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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]

Aim: To examine the relationship between general self‐efficacy and nursing practice competence for nurses in the second year of employment. Design: A cross‐sectional design was used. Data Sources: The study included 596 nurses in their second year of employment at 75 medical facilities across Japan and used an online questionnaire survey for data collection. Results: The covariance structure analysis showed the path from general self‐efficacy (latent variable) to nursing practice competence. Positive correlations were found between all factors on both scales. Multiple regression analysis results showed that the general self‐efficacy factors of 'positivity in behavior' and 'confidence in social competence' affect nursing practice competence. Conclusion: This study emphasizes the importance of enhancing the general self‐efficacy of second‐year nurses to improve their nursing practice competence. To achieve this, it suggests developing strategies from the perspective of the factors that comprise general self‐efficacy. Implications for the Profession and Patient Care: The findings suggest that improving general self‐efficacy can enhance nursing practice competence, which could inform the development of interventions to support nurses in improving their competence. The study provides basic data for improving nurses' practice competence. Impact: This study is the first to establish a relationship between general self‐efficacy and nursing practice competence among second‐year nurses. It demonstrates the significance of general self‐efficacy in enhancing nursing practice competence, particularly for second‐year nurses worldwide who may be struggling with their nursing practice competence and considering leaving the profession. The findings offer practical implications for stakeholders involved in nursing education and training programs, with potential applications in professional development. Reporting Method: This manuscript adheres to the STROBE guidelines for the reporting of cross‐sectional studies. Patient or Public Contribution: There was no patient or public contribution. [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]

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]

We administered a paper-and-pencil questionnaire to 133 female and 99 male Japanese high school students 13-18 years old ( M = 15.9, SD = 1.57) from the Kansai area to examine cultural influences on their body image and body change behaviours. Our aim was to ascertain the independent and combined influences from traditional Japanese, modern Japanese, and Western values. Cluster analyses identified four 'acculturative' groups: 'anti-modern', 'traditional', 'pro-modern/anti-traditional', and 'pro- Western/anti- Japanese'. Pro-modern and pro- Western adolescents were most dissatisfied with their bodies, and pro-Western adolescents were also most likely to attempt weight loss. The results demonstrate the value of assessing cultural interactions in Japan along three dimensions. [ABSTRACT FROM AUTHOR]

Aim: Total hip arthroplasty can effectively improve patients' motility with end-stage osteoarthritis. This study aimed to: (1) compare gradual changes in utility values with total hip arthroplasty and estimated values without; (2) evaluate total hip arthroplasty cost-effectiveness; and (3) evaluate cost-effectiveness by age, diagnosis, and comorbidity. Methods: Patients who underwent total hip arthroplasty between January 2008 and December 2009 were included. Patients completed the EuroQol preoperatively and at 1, 3, 5 and 7 years postoperatively. To derive the qualityadjusted life years gained, a utility score was obtained from the EuroQol item scores and combined with 7 years, and estimates were obtained by discounting the postoperative 1-year utility value at an annual rate of 2%--4%. Mixed-effects regression models were used to compare the estimated and the measured utility values. Results: Mean total cost was 1,921,849 yen, and quality-adjusted life years gain score was 1.746 with per cost as 1,100,715 yen. Compared with actual measurements, the estimated values from 1 to 7 years post-surgery differed significantly, and interaction was observed. Regarding age, the older the patient, the higher the cost per quality-adjusted life years. Patients with lower preoperative physical function had higher quality-adjusted life years gains, while the cost per quality-adjusted life years was lower. Conclusions: Total hip arthroplasty was cost-effective. Compared with actual measurements, the estimated utility values from 1 to 7 years post-surgery significantly differed. Even among older patients and those with impaired preoperative physical functions, its cost was lower than patients' willingness to pay in Japan. [ABSTRACT FROM AUTHOR]

Background: Suicidal ideation is closely related to severe suicidal behaviour and is an important predictor of suicide attempt and completion, including in older people. Older people tend to have many opportunities to be conscious of death, and may have vague suicidal ideation because of various loss experiences, even if they are not depressed. We hypothesised that suicidal ideation among older people might be a risk factor for later transition to depression. The present study aimed to clarify risk factors that predict the incidence of depression in older people 3 years post‐baseline in a rural area of Japan, and to examine the subsequent course of depression among non‐depressed older people with suicidal ideation. Methods: In 2015 and 2018, survey questionnaires were mailed to residents aged 65 years and over living in a rural area in Japan. Participants were divided into a depression group and a non‐depression group using 15‐item Geriatric Depression Scale scores 3 years post‐baseline. Logistic regression analysis was used to identify predictive factors of late‐life depression 3 years post‐baseline. Results: We received 597 valid responses, with a 3‐year follow‐up rate of 78.8%. Regarding suicidal ideation, 6.7% of non‐depressed older people exhibited suicidal ideation at baseline. Of these, 9.8% exhibited depression after 3 years post‐baseline. Logistic regression analysis indicated that development of late‐life depression is significantly associated with suicidal ideation, being female, and poor health‐related quality of life (HRQOL). Conclusions: The results revealed that suicidal ideation, being female, and poor HRQOL were predictive factors of the development of late‐life depression 3 years post‐baseline in a rural area of Japan. These findings provide novel information regarding the transition to depression among community‐dwelling older people who are not depressed but have suicidal ideation. Whereas suicidal ideation is considered to be a symptom of depression, the current results suggest that suicidal ideation may precede depression in some older people. [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]

