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Background: Japanese EFL learners often fail to identify and categorise the different degrees of certainty associated with CERTAIN, PROBABLE, and POSSIBLE items. This computer‐mediated study evaluated the relative effects of animated versus static illustrations on stimulating the spatial concept of distance for the acquisition of this knowledge. Objectives: This study aimed to: (1) discover whether the spatial concept of distance captured by three‐dimensional (3D) images in animated or static illustrations help learners understand spatial relationships more clearly, and (2) whether a static illustration is sufficient for learning the different degrees of certainty. Method: Animated and static visualisation groups used 3D images of animated versus static illustrations that capture the spatial concept of distance, and a contrasting group did not use illustrations. The former applied the spatial concept of distance to learn the degrees of certainty, using animated or static illustrations. A spatial concept‐oriented approach that visualises concepts of distance enabled participants to understand the degrees of certainty. The contrasting approach involved rote learning of a list of target expressions for the different degrees of certainty in English. Results and Conclusions: Both the animated and static versions of the spatial concept‐oriented approaches were equally effective. The difference between the two versions did not significantly impact the overall performance of the groups. Takeaways: Regardless of the type of effect, the spatial concept of distance captured in words and illustrations helped the participants (1) process the different degrees of certainty cognitively in terms of distances and (2) retain them in long‐term memory. Lay Description: What is already known about this topic: Understanding our experiences in terms of metaphors based on spatially visualised concepts of the physical world leads to mapping the embodied concepts onto non‐embodied concepts and retaining these in long‐lasting memory.3D descriptions direct people's attention to the spatially visualised concepts, which influences people to internalise them with ease.The lack of consensus (in previous studies) on the effect of animated versus static versions of the metaphor awareness‐raising approach with either 2D or 3D images has some relevance to the cognitive theory of multimedia learning. What this paper adds: Computer‐generated 3D images were used to help participants in the metaphor‐based groups understand spatial relationships related to the degrees of certainty among certain, probable, and possible items.This study evaluated the relative effects of animated versus static illustrations on stimulating the spatial concept of distance for the acquisition of this knowledge.The animated and static version of the metaphor‐based approach groups outperformed those in the non‐metaphor‐based and control groups. Implications for practice and/or policy: It is necessary to consider all possible confounding variables and control for their effects when designing future animation versus static studies.Further analysis of the spatial concept‐oriented metaphor‐based approach from the perspectives of the cognitive theory of multimedia learning combined with cognitive linguistic theory would be beneficial for fellow researchers and teachers to gain insight into the nuances of the approach and expand its application in the EFL context. [ABSTRACT FROM AUTHOR]

Incorporating systematic evidence with clinical expertise is a key element in the quest to improve quality of care and patient outcomes. The evidence supporting skin‐to‐skin contact in the first hour after birth is robust and includes significantly improved outcomes for both mother and infant. This paper compares available iterative data about newborn behaviour in the first hour after birth to further describe the observable behaviour pattern and to provide clinical insight for further research. Although the evidence for positive outcomes through skin‐to‐skin contact are robust, there is a dearth of research specifically focused on clinical practice. The methodology considers the four available data sets that used Widström's 9 stages, which consists of studies from Japan, Sweden, Italy and the United States, examining the parameters of each stage across settings from around the world. This research provides an expanded understanding of the timing of the newborn's progression through Widström's 9 observable stages. We found that newborns in all four data sets began with a birth cry and continued through the remaining stages of relaxation, awakening, activity, rest, crawling, familiarization, suckling and sleeping during the first hours after birth and consolidated the data into a Sign of the Stages chart to assist in further research. The evidence supports making a safe space and time for this important newborn behaviour. Clinical practices should encourage and protect this sensitive period. [ABSTRACT FROM AUTHOR]

Objective: Two percent of the Japanese population is comprised of foreign residents with further increase expected due to immigration policy revisions. The purpose of this paper is to examine the healthcare needs and difficulties experienced by foreign residents in Japan by level of their Japanese language fluency. Design: A quantitative, descriptive design was used. Sample: We surveyed foreign residents in the greater Tokyo area (N = 209). Measurements: The research team created the survey questions and the contents of the survey include foreign residents' experiences during their visits or stays at medical and public health facilities in Japan. Results: More than 90% of the participants or their families visited medical facilities in Japan regardless of Japanese language fluency; however, those with less Japanese language fluency experienced statistically significant uneasiness or inconvenience concerning communication compared to those with native Japanese language fluency (p =.000). Conclusions: Nurses in Japan may benefit from additional training related to use of interpreters as well as education about diversity and cultural humility. Through better understanding of the specific communication barriers of foreign residents, nurses will be able to better anticipate difficulties and address them. [ABSTRACT FROM AUTHOR]

Aims and objectives: To identify the current state of knowledge about the use of the sit‐to‐stand intervention with older people and to identify implications for further research. Background: Many older people experience mobility challenges which can negatively affect their well‐being. Physical activities are vital to improving or maintaining mobility. Although there is evidence that mobility challenged older people benefit from the sit‐to‐stand intervention, there is a need to systematically examine the state of knowledge about this intervention. Design: Scoping review using Arksey and O'Malley's methodological framework. Methods: A systematic search of three databases was completed. Abstracts were evaluated for relevance using predetermined inclusion criteria. Studies that met the inclusion criteria had data extracted and were appraised for internal and external validity. Narrative synthesis was based on methods described by Popay and colleagues. Results: Of 3,041 papers, six studies met the inclusion criteria. Publications provided a range of sit‐to‐stand interventions with durations varying from four weeks to six months. The frequency of each intervention fluctuated from three to seven times/week with a duration of 15–45 min. Different professionals prompted the activity. Three themes were identified the following: (a) sit‐to‐stand activity as an intervention; (b) generalisability of findings; and (c) sustainability. Conclusions: Most of the studies reviewed indicated improvements in performance of the sit‐to‐stand activity and in motor function. However, issues with studies rigour do not allow us to make generalisations. Further research is needed to confirm the effectiveness of the intervention. Implications for practice: Healthcare providers are expected to offer evidence‐based patient care. This review details current knowledge about the sit‐to‐stand intervention with older people. [ABSTRACT FROM AUTHOR]

Abstract: Evidence supporting the practice of skin‐to‐skin contact and breastfeeding soon after birth points to physiologic, social, and psychological benefits for both mother and baby. The 2009 revision of Step 4 of the WHO/UNICEF “Ten Steps to Successful Breastfeeding” elaborated on the practice of skin‐to‐skin contact between the mother and her newly born baby indicating that the practice should be “immediate” and “without separation” unless documented medically justifiable reasons for delayed contact or interruption exist. While in immediate, continuous, uninterrupted skin‐to‐skin contact with mother in the first hour after birth, babies progress through 9 instinctive, complex, distinct, and observable stages including self‐attachment and suckling. However, the most recent Cochrane review of early skin‐to‐skin contact cites inconsistencies in the practice; the authors found “inadequate evidence with respect to details … such as timing of initiation and dose.” This paper introduces a novel algorithm to analyse the practice of skin to skin in the first hour using two data sets and suggests opportunities for practice improvement. The algorithm considers the mother's Robson criteria, skin‐to‐skin experience, and Widström's 9 Stages. Using data from vaginal births in Japan and caesarean births in Australia, the algorithm utilizes data in a new way to highlight challenges to best practice. The use of a tool to analyse the implementation of skin‐to‐skin care in the first hour after birth illuminates the successes, barriers, and opportunities for improvement to achieving the standard of care for babies. Future application should involve more diverse facilities and Robson's classifications. [ABSTRACT FROM AUTHOR]

