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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]

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]

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 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]

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]

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

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

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]

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

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

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

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

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

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

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

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

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

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

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

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

Aim Gingivitis commonly progresses to periodontitis in permanent dentition but rarely in deciduous teeth. Little is known about the biochemical differences between gingiva of deciduous and permanent teeth. Here, we compared the protein profiles of gingival crevicular fluids ( GCF) from the gingiva of deciduous and permanent teeth. Materials and Methods Forty children with mixed dentition (Hellman's dental age IIIA) were selected and GCF samples were collected from deciduous cuspids and central incisors in the maxilla. Pairs of GCF samples were labelled using isobaric tags to permit quantitative comparison of protein abundance in the samples using liquid chromatography-electron spray ionization-tandem mass spectrometry. Results Sixty-two proteins were upregulated in deciduous teeth GCF and 54 in permanent teeth GCF. In particular, neutrophil-derived proteins, including myeloperoxidase and lactoferrin, were repeatedly higher in deciduous teeth GCF than in permanent teeth GCF. These differences were verified using ELISA ( p < 0.01). In contrast, immunoglobulin components were upregulated in permanent teeth GCF. Conclusions Neutrophil-related proteins were enriched in deciduous teeth GCF and immunoglobulins in permanent teeth GCF. This suggests that neutrophil accumulation plays a protective role in innate immunity against bacterial infection in gingival tissue of deciduous teeth. [ABSTRACT FROM AUTHOR]

Early urinary catheter removal from patients cared for in their own home is often difficult because of incontinence and care burdens, resulting in long duration of catheterization. Urinary tract infection and catheter blockage are major complications associated with long‐term catheterization. Preventing these complications is important for patients who require long‐term catheterization in their own home. This study aimed to examine the occurrence characteristics of urinary catheter blockage and to identify the causative factors of catheter blockage in patients cared for in their own home requiring long‐term urinary catheterization. The study targeted 154 patients cared for in their own home requiring long‐term urinary catheterization. Patient data were collected by questionnaire by the nurse manager. Catheter blockage occurred in 33·8% of patients requiring long‐term catheterization within the first 6 months, and the mean frequency in these patients was 3·0, indicating that catheter blockage occurs repeatedly. The following management factors significantly correlated with the frequency of catheter blockage: ‘check urine volume’, ‘check for flexion and distortion of the catheter’ and ‘check urinary tract infection symptoms’ for catheter management by caregivers. Symptoms correlated with catheter blockage included ‘cloudiness of the urine’, ‘decreased urine volume’, ‘abdominal pain’ and ‘duration of catheterization’. In the future, we would like to prepare the protocol to help visiting nurses improve their abilities to manage catheter blockage in patients requiring long‐term catheterization, by incorporating the findings from this study. [ABSTRACT FROM AUTHOR]

Aim: Globally, awareness of the vital link between health and the natural environment is growing. This pilot study, based on the idea of “forest bathing,” or shinrin‐yoku, the mindful use of all five senses to engage with nature in a natural environment, was initiated in order to determine whether stimulation by viewing an individual's preferred video of sea or forest had an effect on relaxation. Methods: The participants were 12 healthy men in their twenties and they were divided into two groups based on their preference for sea or forest scenery by using the Visual Analogue Scale. The participants watched 90 min DVDs of sea with natural sounds and forest with natural sounds while their heart rate variability and Bispectral Index System value were measured by using MemCalc/Tawara and a Bispectral Index System monitor. Results: The participants were divided into two groups of six based on their preference for sea or forest scenery and each indicator was compared between them. Significant differences in a decrease in heart rate, increase in high frequency, and sustained arousal level were observed while viewing the preferred video. These results indicated that the viewing individual's preferred video of sea or forest had a relaxation effect. Conclusion: This study suggests that individual preferences should be taken into consideration for video relaxation therapy. [ABSTRACT FROM AUTHOR]