Background: Father's closeness and playful behavior influence a child's emotional and cognitive development. In this study, we aimed to assess the long‐term association of paternal involvement in childcare at 1–3 years of life on subsequent behavioral outcomes at 8 years of age. Methods: Data were obtained from the 2010 cohort of the Longitudinal Survey of Newborns in the 21st century in Japan. We used group‐based trajectory modeling to predict the trajectory of total childcare scores in surveys 1, 2 and 3 to determine the overall involvement of fathers in childcare during early childhood. The level of fathers' involvement in childcare was categorized as "low", "medium" and "high". Responses from the eighth survey were used to assess child behavioral outcomes using five indicators when the child was 8 years old. Crude and adjusted logistic regression analysis was conducted to estimate the odds ratio (OR) separately for each of the behavioral outcomes of the child. Results: Among the 17,027 father‐child dyads included in this study, two‐thirds of the fathers were of the age group 30–39 years. Compared to low involvement, children of fathers with high involvement in childcare during the early childhood years were less likely to not want to go to school even after adjusting for covariates (adjusted OR, 0.46; 95% CI: 0.32–0.66). Conclusions: Children benefit from their fathers' involvement in early childcare activities. To improve a child's well‐being, fathers should be encouraged by providing them with a suitable working environment with flexible arrangements and the opportunity to involve in childcare. [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: To determine the factors associated with reduced research activities during the COVID‐19 pandemic in 2020 by comparing nursing researchers working in academic and clinical settings. Methods: This was a secondary analysis of data collected by the Japan Academy of Nursing Sciences, which conducted a cross‐sectional online survey when the pandemic began. We included respondents who worked in either academic or clinical settings and responded that the pandemic negatively affected their research activities. First, we computed a propensity score (PS) using a logistic regression model. Then we performed a one‐to‐one ratio matching between the groups based on the PS to control imbalances between the groups. We identified the factors negatively affecting research activities and who to consult about research concerns by comparing the groups using Chi‐square or Fisher's exact tests. Results: There were 1,532 participants, with a response rate of 16.1%. After PS matching, 214 participants (107 for each group) were included. We identified three significant factors associated with reduced research activities: (i) time required for learning new information and communication technology (ICT) skills; (ii) time required for supporting colleagues with ICT issues; and (iii) time required for preparing and evaluating teaching materials. Approximately 20% of our participants in both settings had nobody to consult regarding research concerns. Conclusion: We found that the time spent on ICT‐related issues negatively affected the research activities of nursing researchers when the pandemic began in Japan. In such an emergency, nursing researchers needed an opportunity to share their difficulties as a part of a support service. [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]

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]

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: 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]

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: 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: 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]

Background: Boey et al. (2009) devised a questionnaire for measuring children's awareness of stuttering and showed that even very young children were often aware of their stuttering. There has been no replication of studies using Boey et al.'s parent‐reported questionnaire. The aim of this study was to test whether using Boey et al.'s seven questions, developed for a Dutch speaking population could be effective for measuring the awareness of stuttering in Japanese children. Methods: Participants were 54 children who stutter (CWS) aged 3–7 years. Parents answered seven questions about their child's awareness of stuttering according to the questions developed Boey et al. Results: Parental‐reported observations of the child responses citing at least one awareness incident were 76%. The percentage of stuttering children with awareness of their own speech difficulties, according to chronological age, were as follows: 70% at age 3 years; 67% at age 4 years; 75% at age 5 years; 81% at age 6 years; and 90% at age 7 years. Conclusions: We found that even at age 3 years, many CWS were already aware of their stuttering. The similarity of the data with the seminal study by Boey et al. suggests that the question‐based assessment is reproducible even in a country with a different spoken language. The seven questions in Boey et al. are useful for evaluating whether children's awareness of stuttering could contribute to a clinical decision as well as stuttering severity. [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: We considered the effect of dysphagia rehabilitation and investigated parameters associated with the resumption of oral intake in the elderly patients receiving home nursing care who were not eating by mouth. Methods: The participants were 116 patients aged ≥65 years (66 men and 50 women, mean age 79.7 ± 8.9 years) who were receiving home nursing care and not eating by mouth because of dysphagia. All patients underwent dysphagia rehabilitation for 6 months with the objective of resuming oral intake. After 6 months of dysphagia rehabilitation, the patients' eating status was assessed using the Functional Oral Intake Scale (FOIS) and the associations of the post‐intervention FOIS score with age, history of pneumonia, duration of enteral nutrition, body mass index (BMI), alertness, physical function (ability to walk) and swallowing function at the initial examination. Results: Functional Oral Intake Scale scores increased significantly after 6 months rather than those at the initial evaluation (P <.001). Eighty patients (69.0%) resumed oral intake (FOIS score ≥2), thirty patients (25.9%) of whom became capable of daily oral intake (FOIS score ≥3). Swallowing function was associated with the resumption of oral intake. In addition, physical function before dysphagia rehabilitation was an important factor to resume daily oral intake. Conclusions: The results of the present study suggest that the resumption of oral intake by patients receiving enteral nutrition requires improvement in swallowing function. In addition, anyone who cannot walk may not recover daily oral intake. [ABSTRACT FROM AUTHOR]

Abstract: Aim: We analyzed the incidence and prognosis of thromboembolism associated with combined oral contraceptives (COCs) by age groups in Japan. Methods: A total of 581 events of venous thromboembolism (VTE) and arterial thromboembolism (ATE) associated with COCs were analyzed from the Pharmaceuticals and Medical Devices Agency database from 2004 to 2013. In a statistical analysis, a good‐prognosis group included recovery cases and a poor‐prognosis group involved unrecovered cases with some sequela and fatal cases. The significant difference between these two groups was calculated by Pearson's chi‐square test, and the age‐specific tendency and the trend of differences in prognosis according to different hormonal contraceptives were examined by Cochran–Armitage trend test. Results: A total of 543 events were analyzed except 38 events due to unknown age, in which DVT only was the most frequent, followed by cerebral infarction, PE with DVT, PE only, cerebral vein thromboses. ATE ratio for overall thromboembolism tended to increase with advancing age (P = 0.0041). Good‐prognosis group was common (291 cases in VTE and 83 cases in ATE), followed by poor‐prognosis group (46 cases in VTE and 34 cases in ATE). All ATE cases had a significantly poorer prognosis in comparison with all VTE cases (P < 0.0001). Types of progestin and age difference, however, showed no trend in the differences between good‐prognosis group and poor‐prognosis group (P = 0.3548 and P = 0.6097). Conclusion: Thromboembolic events were the most frequent in the 40s. The ATE ratio for overall thromboembolism tended to increase with advancing age. All ATE cases had a significantly poorer prognosis in comparison with all VTE cases. [ABSTRACT FROM AUTHOR]

