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BACKGROUND Japan is a superaging society unparalleled in the world. Elderly people who need medical care do not receive adequate support in the community. As a new service to address this issue, a small-scale multifunctional in-home care nursing service called Kantaki was created in 2012. Kantaki, in collaboration with a primary physician, operates 24 hours a day and provides various nursing services (home visits, home care, day care, and overnight stays) to older people living in the community. The Japanese Nursing Association is working hard to promote this system; however, its low utilization rate is an issue. OBJECTIVE This study aimed to determine factors influencing the utilization rate of Kantaki facilities. METHODS This was a cross-sectional study. A questionnaire on the operation of Kantaki was sent to all administrators of Kantaki facilities operating in Japan from October 1 to December 31, 2020. A multiple regression analysis was used to determine factors associated with a high utilization rate. RESULTS Responses from 154 of the 593 facilities were analyzed. The average utilization rate for all valid responding facilities was 79.4%. The average number of actual users and the break-even point were almost equal, resulting in little surplus profit from facility operations. A multiple regression analysis showed that factors that had a significant impact on the utilization rate included the break-even point, a surplus of users relative to the break-even point (ie, the margin of revenues), the number of months in office of the administrator, the type of corporation (ie, nonprofit), and Kantaki’s profit from operating home-visit nursing offices. The break-even point, a surplus of users relative to the break-even point, and the number of months in office of the administrator were robust. In addition, support for reducing the burden on family helpers, a service sought by the system, significantly and negatively affected the utilization rate. In the analysis that removed the most influential factors, the cooperation of the home-visit nursing office, Kantaki’s profit from operating the home-visit nursing office, and the number of full-time care workers were significantly related. CONCLUSIONS To improve the utilization rate, managers need to stabilize their organization and increase profitability. However, a positive relationship was found between the break-even point and utilization rate, suggesting that simply increasing users did not contribute to cost reduction. Moreover, providing services that meet the needs of individual clients may result in lower utilization rates. These results, which are inconsistent with common sense, reflect the divergence between the assumptions underlying the system’s design and actual conditions. To solve these issues, institutional reforms, such as an increase in nursing care fee points, may be necessary.

The purpose of this article is to discuss the current status of research mentoring in nursing across 4 countries (the United States, Taiwan, South Korea, and Japan) and to make suggestions for future research mentoring. Seven leaders reflected on the current status of research mentoring in nursing, provided exemplars/cases from their own experiences, and their reviews of the literature. Six themes were discussed: (a) "culturally defined"; (b) "professionally contextualized"; (c) "teaching research integrity and research practice"; (d) "with mutual respect and care"; (e) "based on effective communication"; and (f) "supported by institutional and governmental commitment and infrastructure."

Breast milk is a valuable and useful source of nutrition; however, surplus milk is routinely discarded for hygiene reasons despite an unclear scientific basis. Here, we profiled the microbiota of expressed breast milk before and after feeding with an artificial nipple and examined the bacterial survival in breast milk stored at 4 °C.Eleven mother-baby pairs were included in the study. Samples of expressed breast milk were collected before and after feeding with an artificial nipple and examined both immediately (0 h) and after storage for 3 and 12 h at 4 °C. Each sample was inoculated onto a blood agar plate and incubated anaerobically and aerobically at 37 °C. Genomic DNA was extracted from individual bacterial colonies, which were identified by 16S rRNA gene sequencing.Before feeding, the bacterial counts at 0 and 12 h were (1.4 ± 1.6) × 10Bacteria were present in the breast milk before feeding. Although the main component of the microbiota shifted from Staphylococcus to Streptococcus species after feeding, these results suggest that surplus expressed breast milk may be preserved safely in a refrigerator for at least 12 h after feeding with an artificial nipple.