Objectives To determine the standard values of and age-related changes in objective oral function of healthy older people; compare oral function of robust, prefrail, and frail older people; and determine the association between oral function and frailty. Design Cross-sectional analysis. Setting General community. Participants Elderly adults (≥65) from the Obu Study of Health Promotion for the Elderly were included and assigned to the robust, prefrail, and frail groups (N = 4,720). Measurements Each participant underwent detailed physical testing to assess frailty. The frailty phenotype was defined according to the presence of limitations in three or more of the following five domains: mobility, strength, endurance, physical activity, and nutrition. The numbers of present teeth and functional teeth were counted, and occlusal force, masseter muscle thickness, and oral diadochokinesis ( ODK) rate were measured, along with sociodemographic and functional status, comorbidities, and blood chemistry. Results The number of present teeth, occlusal force, masseter muscle thickness, and ODK rate decreased with age. The frail group had significantly fewer present teeth (women aged ≥70), lower occlusal force (women aged ≥70; men aged ≥80), lower masseter muscle thickness, and lower ODK rate than the robust group. Multivariate analysis indicated that age, Geriatric Depression Scale score, skeletal muscle mass index, Mini-Mental State Examination score, hypertension, diabetes mellitus, albumin and triglyceride levels, and oral function were significantly associated with frailty. Conclusion Age-related differences in oral function were found in older adults. Moreover, frail older individuals had significantly poorer oral function than prefrail and robust individuals. The risk of frailty was associated with lower occlusal force, masseter muscle thickness, and ODK rate. [ABSTRACT FROM AUTHOR]

Objectives To investigate whether social participation ( SP) in older adults is associated with ability to perform instrumental activities of daily living ( IADLs). Design Prospective cohort study. Setting Two local municipalities of Nara, Japan. Participants Individuals aged 65 to 96 (n = 2,774 male, n = 3,586 female) free of IADL disability at baseline. Measurements SP and IADLs were assessed using self-administered questionnaires. SP was categorized into five types and assessed using the number and type of social activities. IADLs were evaluated using the Tokyo Metropolitan Institute of Gerontology Index of Competence. Logistic regression analysis stratified according to sex was used to examine change in IADLs according to SP, with nonparticipation as a reference. Results During the 3-year follow-up, 13.6% of men and 9.0% of women reported IADL decline. After adjusting for age, family structure, body mass index, pension, occupation, medical treatment, self-rated health, drinking, smoking, depression, cognitive function, and activities of daily living, participation in various social activities was inversely associated with change in IADLs in women but not men. Participation in the following types of social activities had significant inverse associations with IADL disability: hobby clubs (odds ratio ( OR) = 0.68, 95% confidence interval ( CI) = 0.49-0.94) for men and local events ( OR = 0.68, 95% CI = 0.48-0.95), hobby clubs ( OR = 0.53, 95% CI = 0.36-0.79), senior citizen clubs ( OR = 0.74, 95% CI = 0.56-0.97), and volunteer groups ( OR = 0.56, 95% CI = 0.32-0.99) for women. Conclusion Participation in a variety of different types of social activities was associated with change in IADLs over the 3 years of this study in women, and participation in hobby clubs was associated with change in IADLs in men and women. Recommending that community-dwelling elderly adults participate in social activities appropriate for their sex may promote successful aging. [ABSTRACT FROM AUTHOR]

