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Personal recovery is a process of developing new meaning and purpose in life beyond the catastrophic effects of mental illness. Benefit finding (BF) is conceptualized as finding positive changes or benefits through experiences in adversity. Sense of coherence (SOC) focuses on how people can stay healthy and maintain well-being, even in adversity. This study aimed to examine the relationships among the initial levels and longitudinal changes in personal recovery, BF, and SOC among people with chronic mental illness in Japan. In this longitudinal study, a two-wave self-report questionnaire survey was conducted for service users aged 20 or older with mental illness using convenience sampling method in 2014 and 2015. We applied the Latent Change Score approach. Model fit was evaluated according to the CFI and RMSEA. Among 373 eligible participants at baseline, valid responses in both T1 and T2 from 195 respondents were included in the study (valid response rate = 52.3%). Among them, 65.6% were male, with average age of 45.6. The model of the three constructs at the two time points had good to reasonable fit to the data. The initial levels and changes in personal recovery, BF, and SOC were significantly and positively related to each other. [ABSTRACT FROM AUTHOR]

To investigate how having a child without a disability is related to maternal mental health and its predictors, we compared mothers of a single child with intellectual disabilities (single-child group, n = 117) and mothers of children with and without intellectual disabilities (multiple-children group, n = 457), in Japan. Compared to the multiple-children group, the single-child group had lower hope and social capital and poorer mental health; furthermore, 42.5% of them had decided not to have another child, despite desiring one. Hope was the strongest predictor of mental health in both groups but was more positively related to mental health in the multiple-children group. The fear of the possibility of the next child having a disability and receiving inadequate support were the obstacles for mothers who had decided not to have another child. Thus, greater support and more opportunities for obtaining adequate information about the implications of having another child may be needed. [ABSTRACT FROM AUTHOR]

Action potentials are fundamental to relaying information from region to region in the nervous system. Changes in action potential firing patterns in neural circuits influence how the brain processes information. In our previous study, we focused on interneuron/perineuronal astrocyte pairs in the hippocampal CA1 region and reported that direct depolarization of perineuronal astrocytes modulated the firing pattern of interneurons. In the current study, we investigated the morphological and electrophysiological properties of perineuronal oligodendrocytes, and examined their modulatory effects on interneuronal firing in the CA1 region. Perineuronal oligodendrocytes only had a few processes, which were crooked, intricately twisted, and twined around the soma and proximal region of the main processes of adjacent interneurons. Whole-cell current patterns of perineuronal oligodendrocytes were homogenous and the current-voltage relationship showed remarkable outward rectification. Although the K channel blockers, tetraethylammonium and 4-aminopyridine, clearly blocked outward currents, Ba did not significantly alter whole-cell currents. Unlike perineuronal astrocytes, the depolarization of perineuronal oligodendrocytes had no effect on interneuronal firing; however, when the interneurons were firing at a higher frequency, the hyperpolarization of perineuronal oligodendrocytes suppressed their action potentials. The suppressive effects of perineuronal oligodendrocytes were inhibited in the presence of a low concentration of tetraethylammonium, which selectively blocked deep and fast afterhyperpolarization. These results suggest that perineuronal oligodendrocytes suppress interneuronal firing through their influence on K channels, which are responsible for deep and fast afterhyperpolarization. [ABSTRACT FROM AUTHOR]

A high rate of heavy tobacco smoking among people with schizophrenia has been suggested to reflect self-medication and amelioration of cognitive dysfunction, a core feature of schizophrenia. NMDAR hypofunction is hypothesized to be a mechanism of cognitive dysfunction, and excessive schizophrenia-linked neuregulin 1 (NRG1) signaling through its receptor ErbB4 can suppress NMDAR function by preventing Src-mediated enhancement of NMDAR responses. Here we investigated whether chronic nicotine exposure in rats by subcutaneous injection of nicotine (0.5–1 mg/kg, twice daily for 10–15 days) counteracts the suppressive effect of NRG1β on NMDAR-mediated responses recorded from CA1 pyramidal cells in acute hippocampal slices. We found that NRG1β, which prevents the enhancement of NMDAR responses by the Src-family-kinase-activating peptide pYEEI in naive rats, failed to block the effect of pYEEI in nicotine-exposed rats. In naive rats, NRG1β acts only on GluN2B-NMDARs by blocking their Src-mediated upregulation. Chronic nicotine exposure causes enhanced GluN2B-NMDAR responses via Src upregulation and recruits Fyn for the enhancement of GluN2A-NMDAR responses. NRG1β has no effect on both enhanced basal GluN2B-NMDAR responses and Fyn-mediated enhancement of GluN2A-NMDAR responses. Src-mediated enhancement of GluN2B-NMDAR responses and Fyn-mediated enhancement of GluN2A-NMDAR responses initiate long-term potentiation (LTP) of AMPAR synaptic responses in naive and nicotine-exposed CA1 pyramidal cells, respectively. These results suggest that NRG1β suppresses LTP by blocking Src-mediated enhancement of GluN2B-NMDAR responses, but has no effect on LTP in nicotine-exposed rats. These effects of chronic nicotine exposure may counteract the negative effect of increased NRG1-ErbB4 signaling on the cellular mechanisms of learning and memory in individuals with schizophrenia, and therefore may motivate heavy smoking. [ABSTRACT FROM AUTHOR]

We investigated predictors of mental health and positive change among mothers of children with intellectual disabilities in Japan based on the concept of the Double ABCX model. We used variables of having a child with autism spectrum disorder (ASD) and dissatisfaction with systems as stressors, availability of social support and social capital (SC) as existing resources, sense of coherence (SOC) as appraisal of the stressor, and mental health and positive change as adaptation. A self-administered questionnaire was distributed to 10 intellectual disability-oriented special needs schools in Tokyo, and obtained 613 responses from mothers of children under age 20 attending these schools. The results showed that our Double ABCX model explained 46.0% of the variance in mothers' mental health and 38.9% of the variance in positive change. The most powerful predictor of this model was SOC, and SC may be directly and indirectly related to maternal mental health and positive change through mothers' SOC. Increasing opportunity for interaction between neighbors and family of children with disabilities may be one effective way to enhance SOC through SC. Since maternal SOC, SC, mental health, and positive change were significantly correlated with each other, synergy among these elements could be expected. [ABSTRACT FROM AUTHOR]