With the recent impact by the COVID‐19 pandemic, nursing research has gone through unexpected changes across the globe. The purpose of this special report is to present the commonalities in the impact of the COVID‐19 pandemic on nursing research across four countries, including the United States, South Korea, Japan, and Taiwan, and one region, that is, Hong Kong, and to make recommendations for future nursing research during the immediate postpandemic period and future pandemic situations. To identify the commonalities, seven researchers/leaders from the five countries/regions had discussions through 3 days of an international workshop. The content for this discussion paper derived from: (a) the exemplars/cases of the COVID‐19 impact on the research process, (b) researchers/leaders' presentations on the COVID‐19 impact, and (c) memos from the workshop. The materials were analyzed using a simple content analysis. The commonalities included: (a) “a heavy emphasis on teaching and fluctuating productivity,” (b) “increased funding opportunities and governmental support,” (c) “gendered experience complicated by professional differences,” (d) “delays and changes/modifications in research process,” (e) “limited research settings and difficulties in getting access,” and (f) “increased online dissemination activities with positive changes in the image of nursing.” With all collective wisdom that nurse researchers have obtained during the COVID‐19 pandemic, nursing research will evolve again for the successful future of the nursing discipline.

Objectives To clarify the characteristics and growth of bacteria that may infiltrate liquid baby formula during feeding and after storage for more than 3 h, the transfer of oral bacteria through artificial nipples, and bacterial survival in liquid baby formula and a baby drink were examined immediately after drinking and after storage at 4 °C for 12 h and 24 h. Methods Thirteen human subjects (aged 19–24 years) were asked to drink approximately 50 mL of liquid baby formula and a baby drink, via the artificial nipple of a baby bottle. Samples of the remaining liquid after storage at 4 °C for 12 h and 24 h were inoculated onto blood agar plates and incubated anaerobically at 37 °C for 7 days. Genomic DNA was extracted from individual colonies, and the bacterial species were identified by 16S rRNA gene sequencing. Results The mean concentrations of bacteria in the liquid baby formula were (2.6 ± 2.8) × 104 and (4.1 ± 6.6) × 104 colony-forming unit/mL after storage at 4 °C for 12 h and 24 h, respectively. Streptococcus (43.2%), Veillonella (9.3%), and Schaalia (8.2%) species were recovered from the remaining liquid baby formula after storage at 4 °C for 12 h. In contrast, no bacteria were detected in the remaining baby drink after storage at 37 °C for 24 h. Conclusions The levels of bacteria immediately after drinking and after storage at 4 °C for 12 h or 24 h were similar, suggesting that remaining liquid baby formula may be preserved safely in a refrigerator for more than 3 h.

The purpose of this article is to identify the commonalities in nursing perspectives among 6 countries/regions (United States, South Korea, Taiwan, Japan, Hong Kong, and Thailand). Nine leaders from the 6 countries/regions reflected on what nursing perspectives were in their own countries/regions and provided exemplars/cases from their own experiences and literature reviews. The data were analyzed using a content analysis. Seven themes were extracted: (a) "embedded in cultural and historical contexts"; (b) "based on philosophical pluralism"; (c) "women-centered perspectives"; (d) "care-oriented holistic views"; (e) "ethical and humane views"; (f) "respecting and advocating"; and (g) "considering diversities."

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

It is suspected that oral bacteria are transferred to the liquid baby formula through the artificial nipple and multiply in the bottle after feeding. In the present study, in order to understand the influence of bacteria on liquid baby formula after feeding, the transfer of oral bacteria through artificial nipples and their survival in liquid baby formula were examined immediately after drinking as well as after storage at 4°C for 3 h. Four healthy human subjects (20-23 years old) were asked to drink liquid baby formula (Aptamil®, ca. 50 mL) from baby bottles using artificial nipples. Samples of the liquid baby formula (immediately after drinking and 3 h later) were inoculated onto blood agar plates and incubated anaerobically at 37°C for 7 days. Salivary samples from each subject and 6 newborn infants were also cultured. Genomic DNA was extracted from individual colonies, and bacterial species were identified by 16S rRNA gene sequencing. The mean amounts of bacteria (CFU/mL) were (3.2 ± 3.0) ×104 and (3.4 ± 3.3) ×104 immediately after drinking and 3 h later, respectively. Streptococcus (41.6 and 40.5%), Actinomyces (24.3 and 21.5%) and Veillonella (16.2 and 11.0%) were recovered from the samples immediately after drinking and 3 h later, respectively. On the other hand, Streptococcus (38.9%), Actinomyces (17.1%), Neisseria (9.1%), Prevotella (6.9%), Rothia (6.9%) and Gemella (5.1%) were predominant in the saliva of adult subjects, and Streptococcus (65.2%), Staphylococcus (18.5%), Gemella (8.2%) and Rothia (5.4%) were predominant in the saliva of infant subjects. From these findings, oral bacteria, e.g., Streptococcus, Gemella and Rothia, were found to transfer into the liquid baby formula through artificial nipples, and the bacterial composition in the remaining liquid baby formula was found to resemble that of human saliva. The bacterial levels were similar between immediately after drinking and when stored at 4°C for 3 h, suggesting that the remaining liquid baby formula may be preserved in a refrigerator for a specified amount of time.