Purpose Globalization of Japanese dental hygienists is important to match the demands in the present society. The purpose of this study was to gauge opinions on international programmes of Japanese dental hygiene students and educators. Method Data were collected using a survey that was sent to all eight Japanese universities of oral hygiene in December 2014. Participants were composed of 466 university students majoring in oral hygiene (463 women; three men; mean age: 21 years) and 45 educators teaching dental hygiene education (mean age: 50 years). The response rates were 83.81% and 46.88%, respectively. Results 48.06% of 464 students would like to study abroad, and 76.04% of 330 students would like to interact with foreign students frequently. 97.54% of 455 students answered that learning English is important for dental hygienists, but 72.39% of 460 students are not comfortable interacting with foreigners in English. Those who knew more dental English terms had higher interest in studying abroad (odds ratio: 1.136). 75% of 44 educators think that dental hygiene students need to or sometimes need to study abroad. 68.89% of 45 educators think that teaching international programmes is costly. Conclusion We found that Japanese dental hygiene students and educators have positive interest in international programmes. However, they have concerns about their English skills and about the cost of studying it. Therefore, English classes need to be improved, and new approaches are required for lowering the cost of teaching international programmes, while stimulating foreign students' and educators' interest in studying abroad in Japan. [ABSTRACT FROM AUTHOR]

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Methods for preventing aspiration pneumonia are needed soon in order to reduce mortality from aspiration pneumonia and promote the health of the elderly. The aim of this randomised controlled trial was to examine whether oral care with tongue cleaning improves coughing ability in elderly individuals living in geriatric care facilities. Participants comprised of 114 residents of 11 group homes and private nursing homes in Aso City in Kumamoto Prefecture. Participants were randomly assigned to either (i) a group that underwent routine oral care with tongue cleaning (intervention group; n = 58) or (ii) a group that underwent routine oral care alone (control group; n = 56). Coughing ability was evaluated by measuring peak expiratory flow ( PEF) before and after 4 weeks of intervention. Before the intervention, PEF did not differ significantly between the intervention group (1·65 ± 1·11 L s−1) and control group (1·59 ± 1·05 L s−1; P = 0·658). However, on termination of the intervention, PEF was significantly higher in the intervention group (2·54 ± 1·42 L s−1) than in the control group (1·90 ± 1·20 L s−1; P = 0·014). After the intervention, PEF had increased significantly in both groups; however, this increase was significantly greater in the intervention group (0·90 ± 0·95 L s−1) than in the control group (0·31 ± 0·99 L s−1; P < 0·001). Oral care with tongue cleaning led to increased PEF, suggesting improved coughing ability. Oral care incorporating tongue cleaning appears to be important for preventing aspiration pneumonia. [ABSTRACT FROM AUTHOR]

Aim: We aimed to develop a Recognition Scale for Female Intimate Partner Violence (IPV) Patients (RS‐FIPVP); measure the levels and clarify the structure of IPV recognition among clinical nurses; and confirm the validity and reliability of the scale. Methods: A cross‐sectional, anonymous, self‐administered questionnaire was administered to clinical nurses (n = 2570) at seven clinical settings in Okinawa, Japan. As a result, 1855 valid responses were obtained and used in the analysis. The statistical analysis examined an exploratory and confirmatory factor analysis, internal consistency, and construct validity. Results: Four factors, comprising 20 items, were extracted for IPV recognition among clinical nurses. The confirmatory factor analysis showed that the indices of fitness supported these results. The Cronbach's alpha coefficient was 0.83 for the total score and 0.71, 0.73, 0.74, and 0.71 for Factors 1, 2, 3, and 4, respectively. Four factors were extracted from the oblique factor analysis, with a cumulative variance of 50.0%: “understanding of the victim's situation”, “violence that is difficult to detect”, “patient characteristics”, and “support and coordination”. The four factors had a moderate correlation (0.27–0.47, P < 0.01) with each other, which indicated construct validity. These findings confirmed fit for the RS‐FIPVP. Conclusions: The RS‐FIPVP, a recognition scale to measure and evaluate the recognition of female IPV patients among clinical nurses, was developed. It may be used to improve the recognition of female IPV patients in nursing continuing education and also to measure and evaluate educational interventions. The reliability and validity of the scale were verified; however, further refining, testing, and evaluation are required. [ABSTRACT FROM AUTHOR]

Objective To assess oral malodour level and its association with health behaviour, oral health behaviour and oral health status among adolescents. Method A questionnaire survey and clinical examination that included tongue coating and oral malodour status were conducted on 665 senior high school students in Saitama, Japan. Analyses of Pearson chi-square, independent samples t-test and logistic regression were conducted using SPSS 19.0 with the significance level set at P < 0.05. Results There were 173 (26.0%) subjects who had oral malodour and 54.7% of subjects reported they were conscious of their own oral malodour. Logistic regression analysis showed that subjects who skipped breakfast were 1.7 times more likely to have oral malodour than those who had breakfast. Subjects who did not have the habit of cleaning their tongue daily were also 1.7 times more likely to have oral malodour compared to those who had the habit. The odds of having oral malodour increased as the area of tongue coating widened. Conclusion Tongue coating, daily tongue cleaning and breakfast are significant factors for oral malodour among adolescents. Proper tongue coating management together with other healthy lifestyle behaviours, especially having breakfast, should be advocated in adolescents' health education. [ABSTRACT FROM AUTHOR]