Background Although sense of coherence ( SOC) moderates parental stress, the relationship between SOC, parental mental health and physical punishment of children with intellectual disabilities remains uncertain. The present authors describe parental physical punishment towards children with intellectual disabilities and investigate its related demographic characteristics, SOC and parental mental health. Materials and Methods With the cooperation of Tokyo's 10 special needs schools, the present authors obtained 648 questionnaire responses from parents of children with intellectual disabilities. Results Of the parents, 69.7% reported having physically punished their children with intellectual disabilities. This was positively associated with parents' younger age, poorer mental health, lower SOC, children's younger age, birth order (firstborns) and disability type (autism/pervasive developmental disorder). Conclusions This is the first study supporting the relationship between SOC, mental health and physical punishment use among parents of children with intellectual disabilities. It may assist the development of strategies to prevent physical abuse of children with disabilities. [ABSTRACT FROM AUTHOR]

The long-term potentiation (LTP) in the field excitatory postsynaptic potential (EPSP) induced at hippocampal CA1 pyramidal neuron synapses by delivery of high frequency stimulation (HFS), a tetanus of 100 pulses at 100 Hz, is decreased (depotentiation) by a train of low frequency stimulation (LFS) of 1000 pulses at 2 Hz applied 30 min later. Inositol 1, 4, 5-trisphosphate receptors (IP 3 Rs) activated both during the HFS and after the LFS are involved in this depotentiation, the former triggering, and the latter modifying, LTP induction (decreasing the amplitude of the LTP established by the priming HFS). Furthermore, the decrease in the LTP at CA1 synapses requires activation of IP 3 Rs during LFS and activation of calcineurin after LFS. These results suggest that, at hippocampal CA1 neuron synapses, HFS-induced IP 3 R activation, which is modulated by the subsequent LFS, results in postsynaptic protein dephosphorylation after the LFS, leading to a decrease in the field EPSP and in the HFS-induced LTP. [ABSTRACT FROM AUTHOR]

Fibromyalgia (FM) is a controversial disorder with an unknown organic basis, so the legitimacy of the disease is controversial. People with FM struggle to explain their 'invisible' illness and to reconstruct their biographies. This study focuses on the significance of self-help groups (SHGs) in the process of reconstructing biographies of persons with FM. We interviewed 13 individuals with FM who participated in 2 different types of SHGs. Informants suffer from disparities between their severe bodily symptoms and appraisals from others, resulting in self-doubt and existential crisis. These disruptions were partially repaired by receiving a diagnosis, but this provided limited power to explain their 'unreasonable' disruption. Our findings indicate the importance of hearing the life stories of peers which can repair informants' disrupted biographies through the fu-ni-ochiru experience, a form of comprehension of one's illness by which the informant obtains a clear perspective through physical sensation, or full acceptance rather than logical understanding. Thus, our study expands knowledge regarding how people with FM reconstruct their biographies. [ABSTRACT FROM AUTHOR]

In developed countries, human immunodeficiency virus (HIV) has become a chronic disease. The aims of this study were to clarify the physical, social, and psychological factors affecting Japanese HIV patients in a stable condition and to identify factors related to mental health of employed and unemployed HIV patients. The target subjects were people with HIV infection who were treated as outpatients at core hospitals for acquired immune deficiency syndrome (AIDS) treatment in Japan. A questionnaire including items from the Hospital Anxiety and Depression Scale (HADS) was sent to each medical facility with a request for participation from the HIV-infected outpatients. Responses from 1199 patients were analyzed. Mental health was reportedly better in the employed patients than in the unemployed patients. The unemployed patients were more likely to have resigned from their jobs because of poor health, to have resigned voluntarily, or to have been unfairly dismissed. Once the patients stopped working because of HIV, returning to work became difficult. In the employed patients, a good workplace environment was strongly related to lower scores on HADS. Higher HADS scores were recorded for employed patients infected with HIV for six years or more. For the unemployed patients, a relationship was observed between strong feelings of stigmatization and HADS scores. Quitting a job because of an experience related to HIV status may be related to feelings of stigmatization. [ABSTRACT FROM AUTHOR]

Background: There is growing recognition that healthcare policy should be guided by the illness experience from a layperson's or insider's perspective. One such area for exploration would include patient-centered research on traumatic Spinal Cord Injury (SCI), a condition associated with permanent physical disability requiring long-term and often complex health care. The chronicity of SCI can, in turn, affect individuals' sense of self. Although previous research in Western countries suggests that people with SCI find a way to cope with their disability through social participation and family bonds, the process of adjustment among people with cervical SCI (CSCI) living in Japan may be different because of the restrained conditions of their social participation and the excessive burden on family caregivers. The purpose of this study was to examine the impact of injury and the process of accommodation in people with CSCI in Japan. Methods: Semi-structured home interviews were conducted with 29 participants who were recruited from a home-visit nursing care provider and three self-help groups. Interviews were recorded, transcribed and analyzed based on the grounded theory approach. Results: Five core categories emerged from the interview data: being at a loss, discrediting self by self and others, taking time in performance, restoring competency, and transcending limitations of disability. Overall, the process by which participants adjusted to and found positive meaning in their lives involved a continuous search for comfortable relationships between self, disability and society. Conclusions: The results of this study suggest that persons with CSCI do not merely have disrupted lives, but find positive meaning through meaningful interactions. Family members added to the discredit of self by making the injured person entirely dependent on them. Gaining independence from family members was the key to restoring competency in people with CSCI. At the same time, social participation was pursued for transcending the limitations of disability. The results also imply that social issues affect how people interpret their disability. These findings suggest that public health policy makers should recognize the need to enhance independence in people with disability as well as change the social assumptions about their care. [ABSTRACT FROM AUTHOR]

This study on individuals with type 2 diabetes living in Japan aimed to examine work-related factors that influence self-care and psychological health among people. A cross-sectional survey was conducted among 121 working adults with type 2 diabetes. A self-report questionnaire assessed demographics, work characteristics, self-disclosure of diabetes, support in the workplace, work-related difficulties due to diabetes, and workplace conformity. Dietary self-care, exercise, depression, and emotional distress were also evaluated. The results indicated statistically significant influence of working night shifts, self-disclosure of diabetes, and workplace conformity on dietary self-care. Work-related difficulties due to diabetes had negative effects on depression and emotional distress, and job control and support in the workplace were found to be correlated with emotional distress. These findings suggest that work-related factors have an impact on some forms of self-care activities and psychological health and that it is important to increase understanding of these issues and provide appropriate support for workers through education and counseling and adjustments in the workplace. [ABSTRACT FROM AUTHOR]