2017年4月から2018年3月までの1年間,熊本大学教育学部附属特別支援学校教員と熊本大学教育学部教員による各教科等における授業改善に関する共同研究を行った.本稿では,豊かなスポーツライフの実現をめざして高等部で行った保健体育科バスケットボールの実践内容,成果と課題について報告する.

The purpose of this study was to investigate the development of the competence of risk prediction and avoidance through playing activities of early childhood. Transcripts of semi-structured interviews of the care director at a certified centers for early childhood education and were analyzed by M-GTA（Modified Grounded Theory Approach）. The results were as follows: 1）During playing activities, children experience following rules, take on responsibility, and strategize. These experiences foster the ability to think, judge, concentrate, and predict and avoid risk. 2）During playing activities, the act of synchronizing one’s breathing, being preparate and cleare about the exercise bars, and trying to stick to the rules help develop children’s social natures. This is connected to the development of competence in risk prediction and avoidance. 3）The environment in which children experience risk, and share risk and the environment in which children can play freely support the child’s development into an individual with the ability to think and act independently. 4）In childcare, risk is showed and shared, this helps in the development of competence in risk prediction and avoidance. 5）Nursery teachers are required to have the sensitivity to ascertain risk.

This longitudinal study aimed to clarify the relationship of oral health in infancy with that in adulthood among participants who were the subjects of the oral health promotion project (OHPP) conducted in Miyako Island, Okinawa Prefecture, Japan, since 1984. Twenty-seven subjects, around 35 years of age, were examined for dental caries, periodontal diseases (community periodontal index), dental plaque, occlusion, and bite-force and compared with those at 4 and 13–15 years of age. The dental caries status and maximum bite force in adulthood was significantly reflected for those at 4 and 13–15 years of age (p &lt, 0.05). CPI in adulthood was related to the dental caries status at 4 and 13–15 years of age but not to the gingival score at 4 years of age, and it was weakly related to the gingival score at 13–15 years (r = 0.264, p &gt, 0.05). Most of the normal occlusion at 4 years of age became normal permanent occlusion in adulthood (88.9%). Most of the cases involving the discrepancy factor retained the same condition in both the deciduous and permanent dentitions (83.3%) (p &lt, 0.001). Those who participated in the OHPP soon after birth showed significantly fewer DMFT (p &lt, 0.05) compared with those who did not. This study revealed that oral health at 4 years of age was related to that in adulthood, suggesting that fostering good oral health soon after birth is of great importance.

The situation-specific theory (SST) named “Dining Supports for Life Enhancement at Welfare Facilities for Seniors (DLWS) in Japan” was developed with the goal of life enhancement for each individual welfare facility resident. The DLWS theory was developed through the approaches integrating a concept analysis, a literature review and qualitative research on clinical practices of nurses. Thus it would offer the conceptual framework of nursing intervention of dining supports. The DLWS theory explain the phenomena of dining and its support. The DLWS theory involves three sub-concepts for explaining the phenomena related to dining: (1) required conditions, (2) dining, and (3) life enhancement which were developed from the concept analysis of dining. And the DLWS theory organizes the dining conditions and environment and strives to create the ideal dining experience through four support processes: (1) daily life support, (2) dining preparation, (3) dining support, and (4) reflection and improvement. Through these processes, the theory is expected to contribute to lifestyle rebuilding and well-being of residents.

Introduction: Because virtually no theories were available to explain unique characteristics of Asian women’s leadership in nursing, a middle-range theory on women’s leadership in Asian culture was previously published. To reflect recent political and social changes in different countries, there is a necessity to refine the theory. The purpose of this article is to present the refined middle-range theory on Asian women’s leadership in nursing. Methodology: Using an integrative approach, the theory was further developed based on two major sources: literature reviews and exemplars/cases from six different countries. Results: The Refined Middle-Range Theory on Women’s Leadership in Asian Culture has two main domains: (a) leadership frames and (b) leadership contexts. The domain of leadership contexts has been extended with two additional main concepts including demographic contexts and health workforce/system contexts. Discussion: The refined theory is expected to guide Asian women’s leadership in nursing across the globe.