Objectives To examine whether number of remaining teeth and regular dental care affect incident functional disability in elderly Japanese adults. Design Prospective cohort study. Setting Tsurugaya district, Sendai, Japan. Participants Community-dwelling individuals aged 70 and older (N = 834). Measurements The outcome measurement was incident functional disability, defined as first certification of long-term care insurance in Japan, which is determined on the basis of a strictly established uniform nationwide standard. During a median follow-up of 7.9 years (interquartile range 4.8-7.9 years), information on long-term care insurance was obtained from the Sendai Municipal Authority. Oral health was assessed according to number of remaining teeth and presence or absence of regular dental care. Data were also collected on age, sex, body mass index, medical history, smoking, alcohol consumption, duration of education, depressive symptoms, cognitive impairment, physical functioning, and social support. Results Participants with 10 to 19 teeth (adjusted hazard ratio ( aHR) = 1.42, 95% confidence interval ( CI) = 1.03-1.94), one to nine teeth ( aHR = 1.46, 95% CI = 1.04-2.03), and no teeth ( aHR = 1.49, 95% CI = 1.03-2.14) were more likely to develop functional disability than those with 20 or more teeth. There was no significant difference in risk of functional disability between participants with 20 or more teeth and those with zero to 19 teeth who were receiving regular dental care, whereas those with zero to 19 teeth without regular dental care had a significantly greater risk of functional disability than those with 20 or more teeth ( HR = 1.46, 95% CI = 1.11-1.92). Conclusion Tooth loss was associated with greater risk of functional disability in community-dwelling elderly Japanese. Regular dental care might moderate the risk of functional disability in elderly individuals with missing teeth. [ABSTRACT FROM AUTHOR]

Objectives From a life-course perspective, adverse childhood experiences ( ACEs) such as childhood abuse are known risk factors for adult diseases and death throughout life. ACEs could also cause poor dental health in later life because they could induce poor dental health in childhood, initiate unhealthy behaviors, and lower immune and physiological functions. However, it is not known whether ACEs have a longitudinal adverse effect on dental health in older age. This study aimed to investigate the association between experience of childhood abuse until the age of 18 and current number of remaining teeth among a sample of older Japanese adults. Methods A retrospective cohort study was conducted using the data from the Japan Gerontological Evaluation Study ( JAGES), a large-scale, self-reported survey in 2013 including 27 525 community-dwelling Japanese aged ≥65 years (response rate=71.1%). The outcome, current number of remaining teeth was used categorically: ≥20, 10-19, 5-9, 1-4, and no teeth. Childhood abuse was defined as having any experience of physical abuse, psychological abuse, and psychological neglect up until the age of 18 years. Ordered logistic regression models were applied. Results Of the 25 189 respondents who indicated their number of remaining teeth (mean age: 73.9; male: 46.5%), 14.8% had experience of childhood abuse. Distributions of ≥20, 10-19, 5-9, 1-4, and no teeth were as follows: 46.6%, 22.0%, 11.4%, 8.2%, and 11.8% among respondents with childhood abuse, while 52.3%, 21.3%, 10.3%, 6.6%, and 9.5% among respondents without childhood abuse. Childhood abuse was significantly associated with fewer remaining teeth after adjusting for covariates including socioeconomic status (odds ratio=1.14; 95% confidence interval: 1.06, 1.22). Conclusions Childhood abuse could have a longitudinal adverse effect on later dental health in older age. This study emphasizes the importance of early life experiences on dental health throughout later life. [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]

The 'Skippu-Mama' peer support program was developed to improve quality of life and reduce parental stress in mothers of children with autism spectrum disorders. The program was designed to improve these variables by refreshing and healing participants' minds and bodies. Twenty-four mothers of 26 children diagnosed with ASD in Japan were included in the study and completed measures of quality of life and parental stress before, during, and after participation in the Skippu-Mama program. Our results demonstrated that time was a significant main effect. Further, multiple comparisons with Bonferroni corrections indicated a significant increase in World Health Organization Quality of Life 26 scores three months into the program and at its conclusion six months after commencement. Overall, the Skippu-Mama program improved the quality of life of mothers of children with ASD, and we believe that the intervention's focus on both individual and family variables may be especially effective in this population. [ABSTRACT FROM AUTHOR]