Abstract: We investigated the role of inositol 1, 4, 5-trisphosphate receptors (IP3Rs), activated during preconditioning low-frequency afferent stimulation (LFS), in the subsequent induction of long-term potentiation (LTP) in CA3 neurons in hippocampal slices from mature guinea pigs. Induction of LTP in the field excitatory postsynaptic potential (EPSP) by the delivery of high-frequency stimulation (HFS, a tetanus of two trains of 100 pulses at 100Hz with a 10s interval) to mossy fiber-CA3 neuron synapses was suppressed when CA3 synapses were preconditioned by the LFS of 1000 pulses at 2Hz and this effect was inhibited when the LFS preconditioning was performed in the presence of an IP3R antagonist or a protein phosphatase inhibitor. Furthermore, activation of group 1 metabotropic glutamate receptors (mGluRs) during HFS canceled the effects of an IP3R antagonist given during preconditioning LFS on the subsequent LTP induction at mossy fiber-CA3 synapses. These results suggest that, in hippocampal mossy fiber-CA3 neuron synapses, activation of IP3Rs during a preconditioning LFS results in dephosphorylation events that lead to failure of the HFS to induce subsequent LTP. [Copyright &y& Elsevier]

Diacylglycerol kinase (DGK) plays a key role in pathophysiological cellular responses by regulating the levels of a lipid messenger diacylglycerol. Of DGK isozymes, DGKζ localizes to the nucleus in various cells such as neurons. We previously reported that DGKζ translocates from the nucleus to the cytoplasm in hippocampal CA1 pyramidal neurons after 20 min of transient forebrain ischemia. In this study, we examined the underlying mechanism of DGKζ translocation using hippocampal slices exposed to oxygen-glucose deprivation (OGD) to simulate an ischemic model of the brain. DGKζ-immunoreactivity gradually changed from the nucleus to the cytoplasm in CA1 pyramidal neurons after 20 min of OGD and was never detected in the nucleus after reoxygenation. Intriguingly, DGKζ was detected in the nucleus at 10 min OGD whereas the following 60 min reoxygenation induced complete cytoplasmic translocation of DGKζ. Morphometric analysis revealed that DGKζ cytoplasmic translocation correlated with nuclear shrinkage indicative of an early process of neuronal degeneration. The translocation under OGD conditions was blocked by NMDA receptor (NMDAR) inhibitor, and was induced by activation of NMDAR. Chelation of the extracellular Ca blocked the translocation under OGD conditions. These results show that DGKζ cytoplasmic translocation is triggered by activation of NMDAR with subsequent extracellular Ca influx. Furthermore, inhibition of PKC activity under OGD conditions led to nuclear retention of DGKζ in about one-third of the neurons, suggesting that PKC activity partially regulates DGKζ cytoplasmic translocation. These findings provide clues to guide further investigation of glutamate excitotoxicity mechanisms in hippocampal neurons. [ABSTRACT FROM AUTHOR]

Abstract: Long-term potentiation (LTP) at hippocampal mossy fiber-CA3 pyramidal neuron synapses was induced in the field excitatory postsynaptic potential (EPSP) by the delivery of HFS (a tetanus of two trains of 100 pulses at 100Hz with a 10s interval) and was reversed (depotentiated) by a train of LFS of 1000 pulses at 2Hz applied 60min later. This depotentiation was triggered by activation of inositol 1, 4, 5-trisphosphate receptors (IP3Rs) during HFS, which may increase the postsynaptic intracellular Ca2+ concentration, leading to a cellular process responsible for modification of LTP expression at mossy fiber-CA3 synapses. Furthermore, we found that activation of IP3Rs or protein phosphatase during LFS was required for the reversal of LTP expressed at mossy fiber-CA3 synapses. These results suggest that, in hippocampal mossy fiber-CA3 neuron synapses, activation of IP3Rs by a preconditioning HFS results in modulation of IP3R activation and/or postsynaptic protein phosphorylation during a subsequent LFS, leading to a decrease in the field EPSP and the erasure of LTP. [Copyright &y& Elsevier]

This is the preliminary report of a study to evaluate the effectiveness of the Chronic Disease Self-management Program in Japan by comparing changes in health outcomes at the baseline and 3-month and 6-month follow-ups. The program is a patient-centered educational program for the self-management of chronic conditions. The study's participants were recruited from among the attendees of the program workshops. During the study period (August 2006 to May 2007), 18 workshops were held and 128 attendees agreed to participate in the study. The health outcomes that were measured included health status, self-management behaviors, utilization of health services, self-efficacy, satisfaction with daily living, and clinical indicators. These indicators were further analyzed by disease type: diabetes, rheumatic disease, and cardiovascular disease/dyslipidemia. The findings indicated statistically significant positive changes in health distress, coping with symptoms, stretching exercises, communication with the physician, and satisfaction with daily living. The positive changes were especially remarkable among the groups with diabetes and rheumatic disease. These findings suggest that the Chronic Disease Self-management Program can be effective for Japanese people with chronic conditions. [ABSTRACT FROM AUTHOR]

Abstract: In the present study, mice lacking the type 1 inositol-1,4,5-trisphosphate receptor (IP3R) were used to study the role of type 1 IP3Rs in the induction of long-term potentiation (LTP) in hippocampal CA1 neurons. The magnitude of the LTP induced by high frequency stimulation (HFS) consisting of 20 pulses at 30Hz in mice lacking type 1 IP3Rs was significantly larger than that in wild-type mice in terms of the field excitatory postsynaptic potential and population spike. By measuring changes in the intracellular Ca2+ concentration ([Ca2+]i) in CA1 pyramidal neurons using fluorometry, we found that the decay time of the transient increase in the [Ca2+]i evoked by the HFS in mutant mice was significantly longer than that in wild-type mice, whereas the [Ca2+]i at rest and the magnitude of the [Ca2+]i increases caused by the HFS were no different from those in wild-type mice. In slices from the mutant mice, paired-pulse stimulation (PPS) delivered at an interval of 10ms resulted in significantly weaker paired-pulse inhibition (PPI) than in wild-type mice, suggesting that lack of type 1 IP3Rs reduces the PPI induced by PPS in the CA1 region. These results indicate that a lack of type 1 IP3Rs causes a slower decay of the transient [Ca2+]i in CA1 pyramidal neurons and attenuates the activity of inhibitory interneurons, resulting in enhancement of LTP induction. [Copyright &y& Elsevier]