Aim: To investigate the association between homebound status and functional decline over a 2 year follow‐up period and the sex difference in its association. Methods: The study subjects were 2956 independently living older individuals (1267 men, 1679 women). Homebound persons were defined as individuals who left home less than once a week. Subjects judged to be eligible for a support program or long‐term care by the committee of the long‐term care insurance system were considered functionally dependent. Using a Cox proportional hazard model, the present authors evaluated the association between homebound status and onset of functional dependence. Results: Of the 2946 subjects, 223 (7.6%) were homebound. During the follow‐up period, 153 subjects became functionally dependent. Adjusting for age and household type, the hazard ratio (HR) for onset of functional dependence in the homebound group (compared with the non‐homebound group) was 5.46 (95% confidence interval [CI], 3.00–9.94) for men and 2.62 (95% CI, 1.66–4.14) for women. After adjustment for locomotor function, cognitive function, depressive state, age, and household type, the HR for onset of functional dependence in association with homebound status remained significantly increased in men (HR, 3.12 [95% CI, 1.59–6.10]), but not in women (HR, 1.43 [95% CI, 0.87–2.35]). Conclusion: This study suggests that homebound status is a risk for functional dependence in both men and women. In men, being homebound despite intact functional ability was also a risk for functional dependence. Considering the respective characteristics of each sex may be important for planning support programs to prevent homebound for older persons. [ABSTRACT FROM AUTHOR]

Background Recent evidence from alcohol and trauma studies suggests that disasters are associated with increases in the consumption of alcohol. The Great East Japan Earthquake and the associated nuclear disaster have continued to affect the mental health of evacuees from Fukushima. This study aimed to extend these findings by examining the relationship between drinking behaviors and the risk of mental illness after the compound disaster. Methods We conducted the Mental Health and Lifestyle Survey with 56,543 evacuees. Kessler's K6 was used to assess the risk of mental illness, and logistic regression models were applied to analyze how drinking behavior patterns influence the risk of serious mental illness after adjustment for confounding variables. Results Logistic regression analysis evidenced that beginning heavy and light drinkers had the highest and a higher risk of serious mental illness, respectively. Individuals who were nondrinkers pre- and postdisaster had the lowest proportional risk of mental illness. Abstainers also had some risk to their mental health after the compound disaster. Conclusions The results of this study highlight that beginning drinkers have a high risk of serious mental illness. Thus, mental health professionals should pay attention to the drinking behaviors of evacuees, which might predict increased risk of serious mental illness and consequently indicate a need for psychological intervention. [ABSTRACT FROM AUTHOR]

Background: In Japan, the number of dementia patients admitted to hospitals and other care facilities has been increasing and their hospital stays prolonged. Until now, there has been no study examining the differences between patients in psychiatric hospitals and other care facilities. Here we attempt a comparative analysis of characteristics of dementia patients in psychiatric hospitals and other types of facilities based on a nationwide survey. Method: A nationwide, cross‐sectional survey was conducted in 2009–2011. Questionnaires were sent to randomly selected facilities and asked about each facility's status as of September 2009 and about individuals with dementia residing in each facility during the 2008 fiscal year. The portion about individuals consisted of items to assess eligibility for the Long‐Term Care Insurance programme. Based on data from 6121 patients residing in seven different types of facilities, features of dementia patients in psychiatric hospitals and differences among facilities were analyzed. Results: There was a significant difference in average age, activities of daily living level, and dementia severity level among the seven types of facilities. The average age in all types of facilities, except for psychiatric hospitals, was higher than the national average life expectancy of 82.59 years. The results of the study revealed that in psychiatric hospitals the proportion of men, those aged <75 years, demented patients with severe behavioural and psychological symptoms of dementia, and those with frontotemporal dementia was significantly greater than in other types of facilities. In other Long‐Term Care Insurance care facilities, dementia patients >80 years and women accounted for 80% of all patients. Conclusion: Result showed that dementia patients in psychiatric hospitals had a higher proportion of men, younger age groups, and severe dementia than other types of facilities. These features contrast markedly with status of dementia patients in other Long‐Term Care Insurance care facilities. In order to facilitate dementia patients' early discharge from psychiatric hospitals to other care facilities or to home, further fulfilment care services corresponding to severe dementia and early‐onset dementia may be needed. [ABSTRACT FROM AUTHOR]

Aim: Older maternal age has become more common in Japan. Studies suggest that older maternal age and primiparity are associated with post‐partum depression. The present study aimed to identify predictors of post‐partum depression in older Japanese primiparas at 1 month post‐partum. Methods: Participants were 479 primiparas aged 35 years and over, drawn from a prospective cohort study. Data were collected using self‐report questionnaires. Depression was measured with the Japanese version of the Edinburgh Postnatal Depression Scale. Stepwise logistic regression analysis was conducted on binary outcome variables of depression at 1 month post‐partum, along with a stratified analysis based on the risk status of depression. Results: Five predictors were identified: (i) the depression score during hospital stay; (ii) financial burden; (iii) dissatisfaction with appraisal support; (iv) physical burden in daily life; and (v) concerns about infant caretaking. Stratified analysis identified dissatisfaction with instrumental support in the low‐risk group, and the Child‐care Value Scale score as unique predictors in the high‐risk group. Conclusion: These results highlight the importance of early assessment of depressive symptoms and the provision of continuous care. [ABSTRACT FROM AUTHOR]