Paternal postpartum depression may affect not only the mental health and wellbeing of fathers but their partners and children. We investigated the point and period prevalence of paternal postpartum depression and its association with factors measured during pregnancy in a regional longitudinal study in Nishio City, Aichi Prefecture, Japan, between December 1, 2012, and April 30, 2013. Data were collected once in pregnancy and five times in the first three months postpartum. The Edinburgh Postnatal Depression Scale was used to assess paternal depression, and data were collected in pregnancy on demographic and psychosocial factors. Of 215 fathers who returned at least one of the five postpartum assessments, 36 (17%) reported symptoms of depression in the first three months after birth. In logistic regression analyses, among a number of demographic and psychosocial characteristics that previously had been linked to paternal postpartum depression, only fathers' history of psychiatric treatment and depressive symptoms during pregnancy were associated with paternal depressive symptoms in the postnatal period. The results add to the growing body of evidence on prevalence of paternal postnatal depression and indicate that assessment and support for fathers are important starting in pregnancy. © 2016 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

The aim of this multicentre study was to investigate the effect of prosthetic restoration for missing posterior teeth on mastication in patients with shortened dental arches ( SDAs). Partially dentate patients who had an intact teeth in anterior region and missed distal molar(s) (2-12 missing occlusal units) classified as Kennedy Class I or Class II were recruited from seven university-based dental hospitals in Japan. Of the 125 subjects who underwent baseline (pre-treatment) and follow-up/post-treatment evaluation, 53 chose no replacement of missing teeth and 72 chose treatment with removable partial dentures ( n = 53) or implant-supported fixed partial dentures ( n = 19). Objective masticatory performance ( MP) was evaluated using a gummy jelly test. Perception of chewing ability ( CA) was rated using a food intake questionnaire. In the no-treatment group, mean MP and CA scores at baseline were similar to those at follow-up evaluation ( P > 0·05). In the treatment group, mean MP after treatment was significantly greater than the pre-treatment mean MP ( P < 0·05). However, the mean perceived CA in the treatment groups was similar at pre- and post-treatment ( P > 0·05). In a subgroup analysis of subjects in the treatment group, subjects with lower pre-treatment CA showed a significant CA increase after treatment ( P = 0·004), but those with higher pre-treatment CA showed a significant decrease in CA ( P = 0·001). These results suggest that prosthetic restoration for SDAs may benefit objective masticatory performance in patients needing replacement of missing posterior teeth, but the benefit in subjective chewing ability seems to be limited in subjects with perceived impairment in chewing ability before treatment. [ABSTRACT FROM AUTHOR]

Aim: Given limited exposure to various ethnicities, languages, and cultures, providing health care to an increasing foreign population in Japan will likely be challenging for Japanese nurses. This study aimed to examine past and intended future international experiences of Japanese nurses to assess their cultural immersion level. Methods: A cross‐sectional electronic survey was conducted among 2029 nurses in 2010. Participants were categorized by travel purpose, and the frequency of non‐holiday travel was analyzed. To examine participants' desire for and perceived feasibility of future non‐holiday international experiences by background characteristics, logistic regression analyses were performed. Results: Of 1039 participants, 10.1% had past non‐holiday international experiences, with 80% having traveled to high‐income, English‐speaking countries. The median value for travel frequency was once, and the median duration of travel was less than 1 month. The most common purpose of travel was participation in short‐term programs (e.g. professional training, language study). Fifty‐one percent of female nurses reported a desire for future non‐holiday international experiences. Of these, 37.2% considered such experiences feasible. Age of the youngest child, having nursing specialization, English proficiency, and past international experience were significant predictors for feasibility. Conclusion: Japanese nurses with foreign experience were considered valuable human resources for culturally appropriate care. Efforts should be made to integrate them into the Japanese healthcare setting. The present study revealed room for improvement in foreign language proficiency and cross‐cultural training with a focus on non‐English‐speaking and developing countries. A supportive workplace environment should be created that allows nurses to pursue the international experiences they desire. [ABSTRACT FROM AUTHOR]