Hippocampal inhibitory interneurons have a central role in the control of network activity, and excitatory synapses that they receive express Hebbian and anti-Hebbian long-term potentiation (LTP). Because many interneurons in the hippocampus express nicotinic acetylcholine receptors (nAChRs), we explored whether exposure to nicotine promotes LTP induction in these interneurons. We focussed on a subset of interneurons in the stratum oriens/alveus that were continuously activated in the presence of nicotine due to the expression of non-desensitizing non-α7 nAChRs. We found that, in addition to α2 subunit mRNAs, these interneurons were consistently positive for somatostatin and neuropeptide Y mRNAs, and showed morphological characteristics of oriens-lacunosum moleculare cells. Activation of non-α7 nAChRs increased intracellular Ca2+ levels at least in part via Ca2+ entry through their channels. Presynaptic tetanic stimulation induced N-methyl-d-aspartate receptor-independent LTP in voltage-clamped interneurons at −70 mV when in the presence, but not absence, of nicotine. Intracellular application of a Ca2+ chelator blocked LTP induction, suggesting the requirement of Ca2+ signal for LTP induction. The induction of LTP was still observed in the presence of ryanodine, which inhibits Ca2+ -induced Ca2+ release from ryanodine-sensitive intracellular stores, and the L-type Ca2+ channel blocker nifedipine. These results suggest that Ca2+ entry through non-α7 nAChR channels is critical for LTP induction. Thus, nicotine affects hippocampal network activity by promoting LTP induction in oriens-lacunosum moleculare cells via continuous activation of non-α7 nAChRs. [ABSTRACT FROM AUTHOR]

Oligodendrocytes have received much attention in relation to neurological and psychiatric disorders. The involvement of oligodendrocytes and their myelin in normal brain functions has been suggested by many lines of evidence. The conduction velocity of action potentials along axons is dramatically increased by myelination, that is, the formation of a passive insulator. There is a growing understanding of the functional roles of ion channels and neurotransmitter receptors on oligodendrocytes, and the activity-dependent facilitative effect of oligodendrocytes on conduction velocity has been demonstrated. In this article, we summarize evidence for the ability of oligodendrocytes to monitor neuronal activity and for the facilitation of axonal conduction by oligodendrocytes by mechanisms other than myelination. We suggest the underlying mechanisms for this facilitation in relation to the morphological dynamics of myelinating processes and discuss the physiological roles of the facilitation in information processing. [ABSTRACT FROM AUTHOR]

Background: Pervasive developmental disorder (PDD) has an uncertain etiology, no method of treatment, and results in communication deficiencies and other behavioral problems. As the reported recurrence risk is 5%-10% and there are no methods of either prevention or prenatal testing, mothers of PDD children may face unique challenges when contemplating second pregnancies. The purpose of this study was to explore the mothers' lived experiences of second child-related decision-making after the birth of a child with PDD. Methods: The participants for this study were restricted to mothers living within the greater Tokyo metropolitan area who had given birth to a first child with PDD within the past 18 years. The ten participants were encouraged to describe their experiences of second-child related decision-making after the birth of a child with PDD on the basis of semi-structured interviews. Data analysis was performed by using Interpretive Phenomenological Analysis (IPA), which is concerned with understanding what the participant thinks or believes about the topic under discussion. Results: We identified two superordinate themes. The first was balancing hopes and fears, in which hope was the potential joy to be gained by the birth of a new child without PDD and fears were characterized as uncertainty of PDD and perception of recurrence risk, burden on later-born children, and negative effects on a child with PDD. The second superordinate theme was assessing the manageability of the situation, which was affected by factors as diverse as severity of PDD, relationship between mother and father, and social support and acceptance for PDD. Our 10 participants suffered from extreme psychological conflict, and lack of social support and acceptance for PDD created numerous practical difficulties in having second children. Conclusions: Our participants faced various difficulties when considering second pregnancies after the birth of children with PDD in the Japanese society. As lack of social support and acceptance for PDD also played a large role in second child-related decision-making, creating a social environment that more fully accepts those disabled and providing flexible support systems for families of children with PDD are crucial. [ABSTRACT FROM AUTHOR]

Japanese families traditionally avoid disclosing diagnoses of terminal illnesses to patients, seeking to protect the patient from emotional pain and shock. Using awareness theory, in this study we aimed to investigate the attitudes toward disclosure among bereaved families of Japanese hemophiliacs with iatrogenic HIV/AIDS. Semistructured interviews were conducted with 34 bereaved family members. Qualitative content analysis centered around three main issues: (a) family attitudes toward physician nondisclosure of HIV diagnosis; (b) family attitudes regarding the consequences of nondisclosure; and (c) family attitudes regarding the impact of nondisclosure on patient-family relationships. Our findings suggest that families favored disclosure because they felt that knowledge of the iatrogenic HIV infection would benefit the patient. [ABSTRACT FROM AUTHOR]

Rapid activation of nicotinic acetylcholine receptors (nAChRs) at various anatomical and cellular locations in the hippocampus differentially modulates the operation of hippocampal circuits. However, it is largely unknown how the continued presence of nicotine affects the normal operation of hippocampal circuits. Here, we used single and dual whole-cell recordings to address this question. We found that horizontally oriented interneurons in the stratum oriens/alveus continuously discharged action potentials in the presence of nicotine. In these interneurons, bath application of nicotine produced slow inward currents that were well maintained and inhibited by the non-α7 antagonist dihydro-β-erythroidine. Single-cell reverse transcription-polymerase chain reaction analysis showed that nicotine-responding interneurons were consistently positive for the α2 subunit mRNA. These observations suggest that in the presence of nicotine, a subset of interneurons in the stratum oriens/alveus are continuously excited due to the sustained activation of α2* nAChRs. These interneurons were synaptically connected to pyramidal cells, and nicotine increased inhibitory baseline currents at the synapses and suppressed phasic inhibition at the same synapses. Nicotine-induced inhibitory activity increased background noise and masked small phasic inhibition in pyramidal cells, originating from other interneurons in the stratum radiatum. Thus, the continued presence of nicotine alters the normal operation of hippocampal circuits by gating inhibitory circuits through activating a non-desensitizing α2 nAChR subtype on a distinct population of interneurons. [ABSTRACT FROM AUTHOR]

Physicians in Japan typically do not disclose diagnoses of terminal illnesses to patients, in deference to the wishes of family members. Nonetheless, some evidence indicates that relatives of patients with iatrogenic HIV infection would prefer patient disclosure. We collected survey data from 314 family members in 225 households of hemophiliac patients who died from illnesses related to iatrogenic HIV infection in order to examine current attitudes toward patient disclosure in Japan. Family members reported that the diagnosis of iatrogenic HIV infection was disclosed to the patient by the primary physician in 32.8% of cases, by the family in 8.3% of cases, and not disclosed in 26.4% of cases. The majority of families indicated that the timing of the physician's disclosure occurred too late. Multivariate analysis indicated that families wished that patients had been informed of the diagnosis, despite the stigma associated with HIV in Japan. Furthermore, many families blamed the physician for the infection and fatality in those cases in which the physician did not convey feelings of regret. These results have important clinical ramifications to the practice of disclosing terminal diagnoses in Japan. [ABSTRACT FROM AUTHOR]

