthy diet and exercise/nonsmoking. Results: Regarding pathway effects, standardized coefficients of indirect health habits in social networks on late-life health habits were healthy diet = .073 (p < .05) and exercise = .125 (p < .001). Regarding social mobility effects, standardized coefficients of change to poorer health habits in social networks over the life course on late-life health habits, compared to maintaining healthy habits were healthy diet = -.121 (p < .01) and exercise e= -.235 (p < .05). Regarding cumulative effects, standardized coefficients of no exposure to better health habits in social networks over the life course were healthy diet = -0.103 (p < .01) and exercise = -.395 (p < .01). Conclusions: Three models – pathway, social mobility, and cumulative effects – may explain how healthy diet and exercise in social networks over the life course influence these health habits in later life. [ABSTRACT FROM AUTHOR]

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This study investigated the validity of the top-down approach of inverse dynamics analysis in fast and large rotational movements of the trunk about three orthogonal axes of the pelvis for nine male collegiate students. The maximum angles of the upper trunk relative to the pelvis were approximately 47°, 49°, 32°, and 55° for lateral bending, flexion, extension, and axial rotation, respectively, with maximum angular velocities of 209°/s, 201°/s, 145°/s, and 288°/s, respectively. The pelvic moments about the axes during the movements were determined using the top-down and bottom-up approaches of inverse dynamics and compared between the two approaches. Three body segment inertial parameter sets were estimated using anthropometric data sets (Ae et al., Biomechanism 11, 1992; De Leva, J Biomech, 1996; Dumas et al., J Biomech, 2007). The root-mean-square errors of the moments and the absolute errors of the peaks of the moments were generally smaller than 10 N·m. The results suggest that the pelvic moment in motions involving fast and large trunk movements can be determined with a certain level of validity using the top-down approach in which the trunk is modeled as two or three rigid-link segments. [ABSTRACT FROM AUTHOR]

This study examined the potential relationship between participation in physical activity (PA) assessed by triaxial accelerometry and physical fitness testing, including health-related and skill-related parameters of fitness, in 136 Japanese preschoolers (65 girls and 71 boys, 5.5 ± 0.6 years). In partial correlation analyses, grip strength and 20m shuttle run test were positively correlated with time spent in physical activity ratio (PAR) ≥ 4. Better scores on standing long jump distance and jump over and crawl under tests were associated with lower sedentary time and greater moderate-to-vigorous PA time and PAR ≥ 4 time, and increased physical activity level. Moreover, 25m run speed was positively correlated with time spent in PAR ≥ 4 and locomotive activity. These findings suggest that development of both health-related (muscle strength and aerobic fitness) and skill-related fitness (power, agility and speed) may make engagement in PA easier for preschool children, although further research on the cause-effect relationship is needed. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To explore the differences in clinical practice activities and work‐related burden between nurses with past work experience other than nursing (second career nurses: SCNs) and nurses without any past work experience (nonsecond career nurses: NSCNs). Background: The number of SCNs is increasing. Some studies note that SCNs must perform additional clinical practice activities and experience more work‐related burden than NSCNs. However, there are no quantitative studies exploring SCNs' clinical practice and work‐related burden. Design: A cross‐sectional survey. Methods: Research was conducted according to the STROBE statement. Participants were 2,013 nurses working at 56 hospitals in Japan. A 30‐item questionnaire was developed to capture clinical practice activities using clinical ladders, asking about the types of clinical practice activities participants had practiced. Every practiced activity received a score of 1. The total count of each clinical practice activity was then summed. The quantitative workload (QW) scale score was used to investigate levels of QW. Higher QW scores indicated higher levels of work‐related burden. These variables were then compared between SCNs and NSCNs, and the factors that were associated with high QW among SCNs were examined. Results: Altogether, 961 participants (328 SCNs and 633 NSCNs) were included in the analyses. No significant differences were shown in clinical practice activities between the groups; however, SCNs' QW was significantly higher than was NSCNs' after controlling for demographic variables. SCNs' high QW was associated with the following variables: unmarried marital status, not having role model nurses and previous employment as a care worker. Conclusions: Quantitative workload was significantly higher among SCNs than among NSCNs. Tailored support for SCNs' high QW based on their specific needs should be considered. Relevance to clinical practice: These results can help nurse managers reduce SCNs' work‐related burden and illustrate future research directions for this minority group. [ABSTRACT FROM AUTHOR]

