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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]

Objective. The aim of this randomized controlled study was to investigate the effects of insoles with a toe-grip bar on toe function and standing balance in healthy young women. Methods. Thirty female subjects were randomly assigned to an intervention group or a control group. The intervention group wore shoes with insoles with a toe-grip bar. The control group wore shoes with general insoles. Both groups wore the shoes for 4 weeks, 5 times per week, 9 hours per day. Toe-grip strength, toe flexibility, static balance (total trajectory length and envelope area of the center of pressure), and dynamic balance (functional reach test) were measured before and after the intervention. Results. Significant interactions were observed for toe-grip strength and toe flexibility (F=12.53, p<0.01; F=5.84, p<0.05, resp.), with significant improvement in the intervention group compared with that in the control group. Post hoc comparisons revealed that both groups showed significant improvement in toe-grip strength (p<0.01 and p<0.05, resp.), with higher benefits observed for the intervention group (p<0.01). Conversely, no significant interaction was observed in the total trajectory length, envelope area, and functional reach test. Conclusions. This study suggests that insoles with a toe-grip bar contribute to improvements in toe-grip strength and toe flexibility in healthy young women. [ABSTRACT FROM AUTHOR]

Background. This study aimed to investigate whether a lifestyle-based physical activity program could contribute to reduced medical expenditure. Methods. The study participants were 60 adults aged 63.1 (standard deviation, 4.4) years in the intervention group; the case-control group consisted of 300 adults who were randomly selected from Japan’s national health insurance system. This community-based retrospective study incorporated a 3-year follow-up. Results. The total and outpatient medical expenditure in the intervention group were significantly lower than in the control group: total expenditure, $US640.4/year; outpatient expenditure, $369.1/year. The odds ratio for outpatient visiting was 6.47-fold higher in the control than in the intervention group. Conclusion. Our study suggests that a health program to promote physical activity can result in reduced total medical expenditure, outpatient medical expenditure, and possibly also inpatient medical expenditure. [ABSTRACT FROM AUTHOR]

Purpose. Macrophages serve as sweepers of microbes and inflammation-derived wastes and regulators of inflammation. Some traditional Japanese medicines are reported to have adjuvant effects by modifying macrophages. Our aim was to characterize the actions of jumihaidokuto (JHT) for treatment of skin inflammations including acne vulgaris, in which Propionibacterium acnes has pathogenic roles. Methods. Dermatitis was induced in rat ears by intradermal injection of P. acnes. JHT or prednisolone (PDN) was given orally, and ear thickness and histology were evaluated. The effects of constituents and metabolites of JHT on monocytes were tested by cell-based assays using the human monocytic THP-1 cell. Results. JHT and PDN suppressed the ear thickness induced by P. acnes injection. Histological examinations revealed that JHT, but not PDN, promoted macrophage accumulation at 24 h after the injection. PDN suppressed the macrophage chemokine MCP-1 in the inflamed ears, while JHT did not affect it. The JHT constituents liquiritigenin and isoliquiritin increased expression of CD86 (type-1 macrophage marker) and CD192 (MCP-1 receptor) and enhanced phagocytosis by THP-1. Conclusions. JHT suppressed dermatitis, probably by enhancing type-1 macrophage functions, with an action different from PDN. JHT may be a beneficial drug in treatment of skin inflammation induced by P. acnes. [ABSTRACT FROM AUTHOR]

The aims of this study were to identify the preoperative factors influencing ambulation ability at different postoperative time points after total hip arthroplasty (THA) and to examine the cutoff values of predictive preoperative factors by receiver operating characteristic (ROC) curves. Forty-eight women with unilateral THA were measured for hip extensor, hip abductor, and knee extensor muscle strength in both legs; hip pain (visual analog scale, VAS); and the Timed Up and Go (TUG) test pre- and postoperatively. Multiple regression analysis indicated that preoperative knee extensor strength (β = -0.379, R2 = 0.409) at 3 weeks, hip abductor strength (β = -0.572, R2 = 0.570) at 4 months, and age (β = 0.758, R2 = 0.561) at 7 months were strongly associated with postoperative ambulation, measured using the TUG test. Optimal preoperative cutoff values for ambulation ability were 0.56Nm/kg for knee extensor strength, 0.24Nm/kg for hip abductor strength, and 73 years of age. Our results suggest that preoperative factors predicting ambulation ability vary by postoperative time point. Preoperative knee extensor strength, hip abductor strength, and age were useful predictors of ambulation ability at the early, middle, and late time points, respectively, after THA. [ABSTRACT FROM AUTHOR]