Abstract: Using hippocampal slices, we found that chronic ethanol consumption by rats induces tolerance to the impairing effects of acute ethanol treatment on induction of long-term potentiation (LTP) in CA1 neurons. In hippocampal slices from pair-fed control rats, stable LTP was induced by tetanic stimulation consisting of 25 or more pulses at 100 Hz, but not by tetanic stimulation of 15 pulses at 100 Hz, and LTP induction was blocked if the tetanus was delivered in the presence of 8.6 mM ethanol, 1 µM muscimol, a γ-aminobutyric acid (GABA) A receptor agonist, or 2.5 µM dl-2-amino-5-phosphonovaleric acid (AP5), an N-methyl-d-aspartate (NMDA) receptor antagonist. In hippocampal slices from rats chronically fed a liquid diet containing ethanol, a tetanus consisting of 15 pulses at 100 Hz did induce stable LTP, indicating a decrease in the stimulation threshold for inducing LTP. Application of ethanol, muscimol, or AP5 did not affect LTP induction in these cells, suggesting that the effects of chronic ethanol exposure on LTP induction are mediated by a reduction in GABAergic inhibition or an increase in NMDA receptor activity in hippocampal CA1 neurons. [Copyright &y& Elsevier]

Abstract: Considering first- and second-year university undergraduate students as subjects, this study examined the effect of the sense of coherence (SOC) at the baseline level and subsequent changes in SOC after two years on aspects related to the students’ well-being in their third and fourth school years. These aspects included good physical and mental well-being and the successful resolution of developmental themes. A follow-up survey was performed based on a self-administered questionnaire for 406 undergraduates at two universities in Tokyo. The first survey was conducted in June 2000 and the second, in September 2002. Valid responses were received from 281 students (response rate: 69.2%). A multiple regression analysis showed that high baseline-SOC and later SOC-change were predictors of high physical and mental well-being, which consisted of three domains such as somatic symptoms, and so on, and high psycho-social well-being, which consisted of six domains such as growing interest in learning, clarity regarding one’s own career, and so on. Moreover, the effects on well-being differed slightly between males and females. These results demonstrate that Antonovsky’s theory that SOC influences well-being, including successfully responding to the developmental theme, can be confirmed in male students; however, this is only partially confirmed in female students. [Copyright &y& Elsevier]

Abstract: “Sense of Coherence” (SOC) is a core concept of salutogenic theory. This concept can be usefully applied to analyses of stress prevention and health maintenance. Little is known about how factors that correlate with individuals’ SOC vary according to regional socio-cultural conditions. The objective was to examine if living environment influenced the pattern of correlations of SOC with generalized resistance resources (GRRs) and to assess if between area SOC differences relate to GRRs. We sought to examine the relationship between SOC and psychosocial GRRs, including sociodemographic characteristics based on Antonovsky’s theories. Social support and self-efficacy were found to correlate with SOC among both urban and rural residents. SOC was correlated with economic status among urban residents, but not among rural residents; further, in rural areas alone, SOC was found to correlate with residential intention, ties with relatives, and humor. Urban residents in general showed significantly higher SOC scores than rural residents. This may be due to the higher levels of social support, self-efficacy, and higher economic status found among urban residents. We suggest that the practical application of theories of SOC to health policy development in urban and rural areas may benefit from taking into account SOC related characteristics. [Copyright &y& Elsevier]

Here, we show that chronic nicotine exposure induces changes in Src signaling for the modulation of N-methyl-d-aspartate receptor (NMDAR) function and LTP induction in CA1 pyramidal cells. Activation of muscarinic receptors normally potentiates NMDAR responses in pyramidal cells via a Gq/protein kinase C (PKC)/proline-rich tyrosine kinase 2/Src signaling cascade. However, muscarinic, PKC and Src stimulation had no effect on NMDAR responses after chronic nicotine treatment. The lack of effect was apparently due to enhanced tyrosine phosphorylation, and therefore further stimulation of the signaling cascade caused no effect on NMDAR responses. Interestingly, another Src-family kinase potentiated NMDAR responses after, but not before, chronic nicotine treatment. In control pyramidal cells, Src inhibitor peptides prevented tetanus-induced long-term potentiation (LTP). Conversely, in chronic nicotine-exposed cells, the inhibitor was ineffective in blocking tetanus-induced LTP. Furthermore, in control pyramidal cells, applying exogenous Src and administration of an endogenous Src-family kinase activator increased α-amino-3-hydroxy-5-methylisoxazole-4-propionate receptor (AMPAR)-mediated responses. This increase was blocked by Src inhibitor peptides and occluded tetanus-induced LTP, as reported previously. In contrast, in chronic nicotine-treated pyramidal cells, applying exogenous Src had no effect on AMPAR-mediated responses and a tetanus-induced LTP. Interestingly, however, administration of an endogenous Src-family kinase activator enhanced AMPAR-mediated responses, which occluded tetanus-induced LTP. This enhancement was not prevented by co-application of Src inhibitor peptides. Thus, it appears that chronic nicotine exposure recruits another member of the Src-family for the regulation of NMDAR function and LTP induction. The nicotine-induced distinct signaling cascades may be involved in long-lasting memories of nicotine misuse. [ABSTRACT FROM AUTHOR]

We have previously reported that acute and chronic nicotine exposure lower the threshold for long-term potentiation (LTP) induction in the rat hippocampal CA1 region, and acute application of nicotine in the chronic-nicotine-treated hippocampus further reduces the threshold. However, it is unknown how withdrawal from chronic nicotine exposure affects the induction of LTP. Here, we show that, following nicotine withdrawal, the threshold for LTP induction fluctuates before returning to the basal level and acute nicotine is no longer effective in lowering the threshold at 4 days after withdrawal. Chronic nicotine-induced enhancement of N-methyl-d-aspartate receptor responses slowly diminishes and returns to the control level by 8 days of withdrawal. In 4-day-withdrawn hippocampi, there is functional up-regulation of postsynaptic α7 nicotinic acetylcholine receptors (nAChRs) on interneurons in the stratum radiatum, whereas the release of γ-aminobutyric acid from their terminals is reduced. In both control and chronic nicotine-exposed hippocampi, acute nicotine depresses monosynaptic inhibitory postsynaptic currents recorded in pyramidal cells but has almost no effect at 4 days of withdrawal. The lack of effect is due, at least in part, to the loss of a presynaptic nicotine effect. These withdrawal-induced changes are accompanied by decreases in normal nicotine-induced enhancement of N-methyl-d-aspartate receptor responses, which may be responsible for the lack of acute nicotine-mediated facilitation of LTP induction in 4-day-withdrawn hippocampi. These withdrawal-induced changes may contribute to the cellular basis of unpleasant withdrawal symptoms and, thus, nicotine dependence. [ABSTRACT FROM AUTHOR]