Purpose: Despite the importance of research in the discipline of nursing, current trends in nursing research have rarely been discussed across countries. The purpose of this article was to identify current trends in nursing research across five countries, including the United States, South Korea, Taiwan, Japan, and Hong Kong, in order to provide directions for future global nursing research. Organizing Construct: A discussion article. Methods: To identify the current trends, seven leaders from the five countries had discussions through a series of workshops and conference presentations. After the most recent conference, all the leaders reflected for a month on their presentations and compiled the exemplars and cases from their experience and the existing literature in individual countries into a table. The tables and supporting references were collected at the completion of the reflection period. Then, the PowerPoint (Microsoft Corporation, Redmond, WA, USA) slideshows of the conference presentations by the leaders and the collected tables were analyzed using a content analysis. Findings: Six themes reflecting the current trends in nursing research were extracted: (a) demographic alterations; (b) increasing diversities and globalization; (c) technology innovation; (d) individualized or personal care and population health initiatives; (e) health policies and regulations; and (f) nursing workforce changes. Conclusions: Future directions for nursing research across the countries were proposed: (a) cost‐effectiveness research; (b) implementation science; (c) data science; (d) training of the future generation of nurse researchers; (e) population health; and (f) team science. Clinical Relevance: This topic could be applied to any clinical settings. [ABSTRACT FROM AUTHOR]

The present study examined the processes by which children acquire pro-environmental behaviours in different cultures. Our focus was on parental influence. Several studies have been conducted on adults' environmental behaviours; however, we know little about how children's environmental attitudes and behaviours are formed. We conducted a questionnaire survey with elementary school children and one of their parents in Germany and Japan. Two hundred and twenty-one pairs participated in Germany and 365 in Japan. The results of structural equation modelling showed that parents' behaviours affected children's environmental behaviours directly and also via the subjective norm (the children's experienced expectations of their parents). A comparison of the two countries revealed that hypothesized cultural differences between the impact of personal norms and subjective norms were clearer for adults. The results also showed that the effects of subjective norms were stronger for children, indicating that children are more likely to be influenced by expectations of others. The results of the study suggest that for promoting children's environmental behaviours, showing the behaviours in daily life would be most effective. [ABSTRACT FROM AUTHOR]

Aim: The paper examines recent time trends, explores potentially influential background factors and discusses prevention strategies of pregnancy among girls under 15 years of age in Japan. Methods: Using Japanese government data, we first analyzed time trends of early adolescence (<15 years of age) abortion, live birth and child sexual abuse from 2003 to 2010. Second, we analyzed ecological correlations of early adolescent pregnancy (abortion, live birth and stillbirth) with pregnancy in other age groups, child sexual abuse, and indicators of juvenile victimization and juvenile delinquency, using prefectural data. Results: We found that rates of both abortion and live birth in early adolescents have increased since 2005 (annual percent change 5.3% and 2.3%, respectively), despite declining rates in older age groups. The abortion ratio in early adolescence remained the highest among all age groups in Japan. The early adolescent pregnancy rate showed significant correlation with the rates of juvenile victimization of welfare crimes (obscenity, alcohol drinking, smoking and drug use) ( Spearman's rank correlation coefficient [rs] = 0.42, P = 0.00) and juvenile delinquency among junior high school students (12-14 years of age) (rs = 0.69, P = 0.00). Conclusion: The observed rise in rates of abortion, live birth and child sexual abuse among early adolescents along with strong ecological correlations of their pregnancy rate with juvenile victimization and delinquency indicators suggests that epidemiological investigation and public health programs at the individual and community levels are needed to address the complex social roots of these trends and to produce effective improvements in early adolescent reproductive health. [ABSTRACT FROM AUTHOR]

OBJECTIVES: PPARg regulates bone metabolism and inflammation. Our previous study suggested PPARg Pro12Ala polymorphism to represent a susceptibility factor for periodontitis in pregnant Japanese women. Several recent papers have drawn attention to a possible link between low bone mineral density (BMD) and periodontitis in postmenopausal women. Since the pathogenesis for both involve bone remodeling, they might share common risk factors such as gene polymorphisms and vitamin D level. The present study investigated possible associations between the PPARgPro12Ala polymorphism, periodontitis, BMD and serum 25(OH)D in postmenopausal Japanese women. MATERIALS AND METHODS: PPARgPro12Ala genotypes of 359 women were determined by PCR-RFLP. BMD and periodontal parameters of each woman were measured. Serum 25(OH)D levels were determined by radioimmunoassay. RESULTS: PPARgPro12Ala polymorphism was not associated with periodontitis or BMD as an independent factor. Serum 25(OH)D was significantly higher in Ala allele carriers compared to non-carriers. Only in the Ala allele carriers, positive correlations were found between mean clinical attachment level and BMD, between BMD and 25(OH)D, and between percentage of sites with probing depth ≥ 4 mm and 25(OH)D. CONCLUSIONS: PPARgPro12Ala polymorphism was not independently associated with perioclontitis or BMD. However, the polymorphism might be a modulator of the relationship between the two conditions in postmenopausal Japanese women. [ABSTRACT FROM AUTHOR]

Aim: To describe factors affecting critical appraisal of research articles in evidence‐based practice by certified nurse specialists who were advanced practice nurses in Japan. Design: A descriptive qualitative study. Methods: Fourteen certified nurse specialists with master's degree were included by a snowball sampling to maximize the variety of specialty fields for advanced practice nurses in Japan. Individual semi‐structured interviews were conducted between November 2016 and March 2017. Interview guides included the experience of evidence‐based practice and learning about critical appraisal. Results: The following four aspects were identified as factors affecting the critical appraisal of research articles in evidence‐based practices—individual beliefs and attitude, learning status, organizational readiness and availability of research evidence. Each factor included both positive and negative aspects for critical appraisal in evidence‐based practice. Patient or Public Contribution: If advanced practice nurses acquire knowledge/skills of critical appraisal, they would be able to select more appropriate care. This will increase to improve the health‐related outcome for patients or populations. [ABSTRACT FROM AUTHOR]

Objective: This meta‐analysis aimed to determine the effect of mindfulness interventions on nurses' levels of depression and anxiety. Design: Meta‐analysis of randomised controlled trials. Methods: The following Chinese and English databases were searched: PubMed, Embase, Cochrane Library, Web of Science, and China National Knowledge Internet (CNKI). The retrieval period was from database construction to 30 March 2022. Two researchers screened the relevant literature and extracted the data. After a cross‐check, data were input into Stata version 16.0 for meta‐analysis. Results: Twelve randomised controlled trials from 2017 to 2021 were included, which involved 807 subjects (405 and 402 in the intervention and control groups, respectively). Meta‐analysis results showed that nurses' anxiety reduced by mindfulness‐based interventions was significantly higher compared to that of the control group (SMD = 0.91, 95% CI: 0.27–1.55, p < 0.05). Furthermore, an 8‐week mindfulness‐based intervention (SMD = 1.43, 95% CI: 0.61–2.24) reduced the level of anxiety significantly more compared to a 4‐week intervention (SMD = 1.03, 95% CI: 0.36–1.71). Mindfulness‐based interventions were better compared to conventional intervention to reduce the level of depression (SMD = 1.02, 95% CI: 0.42–1.61, p < 0.05), and an 8‐week mindfulness intervention (SMD = 1.81, 95% CI: 0.78–2.84) reduced the level of depression significantly more compared to a 4‐week intervention (SMD = 0.82, 95% CI: 0.29–1.35). Since limited studies had interventions longer than 8 weeks, results on longer mindfulness interventions in reducing nurses' anxiety and depression are inconclusive. In conclusion, mindfulness intervention for 8 weeks or less can significantly reduce nurses' anxiety and depression levels. Patient or Public Contribution: None. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to develop and assess the validity and reliability of the Care Transitions Scale for Patients with Heart Failure (CTS‐HF) as a nurse‐reported measure for evaluating patients' readiness for hospital discharge. Methods: We conducted a cross‐sectional study of cardiovascular ward nurses from 163 hospitals across Japan. Structural validity was assessed using exploratory factor analysis with development participants and confirmatory factor analysis with validation participants. Convergent validity was assessed by correlation with the Discharge Planning of Ward Nurses scale (DPWN). Hypotheses testing for construct validity was performed as comparisons between subgroups of transitional care practice. Results: Valid responses were obtained from 704 nurses (development participants, n = 352; validation participants, n = 352). The final scale comprised 21 items divided into six factors: "Clear preparation for how to manage health at home," "Adjusting to home care/support system," "Transitions of medication management from hospital to home," "Dealing with patients' concerns and questions," "Transitions of disease management from hospital to home," and "Family support." Indices of fit supported these results (comparative fit index = 0.944, root mean square error of approximation = 0.057). The CTS‐HF was significantly correlated with the DPWN. The nurses' subgroup with higher transitional care practice had higher CTS‐HF scores. Cronbach's alpha was.93 for the CTS‐HF. Conclusions: The CTS‐HF showed sufficient reliability and validity for use in evaluating discharge care. Further studies are needed regarding the usefulness of this scale in nursing practice. [ABSTRACT FROM AUTHOR]