This study examined the assessment criteria based on which care managers (CMs) decide to commence home-visit nursing to develop a common assessment scale to guide CMs in making sound decisions about whether to commence home-visit nursing. For this purpose, we conducted a postal survey of 200 CMs. After removing 17 items from the questionnaire based on item analysis, we analyzed the remaining factors to confirm construct validity. This factor analysis identified 96 items comprising the following four factors: (1) the daily life condition of users and the support required by them, (2) strengthening medical support, (3) scheduling medical treatment/management or recuperation, and (4) preparing for users' mental and physical changes and preventing the deterioration of the situation. The results of the study indicate the first step in the process of developing a common assessment scale; in this study, we clarified the general factors that underpin a decision to commence home-visit nursing and the relationships among the items for each factor. [ABSTRACT FROM AUTHOR]

Background: Moral distress occurs when one knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action. Moral distress was found to cause negative feelings, burnout, and/or resignation. Not only external factors such as lack of staff but also internal ones affect moral distress. Moral sensitivity, which is thought of as an advantage of nurses, could effect moral distress, as nurses being unaware of existing ethical problems must feel little distress. Objectives: To examine the impact of moral sensitivity on moral distress among psychiatric nurses, and affirm the hypothesis that nurses with higher moral sensitivity will suffer moral distress more than nurses with less moral sensitivity in two different samples. Ethical consideration: The study obtained ethical approval from the Research Ethics Committee of the Faculty of Medicine at Mie University (# 1111, 20.4.2010), and by the Turku University Ethics Board (29.5.2012). Permissions to undertake the study was obtained from the in two hospital districts and in one city (§ 48/4.10.2012, § 63/4.9.2012, 51/2012 27.8.2012). Informed consent was not formally obtained, because the questionnaire was anonymously reported by the participants who volunteered to answer. The participants responded voluntarily and anonymously. Methods: An anonymous questionnaire containing the Revised Moral Sensitivity Questionnaire and the Moral Distress Scale for Psychiatric nurses was conducted to 997 nurses in 12 hospitals in Japan, and 974 nurses in 10 hospitals in Finland after obtaining of approval by research ethics committees. Data were analyzed using a multi-group structural equation model analysis. Findings: A set of analyses imply that the association of moral sensitivity with moral distress is significant and similar between Japan and Finland, whereas the factor structures of moral sensitivity and moral distress may be partially different. Discussion: The result of this study may indicate that nurses with high moral sensitivity can sense and identify moral problems, but not resolve them. Therefore, supporting nurses to solve ethical problems, not benumbing them, can be important for better nursing care and prevention of nurses' resignation. Conclusion: Moral sensitivity and moral distress were positively correlated among psychiatric nurses in both Japan and Finland, although the participating nurses from the two countries were different in qualification, age, and cultural background. Nurses with high moral sensitivity suffer from moral distress. [ABSTRACT FROM AUTHOR]

Aim: To dentify the predictors of the quality of life (QOL) of infertile men who are undergoing infertility treatments in Japan and to create a QOL prediction model, with the main variables aimed at providing more adequate support to male patients. Methods: This cross‐sectional study used the quantitative data that were collected from 321 returned self‐report questionnaires that had been distributed to the men of 411 couples who were undergoing fertility treatment. The following four scales were used to measure the main outcomes: FertiQoL, psychological distress, spousal support, and workplace support. The data were analyzed by descriptive statistics, multiple regression analyses, and structural equation modeling. Results: The number of returned questionnaires was 321 (78.1%). The QOL that was measured by FertiQoL was significantly lower in those men who were diagnosed with male factor infertility than in the other male patients. The two significant predictors of QOL were: spousal support and the infertility period. The structural equation modeling revealed that the same factors were related to QOL. Conclusions: Male factor infertility, less spousal support, and a longer period of infertility were associated with a poorer QOL of those men who were undergoing infertility treatment. These results suggest that focusing on infertility causes, the length of the infertility period, and the couples' partnership during treatment is needed to provide full support to men who have been diagnosed with infertility. [ABSTRACT FROM AUTHOR]