To evaluate the intent and practice of condom use among Japanese HIV-positive men who have sex with men (MSM), a survey using anonymous questionnaires was carried out and 117 respondents were investigated. For anal sex and oral sex, respectively, 58.1% and 15.2% intended to use condoms and 47.2% and 12.4% used condoms all of the time. The intent of condom use decisively affected the practice of condom use and was closely related to the perceived risk level of HIV/sexually transmitted (STI) transmission. In anal sex, willingness to protect sexual partners from HIV infection was strongly related not only to the intent but also to the practice. Enhancement of willingness to protect oneself from STI was suggested to enhance willingness to protect his/her sexual partners from HIV infection with secondary enhancement of the intent or the practice of condom use. Specific support of MSM with HIV for improving the intent and practice of condom use is urgently needed. [ABSTRACT FROM AUTHOR]

The use of nicotine via cigarette smoking forms long-lasting memories that are recalled in response to environmental cues associated with previous nicotine use. However, the changes in brain memory systems that underlie these long-lasting memories are not well understood. The N-methyl-d-aspartate receptor (NMDAR) is critical for long-lasting modifications of synapses. Here we show that in vivo nicotine exposure induces the enhancement of NR2B-containing NMDAR-mediated currents in the hippocampus, a brain region associated with the formation of memories. This nicotine effect is maintained during continued nicotine exposure and is accompanied by increased tyrosine phosphorylation of NR2B. Furthermore, long-term potentiation (LTP), which is considered to be a cellular substrate of learning and memory, induced in nicotine-exposed hippocampi contains a protein synthesis-independent long-lasting component. An NR2B-selective antagonist blocks a long-lasting component of LTP, but not LTP. These results suggest that exposure to nicotine provides conditions that promote the induction of long-lasting modifications of synapses, which may be involved in the formation of memories involving nicotine use. [ABSTRACT FROM AUTHOR]

Abstract: This research examined the experience of Amyotrophic Lateral Sclerosis (ALS) patients who depend on an invasive mechanical ventilator in Japan. We investigated their difficulties in expressing their needs, their desires and wishes, and their sources of support and happiness. We examined the relationship between these factors and patient demographics, and hope as an indicator of successful adaptation to the illness experience (assessed by the Herth Hope Index). Interview results guided the formation of an anonymous questionnaire distributed to patients by mail. We interviewed 27 patients and their families and surveyed 157 respondents with a questionnaire. Most patients experienced multiple categories of difficulties, which correlated with reduced hope. More severe physical symptoms correlated with more emotional and social difficulties. Notable findings included a high prevalence of unalleviated pain, fear or experience of ventilator difficulties, and fear of burdening others. Having more sources of psychosocial support and happiness was associated with greater hope. Living at home was associated with fewer social difficulties. No patients claimed additional sources of support without claiming family or professional caregiver support, suggesting their mediation may be crucial in maintaining other social connections. Users of computer communication reported more sources of support and happiness and less frustration from difficulty expressing themselves. The most common reported desires, following a cure for ALS, related to the happiness of the patients’ families, and a desire not to burden them. We also found that invasive mechanical ventilation (IMV) had been initiated emergently in 30.1% of patients without patient or family consent. Our results provide an insight into the world of this challenged population, elucidating the difficulties they face, and clarifying the role of support and other factors in maintaining hope. We identify concrete areas to which increased attention should be directed in patient care. [Copyright &y& Elsevier]

The social and political environments surrounding patient-physician relationship have been changing in Japan for the last few decades. This paper aims to illustrate social and cultural factors that underlie current situations and problems of patient-physician relationship in Japan through a comparison with those in western countries, and to consider how mutual participation model of patient-physician relationship could be applied and fostered in Japan as well as other Asian cultures. Four major sociocultural factors are discussed in relation to the patient-physician relationship in Japan: (1) individualism versus collectivism; (2) low context versus high context; (3) femininity versus masculinity; and (4) Christianity versus Confucianism. Two key issues in discussing the mutual participation model of patient-physician relationship in Japan have emerged; the family and the communication style. The patient autonomy in Japan should be considered within the context of the triadic relationship of patient, family, and physician. Also, since the communication style might differ between Japan and western countries, communication training programs and interventions for medical professionals as well as for patients should be tailored in a culturally appropriate way in order to improve the communication in medical encounters and to achieve the mutual participation. Beyond mere advocacy of the patient autonomy, the mutual participation model of patient-physician relationship should be pursued within our social and cultural context to be truly fruitful for patients and physicians in Japan. [ABSTRACT FROM AUTHOR]

Abstract: Nine healthy subjects standing upright, initiated small, medium and large (S, M and L conditions, respectively) forward movements of their right (Rt) arm together with backward movements of their left (Lt) arm. They also performed medium-size movements while holding a 3kg dumbbell in each hand (D condition). Movements started with the arm hanging alongside the body and ended when the shoulder reached a desired orientation. The arm and trunk movements were videotaped and recorded by accelerometers taped to the wrists, shoulders, and hips bilaterally. The torque around the vertical axis was measured using a force-plate on which the subjects stood. EMGs were recorded with surface electrodes bilaterally from the shoulder, trunk, and thigh muscles. Trajectories of the center of foot pressure were measured in additional experiments. In association with arm movements, there was a small counterclockwise (ccw: the Rt shoulder forward and the Lt backward) rotation of the trunk, followed by large alternate rotations of the trunk, first clockwise (cw) and subsequently ccw. The intervals from the hand acceleration to the shoulder and hip accelerations were, respectively, 0±15ms (mean and S.D. for all subjects) and −17±15ms. The force-plate showed initial cw and later ccw torques 63±41ms after hand acceleration. The EMGs of the Rt hamstrings (Ham) and Lt rectus femoris (RFem) were followed by those of the Lt Ham and Rt RFem which, respectively preceded the alternate trunk rotations. The integrated EMGs and torques increased with increasing amplitude of arm movement and load. The integrated torques increased in the order of S, M, L, and D conditions. The integrated EMGs of the thigh muscles correlated with the integrated torques (medians: r =0.880, 0.696, 0.785, and 0.688, respectively, in the Rt Ham, Lt Ham, Rt RFem, and Lt RFem). The trajectories of the center of foot pressure showed variations, initially toward the Rt side and then the Lt side which, respectively coincided with the initial and later phases of the trunk rotations and the muscle activation. The trunk muscles were generally coactivated between the Rt and Lt muscles, and the integrated EMGs increased with increasing the integrated torques. Our results showed that alternate rotations of the upper trunk, produced by rapid arm movements, were transmitted to the hip in part due to cocontraction of trunk muscles, and each pair of hip joint muscles contributed to the maintenance of the standing posture by stabilizing the hip joints against alternating trunk rotations. [Copyright &y& Elsevier]