Aim: Work performance of nurses is a critical aspect that concerns the safety of both nurses and patients, but also secondarily influences nurses' turnover due to serious fatigue and burnout. Monitoring nursing performance as well as fatigue is important for appropriate safety management of patients and nurses, and the development of a monitoring tool is essential. The Nursing Performance Instrument (NPI) can provide comprehensive and brief monitoring of nursing performance. This study aimed to verify the validity and reliability of a Japanese version of the NPI (NPI‐J). Methods: A cross‐sectional study was conducted on nurses who work in inpatient care across five Japanese hospitals. We considered appropriate factor numbers with parallel analysis and the Velicer's minimum average partial test. The construct validity was evaluated using exploratory factor analysis, confirmatory factor analysis (CFA), and Pearson's correlation analysis. Cronbach's alpha was calculated for the internal consistency. Results: A three‐factor model eventually showed acceptable fit indices in the CFA. Moreover, the correlation results among the three factors indicated discriminant validity comparable to the original NPI. The correlation results with acute fatigue, chronic fatigue, and burnout verified convergent validity. Internal consistency was insufficient. Conclusion: The NPI‐J demonstrated acceptable construct validity. This instrument can assess nurses' perceptions of their performance by measuring each item. Future work on the reliability of the sub‐concepts will require additional items or reliability testing based on generalizability theory and item response theory. [ABSTRACT FROM AUTHOR]

Over the last decade, the importance of Advanced Care Planning has been recognized in Japan. However, it is still difficult for healthcare providers and patients to verbalize how they want to spend the last days of their lives and what unfinished business they have left to accomplish. This study aimed to clarify how nurses intervened to assist patients with cancer at the end of life to express their thoughts and concerns. Twenty‐four nurses were interviewed regarding how they intervened for patients' thoughts and concerns, and data were analyzed qualitatively using a modified grounded theory approach. A 25‐item scale was selected, and the questionnaires, which included the scale, were distributed to nurses in general wards, palliative care units, and home visiting nurse services. A total of 1864 responses were analyzed. Factor analysis and structural equation model analysis were used, and three factors were identified: "assessment and intervention," "basic care," and "knowledge and communication," which led to the formulation of an intervention structure model for uncovering thoughts and concerns. These results indicate the importance of basic care and communication during interventions for patients. [ABSTRACT FROM AUTHOR]

Introduction: Although many studies have investigated the relationship between patient outcomes and the level of nurse staffing, little is known about the association between increased night‐shift nurse staffing and patient outcomes. In the Japanese universal health insurance system, a new scheme of additional financial incentives for acute care hospitals was launched in 2012 to increase the number of nurses during the night shift in general wards. The objective of this study was to investigate whether an additional financial incentive to increase night‐shift nurse staffing in general wards was associated with better patient outcomes. Design: Adoption of the above‐mentioned scheme of additional financial incentives was used as a natural experiment, and the difference‐in‐differences method was conducted to evaluate the effect of the scheme. The study was performed using a nationwide inpatient database and hospital information in Japan. Methods: To conduct a difference‐in‐differences analysis, first, hospitals with and without increased night‐shift nurse staffing were matched using propensity score matching. A patient‐level difference‐in‐differences analysis was then conducted. The intervention group comprised the hospitals that adopted the new scheme of additional financial incentives. The outcome measures were in‐hospital mortality, failure to rescue, and length of hospital stay. Results: Subjects were 403,971 adult patients who underwent planned major surgeries in Japanese acute care hospitals from April 2012 to March 2018. The adjusted difference‐in‐differences estimates were not significant for in‐hospital mortality (odds ratio: 0.83; 95% confidence interval: 0.68 to 1.01; p = 0.07) or failure to rescue (odds ratio: 0.92; 95% confidence interval: 0.73 to 1.14; p = 0.44). The adjusted difference‐in‐differences estimate for length of hospital stay was significant (percent change: −3.2%; 95% confidence interval: −6.1 to −0.3%; p = 0.029), indicating that the adoption of the scheme was associated with a decreased length of hospital stay. Conclusions: Increased night‐shift nurse staffing was not associated with a decrease in in‐hospital mortality or failure to rescue, but it was associated with a reduction in the length of hospital stay. It may be necessary to consider changes in policy content to make the policy more effective. The findings of this study are potentially useful for medical policymakers considering nurse staffing to decrease the length of stay, which may decrease costs. Clinical relevance: This study showed that increased night‐shift nurse staffing was not associated with a decrease in in‐hospital mortality or failure to rescue, but it was associated with a reduction in the length of hospital stay. The examination of the effectiveness of increasing nurse staffing during a specific shift in acute care hospitals is potentially useful for health policymakers worldwide in their considerations of future nurse staffing policies. [ABSTRACT FROM AUTHOR]

Background: The RASopathies (Noonan syndrome [NS] and Costello syndrome [CS]) are rare disorders. Although these have been characterized, precise delineation of the differences in the spinal deformities associated with RASopathy has not been described. This study characterized the spinal deformities found in NS and CS and describes a strategy for the screening of scoliosis. Methods: The clinical records and spinal X‐rays of 35 consecutive NS and CS patients were reviewed. Spinal X‐rays were assessed to define the presence and progression of scoliosis. Clinical records were examined to identify the risk factors associated with scoliosis. In addition, we investigated the association between clinical records and scoliosis using logistic regression analysis. Results: Twenty‐four patients with NS and 11 with CS were included. Nine patients with NS and five with CS showed scoliosis. The mean ± SD age at diagnosis was 12.6 ± 2.4 years in NS and 11.4 ± 2.5 years in CS (p = 0.55), and mean follow‐up period was 4.8 ± 2.6 years and 6.3 ± 2.4 years (p = 0.42), respectively. The coronal angular deformity at final follow‐up was 27.3 ± 8.5° in NS and 19.4 ± 6.9° in CS (p = 0.030) with a mean annual progression of 2.8 ± 1.1° in NS 1.0 ± 1.0° in CS (p = 0.030). Cardiac disease was present in eight out of nine patients with NS with concomitant scoliosis in NS, and significantly more than in CS (p = 0.007). PTPN11 significantly correlated with scoliosis (odds ratio 12.4 0.035, 95% confidence interval: 1.20–128.00). Conclusions: Spinal deformity in NS is more severe than in CS. This study identified a relationship between PTPN11 and scoliosis. Therefore, PTPN11 can be used for the screening of scoliosis. [ABSTRACT FROM AUTHOR]