Aim: To examine the main effects of time pressure and relational coordination with nursing managers on burnout and to further analyze the moderating role of relational coordination with nursing managers on the association between time pressure and burnout among home‐visiting nurses in Japan. Methods: This was a cross‐sectional, quantitative study comprising 93 home‐visiting nurses in Japan. A hierarchical moderated regression analysis with mean‐centered predictor variables was used to explore the main effects of time pressure and relational coordination with nursing managers on burnout and the moderating effect of relational coordination with nursing managers on the time pressure and burnout relationship. Results: Time pressure was a significant positive predictor for emotional exhaustion and depersonalization, respectively. Relational coordination with the nursing managers was significantly and negatively related to depersonalization; however, its main effect on exhaustion was non‐significant. Significant interaction effects of time pressure and relational coordination with the nursing managers on exhaustion and depersonalization also were identified. Time pressure was a significant positive contributor to exhaustion and depersonalization when the home‐visiting nurses reported low relational coordination with the nursing managers. Conclusion: Relational coordination with nursing managers is a critical resource for dealing with high time pressure. Strategies, such as establishing a skill‐mix program to alleviate nurses' time pressure and creating a supportive work environment to facilitate relational coordination with nursing managers, might be effective ways to prevent burnout, as well as management interventions among home‐visiting nurses. [ABSTRACT FROM AUTHOR]

Background: As context may impact everyday technology (ET) use it is relevant to study this within different contexts. Aims: To examine the usefulness of the Everyday Technology Use Questionnaire (ETUQ) in different contexts by investigating and comparing (1) the level of challenge of ETs in the ETUQ and (2) the relevance of and perceived ability to use ET in samples of Swedish and Japanese older adults. Materials and methods: The Swedish and the Japanese samples (n = 86/86) were interviewed using the ETUQ about relevance of and perceived ability to use ET. Data were analyzed using Rasch analysis, chi square and a general linear model. Moreover, Differential Item Functioning (DIF) was investigated. Results: The hierarchy of ETs' level of challenge was generally stable in the two contexts. On group-level, the relevance was somewhat higher and the perceived ability to use ET significantly higher in the Swedish sample than in the Japanese. Conclusions and significance: The similarities and differences between the technological landscapes of Sweden and Japan could be detected by ETUQ, demonstrating its usefulness in both countries. The potential causes to the differences in relevance of and perceived ability to use ET between older adults in Sweden and Japan need further exploration. [ABSTRACT FROM AUTHOR]

Abstract: Objective: This study aimed to evaluate the educational improvement outcomes after introducing undergraduate public health nursing electives from the perspective of students, teachers, and public health nurses. Design and Sample: Post‐test design with control group was used. We surveyed three groups of participants on the relevance of achieved skill items. These groups were as follows: fourth‐year students, teaching staff from seven universities, and public health nurses from special districts of Tokyo who had pioneered the introduction of public health nursing electives. Measures: The three participant groups were surveyed in 2013 and 2014 to compare the students’ levels of achievement in the 98 skill items presented by the Japanese Ministry of Health, Labour, and Welfare. Practical training introduced educational reform in 2014. Anonymous self‐administrated questionnaires were used. Results: The mean achievement rates of the 98 items in 2013 and 2014 were 67.9% and 72.6%, respectively, for students; 40.9% and 59.7% for teachers; and 44.4% and 59.4% for PHNs. A significant difference was observed between ratios of 2013 and 2014 in all three groups. Conclusions: The results demonstrated that the introduction of educational reform increased the achievement rates of students through the electives. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Although a growing number of interventional studies on health literacy have been conducted recently, the majority were designed in clinical settings, focusing mainly on functional health literacy. This study evaluated a programme designed to improve health literacy in a community population, with a scope of going beyond functional health literacy. Methods: In collaboration with an Approved Specified Nonprofit organization (NPO), we evaluated a five‐session programme designed to provide basic knowledge on health‐care policy and systems, current issues in health care in Japan, patient roles and relationships with health‐care providers and interpersonal skills. In total, 67 of 81 programme participants agreed to participate in the study, and 54 returned the completed questionnaires at baseline and at follow‐up. Health literacy and trust in the medical profession were measured at baseline and at follow‐up. Participants’ learning through the programme was qualitatively analysed by thematic analysis. Results: Quantitative examinations of the changes in health literacy and degree of trust in medical professionals between the baseline and follow‐up suggested that health literacy significantly improved after implementing the programme. The thematic analysis of participants’ learning throughout the programme suggested that they not only acquired knowledge and skills but also experienced a shift in their beliefs and behaviours. Discussion: Providing individuals who are motivated to learn about health‐care systems and collaborate with health‐care providers with the necessary knowledge and skills may improve their health literacy, which could enable them to maintain and promote their health and that of their family and other people around them. [ABSTRACT FROM AUTHOR]