Nicotine facilitates the induction of long-term potentiation (LTP) in the hippocampal CA1 region. The present study reveals the potential mechanisms underlying this effect of nicotine. Timed ACh-mediated activation of α7 nicotinic acetylcholine receptors (nAChRs) on pyramidal cells is known to promote LTP induction. Nicotine could suppress this timing-dependent mechanism by desensitizing nAChRs. Timed ACh-mediated activation of α7 nAChRs on feedforward interneurons can prevent LTP induction by inhibiting pyramidal cells. Nicotine diminished this ACh-mediated inhibition by desensitizing α7 nAChRs, thereby reducing the inhibitory influence on pyramidal cells. In addition to these desensitizing effects, nicotine activated presynaptic non-α7 nAChRs on feedforward interneurons to decrease the evoked release of γ-aminobutyric acid (GABA) onto pyramidal cells. Furthermore, nicotine increased the frequency of spontaneous inhibitory postsynaptic currents (IPSCs) in pyramidal cells, and concomitantly caused a reduction in the size of responses to focal GABA application onto the dendrites of pyramidal cells, suggesting that the nicotine-induced increase in interneuronal activity leads ultimately to a use-dependent depression of evoked IPSCs in pyramidal cells. These nicotine-induced suppressions of inhibition of pyramidal cells were accompanied by enhanced N-methyl- d-aspartate (NMDA) responses in pyramidal cells. Thus, our results suggest that nicotine promotes the induction of LTP by diminishing inhibitory influences on NMDA responses while suppressing the ACh-mediated mechanisms. These ACh-independent mechanisms probably contribute to the nicotine-induced cognitive enhancement observed in the presence of cholinergic deficits, such as those in Alzheimer's disease patients. [ABSTRACT FROM AUTHOR]

Traumatic abdominal wall hernia (TAWH) is a rare condition secondary to blunt abdominal trauma in children. We herein report an 8-year-old boy who developed TAWH after falling onto a bicycle handlebar. Neither physical examination nor radiological findings suggested a diagnosis of TAWH at first presentation. TAWH in the right lower quadrant could not be identified until exploratory laparoscopy was performed. An open surgical repair was done, and the postoperative course was uneventful. The literature on pediatric TAWH is briefly reviewed and the findings discussed. [ABSTRACT FROM AUTHOR]

This study examines correlations between observable communicative behaviors and patient perceptions of patient–physician interaction in 86 breast cancer outpatient consultations from three patient-centered perspectives: patient participation, physician collaboration, and communicative success. Analysis relied on audio tape recordings and questionnaires, and incorporated non-behavioral factors particular to each physician, patient, and consultation. Results revealed that patient perceptions of self-participation depended on the length of consultation. Physician collaboration depended on the degree to which patients were given the opportunity to speak, while communicative success reflected a patient’s level of anxiety at the time of the consultation. Yet patient perceptions of mutual participation reflected observable communicative behaviors only partially. This gap suggests that perceptual and behavioral measures reveal different aspects of participation and that the study of patient–physician interaction benefits from the inclusion of both kinds of measure. [Copyright &y& Elsevier]

In Japan, as in other advanced industrial societies, user-helper relationships shaped by the Independent Living Movement have gradually been taking root. In this study, we interviewed 31 Center for Independent Living (CIL) consumers in Japan in order to explore the nature of the relationship between persons with disabilities influenced by IL ideals and their assistants. Interviews revealed three significant dimensions to the relationship—one functional, one interpersonal and one collective. The functional dimension of the relationship was expressed in a characterization of assistants as 'instruments', the interpersonal dimension in their characterization as 'employees' (a task-orientated aspect) and 'companions' (a socio-emotional aspect), and the collective dimension in the characterization of assistants as 'social assets'—individuals without disabilities who understand the ideals and demands of independent living. Participant responses also form the basis of our discussion of theoretical and practical implications for the building of user-helper relationships based within a user-centred agency in the context of Japanese medical and social services. [ABSTRACT FROM AUTHOR]

The objective of this study was to determine the organization of coactivation in the arm and shoulder muscles. Normal human subjects made alternate movements of a joint in the horizontal plane, either adduction–abduction of the second finger and shoulder, ulnar–radial deviation of the wrist, or extension–flexion of the elbow, during which they fixed a focal joint while decreasing the movement amplitude and increasing the fixation strength. They varied the fixation strength at four different levels up to the maximum. The focal-joint angle, and surface electromyograms (EMGs) from the intrinsic hand, antebrachial, upper-arm, and shoulder muscles were recorded. EMGs in the phase of fixation were quantified by integration after rectification. The degree of coactivation among the muscles was evaluated by calculating correlation coefficients across the integrated EMGs. There were correlations in the integrated EMGs among focal-joint muscles (FJMs), and also between one of the FJMs and the muscles distal and/or proximal to the FJMs: in the finger fixation between the hand and antebrachial muscles, in the wrist fixation between the antebrachial and hand/upper-arm muscles, in the elbow fixation between the upper-arm and antebrachial/shoulder muscles, and in the shoulder fixation between the shoulder and upper-arm muscles. Moderate or slight correlations were seen in muscles more distant from FJMs. Our results indicate that the longitudinal distance from FJMs in the shoulder and arm muscles is an important factor in determining levels of coactivation. This is discussed in relation to the fact that neighboring muscles share joints with FJMs. [Copyright &y& Elsevier]

Long-term potentiation (LTP) in the hippocampal CA1 region is widely regarded to be the cellular substrate of learning and memory, and its induction critically depends on the activation of N-methyl-d-aspartate receptors (NMDARs). Nicotine reverses memory deficits caused by a lesion of the cholinergic system in animals. The mechanisms underlying this effect and the effect of nicotine on LTP after cholinergic degeneration are unknown. Here we show that cholinergic lesions impaired the induction of LTP, and nicotine reversed this effect and promoted the induction of LTP. The compensatory action of nicotine appears to be due to the enhancement of NMDAR responses mediated by nicotine-induced disinhibition of pyramidal cells. This may represent the cellular basis of nicotine-mediated cognitive enhancement observed in the presence of cholinergic deficits. [Copyright &y& Elsevier]