Background: Patients in intensive care units (ICU) are frequently prescribed sedatives, which might increase the risk for pressure injury (PI). Although the association between sedation and incidence of PI has been noted, the adequate sedation level to prevent the incidence of PI in patients admitted to ICU is still unclear. Aim: This study aimed to investigate the association between fluctuating sedation levels and the incidence of PI in patients admitted to ICU. Study Design: We retrospectively reviewed the medical records of 104 patients admitted to ICU. Data regarding the length of ICU stay (LOS) and comorbid infection were abstracted from medical records. The Richmond Agitation‐Sedation Scale (RASS) was scored twice per day, and the standardized RASS (S‐RASS, summation of RASS values divided by the number of samples) was used to evaluate changes in sedation levels. Results: Among the 104 included patients, 65 patients (62.5%) were male (median age: 68.0 years), and 13 patients (12.5%) had PI during ICU admission. S‐RASS scores were lower in patients with PI than in those without PI (P =.0001) even after adjustment for confounders (OR [95%CI]: 0.14 [0.03–0.58], P =.006). The LOS and infections were higher in patients with PI than in those without PI (P <.0001 and P =.005, respectively). The cut‐off value of S‐RASS for PI incidence was −3.2 (sensitivity: 88%; specificity: 85%), and a significant predictor of PI incidence (HR [95%CI]: 20.07 [2.53–159.11], P =.005). Conclusions: Deeper sedation levels based on S‐RASS scores, which account for the effects of fluctuating sedation levels, were a strong, highly accurate predictor of PI incidence in patients admitted to ICU. Relevance to Clinical Practice: Assessing fluctuations in the level of sedation using the S‐RASS might help to identify sedative‐induced PI in patients admitted to ICU. [ABSTRACT FROM AUTHOR]

Objectives: Effective daily oral hygiene behaviour will prevent periodontal disease. This study aimed to examine the oral symptoms, oral hygiene behaviours and factors contributing to oral hygiene behaviours among patients with type 2 diabetes in a hospital in Japan. Methods: A cross‐sectional survey was conducted with 198 patients with type 2 diabetes. Oral symptoms were assessed using a dichotomous scale based on clinical guidelines. Oral hygiene behaviours were assessed based on the frequency of daily tooth brushing and the use of interdental cleaning aids. Chi‐square tests and logistic regression analyses were also performed. Results: Overall, 71.2% of the participants had oral symptoms. Of the participants, 80.3% performed twice daily tooth brushing and 61.1% did not perform interdental cleaning on a daily basis. Logistic regression analysis revealed that tooth brushing behaviour was negatively associated with male patients (odds ratio [OR] = 0.45, 95% confidence interval [CI]: 0.25–0.80), difficulty with mastication (OR = 0.63, CI: 0.43–0.92) and tooth loss (OR = 0.68, CI: 0.46–1.00) and positively associated with periodontal disease (OR = 1.73, CI: 1.10–2.72). There were no significant variables related to the use of interdental cleaning aids. Conclusions: Patients need to learn about the necessity for regular oral hygiene behaviours and the appropriate way. In particular, support for male patients, those who have difficulty with mastication, those who have experienced natural tooth loss, and those who have not been diagnosed with periodontal disease are needed. [ABSTRACT FROM AUTHOR]

Aim: Hiesho is a condition characterized by having a cold sensation in the hands or feet (i.e., sensitivity of the hands or feet to cold). This condition is common among Japanese women and is an important health problem. In this study, we aimed to evaluate a hiesho intervention program for nurses called "Preventing Hiesho: Intervention Program for Educating Nurses" in terms of its effectiveness in improving the knowledge and perceptions of nurses about the importance of hiesho care. Methods: A total of 130 nurses from Japanese hospitals and clinics providing prenatal care participated in our randomized controlled trial. Sixty‐eight nurses participated in the "Preventing Hiesho: Intervention Program for Educating Nurses" for 2 weeks (intervention group). Sixty‐two nurses received a pamphlet on hiesho care (control group). The responses of the participants to the questionnaire survey were collected by postal mail. An intention‐to‐treat analysis of the results was conducted. Results: One week after the implementation of the web‐based learning program, the scores of knowledge and perceptions of the importance of administering hiesho care were significantly higher in the intervention group than in the control group. Conclusions: A 2‐week web‐based learning program for educating nurses on preventing hiesho significantly improved their knowledge and perceptions of the importance of hiesho care. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to evaluate whether nurse‐initiated sedation management could provide more appropriate sedation compared to usual care in a Japanese intensive care unit (ICU). Methods: We conducted a single‐center, prospective observational study before and after implementing nurse‐initiated sedation using instruction sheets. Patients who had been admitted to a general adult ICU were enrolled. Before our ICU started nurse‐initiated sedation (pre‐implementation care), adjustment of sedatives and analgesics was performed only by a physician's written or verbal order; however, after implementing nurse‐initiated sedation, nurses titrated drugs using instruction sheets. The primary outcome was the efficacy of nurse‐initiated sedation, evaluated by the proportion achieving the target Richmond Agitation‐Sedation Scale (RASS) score. The analgesic status evaluated by Critical‐Care Pain Observation Tool (CPOT), days of delirium, ventilator days, ICU mortality and hospital mortality were also evaluated. Results: The study examined 30 patients in the pre‐implementation care phase and 30 patients in the nurse‐initiated sedation phase. The proportions achieving the target RASS were 68% in the nurse‐initiated sedation group and 42% in the pre‐implementation care group (mean difference, 25%; 95% confidence interval, 13.4%–37.5%; P <.001). Almost all measured CPOT were within the range of 0–3 during both phases. Days of delirium, ventilator days, ICU survival, and hospital survival did not differ significantly between the two groups. Conclusions: Nurse‐initiated sedation management achieved a significantly higher degree of target sedation status and was incorporated as part of the care in our ICU. It is a safe approach in countries, such as Japan, where sedation protocols are not widely used. [ABSTRACT FROM AUTHOR]

Background and purpose: Social engagement is an important active aging strategy to promote older adults' mental health. The purposes of this study were to compare social engagement in older populations around the world and explore associations with mental health outcomes. Materials and methods: An international cross‐sectional survey was conducted from 2017 to 2019. Data were retrieved from The International Social Survey Programme for a secondary data analysis across 30 countries. This study applied the Taxonomy of Social Activities and its six levels as operational definitions for a consistent concept of social engagement for international comparisons. Results: In total, 9403 older adults with a mean age of 72.85 ± 6.40 years responded. The highest levels of older adults' social engagement were found in Switzerland, Thailand, and New Zealand. Older adults of a higher age, with a lower educational level, who were permanently sick or disabled, who had no partner, who were widowed or whose civil partner had died, who lived alone, and who had lower self‐placement in society had significantly lower social engagement than did their counterparts. In the regression model, older adults' social engagement positively predicted general health, self‐accomplishment, and life satisfaction, but negatively predicted loneliness and depression. Conclusions: In aging societies worldwide, encouraging older adults' social engagement would be beneficial to promote mental health. Implications for nursing practice and health policies: Community professional nurses can develop strategies of social engagement based on the needs and sociodemographic factors of older adults to improve their mental health. Developing efficient strategies and local policies by learning from successful experiences in other countries is important to promote social engagement in aging societies. [ABSTRACT FROM AUTHOR]

Despite increasing research into connections between adverse childhood experiences (ACEs) and health problems, the impact of parental ACEs on parenting practices has not been sufficiently clear. The objective of the study was to consider whether the association between maternal ACEs and child maltreatment is affected by three mediating factors: socio‐economic status (SES), social support and maternal psychological distress in adulthood. The Kochi Child Health Impact of Living Difficulty (K‐CHILD) study (2016) provided the data for this study. Mothers who had children in the first, fifth, eighth and eleventh grade and who lived in the Kochi Prefecture of Japan participated. A pool of 11,954 completed child and caregiver questionnaires was used for analysis. We found that a large number of maternal ACEs was connected to higher risk of physical abuse, psychological abuse and neglect. Maternal psychological distress had the greatest mediating effect. Maternal ACEs can be a risk factor for maltreatment of children. This study suggests that care for mothers with psychological distress will be a key intervention to break the cycle of childhood adversity. [ABSTRACT FROM AUTHOR]