We investigated the difference in relationship between muscle strength and quality of life (QOL)/fatigue in long‐term cancer survivors and healthy subjects. Thirty‐six cancer survivors and 29 healthy subjects were assessed for body composition and bone status at the calcaneus using the Osteo Sono Assessment Index. Muscle strength was evaluated via handgrip and knee extensor strength. Health‐related QOL was assessed using the Medical Outcome Study 36‐item Short‐Form Health Survey. Fatigue was measured using the brief fatigue inventory. Cancer survivors exhibited lower QOL scores in the physical functioning, physical role function, bodily pain and general health domains (p < .05). Grip and knee extension muscle strength in cancer survivors was positively correlated with the physical function and bodily pain of QOL (p < .05). The usual fatigue subscale score was only significantly higher in cancer survivors than in healthy subjects (p < .05). However, there were no correlations between muscle strength and fatigue in cancer survivors. Our results showed that muscle strength was an important factor for improving QOL in cancer survivors. We believe that the findings of this study will be relevant in the context of planning rehabilitation for cancer survivors. [ABSTRACT FROM AUTHOR]

Japanese communication relies heavily on nonverbal cues and context. The purpose of this study was to examine the impact of video-mediated communication (VMC) on communication satisfaction and marital relationships in young couples separated during the perinatal period as they honor the Japanese tradition of Satogaeri Bunben. Couples were assigned to the VMC treatment group (n = 14) or control group (n = 13). A mixed-methods approach to data collection and analysis was used. Longitudinal quantitative analysis from the Primary Communication Inventory and Intimate Bond Measure revealed significant differences between the Husband groups. Primary Communication Inventory and Intimate Bond Measure were strongly correlated regardless of group. Qualitative analysis of participant diaries revealed the addition of visual cues helped create a sense of “virtual co-presence,” which was both positive and negative. In conclusion, VMC appears to improve communication in the separated Japanese perinatal couples, especially through the addition of visual cues provided with VMC. [ABSTRACT FROM AUTHOR]

Abstract: Due to an increasingly ageing population, the Japanese government has promoted elderly deaths in aged care facilities. However, existing facilities were not designed to provide resident end‐of‐life care and the proportion of aged care facility deaths is currently less than 10%. Consequently, the present review evaluated the factors that promote aged care facility resident deaths in Japan from individual‐ and facility‐level perspectives to exploring factors associated with increased resident deaths. To achieve this, MEDLINE, CINAHL, Web of Science and Ichushi databases were searched on 23 January 2016. Influential factors were reviewed for two healthcare services (insourcing and outsourcing facilities) as well as external healthcare agencies operating outside facilities. Of the original 2324 studies retrieved, 42 were included in analysis. Of these studies, five focused on insourcing, two on outsourcing, seven on external agencies and observed facility/agency‐level factors. The other 28 studies identified individual‐level factors related to death in aged care facilities. The present review found that at both facility and individual levels, in‐facility resident deaths were associated with healthcare service provision, confirmation of resident/family end‐of‐life care preference and staff education. Additionally, while outsourcing facilities did not require employment of physicians/nursing staff to accommodate resident death, these facilities required visits by physicians and nursing staff from external healthcare agencies as well as residents' healthcare input. This review also found few studies examining outsourcing facilities. The number of healthcare outsourcing facilities is rapidly increasing as a result of the Japanese government's new tax incentives. Consequently, there may be an increase in elderly deaths in outsourcing healthcare facilities. Accordingly, it is necessary to identify the factors associated with residents' deaths at outsourcing facilities. [ABSTRACT FROM AUTHOR]