Fifty-eight healthy subjects made rapid elbow extensions to a target over 54 degrees. Angular acceleration was measured and surface electromyograms (EMGs) were recorded from the antagonistic muscles using monopolar rather than bipolar electrode configurations. Marked individual differences were found in the peak value of the first derivative of acceleration (dAcc/dt_Pk). The dAcc/dt_Pk correlated with both quantitative and qualitative properties of the agonist EMGs, but not with those of the antagonist EMG. The agonist EMGs, integrated until the moment of dAcc/dt_Pk, were positively correlated with dAcc/dt_Pk. The interval between EMG onset and EMG peak decreased with increasing dAcc/dt_Pk. The duration of the initial negative phase in the EMGs, which was considered to index the time required to recruit high-threshold MUs, decreased with increasing dAcc/dt_Pk. The results indicate that the ability to rapidly accelerate the lower arm varies across subjects, probably due in part to individual differences in the neural capacity to drive the agonists. [ABSTRACT FROM AUTHOR]

The perfusion of adenosine triphosphate (ATP) induces long-term potentiation (LTP) in CA1 synapses of hippocampal slices, whereas the perfusion of ATP plus d,l-2-amino-5-phosphonovaleric acid (AP5) can result in the formation of long-term depression (LTD). To clarify the difference in change of intracellular calcium concentration ([Ca2+]i) corresponding to induction of LTP or LTD, we measured [Ca2+]i during the perfusion of ATP or ATP+AP5, while simultaneously recording evoked field potentials. In both cases, ATP (or ATP+AP5) perfusion transiently increased [Ca2+]i but the extent of increase of [Ca2+]i by ATP was larger than that caused by ATP+AP5. Thus, the larger rise in [Ca2+]i induces LTP but the smaller rise induces LTD. These results are consistent with the Ca2+ hypothesis as proposed by Lisman (Trends Neurosci. 17 (1994) 406). [Copyright &y& Elsevier]

Examines the relationship between the outpatients' perception of physicians' communication styles and anxiety levels of patients in Japan. Measurement of anxiety level of patients; Development of the Perceived Physician's Communication Style Scale; Effects of the communication style of physicians on post-consultation anxiety levels of patients.

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. [ABSTRACT FROM AUTHOR]

A three-item sense of coherence (SOC) scale was developed, incorporating the definitions of the three subordinate concepts of SOC for use in population surveys. A cross-sectional Internet survey was conducted in the latter part of July 2006. Cronbach's α was 0.84. The correlation coefficient of SOC-13 and the newly devised University of Tokyo Health Sociology version of the SOC Scale (SOC-3-UTHS) was 0.51. As regards correlation with a health index, SOC-3-UTHS had a significant association, although this association was somewhat weaker than that of SOC-13. Therefore, certain levels of convergent and concurrent validities of SOC-3-UTHS have been indicated. [ABSTRACT FROM AUTHOR]

Objective: To compare support for three groups by considering usage patterns with regard to two peer support resources, online communities, and face-to-face support groups, among patients with breast cancer in Japan. Methods: We conducted a cross-sectional survey of 1039 breast cancer patients. Results: Factor analysis indicated that all groups show the five aspects of support: “Emotional support/Helper therapy,” “Emotional expression,” “Conflict,” “Advice,” and “Insight/Universality.” Within the group using two support resources, the support scores of “Emotional expression” and “Advice” were higher for the online community, and those of “Emotional support/Helper therapy,” and “Insight/Universality” were higher for the face-to-face support group. Among the three groups, the members who received the most peer support were those who used both an online community and a face-to-face support group. Conclusion: Patients who received the most social support from peers were in the group using both online communities and face-to-face support groups. Practice implications: Healthcare providers should provide information about peer support through not only traditional face-to-face support groups but also online communities. [Copyright &y& Elsevier]

Background The present study investigated when and how Japanese people with cleft lip and palate (CL/P) learn that their condition is congenital; the perceived effects of withholding the CL/P diagnosis on patients; and whether the resulting social experience and self-esteem are related. A questionnaire survey was conducted in 71 adults with CL/P recruited through a hospital, a patients' association, and by snowball sampling. Results The participants became aware of their physical difference in childhood, but many reported difficulty in understanding their condition. Participants reported that their families avoided the topic of diagnosis. Participants who understood their condition during childhood rather than in adulthood were significantly more likely to consider this scenario as positive (p < 0.001). Although stigmatising experiences were extremely painful, most patients hid their suffering, making it more difficult to obtain social support. Participants with high self-esteem were more likely to feel that they received adequate support. Conclusions It is important to explain the congenital nature of CL/P sufficiently and early. In addition, openness by the family about the diagnosis, rather than avoidance, may improve patients' self-esteem. Sufficient support from family, health care providers, and significant others is needed for patients to develop adequate self-esteem. [ABSTRACT FROM AUTHOR]

This study examined the relationship between the sense of coherence (SOC), which is conceptually the ability to successfully cope with stress, of Japanese junior high school students and their mothers, and investigated SOC-related factors among the students. We analyzed self-reported data from 134 junior high school students (aged 12–14 years) and their mothers (average age: 45.5 ± 4.1 years), based in an urban area of Japan. We found a weak correlation between the SOC total scores of female students and their mothers; further, few subscales showed weak correlations. However, the SOC of male students was not correlated with that of their mothers, including the three subcomponents that constitute the SOC. The results of multiple regression analysis indicated that the SOC of female students was negatively associated with ASD-related characteristics, sensitivity to evaluation, and avoidant help-seeking style, and positively associated with a sense of belonging to the school. However, male students' SOC showed a negative relationship with excessive response to evaluation and a strong sense of parental control. To improve SOC in adolescents, it is necessary to consider their gender differences and support them, both at home and school. [ABSTRACT FROM AUTHOR]

Aims: The objectives of this study were to understand the experiences of people with cleft lip and cleft palate (CLCP) and to describe the processes and factors leading to the acquisition of high self-esteem. Methods: Semi-structured interviews were conducted of 19 subjects with CLCP recruited via hospitals and through snowball sampling, and the results were analyzed qualitatively, comparing high and low self-esteem groups. Results: Participants with high self-esteem had gone through the phases of 'noticing their difference from others', 'knowing about and deepening their understanding of CLCP', 'no denial of their life with CLCP' and 'affirmation of life with CLCP'. Seven factor categories including 'received sufficient explanation of CLCP condition (from parents) in the early stage', 'have not received negative messages about CLCP' and 'feeling the presence of someone who accepts their feelings and supports them' were extracted as factors promoting these processes. Conclusions: Knowing about and understanding CLCP enables individuals to acquire a sense of coherence in their lives, which may be related to gaining a feeling of control over their cleft condition, acquiring a sense of autonomy, and finding a meaning for their lives. Thus, medical professionals should provide explanations that enable patients to understand CLCP, and also facilitate interaction between patients with the same condition. [ABSTRACT FROM AUTHOR]