Aim: To explore the unclear association between temporary discharge home from the palliative care unit and achievement of good death, in the background of increases in discharge from the palliative care unit. Association between experiences and circumstances of patient and family and duration of temporary discharge was also examined. Methods: This study was a secondary analysis of data from a nationwide post‐bereavement survey. Results: Among 571 patients, 16% experienced temporary discharge home from the palliative care unit. The total good death inventory score (p <.05) and sum of 10 core attributes (p <.05) were significantly higher in the temporarily discharged and stayed home ≥2 weeks group. Among all attributes, "Independent in daily activities" (p <.001) was significantly better in the temporarily discharged and stayed home ≥2 weeks group. Regarding the experience and circumstance of patient and family, improvement of patient's appetite (p <.05), and sleep (p <.05) and peacefulness (p <.05) of family caregivers, compared to the patient being hospitalized, were associated with longer stay at home after discharge. Conclusions: Patient's achievement of good death was better in the temporarily discharged and stayed home longer group, but this seemed to be affected by high levels of independence of the patient. Temporary discharge from the palliative care unit and staying home longer was associated with improvement of appetite of patients and better sleep and mental health status of family caregivers. Discharging home from palliative care unit is worth being considered even if it is temporary. [ABSTRACT FROM AUTHOR]

Aim: Previous studies have reported high prevalence of depression and anxiety symptoms among frontline nurses caring for COVID‐19 patients. Yet, only a limited number of prospective studies examining nurses' mental health problems have been performed. The present study aimed to examine depressive symptoms and COVID‐19‐related stresses among nurses working specifically in a hospital COVID unit over a 7‐month period. Methods: In this study, depressive symptoms and COVID‐19‐related stresses of a total of 28 nurses who worked in the COVID unit were assessed using the Quick Inventory of Depressive Symptom (QIDS) and the Tokyo Metropolitan Distress Scale for Pandemic (TMDP) over the 7‐month period from December 2020 to June 2021. Results: The mean QIDS scores in all participants fluctuated during the study period, showing a high correlation with the reported number of new COVID‐19 cases in the region. The mean TMDP scores showed a gradual decline over the period. Scores on the social stress factor of the TMDP demonstrated a statistically significant correlation with the QIDS scores. Conclusions: The results indicate that the number of new COVID‐19 patients in the region is associated with depressive symptoms among nurses in the hospital COVID unit. Scores on the social stress factor in the TMDP are also correlated with depressive symptoms among nurses. [ABSTRACT FROM AUTHOR]

Background: Direct oral anticoagulants (DOACs) have been used for both primary and secondary prevention of cerebral infarction in older patients with atrial fibrillation (AF). However, whether DOACs are more effective and safer than warfarin for secondary prevention of cerebral infarction in older patients with AF remains unclear. Methods: Using the Japanese Diagnosis Procedure Combination database, we identified patients with AF who were hospitalized for cerebral infarction from January 1, 2015 to March 31, 2019 and were aged ≥75 years at admission. We performed propensity score‐stabilized inverse probability of treatment weighting analyses to balance measured confounders between patients with AF receiving DOACs and those receiving warfarin after discharge. The primary outcomes were 365‐day readmission for (a) benefit: cerebral infarction or (b) harm: bleeding events after discharge. The secondary outcomes were 365‐day readmission for intracranial bleeding or gastrointestinal bleeding after discharge as well as all‐cause death during readmission. Using a Fine–Gray model, we compared the subdistribution hazard ratios (SHRs) of readmission between the DOAC group and warfarin group. Results: We identified 101,389 eligible patients, including 80,726 patients receiving DOACs and 20,663 patients receiving warfarin. After the propensity score‐stabilized inverse probability of treatment weighting, the adjusted SHRs of readmission (95% confidence interval [CI]) for cerebral infarction, bleeding events, and intracranial bleeding in the DOAC group as compared with the warfarin group were 0.76 (0.71–0.81), 0.78 (0.68–0.90), and 0.69 (0.57–0.82), respectively. There was no significant difference in readmission for gastrointestinal bleeding (SHR, 1.01; 95% CI, 0.72–1.41) between the DOAC and warfarin groups. Conclusion: In this retrospective nationwide study, DOACs were more effective and safer than warfarin for preventing reinfarction and bleeding events in patients with AF aged ≥75 years who have a history of cerebral infarction. [ABSTRACT FROM AUTHOR]

Affective styles are assumed to play an important role in maintaining negative affect, including anxiety and depression. However, little is known about the longitudinal relationship between affective styles and symptoms. Therefore, we conducted a longitudinal study to examine the influence of affective styles, assessed using the Affective Style Questionnaire, on anxiety and depression among clinical populations in Japan. Using an online survey, 1521 participants (406 with major depressive disorder; 479 with one or more anxiety disorders; and 636 with both) answered the Affective Style Questionnaire and measures of emotion regulation, anxiety and depression symptoms. Data were collected twice over 2 months. Confirmatory factor analyses replicated the same four‐factor structure found in a previous sample of Japanese university students. Hierarchical regression analyses revealed that the affective styles had a slightly greater effect on anxiety symptoms but not on depression compared to other common emotion regulation strategies, such as suppression and reappraisal measured by the Emotion Regulation Questionnaire (ERQ). Limitations of this study were that it used online surveys, in which, participants' diagnostic statuses were based on unverifiable self‐reports. In conclusion, the association of affective styles with anxiety and depression among the clinical populations was prospectively confirmed. Further study is needed to examine the association considering the combination or profiles of affective styles among different emotional disorders. [ABSTRACT FROM AUTHOR]

Aim: This study examined the maternal experience of threatened abortion, threatened premature labor, or preterm birth before, during, and after the first state of emergency for COVID‐19 in 2020 in Japan. Methods: This was a cross‐sectional, internet‐based questionnaire survey. We recruited 600 postpartum women and divided them into three groups by date of delivery: before (October 2019–March 2020), during (April–May 2020), and after (June–October 2020) the first state of emergency. The outcome was the presence of at least one of the following complications: threatened abortion, threatened premature labor, and/or preterm birth. The prevalence ratios (PRs) of the outcome were calculated and compared among the three groups using a multivariable Poisson regression model with adjustment for potential confounders. Results: Of the 553 women eligible for analysis, those who delivered during (PR 0.69, 95% confidence interval [CI] 0.47–0.99) and after (PR 0.62, 95% CI 0.42–0.90) the state of emergency were less likely to have experienced either threatened abortion, threatened premature labor, or preterm birth than those who delivered before the state of emergency. Among the adjustment variables, smoking at the time of survey (PR 1.68, 95% CI 1.01–2.80) and living in the prefectures with a population of >5 million (PR 0.71, 95% CI 0.51–0.97) were associated with the study outcome. Conclusion: Threatened abortion, threatened premature labor, or preterm birth appeared to decrease during and after the first state of emergency in 2020. The longitudinal effects of coronavirus disease on maternal and newborn health should be monitored continuously. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to explore mentoring competence in nursing student mentors during clinical practice by identifying different mentor profiles and connections between different competence areas among five European countries and Japan. Methods: The study implemented a cross‐sectional design in Finland, Italy, Lithuania, Slovenia, Spain, and Japan during 2016 and 2019. In total, 6208 mentors were invited, and 1862 participated from 58 healthcare organizations. The data were collected with a survey questionnaire by including background question items with the Mentor Competence Instrument. K‐clustering and structural equation modeling were used for data analysis. Results: Four mentor profiles, A (43%), B (30%), C (18%), and D (9%), were identified according to the seven mentoring competence areas with high statistical significance (p < 0.001). Higher mentoring competence (mean >3.50) was observed among Finnish, Lithuanian, and Slovenian mentors with university education in nursing, older ages, more work experience, and previous education in mentoring. Lower competence (mean <2.49) was observed among Japanese and Italian mentors with diplomas in nursing, younger ages, less work experience, and no previous education in mentoring. Conclusion: Mentoring requires motivated, highly competent mentors since mentoring is a critical aspect of nursing education. Mentoring roles should be given to nurses with higher education and mentoring training. Younger, less experienced nurses without formal mentoring training may need support from senior nurses when performing mentoring roles and could also facilitate a more balanced workload between patient care and mentoring for senior nurses. [ABSTRACT FROM AUTHOR]