SUMMARY: Objectives: This study from Japan extracted performance measures for dialysis unit management and investigated their characteristics from professional views. Methods: Two surveys were conducted using self‐administered questionnaires, in which dialysis managers/staff were asked to rate the usefulness of 44 performance indicators. A total of 255 managers and 2,097 staff responded. Results: Eight performance measures were elicited from dialysis manager and staff responses: these were safety, operational efficiency, quality of working life, financial effectiveness, employee development, mortality, patient/employee satisfaction and patient‐centred health care. These performance measures were almost compatible with those extracted in overall healthcare settings in a previous study. Internal reliability, content and construct validity of the performance measures for the dialysis setting were ensured to some extent. As a general trend, both dialysis managers and staff perceived performance measures as highly useful, especially for safety, mortality, operational efficiency and patient/employee satisfaction, but showed relatively low concerns for patient‐centred health care and employee development. However, dialysis managers’ usefulness perceptions were significantly higher than staff. Conclusions: Important guidelines for designing a holistic hospital/clinic management system were yielded. Performance measures must be balanced for outcomes and performance shaping factors (PSF); a common set of performance measures could be applied to all the healthcare settings, although performance indicators of each measure should be composed based on the application field and setting; in addition, sound causal relationships between PSF and outcome measures/indicators should be explored for further improvement. [ABSTRACT FROM AUTHOR]

Aims and objectives: To clarify the effects of different methods of reflection on nurses’ gaze and judgement in a task using a touch panel, written and oral methods of reflection were compared. Background: Recently, with the development of ICT, nursing education and learning with ICT have spread. However, there are few studies that have analysed the objective effects of learning with ICT and the effects of different methods of learning. Design: This study was a randomised controlled trial comparing writing and oral reflection groups. Methods: Forty-one nurses were divided into two groups as follows: 21 nurses in the writing group and 20 nurses in the oral group. Eye movements were recorded as subjects performed a task on a touch panel. A still photograph of the hospital room was displayed on the touch panel, and the subjects touched the panel according to the instructions provided. Statistical analyses were performed using the Mann–Whitney test to compare the results between the two groups. Results: In an observation task using a touch panel of a setting requiring environmental improvement, we found no observable differences between the two reflection methods with regard to gaze and judgement in the overall setting. How ever, with respect to the items in the setting, the writing group judged with gazing after reflection, whereas the oral group judged without gazing. Conclusions: Oral reflection as well as reflective writing had positive effects on observation for tasks requiring overall gaze and judgement. On the other hand, reflective writing promoted the visual verification of items requiring observation in the hospital setting. Relevance to clinical practice: Reflective writing promotes visual verification in nurses in a clinical setting while performing a task using a touch panel. [ABSTRACT FROM AUTHOR]

Aim To evaluate the long-term effectiveness of modified brief assertiveness training (with cognitive techniques) for nurses. Background Most assertiveness training takes a long time to conduct; thus, briefer training is required for universal on-the-job training in the workplace. Methods In this single-group study, nurses received two 90-min training sessions with a 1-month interval between sessions. The degree of assertiveness was assessed by using the Rathus Assertiveness Schedule as the primary outcome, at four time points: pre- and post-training, 3-month follow-up and 6-month follow-up. Results A total of 33 nurses received the training, and the mean Rathus Assertiveness Schedule score improved from −14.2 ( SD = 16.5) pre-training to −10.5 ( SD = 18.0) post-training ( p < .05). These improvements were maintained until the 6-month follow-up. The pre-post effect size of 0.22 (indicating small effect) was larger than the effect sizes ranging from −0.56 to 0.17 (no effect) reported in previous studies that used brief training. Conclusions Modified brief assertiveness training seems feasible and may achieve long-term favourable outcomes in improving assertiveness among nurses. Implications for Nursing Management The ease of implementation of assertiveness training is important because creating an open environment for communication leads to improved job satisfaction, improved nursing care and increased patient safety. [ABSTRACT FROM AUTHOR]