Aim: The Magnet Recognition Program is a system in the USA that recognizes a hospital as a magnet hospital for having a high retention rate of nurses and providing high quality patient care. The purpose of this study was to examine the effect of nurses' work environment with characteristics that are similar to those of magnet hospitals on patient satisfaction in Japan. Methods: The authors distributed anonymous self‐administered questionnaires in August 2011 to all nurses via the directors of the nursing departments of four private hospitals. The response rates were 91% (n = 425) for nurses and 51% (n = 379) for patients. In the questionnaire for nurses, the items addressed basic attributes and a scale of work environment characteristics of a magnet hospital (the Japanese version of the Practice Environment Scale of the Nursing Work Index [PES‐NWI]). The questionnaire for patients addressed basic attributes, information about their hospitalization, and items to assess patient satisfaction. To examine the effects of the PES‐NWI subscales on patient satisfaction, the authors conducted multivariate logistic regression analysis for groups, which were dichotomized by 75 percentile of the scores of patient satisfaction. Results: The result of model 1 in the multivariate logistic regression analysis demonstrated that collegial nurse–physician relations showed significant relationships with low patient satisfaction (odds ratio = 0.144, P < 0.05), while the significance was diminished in model 2, in which dummy variables of hospitals were entered into the equation. Conclusion: These findings suggested that a favorable work environment for nurses, which is similar to that of magnet hospitals, may influence patient satisfaction in hospitals in Japan. [ABSTRACT FROM AUTHOR]

Interprofessional communication and teamwork are essential for medication safety; however, limited educational opportunities for health professionals and students to develop these skills exist in Japan. This study evaluated the impact of an interprofessional multimedia learning resource on registered nurses' and nursing students' intention to practice in a manner promoting medication safety. Using a quasi-experimental design, Japanese registered nurses and nursing students (n = 203) were allocated to an experimental (n = 109) or control group (n = 94). Behavioral intentions of medication safety and the predictor variables of attitudes, perceived behavioral control, and subjective norms were measured using a Japanese version of the Theory of Planned Behavior Medication Safety Questionnaire. Registered nurses in the experimental group demonstrated a greater intention to collaborate and practice in a manner that enhanced medication safety, evidenced by higher scores than the control group on all predictor variables. The results demonstrate the potential for interprofessional multimedia learning resources to positively impact the behaviors of Japanese registered nurses in relation to safe medication practices. Further research in other contexts and with other cohorts is warranted. [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives The provision of information is now considered a major area in pharmacist-patient interactions. However, few reports have simultaneously evaluated patient and pharmacist perceptions with regard to the pharmacist's information provision. The aims were to clarify the perceptions of pharmacists and patients regarding information provision and the level of influence of those perceptions on patient satisfaction. Methods A cross-sectional survey with respect to information provision was conducted for patients and pharmacists in community pharmacies in Fukuoka Prefecture, Japan. In total, 407 patient-pharmacist pairs were included in a t-test and multilevel analysis. Results The levels of patient perception regarding information provision were significantly higher than the levels of pharmacist perception in all variables. The pharmacists' perceived level of information provision concerning medication effects had a negative and significant association with patient satisfaction, while the patients' perceived level of information provision by the pharmacist had a positive and significant association with patient satisfaction. Higher patient expectations regarding the level of information provision concerning medication side effects and older age of the pharmacist were adversely related to patient satisfaction. Both pharmacist and patient perceptions of the information provision by pharmacists personalized to the patient had positive associations with patient satisfaction. Conclusions Pharmacist perceptions related to the information provision were not associated with patient satisfaction. The present study highlights accurate information provision, building good patient-pharmacist relationships, and improving pharmaceutical care in community pharmacy settings. [ABSTRACT FROM AUTHOR]

Aim: The number of older primiparas is increasing in Japan. These women have been shown to be more vulnerable to post‐partum depression. This study aimed to identify factors for predicting post‐partum depressive symptoms during hospitalization after childbirth in Japanese primiparas aged 35 years and over. Methods: The present authors used the data of 479 primiparas aged 35 years and over from a prospective cohort study. Data were collected using self‐report questionnaires on the day before hospital discharge. The questionnaire consisted of: demographics and background information; depressive symptoms; fatigue; maternal confidence and maternal satisfaction; child‐care values; physical symptoms; perceptions of daily life during hospitalization; concerns about child care and daily life; and infant feeding. Additionally, vital records data were obtained from the hospitals. A stepwise logistic regression analysis was performed on the binary outcome variable of depressive symptoms, measured by the Japanese version of the Edinburgh Postnatal Depression Scale. Women who scored 9 or more were considered to be at high risk for post‐partum depression. The authors obtained informed consent from all participants and institutional ethics approvals before initiating the study. Results: The following six variables reliably predicted the risk of post‐partum depression: emergency cesarean section, lower satisfaction with birth experience, higher physical burden in daily life, long‐term complications with the newborn, more concerns about newborn caretaking after discharge, and more concerns about one's own life after discharge. Conclusion: Recognition of women with these factors will help nurses to identify those at risk for developing post‐partum depression and to provide appropriate care during hospitalization after childbirth. [ABSTRACT FROM AUTHOR]

Aim: This cross‐sectional study aims to explore the relationship between different types and sources of social support and psychological distress by age and sex among survivors living in temporary housing 10 months after the Great East Japan Earthquake. Methods: Self‐reported questionnaires/structured interviews administered from January to March 2012 recorded demographic characteristics, damage involving participants' families, social support, and psychological distress. Results: Data on 296 participants aged 20 years or more from nine temporary housing complexes in Otsuchi were analyzed; K6 scores indicating psychological distress averaged 5.1 (standard deviation, 5.9; range, 0–24). Multiple logistic regression analyses indicated differences among types and sources of social support with regard to psychological distress by age and sex among disaster survivors. For men aged less than 65 years, social support by family was related to lower psychological distress. For women aged 65 years or more, emotional support from family, informational and instrumental support, and social companionship from friends in their own temporary housing complexes were related to less psychological distress. Conclusion: Differences in age and sex were related to different sources of social support in relation to psychological distress. It is necessary to pay more attention to those who lost family members in the disaster, especially men aged less than 65 years. It may also be necessary to support survivors in making friends when they relocate to temporary housing, especially women aged 65 years or more. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to clarify conditions of women experiencing post‐partum anemia and identify factors that work against the alleviation of anemia. Methods: This was a retrospective longitudinal study, involving 246 women giving birth at five participating institutions, diagnosed with anemia on day 3 post‐partum, and given a blood sample at the medical examination 1 month after the birth. With answers about alleviation of anemia during the 1 month post‐partum period as an objective variable, and explanatory variables, multiple logistic regression analysis was performed. The explanatory variables included demographic data of the participants, information about anemia, following the nutrition instruction advice for anemia alleviation, family structure and others assisting the participants, and self‐management skills (measured by the Self‐Management Skill [SMS] scale). Results: The present authors collected 211 valid responses; the average age was 32.6 years. The mean hemoglobin values on the 3rd and 30th days post‐partum were 9.6 and 12.0 g/dL, respectively. One fifth of the participants (21.3%) showed no anemia alleviation. The mean value on the SMS scale was 28.35, and the anemia alleviated group (30.78) was significantly higher than the non‐alleviated group (19.38). Results of the multiple logistic regression analysis showed a strong relationship between anemia risk and self‐management skills. The absence of anemia alleviation increased 2.51 times as the total score of the SMS decreased 1 point. Conclusion: There is an urgent need to develop an intervention program to alleviate post‐partum anemia focusing on the low score items because self‐management skills strongly affect alleviation improvement. [ABSTRACT FROM AUTHOR]