Objectives To examine the association between four markers of overall nutritional status (a serum biomarker (albumin) and three anthropometric indices (body mass index ( BMI), midarm circumference ( MAC), calf circumference ( CC))) and incident hearing impairment in older Japanese adults. Design Community-based prospective cohort study. Setting Kurabuchi Town, Gunma Prefecture, Japan. Participants Individuals aged 65 and older (143 men, 195 women) without hearing impairment at baseline examination (2005-06) who participated in repeated examinations 4 years later (2009-10) (N = 338). Measurements The three anthropometric indices were measured at baseline, and nephelometry was used to assess serum albumin levels. Hearing impairment was defined as failure to hear a 30- dB hearing level signal at 1 kHz and a 40- dB signal at 4 kHz in the better ear on pure-tone audiometry. Results Over the 4-year period, 16.3% of participants developed hearing impairment. Those with lower marker values had greater risk of hearing impairment than those with higher marker values (multivariable adjusted odds ratio ( aOR) = 2.18, 95% confidence interval ( CI) = 1.05-4.57 for albumin ≤4.0 g/ dL; aOR = 2.72, 95% CI = 1.10-6.71 for BMI <19.0 kg/m2). The pattern of association showed a similar tendency for MAC and CC. Excluding obese participants did not changed the results substantially. Conclusion Further research is needed to determine whether interventions that improve markers of nutritional status may help prevent age-related hearing loss in older adults. [ABSTRACT FROM AUTHOR]

Aim The aim of the study was to improve the measurement of ageing taking into account characteristics of populations and in particular changes in life expectancy. Method Using projected life tables, we calculated prospective old age dependency ratios ( POADRs) to 2060, placing the boundary to old age at a moving point with a fixed remaining life expectancy ( RLE) for all countries of East Asia. Results POADRs grow less rapidly than old age dependency ratios ( OADRs). For example, in the Republic of Korea, the OADR is forecast to increase from around 0.1 in 1980 to around 0.8 in 2060, while the POADR is forecast to increase from around 0.1 to 0.4 over the same period. Conclusion Policy makers may wish to take into account the fact that the increases in measures of ageing will be slower when those measures are adjusted for changes in life expectancy. [ABSTRACT FROM AUTHOR]

Previous studies have identified various factors related to masticatory performance. This study was aimed to investigate variations and impacts of factors related to masticatory performance among different occlusal support areas in general urban population in Japan. A total of 1875 Japanese subjects (mean age: 66·7 years) were included in the Suita study. Periodontal status was evaluated using the Community Periodontal Index (CPI). The number of functional teeth and occlusal support areas (OSA) were recorded, and the latter divided into three categories of perfect, decreased and lost OSA based on the Eichner Index. Masticatory performance was determined by means of test gummy jelly. For denture wearers, masticatory performance was measured with the dentures in place. The multiple linear regression analysis showed that, when controlling for other variables, masticatory performance was significantly associated with sex, number of functional teeth, maximum bite force and periodontal status in perfect OSA. Masticatory performance was significantly associated with number of functional teeth, maximum bite force and periodontal status in decreased OSA. In lost OSA, masticatory performance was significantly associated with maximum bite force. Maximum bite force was a factor significantly influencing masticatory performance that was common to all OSA groups. After controlling for possible confounding factors, the number of functional teeth and periodontal status were common factors in the perfect and decreased OSA groups, and only sex was significant in the perfect OSA group. These findings may help in providing dietary guidance to elderly people with tooth loss or periodontal disease. [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]

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]

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]

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]