This study aimed to implement an experience-based program to promote the understanding of the concept of recovery, which is defined as a meaningful life and valued sense of integrity based on subjective and individual viewpoints, among psychiatric nurses working in hospitals in Japan and to evaluate this program. Methods: We conducted a preliminary survey of nurses at six facilities with psychiatric wards. The experience-based program was conducted for 12 nurses who expressed a wish to participate. The program spanned three days and consisted of lectures, assertive community treatment (ACT) staff visits for recovery orientation, and group work. Results: The mean Recovery Knowledge Inventory of nine participants ultimately included was 3.41 points (SD, 0.28) before the program and 3.69 points (SD, 0.24) after the program, indicating a significant difference (p = .004). Categories obtained from ACT support experiences included the following: “Continuing to attend to the need to live in one’s community/home regardless of how bad psychiatric symptoms become without the use of medicines,” “Viewing the person living their life in a place where they belong and in their own individual style,” “Valuing the patient’s wishes is the slow but sure way to a fruitful relationship,” and “Become familiar to the patient and their family’s lifestyle by carefully listening to the family’s feelings”. Discussion: We believe that this program can help establish the concept of recovery in hospital, which tend to rely on the medical model, and enable daily nursing practice to be implemented from a strength-based viewpoint. [ABSTRACT FROM PUBLISHER]

With the growing focus on continuous professional development, demands placed on nurses to uphold nursing competence have been increasing. This study examined how nurses with different lengths of clinical experience perceived the relationship between their actual competence and the competence they felt was demanded of them, and how this relationship was related to their turnover intentions. Survey questionnaires were distributed to 1,377 nurses, of whom 765 returned usable completed forms. The results showed that across all the groups of clinical experience, nurses perceived the demanded competence levels to be higher than their actual competence levels. However, turnover intentions were not related to nurses’ perceptions of demanded competence and were negatively related to perceptions of actual competence. The levels of competence demanded should not be considered as threats for nurses. Improving nurses’ competence may reduce their turnover intentions. [ABSTRACT FROM AUTHOR]

Background and Objective During orthodontic tooth movement (OTM), periodontal ligament (PDL) is remodeled dynamically, which requires sufficient blood supply for the regeneration of PDL. However, little is known about the remodeling of blood vessels during OTM. In this study, we hypothesized that the orthodontic tensile strain upregulates matrix metalloproteinase-12 (MMP-12) expression in the tension zone and induces angiogenesis via degradation of type IV collagen (Col-IV) in vascular endothelial basement membrane during the early stage of OTM. Material and Methods Temporal and spatial MMP-12 expression in the tension zone of PDL, during the early stage of OTM, were examined by immunohistochemistry in rats. Continuous tensile strain was applied to cultured human immortalized PDL cell lines (HPL cells) and MMP-12 expression was examined in vitro. Colocalization of MMP-12 and Col-IV in vivo were examined by immunohistochemistry. To investigate whether MMP-12 produced by HPL cells could degrade Col-IV, recombinant Col-IV was incubated in the culture supernatants of HPL cells. Intact Col-IV in vitro was also examined by western blot analysis. Finally, the changes in blood vessels in the PDL were examined by micro-computed tomography analysis with perfused contrast agents and by conventional histological analysis. Results Orthodontic tensile strain induced MMP-12 expression in PDL cells in vivo and in vitro. Immunohistochemistry revealed that MMP-12-positive cells were observed adjacent to the Col-IV-positive tubular area in the tension zone of PDL. MMP-12 in culture supernatant of HPL cells degraded recombinant Col-IV, and specific MMP-12 inhibitor blocked the Col-IV degradation. Micro-computed tomography analysis and conventional histological analysis demonstrated that the areas of blood vessels were increased in the tension zone of the PDL after OTM. Conclusion We discovered that the orthodontic tensile strain upregulates MMP-12 expression in the tension zone of PDL and induces angiogenesis via degradation of Col-IV in the vascular endothelial basement membrane. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to evaluate the psychometric properties of the Beliefs Toward Mental Illness Scale (BMI) across women from the United States, Japan, and South Korea. Methods: A cross-sectional study design was employed. The sample was 564 women aged 21–64 years old who were recruited in the United States and Korea (American = 127, Japanese immigrants in the United States = 204, and Korean = 233). We carried out item analysis, construct validity by confirmatory factor analysis (CFA), and internal consistency using SPSS Version 22 and AMOS Version 22. Results: An acceptable model fit for a 20-item BMI (Beliefs Toward Mental Illness Scale–Revised [BMI-R]) with 3 factors was confirmed using CFA. Construct validity of the BMI-R showed to be all acceptable; convergent validity (average variance extracted [AVE] ≥0.5, construct reliability [CR] ≥0.7) and discriminant validity (r =.65–.89, AVE >.79). The Cronbach's alpha of the BMI-R was.92. Conclusion: These results showed that the BMI was a reliable tool to study beliefs about mental illness across cultures. Our findings also suggested that continued efforts to reduce stigma in culturally specific contexts within and between countries are necessary to promote help-seeking for those suffering from psychological distress. [ABSTRACT FROM AUTHOR]