Keishibukuryogan (KBG; Guizhi-Fuling-Wan in Chinese) is one of the Kampo (Japanese traditional) medicines used to treat patients with climacteric syndrome. KBG can be used by patients who cannot undergo hormone replacement therapy due to a history of breast cancer. We evaluated whether cytosine-adenine (CA) repeat polymorphism of the estrogen receptor β gene can be a predictor of the beneficial effect of KBG on climacteric syndrome. We also investigated the relationship between CA repeat polymorphism, the patients' profiles, and the therapeutic effect. We found that CA was an SS, SL, or LL genotype according to the number of repeats. We studied 39 consecutive patients with climacteric disorders who took KBG for 12 weeks. The diagnosis of climacteric disorders was made on the basis of the Kupperman index. KBG significantly improved the patients' climacteric symptoms (i.e., vasomotor symptoms in the patients with the LL genotype andmelancholia in the patients with the SL genotype). No relationship between the patients' profiles and CA repeat polymorphism was recognized. CA repeat polymorphism could thus be a potential biomarker to predict the efficacy of KBG in climacteric syndrome, and its use will help to reduce the cost of treating this syndrome by focusing the administration of KBG on those most likely to benefit from it. [ABSTRACT FROM AUTHOR]

Objectives. To identify the correlates of headaches in middle-aged women and investigate the effects of Tokishakuyakusan (TJ-23), a formula of traditional Japanese herbal therapy Kampo, on headache and concomitant depression. Methods. We examined crosssectionally the baseline records of 345 women aged 40-59 years who visited our menopause clinic. Among them, 37 women with headaches were treated with either hormone therapy (HT) or TJ-23; the data of these women were retrospectively analyzed to compare the effects of the treatment. Results. The women were classified into 4 groups on the basis of their headache frequency, and no significant intergroup differences were noted in the physical or lifestyle factors, except age. Multiple logistic regression analysis revealed that the significant contributors to the women's headaches were their age (adjusted OR 0.92 (95% CI 0.88-0.97)) and their depressive symptoms (adjusted OR 1.73 (95% CI 1.39-2.16)). Compared to women treated with HT, women treated with TJ-23 reported relief from headaches (65% versus 29%) and concomitant depression (60% versus 24%) more frequently. Improvement in the scores of headaches and depression correlated significantly with TJ-23 treatment. Conclusions. Headache in middle-aged women is significantly associated with depression; TJ-23 could be effective for treating both of these symptoms. [ABSTRACT FROM AUTHOR]

The present study aimed to investigate the influence of 10 activities on quality of life (QOL) in Japanese older adults and to verify which activities had higher influence on QOL level. The subjects were 465 Japanese community-dwelling older adults. QOL was assessed by the brief version of the World Health Organization Quality of Life (WHOQOL-BREF) and the complementary assessment to measure the QOL of older adults (WHOQOL-OLD) module. Activity and participation were measured through a questionnaire concerning frequency of engagement in several activities. The activity with the highest influence on WHOQOL-BREF was physical activity ( β = 0.209, p < 0.01), followed by art activity ( β = 0.169, p < 0.01) and reading and writing ( β = 0.141, p < 0.01). The activity with the highest influence on WHOQOL-OLD was social activity ( β = 0.222, p < 0.01), followed by reading and writing activity ( β = 0.118, p < 0.05). The limitations of this study were the proportion of subjects and the place of recruitment. Further studies investigating in deep the relation between QOL and activity and participation, and other subjective and environmental factors that may influence the QOL are still needed among a higher and homogeneous subjects sample. Copyright © 2012 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