This study examined the association between adding nurse aides and patient mortality in acute care settings. We conducted a retrospective cohort study using a national healthcare administrative claims database. We identified patients who underwent planned surgery for six types of cancer from 2010 to 2017. Multivariable logistic analyses were used to examine the association between the nurse aide staffing level and patient outcomes. The primary outcomes were failure to rescue and 30‐day hospital mortality. We examined 330 666 in‐hospital patients. The median number of nurse aides per 100 occupied beds was 6.60 (interquartile range, 4.61–8.43). In the multivariable analysis, nurse aide staffing level was not significantly associated with failure to rescue or 30‐day hospital mortality. The Japanese government provides economic incentives to hospitals that hire more nurse aides, expecting that a higher nurse aide staffing level will help licensed nurses concentrate on the tasks that need their specialties. However, our findings suggest that adding nurse aides may not be associated with lower rates of failure to rescue or 30‐day hospital mortality in acute care settings. [ABSTRACT FROM AUTHOR]

Aim: To investigate how nursing faculties' perceived time devoted to research changed during the first wave of the pandemic in Japan (April–June 2020) compared to pre‐pandemic. Methods: This cross‐sectional study was conducted online from July 1 to August 10, 2020 and involved 1,023 nursing faculties in Japan. Participants were asked to respond to a questionnaire based on their experiences from April to June 2020. We calculated descriptive statistics for several measures and examined associations between professional/personal demographic factors and declines in overall research time. Results: Of the 1,023 participants, 71.1% were spending less time on overall research activity; 79.6% spent less time attending academic events/conferences, and 77.4% spent less time conducting experiments/surveys. In contrast, 81.2% spent more time teaching, a much greater proportion than the global scientific community in a previous survey. As for work time allocation during the pandemic, teaching was by far the one activity that participants spent the most time on. Logistic regression analysis revealed that declines in overall research time were associated with several professional demographic factors, such as type of university, current academic position, and acquisition status of Japan's major research grant (KAKENHI) (all p <.05). Conclusions: Nursing faculties in Japan clearly spent less time on research, and more time on teaching during the first wave of the pandemic compared to pre‐pandemic. The initial impact of the pandemic on nursing faculties revealed through this study is an eye‐opener and a start for addressing the long‐term impact on the nursing scientific community. [ABSTRACT FROM AUTHOR]

Objectives Coffee, green tea, and caffeine are potential preventive factors for dementia, but the underlying evidence is insufficient. This study aimed to examine associations between the consumption of coffee, green tea, and caffeine and dementia risk in middle‐aged and older people. Methods: This was a cohort study with an 8.0‐year follow‐up. Participants were community‐dwelling individuals (n = 13,757) aged 40–74 years. A self‐administered questionnaire survey was conducted in 2011–2013. Predictors were the consumption of coffee/green tea, from which caffeine consumption was estimated. The outcome was incident dementia obtained from the long‐term care insurance database. Covariates were demographic factors, body mass index, physical activity, energy, smoking, drinking, and disease history. Adjusted hazard ratios (HRs) were calculated using Cox proportional hazards models. HRs were also calculated using a Cox model with delayed entry. Results: The number of dementia cases during the study period was 309. Participants with higher coffee consumption had lower HRs (adjusted p for trend = 0.0014), with the fifth quintile (≥326 ml/day) having a significantly lower HR (0.49, 95% confidence interval [CI]: 0.30–0.79) than the first quintile (<26 ml/day, reference). Similarly, participants with higher caffeine consumption had a significantly lower HR (adjusted p for trend = 0.0004) than the reference. The Cox model with delayed entry yielded similar results. These associations were significant in men, but not in women. Moreover, participants who consumed 2–2.9 cups/day and ≥3 cups/day of coffee had lower HRs (0.69, 95% CI: 0.48–0.98 and 0.53, 95% CI: 0.31–0.89, respectively) than those who consumed 0 cup/day. The association between green tea consumption and reduced dementia risk was significant (adjusted p for trend = 0.0146) only in the 60–69 years age subgroup. Conclusions: High levels of coffee and caffeine consumption were significantly associated with a reduced dementia risk in a dose‐dependent manner, especially in men. Moreover, coffee consumption of ≥3 cups/day was associated with a 50% reduction in dementia risk. [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]

Aim: This study aimed to identify the factors related to complex care needs of older adults in community‐based integrated care centers. Methods: We sent 936 self‐reported questionnaires to community‐based integrated care center directors in the Kinki region of Japan. These questionnaires included questions not only about the directors' demographic data, but also regarding the sociodemographic, psychosocial, and family‐related dimensions of the older adults in the community centers. The directors divided their cases into two categories: "Complex cases" and "Straightforward cases." We compared the intergroup differences and examined the factors related to complex care needs in older adults. Results: A total of 232 directors responded. Complex cases were significantly associated with younger age, poor health conditions, and having a family member who needs care, as compared to straightforward cases where these associations were not present. Logistic regression showed that in older adults, factors of refusing support or social services, social isolation, and trouble with neighbors were associated with their complexities. Additionally, family members with a high likelihood of refusing social services, older adults without a key family member, and difficulties in forming their consensus regarding care were associated with older adults' complexities. Conclusion: Older adults with complex care needs could have the risk of self‐neglect, and their families faced difficulties in supporting them as family members. Healthcare professions should carefully assess these factors and develop needs‐oriented services for them without their family support as an upstream intervention. [ABSTRACT FROM AUTHOR]

Approximately 20% of Japanese women in their reproductive years are smokers. Therefore, in the present study, we report the behavioral changes of woman who undertook a 3 month stop-smoking program. Sixty-six pregnant smokers in the first trimester of pregnancy participated in this study from two hospitals and an obstetric clinic in Japan. Our newly-developed e-learning program uses a cell phone Internet connection service to support pregnant women who want to quit smoking. Using this, service participants were given guidance concerning smoking, and were breath tested for their carbon monoxide levels every 4 weeks for 3 months. An e-learning cessation smoking-support program was maintained throughout the same period. Consequently, 52 of 66 pregnant smokers from three settings began the program, and 48 of 52 eventually completed it. The achievement rate of non-smoking was 71.1% (37/48), and their carbon monoxide exhalation levels significantly decreased from 6.43 ± 4.5 ppm at the beginning to 0.7 ± 1.0 ppm in 1 month, to 0.29 ± 1.08 in 3 months ( P < 0.001). These results suggest the effectiveness of our e-leaning program. This paper reports the results of the study. [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]

Aim: Although poor childhood rearing environment is known to negatively impact late‐life cognitive function, there is a scarcity of evidence on the contribution of positive parenting behaviors. The present study investigates the association between parental involvement in childhood and late‐life cognitive function. Methods: A total of 266 older adults aged between 65 and 88 years living in Wakuya City, Miyagi Prefecture, Japan, without indication of mild cognitive impairment or dementia, participated in a survey. Parental involvement in childhood was assessed by a questionnaire, and late‐life cognitive function was measured by the Japanese version of the Quick Mild Cognitive Impairment (QMCI) screening test (range: 0–100). Multiple regression analysis was performed to investigate the association, adjusting for potential confounders and mediators. Results: After adjusting for age, sex, other child‐rearing environment, and academic performance in grade 6, older adults with a high level of positive parental involvement in childhood scored 6.00 (95% CI: 2.39, 9.61) points higher for the QMCI total score than those without. Parental involvement in childhood showed significant dose–response positive associations with the QMCI total score (P < 0.001), clock‐drawing test score (P < 0.05), and verbal fluency score (P < 0.001). Among the six types of positive parental involvement, book reading showed a significant independent positive association with QMCI total score (P < 0.01) and logical memory score (P < 0.01). Conclusions: Greater parental involvement in childhood, particularly book reading, was associated with better late‐life cognitive function. Geriatr Gerontol Int 2021; 21: 794–801. [ABSTRACT FROM AUTHOR]