Backgrounds With Japan's globalization, maternal-child health care for foreign mothers is highly necessary. We examined postpartum depressive symptoms in foreign mothers in Japan and the factors associated with such symptoms, particularly social support. Method A cross-sectional study was conducted for Japanese and foreign mothers at 3 to 4 months postpartum. The Edinburgh Postnatal Depression Scale was used to evaluate postpartum depression symptom, and social support was evaluated by support type and provider. Multiple regression analyses was used. Results Data from 97 Japanese mothers and 68 foreign mothers were analyzed. The average score of Edinburgh Postnatal Depression Scale for foreign mothers was 7.5, significantly higher than that for Japanese mothers (4.2). Financial circumstances, spouse-partners' emotional support, and families' informational support were significantly related to foreign mothers' postpartum depressive symptoms. Conclusion Postpartum depression symptoms were more common among foreign mothers than among Japanese mothers. Medical personnel should encourage such mothers to obtain more social support from their spouse-partners and family. [ABSTRACT FROM AUTHOR]

Studies of aspirational ideals of medical care generally focus on patients rather than on ordinary people receiving or not receiving medications at the time of interview. The literature has not accurately conveyed the distinct ideals in individual communities or undertaken inter-regional comparisons. This current qualitative study focused on ideal medical care as perceived by residents of distinct Japanese communities in their everyday lives. Between December 2011 and November 2012, one-on-one and group-based semi-structured interviews were conducted with 105 individuals, each of whom had continuously lived for 20 years or more in one of the four types of communities classified as either 'metropolitan area', 'provincial city', 'mountain/fishing village' or 'remote island' in Japan. Interviews were transcribed from digital audio recordings and then analysed (in tandem with non-verbal data including participants' appearances, attitudes and interview atmospheres) using constructivist grounded theory, in which we could get the voice and mind of the participant concerning ideal medical care. The common themes observed among the four community types included 'peace of mind because of the availability of medical care' and 'trust in medical professionals'. Themes that were characteristic of urban communities were the tendency to focus on the content of medical care, including 'high-level medical care', 'elimination of unnecessary medical care' and 'faster, cheaper medical care', whereas those that were characteristic of rural communities were the tendency to focus on lifestyle-oriented medical care such as 'support for local lifestyles', 'locally appropriate standards of medical care' and 'being free from dependence on medical care'. The sense of ideal medical care in urban communities tended to centre around the satisfaction with the content of medical care, whereas that in rural communities tended to centre around the ability to lead a secure life. By considering medical care from the geographical point of view, we found out the significant relationship between communities and perceptions of medical care ideals. [ABSTRACT FROM AUTHOR]