OBJECTIVES: To clarify the relationship between self-reported hearing loss (HL) and 5-year decline in higher-level functional capacity in high-functioning elderly adults. DESIGN: Population-based, prospective cohort study. SETTING: The Fujiwara-Kyo Study, Nara, Japan. PARTICIPANTS: Community-dwelling individuals aged 65 and older with a perfect baseline and valid follow-up instrumental activity of daily living (IADL) (n = 3,267), intellectual activity (IA) (n = 2,925), and social role (SR) (n = 2,698) scores. MEASUREMENTS: Self-reported HL was evaluated using a single question: "Do you feel you have hearing loss?" IADLs, IA, and SR were measured using the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC) subscales. Geriatric syndromes (depressive symptoms, cognitive impairment, sleep disturbance, falls, urinary incontinence, visual impairment) were self-reported at baseline. Blood tests were performed to measure cardiovascular risk factors. RESULTS: During 5-year follow-up, new declines developed for 213 participants in IADLs, 272 in IA, and 327 in SR. After adjustment for all covariates, including geriatric syndromes, using multiple logistic regression analysis, self-reported HL at baseline was associated with a decline in IA (odds ratio (OR) = 1.39, 95% confidence interval (CI) = 1.04-1.86) and SR (OR = 1.34, 95% CI = 1.02-1.76) but not IADLs (OR = 1.07, 95% CI = 0.76-1.48). CONCLUSION: Self-reported HL was found to be a significant predictor of decline in IA and SR. Preventive intervention against age-related HL may contribute to maintaining high-level functional capacity in independent elderly adults. [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 The aim of this study was to clarify the mortality and long-term outcomes of extremely low-birthweight infants according to the process of maternal or infant transport and indications for maternal transport. Material and Methods We conducted a population-based study between 2005 and 2009. The collected data included the process and indications for maternal or neonatal transport, maternal and infant characteristics and the prognosis of extremely low-birthweight infants. Intergroup comparisons were made using the Mann- Whitney U-test, while multiple group comparisons were made using the Kruskal-Wallis test followed by the post-hoc paired t-test according to the Dunn procedure. Comparisons of the cumulative survival rates based on postnatal age according to the process of maternal or neonatal transport were performed using a Kaplan-Meier survival analysis and the log-rank test. Results The study subjects included 195 infants from 189 mothers following 50 632 deliveries during the study period. Overall, 32 (16.4%) infants died and 33 (20.2%) infants had neurological impairments. The rates of mortality and handicaps among the infants in the maternal transport group were 15.2% and 23.2%, respectively, compared to 25% and 44%, respectively, in the neonatal transport group. There were no differences in the prognoses of the infants according to the process of maternal transport, although more premature neonates were managed in the tertiary center. There were no differences in the cumulative survival rates based on the institution that managed the neonate. The incidence of a poor prognosis was significantly higher among the infants born from mothers transported to the tertiary center due to bulging membranes ( P = 0.047). All mothers with placental abruption were transported to the nearest secondary center. Conclusion The morbidity and mortality of extremely low-birthweight infants demonstrated a low incidence following the regionalization of high-risk pregnancies in our region. Further reductions in severe neonatal morbidities may depend on reducing the rate of neonatal transport. [ABSTRACT FROM AUTHOR]

Background and Objective Epithelial cells are recognized as the first line of defense against bacterial infection and environmental harmful stimuli such as cigarette smoke ( CS). Although previous studies explored the effects of nicotine on host cells, mechanisms by which CS affects cellular functions remain uncertain. The present study investigated the effects of CS condensate ( CSC) on in vitro wound closure of gingival epithelial cells and their potential interactions with a major periodontal pathogen, Porphyromonas gingivalis. Material and Methods Human gingival epithelial cells (Ca9-22) were treated with CSC for 24 h. Cell proliferation was determined using a WST-1 assay. Cell migration was assessed using a wound closure model. The expression of integrins was analyzed by confocal scanning laser microscopy and real-time PCR. Intracellular invasion of P. gingivalis was evaluated by confocal scanning laser microscopy and an antibiotic protection assay. Results Low concentrations (1-10 μg/mL) of CSC showed no significant effect on cell proliferation. CSC demonstrated dual effects on epithelial wound closure of Ca9-22 cells: high concentrations (i.e. 250 μg/mL) significantly inhibited the wound closure whereas low concentrations (i.e. 10 μg/mL) promoted it ( p < 0.01). CSC induced distinct changes in cytoskeleton. When CSC-exposed cells were infected with P. gingivalis for 2 h, a significant inhibition of wound closure was observed concurrent with a decrease in integrin α3 expression near the wound area. A significantly increased P. gingivalis invasion into Ca9-22 was observed when exposed to low concentrations of CSC. Conclusion Low concentrations of CSC increased invasion of human gingival epithelial cells by P. gingivalis and induced changes in cytoskeleton and integrin expression, thereby modulating the cell migration. [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]