Background: In Japanese high schools, understanding of school non‐attendance and students with developmental disabilities, including autism spectrum disorder (ASD), is gradually improving. On the other hand, few people recognize social anxiety disorder (SAD), the onset of which commences during youth. Social anxiety disorder and ASD share various overlapping characteristics but have different diagnostic criteria. The anxiety caused by these disorders sometimes appears as school non‐attendance. This study examines the relationship between SAD, ASD, and history of school non‐attendance in high school students. Methods: One hundred and fifty‐eight students at one Japanese high school that accepts school non‐ attending students were investigated. To understand the features of ASD and how it relates to SAD tendencies, the Liebowitz Social Anxiety Scale – Japanese (LSAS‐J) and Autism‐Spectrum Quotient – Japanese (AQ‐J) were used. Based on the LSAS‐J cutoff point, participants were divided into high and low anxiety groups and then data were compared between the two groups. Potential factors associated with a high‐SAD trend were evaluated using multivariate logistic regression. Results: The results showed that students with high ASD scores were more likely to have SAD and that a lack of "social skill," a subscale of ASD, was closely associated with a social anxiety trend. However, the relationship between school non‐attendance and social anxiety could not be confirmed. Conclusions: Focusing on the lack of social skills in ASD may provide an opportunity to identify students with high SAD tendencies. This study will contribute to the understanding of high school students with high SAD tendencies in Japan. [ABSTRACT FROM AUTHOR]

Background: Many trace elements are essential for infant growth and development during early life. Their concentrations in breast milk vary depending on social and economic factors. Nonetheless, the present available values in Japan were derived from lactating mothers approximately 15 years ago. Methods: Healthy mothers who gave birth to a single infant after 37 weeks of gestation at Teikyo University Hospital were recruited between July 2016 and December 2017. They were encouraged to collect breast milk samples and a self‐administered food frequency questionnaire at 1 and 3 months postpartum. Anthropometric data for the mothers and their infants were also collected. Overall, 79 subjects were analyzed after excluding subjects with inadequate data in the food frequency questionnaire, insufficient breast milk samples, and medication that could affect dietary intakes. Trace element concentrations were determined by inductively coupled plasma mass spectrometry, and their correlation with several factors were investigated. Results: Trace element concentrations were widely distributed as previously reported. Median concentrations of Cr, Mn, Fe, Cu, Zn, Se, and Mo were 0.8, 0.8, 98, 50, 272, 2.2, and 0.7 µg/dL at 1 month postpartum and 0.6, 0.7, 55, 33, 177, 2.1, and 0.7 µg/dL at 3 months postpartum, respectively. There were no correlations between trace element concentrations and either mothers' intakes or infants' growth. In contrast, there were significant correlations between several trace elements and macronutrients in addition to inter‐element correlations among almost all trace elements. Conclusions: Trace element concentrations in mature breast milk were determined from recently lactating mothers in Japan. [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]

Background: This study aims to clarify the association between marital status and dementia in Japan, adjusting for socioeconomic, lifestyle, and lifestyle‐related disease factors. Methods: Data from the Japanese Toyama Dementia Survey were used. Individuals aged ≥65 years living in Toyama Prefecture were randomly selected, and 1171 participants were analysed, with a sampling rate of 0.5%. The participants' marital status, socioeconomic status, lifestyle factors, and lifestyle‐related diseases were assessed. The odds ratio (OR) of marital status for each lifestyle factor and medical histories were calculated by logistic regression analysis. The OR of marital status for dementia was also calculated by logistic regression analysis. Results: The prevalence of dementia was 7.4% for married, and 20.6% for non‐married participants. Non‐married participants showed a higher prevalence of a history of stroke than married participants. The age‐ and sex‐adjusted OR of marital status for dementia was 1.99 (95% confidence interval (CI) 1.24–3.18) for non‐married compared with married participants. Following variable adjustments, the OR for dementia was higher for non‐married participants (adjusted OR 1.71; 95% CI 1.03–2.85). Conclusions: Non‐marital status was an independent risk factor for dementia in Japan even after adjusting for socioeconomic, lifestyle, and lifestyle‐related disease factors. Non‐married people were more likely to have dementia because of their history of stroke. [ABSTRACT FROM AUTHOR]

Background: Children born small for gestational age (SGA), particularly when associated with an extremely low birthweight (ELBW), have a higher risk of renal dysfunction. Growth hormone (GH) treatment is used to treat short‐statured children born SGA; however, its effects on renal function remain elusive, especially in those born SGA with ELBW. Methods: Short‐statured children born SGA (N = 42) were included. Subjects were subdivided into two groups based on their birthweight: the ELBW group (N = 15) with a birthweight of <1,000 g, and the non‐ELBW group (N = 27) with birthweights ranging between 1,000 and 2,500 g. The creatinine‐based estimated glomerular filtration rates (eGFR) before (pre‐eGFR) and 5 years after GH treatment (post‐eGFR) were compared. Correlations between eGFR, anthropometric, or birth parameters, and cumulative GH dose were evaluated using Spearman's rank correlation coefficient. Results: The ELBW group had a lower pre‐ and post‐eGFR than the non‐ELBW group. Five‐year GH treatment did not significantly reduce eGFR in either group. Post‐eGFR was positively associated with gestational week and birthweight. However, the cumulative GH dose was not correlated with pre‐eGFR, post‐eGFR, or percentage change in eGFR (%ΔeGFR). The change in bodyweight standard deviation score during GH treatment was positively correlated with %ΔeGFR in the ELBW group. Conclusions: The current results indicated that GH treatment was unlikely a risk for the reduction in eGFR in short‐statured children born SGA. However, eGFR should be carefully monitored, especially in those born SGA with ELBW because these subjects had lower eGFR than non‐ELBW subjects. [ABSTRACT FROM AUTHOR]

Employee voice is an important organizational behavior that affects work group performance, and many studies have explored its mechanism; nonetheless, the existing literature narrowly defines the construct and overlooks a variety of strategic approaches employees take as they engage in voice. Based on this problematization, the current research has developed and validated a scale of employee voice strategy through four studies in Japan (total N = 1,156). Employee voice strategy is defined as a set of direct and indirect communicative approaches that organizational members utilize to share ideas with intentions to exert constructive influence to their work group. Studies 1 and 2 analyzed interview narratives to develop an initial typology, which was refined in Study 3 into a six-factor scale. Study 4 replicated it through confirmatory factor analyses. Construct validity of the scale was also examined by testing the strategy factors' nomological network-as expected, proactive personality was positively associated with assertive strategies, while relationship maintenance goal orientation was linked to conciliatory, nonconfrontational strategies; negative emotion display showed negative associations with voice strategy use in general. These findings were discussed vis-à-vis culturally inclusive human resource management practices, as well as theoretical exploration of the employee voice phenomena from process-centered perspectives. © 2014 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Background: A psychosocial dementia care programme for challenging behaviour (DEMBASE®) was developed in collaboration with a Swedish BPSD‐registry team for in‐home care services use in Japan. The programme consisted of a web‐based tool for the continued assessment of challenging behaviours and interdisciplinary discussion meetings. Effectiveness of the adapted programme was verified through a cluster‐randomised controlled trial. The Tokyo Metropolitan Government provided municipal funding to introduce the programme into daily practice beginning in April 2018. Objectives: To investigate both facilitators and barriers associated with programme implementation. Design: A secondary analysis of qualitative and quantitative data. Settings: Data were collected in naturalistic long‐term care settings from April 2018 to March 2019. Participants: A total of 138 professionals and 157 people with dementia participated in the programme. Methods: Challenging behaviour in persons with dementia was assessed by professionals using a total Neuropsychiatric Inventory score. Data on expected facilitators and barriers were extracted for qualitative analysis from a debriefing meeting between professionals. Results: Of the 157 persons with dementia, 81 (51.6%) received follow‐up behavioural evaluations by March 2019. The average level of challenging behaviour was significantly reduced for 81 persons from baseline to their most recent follow‐up evaluations. Facilitators included 'programme available for care managers', 'visualised feedback on professionals' work', 'affordable for providers and professionals' and 'media coverage'. Barriers included 'professionals from different organisations', 'unpaid work', 'operation requirement for municipalities' and 'conflict with daily benefit‐oriented framework'. Conclusions: A follow‐up evaluation was not fully achieved. Further strategies to address barriers may include the development of a benefit‐rewarding scheme for interdisciplinary discussion meetings, an e‐learning system capable of substituting training course portions and a cross‐municipality training course. [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]