Background Gastroesophageal reflux disease ( GERD) in infants is among the most common reason for physician consultation worldwide. A traditional Japanese medicine, rikkunshito ( RKT), is effective for GERD in adult and pediatric patients. The aim of this study was to evaluate the efficacy and safety of RKT in infants with GERD. Methods Fifty-four infants were referred to between July 2004 and December 2012 for evaluation and treatment of GERD. All infants had failure to thrive. We excluded nine patients with cow's milk protein allergy, neurological impairment or surgical indications. We retrospectively reviewed the clinical records of 45 infants with GERD. Twenty-nine infants were treated with RKT ( TJ-43; 0.3 g/kg/day; RKT group), and 16 infants were treated with mosapride citrate at 0.5 mg/kg/day (mosapride group). The primary endpoint was RKT-induced relief of clinical symptoms and bodyweight gain in infants with GERD. Results After 3 months of treatment, the frequency of vomiting per day was significantly lower in the RKT group than in the mosapride group ( P = 0.0146) and the weight Z-score was significantly higher in the RKT group than in the mosapride group ( RKT group, −2.5 ± 1.5 vs mosapride group, −5.0 ± 2.0; P = 0.0386). No adverse effects were noted in either group. Conclusions RKT may be safe and effective for relief of GER symptoms and for bodyweight gain in infants with GERD. [ABSTRACT FROM AUTHOR]

Background and Objective Various studies have reported the relationship between alcohol consumption and gingival condition. However, they focus on the direct effects of alcohol consumption or alcohol sensitivity on gingival condition, and it is unclear how oral health behaviors relate these relationships. The aims of this study were to assess the inter-relationships between gingival condition, tooth-brushing behavior after drinking alcohol and alcohol sensitivity in university students who drink more than once per week on average. Material and Methods A total of 808 students (541 males, 267 females) that habitually consume alcohol were analyzed. The disease activity of gingival condition was assessed as the percentage of bleeding on probing (% BOP). Additional information regarding alcohol sensitivity and oral health behaviors, including tooth-brushing behavior after drinking, were also collected. Results Thirteen percent of the current participants reported neglecting tooth-brushing after drinking, and their alcohol consumption was higher than those who did not neglect tooth-brushing. Logistic regression analysis showed that high % BOP (% BOP ≥ 20) was associated with male ( OR = 1.53; 95% CI, 1.01-2.33), neglect of tooth-brushing after drinking ( OR = 2.60; 95% CI, 1.20-5.61) and debris index ( OR = 8.38; 95% CI, 4.24-16.60) in participants with low alcohol sensitivity. In participants with high alcohol sensitivity, high % BOP was associated with debris index ( OR = 7.60; 95% CI, 3.12-18.51), but not with any oral health behaviors. Conclusions The study revealed that alcohol consumption was indirectly related to gingival disease activity through the neglect of tooth-brushing after drinking alcohol in university students with low alcohol sensitivity. [ABSTRACT FROM AUTHOR]

Background Inflammatory bowel disease ( IBD) - Crohn's disease ( CD) and ulcerative colitis ( UC) - are chronic inflammatory disorders of the intestine. Patients with IBD are at risk of hospitalization for disease exacerbation or IBD-associated complications. In the pediatric population, however, there are limited data on IBD hospitalizations. We therefore investigated the descriptive epidemiology of hospitalizations relevant to pediatric IBD. Methods The national inpatient claims database in Japan was searched for children (≤18 years old) with a diagnosis of IBD. The study period was 2007-2010. Data on demographic characteristics and descriptive statistics of the hospital course were extracted and analyzed. Results A total of 3559 admissions of 2175 patients met the definition of pediatric IBD: there were 1999 admissions for CD and 1560 admissions for UC. Internists were responsible for patient care in 56.6% of admissions, followed by pediatricians (27.5%). Of 3559 admissions, unscheduled hospitalizations accounted for 79.7%, and 7.6% of hospitalizations were attributable to complications of IBD, including intestinal, extraintestinal and other manifestations. The median age at first admission was 16 years (IQR, 13-17 years), in both the CD and UC groups. Compared with UC patients, CD patients had a higher number of hospitalizations ( P < 0.001), but hospital stay was shorter (median: 6 vs 16 days, P < 0.001). There were seven fatal cases of IBD, accounting for 0.32% in the present series, and sepsis was the cause in five. Conclusions This study provides a description of pediatric inpatients with IBD and their hospital course in Japan. [ABSTRACT FROM AUTHOR]