We investigated the effects of purified eicosapentaenoic acid (EPA) on vascular endothelial function and free fatty acid composition in Japanese hyperlipidemic subjects. In subjects with hyperlipidemia (total cholesterol ⩾ 220 mg/dL and/or triglycerides ⩾ 150 mg/dL), lipid profile and forearm blood flow (FBF) during reactive hyperemia were determined before and 3 months after supplementation with 1800 mg/day EPA. Peak FBF during reactive hyperemia was lower in the hyperlipidemic group than the normolipidemic group. EPA supplementation did not change serum levels of total, HDL, or LDL cholesterol, apolipoproteins, remnant-like particle (RLP) cholesterol, RLP triglycerides, or malondialdehyde-modified LDL cholesterol. EPA supplementation did not change total free fatty acid levels in serum, but changed the fatty acid composition, with increased EPA and decreased linoleic acid, γ-linolenic acid, and dihomo-γ-linolenic acid. EPA supplementation recovered peak FBF after 3 months. Peak FBF recovery was correlated positively with EPA and EPA/arachidonic acid levels and correlated inversely with dihomo-γ-linolenic acid. EPA supplementation restores endothelium-dependent vasodilatation in hyperlipidemic patients despite having no effect on serumcholesterol and triglyceride patterns. These results suggest that EPA supplementationmay improve vascular function at least partly via changes in fatty acid composition. [ABSTRACT FROM AUTHOR]

Purpose. To determine the factors associated with the development of amacular hole (MH) after successful rhegmatogenous retinal detachment (RRD) surgery. Methods. Of 1260 eyes that underwent surgery for RRD between April 2005 and March 2010 in our hospital, the medical records of 4 cases from our hospital and one case from another hospital that had undergone RRD surgery and later developed MH were reviewed. This is a retrospective study. Results. 837 eyes underwent pars plana vitrectomy (PPV) with or without scleral buckling (SB), and 423 eyes underwent SB. The four cases that developed MH had PPV alone and one case had PPV with SB. After including the results of three earlier reports, the mean interval for the MH to develop after SB alone was significantly shorter than after PPV alone or after PPV with SB. Conclusions. The SB procedures might accelerate the development of MH after RRD surgery. [ABSTRACT FROM AUTHOR]

Takii M, Uchigata Y, Kishimoto J, Morita C, Hata T, Nozaki T, Kawai K, Iwamoto Y, Sudo N, Kubo C. The relationship between the age of onset of type 1 diabetes and the subsequent development of a severe eating disorder by female patients. Objectives: To determine the age of onset of type 1 diabetes that is most closely related to the subsequent development of a severe eating disorder such as anorexia nervosa (AN) or bulimia nervosa (BN). Methods: Participants were 53 female type 1 diabetes patients with AN or BN referred to our outpatient clinic from the Diabetes Center of Tokyo Women's Medical University. Forty-nine female type 1 diabetes patients who regularly visited the Diabetes Center and had no eating disorder-related problems constituted the 'direct control' group, whereas 941 female patients who for the first time visited the Diabetes Center constituted the 'historical control' group. The kernel function method was used to generate a density estimation of the onset age of each group and the chi-square test was used to compare the distribution. Results: The control groups had similar density shapes for the onset age of type 1 diabetes, but both differed from the 'eating disorder' group. For onset age 7-18 yr, the density of the 'eating disorder' group was higher than those of the control groups, but for the younger and older onset ages the densities were lower. The 'eating disorder' group developed type 1 diabetes significantly more frequently than the 'historical control' group between 7 and 18 yr of age (χ = 9.066, p < 0.011). Conclusion: The development of type 1 diabetes in preadolescence or adolescence seems to place girls at risk for the subsequent development of AN or BN. Careful attention should be paid to these high-risk patients. [ABSTRACT FROM AUTHOR]