Aim: There is a large discrepancy between people's preferred and actual place of death in Japan. To manage this discrepancy, this study aimed to identify the variability in preferred places of death and their associated factors among Japanese older people. Methods: Cross‐sectional survey data were collected in 2016 as part of the Japan Gerontological Evaluation Study, in which 20 204 participants were asked about their preferred place of death. Logistic regression analyses were conducted to examine the final determinants for home as the preferred place of death. Results: Based on survey data, 35.8% of respondents preferred home as the place of death, 42.7% preferred some sort of facility and 21.5% were unsure. Those who preferred to be at home when receiving end‐of‐life care were more likely to be older in age, live with others, be employed, be homeowners, have lived in their current residence for a longer period, not be vaccinated for influenza in the past year, engage in physical work or intense sports, not have participated in end‐of‐life discussions regarding preferred place of death, have experienced relatives dying at home, practice norms of reciprocity, have a sense of attachment to their neighborhood, receive instrumental social support, interact with neighbors and live in a rural area. Conclusions: Factors related to community attachment were associated with choosing home as the preferred place of death. To fulfill the preferences of Japanese older people, a broad range of demographic, health, behavioral, social, cultural and environmental factors should be considered. Geriatr Gerontol Int 2021; 21: 345–352. [ABSTRACT FROM AUTHOR]

Empathy is an important characteristic for healthcare students and professionals that may improve the quality of healthcare interactions. Empathy has predominantly been studied within medicine, but also among various allied health personnel. Within paramedicine, empathy has previously been examined internationally, but not within Japan. This study used a descriptive, cross‐sectional methodology which aimed to examine self‐reported empathy in Japanese paramedic students using the Jefferson Scale of Empathy, and compare results with similar international cohorts. Empathy levels in the Japanese cohort were higher among females compared to males. In addition, there was a decrease in empathy with each subsequent year of the paramedic program, and a general decrease as age increased. This contrasts with comparable Australian cohorts which demonstrate no significant change in empathy levels during the undergraduate program. Empathy levels measured in the Japanese paramedic cohort were generally lower than for Australian cohorts. The reasons for the differences are unclear at present and thus further research in this area is required to fully determine and describe the contributing factors. [ABSTRACT FROM AUTHOR]

Aim: To conduct a systematic review to understand the experiences of foreign‐educated nurses in Japan. Background: The experiences of foreign nurses in host countries, and the challenges they face, have been widely investigated around the world. However, no systematic review has focused on the experience of foreign‐educated nurses in Japan. Methods: A systematic literature review was conducted by following the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses Guidelines. Japan Medical Abstract Society, Citation Information by National Institute of Informatics, Cumulative Index to Nursing and Allied Health Literature, and PubMed databases were used for the literature search. Inclusion criteria were research articles published between 2013 and 2020 written in Japanese or English. A quality assessment was performed using Version 2018 of the Mixed Methods Appraisal Tool. Selected articles were read repeatedly, and relevant contents were extracted and summarized thematically. Results: Twenty‐five studies were selected for the review. The themes generated included (1) reasons for nurses to come to Japan, (2) experiences and current situations among the Economic Partnership Agreement nurses/nurse candidates living in Japan, and (3) experiences and current situation of nurses who had returned to their home countries. The second theme was classified into four categories: language and communication barriers, low pass rates for the national qualification exam, adaptation to workplaces and social environments, and psychological distress. Conclusion: Foreign nurses in Japan face various challenges and difficulties, even after they return to their home countries. Solving these problems may improve the wellbeing of foreign‐educated nurses in Japan. Implications for Nursing Policy: The results from the current review highlight the necessity for immediate intervention by policymakers to improve the current support system for Economic Partnership Agreement nurses/nurse candidates. A thorough pre‐arrival orientation should be provided for the nurse candidates to able them to make a well‐informed choice. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to examine the association of knowledge and self‐efficacy as variables for behavior related to dental consultations among patients with type 2 diabetes, depending on the diagnosis of periodontal disease at a general hospital in Japan. Methods: A cross‐sectional survey was conducted with 198 patients with type 2 diabetes (mean age: 66.1 ± 10.1 years, men: 56.6%, mean glycated hemoglobin: 7.3 ± 1.0%). The self‐efficacy of patients with periodontal disease was assessed using the Self‐Efficacy Scale for Self‐Care. Knowledge was measured using five dichotomous items based on reference to clinical guidelines. Dental consultation behavior was assessed from regular dental checkup behavior. Results: In total, 31.8% of participants attended their regular dental checkup in the last year. Logistic regression analysis revealed that dental consultation behavior was positively associated with self‐efficacy among patients diagnosed with periodontal disease (odds ratio [OR] = 1.26, 95% confidence interval [CI]: 1.10–1.45), and positively associated with the knowledge among patients not diagnosed with periodontal disease (OR = 1.54, 95%, CI: 1.09 − 2.16). Conclusion: Patients without periodontal disease need to learn about accurate knowledge regarding periodontal disease as a complication of diabetes and its prevention via dental checkups. Supportive consultation to improve self‐efficacy with respect to dental consultations should be offered to patients with periodontal disease. Medical professionals will be able to support each patient with type 2 diabetes by changing the educational approach for promoting regular dental checkups at the time of diabetes consultations. [ABSTRACT FROM AUTHOR]

Purpose The study purpose was to investigate whether years of clinical experience and experience of encountering heart failure affect perceptions of the need for physical assessment, and the nature of the association between perceptions and years of clinical experience. Methods: This study was survey‐based. Of hospitals in Japan with ≥200 beds, 298 hospitals were randomly selected as candidate research sites. Ultimately, 44 hospitals agreed to participate in this study. A self‐administered questionnaire measuring 48 physical assessment skills was developed and distributed to nurses. The questionnaire rated the perceived need for 48 skills assessing acute progression of heart failure. Results: Of 1,113 nurses sampled, 373 (33.5%) responded. Of these, 347 completed questionnaires (response rate: 93.0%). Nurses' perceived need for skills involving systematic or cardiovascular system assessment decreased with clinical experience. Nurses' perceived need for skills involving cardiovascular symptoms and circulatory failure assessment increased with clinical experience. We found four patterns of change for nurses' perceptions of physical assessment skills according to clinical experience. Conclusions: The findings showed that differences in nurses' perceived need for physical assessment skills were associated with differences in clinical experience. Nurses with more experience selected more suitable skills for detecting acute progression of heart failure. Nurses' perceptions of the need for specific skills were proportional to years of clinical experience, and there may be a threshold value of years of experience. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to develop and evaluate the effectiveness of using e‐learning on smartphones to provide dental hygiene education on dental treatment procedures. Methods: This was a randomized controlled trial. Two‐hundred ninety‐three dental hygiene students in four universities, one junior college and one technical school took a preliminary examination, and based on the results, participants in each school were randomly divided into two groups, a test or control group. Both groups took pre‐ and post‐examinations at a 4‐week interval. The test groups learned dental treatment procedures and four‐handed techniques with interactive learning materials using smartphones. The learning materials allowed them to watch videos of dental treatments. The control groups were not provided any learning material. Results: Results of all schools combined showed that the changes from pre‐ to post‐examination scores in the test groups were significantly higher than those of the control groups (p <.05). Post‐examination scores were significantly higher than pre‐examination scores in the test groups in all schools (p <.05). Also, post‐examination scores of the test groups were significantly higher than those of the control groups (p <.05). The changes from pre‐ to post‐examination scores in the test groups of two schools were significantly higher than those of control groups (p <.05). Post‐examination scores of the control groups in two schools were significantly higher than pre‐examination scores (p <.05). Conclusions: Learning dental treatment procedures through e‐learning on a smartphone was effective in developing participants' understanding of dental treatment procedures and four‐handed techniques. [ABSTRACT FROM AUTHOR]