Background Substrate-based catheter ablation (CA) can be applied to more complicated cases such as hemodynamically unstable ventricular tachycardia (VT). We aimed to compare the efficacy between substrate-based and activation/entrainment-based ablation. Methods We investigated 85 consecutive patients (62 male, 53 ± 16 years) who underwent CA of VT to analyze the relationship between the ablation strategy and clinical outcome. The patients included 34 individuals with arrhythmogenic right ventricular cardiomyopathy, 16 with ischemic heart disease, 14 with dilated cardiomyopathy, 11 with sarcoidosis, and 10 with other heart diseases. The primary strategy was activation/entrainment mapping (Group-AE, N = 35); otherwise, substrate-based strategy was adopted (Group-S, N = 50) because of non-inducibility of VT or hemodynamic instability. Successful CA was defined as the non-inducibility of any VT at the end of the procedure in those with inducible clinical VT before ablation, and substrate elimination in those without. Results There were no significant differences in the left ventricular function, percentage of implantable cardioverter-defibrillator implantations, results of CA, and number of radiofrequency applications between Group-S and Group-AE. During 5 years of follow-up, there were no significant differences in sustained VT recurrences (15/50 vs. 15/35, P = 0.22), and cardiac death (2/50 vs. 3/35, P = 0.38). In patients with inducible VT before ablation, the elimination of the VT inducibility was associated with a lower recurrence rate (12/47 vs. 16/26, P = 0.003). Conclusions The substrate-based strategy adopted as an alternative option when the activation/entrainment-based strategy was unable to be performed resulted in a comparable VT recurrence rate. The extinction of VT inducibility achieved a favorable prognosis in structural heart disease patients. [ABSTRACT FROM AUTHOR]

Aim The purpose of this study was to investigate relaxation effects of back massage for puerperants on the first post-partum day using physiological and subjective indicators. Methods This randomized controlled trial included both primiparous and multiparous groups, each of which was divided into intervention and control groups. The intervention group was given a back massage for 20 min, while the control group maintained a sitting position for 20 min. Physiological measurements included heart rate variability, parasympathetic nerve activity (high frequency, HF), sympathetic nerve activity (low frequency, LF/ HF), and blood pressure. The subjective indicator was an assessment of the feeling of relaxation. Results The intervention group included 27 primiparous and 26 multiparous women, and the control group included 23 primiparous and 25 multiparous women. In both primiparous and multiparous women, there were significant differences in heart rate variability and sense of relaxation between the intervention and control groups, and a partial reduction of physical symptoms was found in the intervention groups. In the multiparous women, a significant difference in HF was also observed, and beneficial effects were found in the intervention group. Conclusion A back massage is considered to be one of the effective nursing care methods with which psychological relaxation can be given to puerperants in the early part of the puerperium. The multiparous group demonstrated the relaxation effects because a significant effect was observed in heart rate, HF, and diastolic blood pressure. However, no significant difference was seen in LF/ HF; therefore, further investigation of this relaxation effect using physiological indicators is warranted. [ABSTRACT FROM AUTHOR]

Aim Although the awareness of disasters has increased among nurses, the concept of disaster preparedness and response has not been sufficiently explored with undergraduate nursing students. The aim of this study was to assess and compare the perceptions of students regarding disaster preparedness and response that live in different earthquake-prone cities; Istanbul, Turkey and Miyazaki, Japan. Methods A cross-sectional study employing seven questions was conducted in a final group of 1053 nursing students from Istanbul, Turkey, and Miyazaki, Japan. Results Most study respondents were female, aged 18-22 years, with a high proportion of second year students in both cities. Istanbul's students had more knowledge about disaster preparedness and response in relation to age and year of university, showing statistically significant differences. Istanbul's highest rated responses to disaster characteristics were on structural elements and injuries/deaths, while Miyazaki's was 'unpredictable/sudden/disorganized'. Respondents in Istanbul identified earthquakes as the disaster most likely to occur, while respondents in Miyazaki identified typhoon/hurricane. Study participants responded that they could provide caregiver roles during a disaster event rather than triage or managerial roles as disaster responders. Conclusion Disaster characteristics were not described by one third of the students. Of the two-thirds that were described, most were of events that were highly predictable because of their frequencies in the given areas. Universities need to target and then focus on high-risk factors in their areas and have disaster plans for students who can provide triage and managerial nursing roles as disaster responders. [ABSTRACT FROM AUTHOR]

This study investigated sensitivity to teacher and peer criticism among 89 Japanese 6-year-olds and examined the connection between sensitivity to criticism and first-order and second-order theory of mind separately. Participants completed a common test battery that included tasks assessing sensitivity to criticism (teacher or peer condition), the Picture Vocabulary Test-Revised, and theory of mind tasks. The results showed that the children with better understanding of second-order mental states rated their ability negatively after teacher criticism, but they were motivated to keep trying. This phenomenon was found under only the teacher condition, and peer criticism did not significantly affect children's response, irrespective of theory-of-mind level. Cognitive and social factors that may have contributed to the children's responses to criticism are discussed. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objective The aim of this study was to define the profile of unemployed dental hygienists who could be enticed to re-enter the workforce and the factors that could facilitate their re-entry into the dental field in Japan. Methods The questionnaire was mailed with a postage-paid return envelope to a sample of 3095 licensed dental hygienists. A 50.4% response rate ( S = 1477) was observed. Results The rate of working dental hygienists was 60.3% ( n = 891), and of unemployed dental hygienists was 39.7% ( n = 586). Of the latter, 31.9% ( n = 187) stated intentions of returning to the workplace. The unemployed dental hygienists seeking employment were more often married and had more children, compared with working dental hygienists currently. This group also had significantly fewer total service years. Moreover, only 11.96% of them belonged to the Japan Dental Hygienists' Association, and 41.3% of those attended training workshops. According to their response, they perceived their top three major barriers to re-entry as 'lack sufficient dental hygiene skill', 'child rearing' and 'poor working atmosphere'. 'Flexibility in the work schedule' and 'location' were the most important factors for re-entry from their perspective. Conclusion There were not many dental hygienists hoping to return to the dental field. The findings suggested that strategies to encourage non-practicing dental hygienists to re-entry should be emphasized in the areas of a flexible working atmosphere, easy access to information on how to return to practice and guidance on how to maintain professionalism during inactivity. [ABSTRACT FROM AUTHOR]

Background and Objective Xerostomia is a subjective symptom of dryness in the mouth. Although a correlation between xerostomia and oral conditions in the elderly has been reported, there are few such studies in the young adults. The aim of this study was to examine the relationship of xerostomia with the gingival condition in university students. Material and Methods A total of 2077 students (1202 male subjects and 875 female subjects), 18-24 years of age, were examined. The disease activity and severity of the gingival condition were assessed as the percentage of teeth with bleeding on probing (% BOP) and the presence of teeth with probing pocket depth of ≥ 4 mm, respectively. Additional information on xerostomia, oral health behaviors, coffee/tea intake and nasal congestion was collected via a questionnaire. Path analysis was used to test pathways from xerostomia to the gingival condition. Results One-hundred and eighty-three (8.8%) students responded that their mouths frequently or always felt dry. Xerostomia was related to % BOP and dental plaque formation, but was not related to the presence of probing pocket depth ≥ 4 mm. In the structural model, xerostomia was related to dental plaque formation ( p < 0.01), and a lower level of dental plaque formation was associated with a lower % BOP. Xerostomia was associated with coffee/tea intake ( p < 0.01) and nasal congestion ( p < 0.001). Conclusion Xerostomia was indirectly related to gingival disease activity through the accumulation of dental plaque. Nasal congestion and coffee/tea intake also affected xerostomia. These findings suggest that xerostomia should be considered in screening for gingivitis risk in young adults. [ABSTRACT FROM AUTHOR]

Aim The purpose of this study was to compare prophylactic subcutaneous drainage plus subcuticular sutures versus staples for the risk of wound separation after skin closure following gynecologic malignancy surgery, and to investigate the risk factors of this procedure. Material and Methods Patients were divided into two groups: 120 patients who were treated with subcutaneous drainage plus subcuticular sutures ( Suture group) and 201 patients with staples plus subcutaneous sutures ( Staples group). In the Suture group, subcuticular tissue was approximated with interrupted 4-0 polydioxanone sutures, and adhesive closure strips were used on the skin surface. A 3.3-mm closed drainage was implicated in subcutaneous tissue. In the Staples group, subcutaneous tissue was approximated with interrupted polyglactin ( Vicryl, Ethicon) sutures. Results Baseline characteristics were not significantly different between the two groups. Mean operation times were compatible (201 vs 196 min, P = 0.16). The incidence of wound separation was less in the Suture group than in the Staples group (3/120 vs 17/201, P = 0.033). Multiple logistic regression analysis revealed that the Staples group was an independent risk factor for wound separation (odds ratio 7.34, 95% confidence interval: 1.59-33.91, P = 0.011), independent of obesity, International Federation of Gynecology and Obstetrics stages, and operation time. None of the 14 obese patients in the Suture group showed surgical wound separation. Conclusions The combination of a prophylactic subcutaneous drain and subcuticular sutures reduced wound separation after skin closure following gynecologic malignancy surgery. With the information regarding risk factors established in this study, the above method provides the best results to minimize the risk, particularly in obese patients. [ABSTRACT FROM AUTHOR]

Aim This study investigated: (i) the relationship between admission day of the week and the timing of surgery; (ii) whether the admission day of the week predicted length of stay or patients' outcomes; and (iii) the relationship between the timing of surgery and mortality. Methods This was a retrospective, observational study of two community general hospitals in Japan. The inclusion criteria were patients aged 65 years or older who had experienced a hip fracture and undergone surgery during April 2007 to March 2011. Data on demographics, care processes, and health outcomes during hospital stays were collected from hospital records. A questionnaire was sent to patients and/or their family members about the patients' health outcomes after discharge from hospital for hip fracture surgery. Results Data were collected from a total of 714 patients. In both hospitals, orthopedic surgery was not scheduled every day, and the admission day was significantly related to the timing of surgery. In hospital 1, the admission day explained 38.1% of the variance in the timing of surgery, and in hospital 2, it explained 8.3%. The admission day with early surgery predicted an early discharge. The admission day with delayed surgery predicted better survival. There was no significant relationship between the timing of surgery and mortality in either hospital. Conclusion Earlier surgery, by daily operations, may reduce the length of hospital stays, but its effect on patient outcome remains unclear. It is necessary to carefully determine which patients will benefit from earlier surgery. [ABSTRACT FROM AUTHOR]

Background Missing data are inevitable in almost all medical studies. Imputation methods using the probabilistic model are common, but they cannot impute individual data and require special software. In contrast, the ipsative imputation method, which substitutes the missing items by the mean of the remaining items within the individual, is easy and does not need any special software, but it can provide individual scores. The aim of the present study was to evaluate the validity of the ipsative imputation method using data involving the 15-item Geriatric Depression Scale. Methods Participants were community-dwelling elderly individuals ( n = 1178). A structural equation model was constructed. The model fit indexes were calculated to assess the validity of the imputation method when it is used for individuals who were missing 20% of data or less and 40% of data or less, depending on whether we assumed that their correlation coefficients were the same as the dataset with no missing items. Finally, we compared path coefficients of the dataset imputed by ipsative imputation with those by multiple imputation. Results When compared with the assumption that the datasets differed, all of the model fit indexes were better under the assumption that the dataset without missing data is the same as that that was missing 20% of data or less. However, by the same assumption, the model fit indexes were worse in the dataset that was missing 40% of data or less. The path coefficients of the dataset imputed by ipsative imputation and by multiple imputation were compatible with each other if the proportion of missing items was 20% or less. Conclusion Ipsative imputation appears to be a valid imputation method and can be used to impute data in studies using the 15-item Geriatric Depression Scale, if the percentage of its missing items is 20% or less. [ABSTRACT FROM AUTHOR]