Background Continuing education is vital for the development of the competencies of nurses and midwives. We analysed the effectiveness of a distance education programme for maternal and child health nurses and midwives in Mongolia, assessing its strengths and limitations and ways in which it could be improved. The aim of this research is to provide an analysis of the successes and failures of the programme, in order to improve future versions of this and similar programmes in Mongolia and elsewhere. Methods We carried out a qualitative descriptive study in Mongolia in August 2015. This consisted of three semi-structured interviews and two focus groups in the Second National Hospital, Ulaanbaatar, and three semi-structured interviews and one focus group in Dornogovi Provincial Maternal Hospital, Sainshand, Dornogovi Province. In total, there were 22 participants in our research. Data from the interviews and focus groups were thematically coded and analysed using NVivo version 10. Findings The distance education programme is well received by participants. They suggest that it has improved their clinical practice and education in a number of areas, and are anxious for the programme to continue. A number of alterations would be necessary to improve both the quality of the programme and the ability of participants to foster change on the basis of what they have learnt. This provides challenges for both the programme organizers and the providers of maternal and child health services in Mongolia. Implications for nursing and/or health policy The success of the distance education programme suggests that collaborations of this type are a cost-effective method of disseminating best practice in policy and practice to improve the quality of care provided to mothers and children in low-resource settings. Conclusions A distance education programme is vital to link maternal care providers in Mongolia to new trends in care. Mongolia's relative isolation means that this programme is particularly valuable there. However, the programme could work equally well in other developing country settings.

Introduction: Asian cultures reflect patriarchal cultural values and attitudes, which likely have influenced women leaders in their countries differently from women in Western cultures. However, virtually no leadership theories have been developed to reflect the experiences and development of nursing leaders from Asian cultures. The purpose of this article is to present an emerging integrated middle-range theory on Asian women’s leadership in nursing. Methodology: Using an integrative approach, the theory was developed based on three major sources: the leadership frames of Bolman and Deal, literature reviews, and exemplars/cases from five different countries. Results: The theory includes two main domains (leadership frames and leadership contexts). The domain of leadership frames includes human resources/networks, structure/organization, national/international politics, and symbols. The domain of leadership contexts includes cultural contexts, sociopolitical contexts, and gendered contexts. Discussion: This theory will help understand nursing leadership in Asian cultures and provide directions for future nurse leaders in this ever-changing globalized world.

Objectives: A program fostering self-management for the elderly was implemented and the effects of the program and their continuities were assessed. Methods: Subjects consisted of 19 males and 131 females (average age, 73.1 ± 7.4; range, 60–94 years). The intervention program consisted of the collective experience learning and private consultation. The collective experience learnings included; (1) monitoring the oral condition and practicing oral self-care, (2) monitoring the oral function and practicing oral exercises, and (3) group discussion on continuing oral self-care. Outcomes were evaluated at the beginning and the end of the intervention program, and three months after the investigation by the scores in; (1) oral self-care (2) oral condition, i.e., decayed teeth, community periodontal index (CPI), deposits of plaque and dental calculus, (3) oral function such as RSST, oral diadochokinesis, (4) QOL (SF-8 v2™, and GOHAI), and (5) cognitive function (MMSE-J). Informed consent was obtained fro...

The aim of this study is to determine the effect of food consistency on health and related factors among residents in welfare facilities for seniors (n = 227, mean age, 86.2 &plusmn, 8.0 years, 78.9% female). Residents who ate regular food had a lower incidence of fever during the 3-month period (p &lt, 0.001) and consumed more calories (1325.97 &plusmn, 220.2 kcal) than those who ate chopped (1125.0 &plusmn, 256.8 kcal), paste (1122.0 &plusmn, 288.5 kcal), and gastric tube food (812.5 &plusmn, 150.7 kcal) (p &lt, 0.001). Modifying a resident&rsquo, s food by making it softer and finer did not reduce the incidence of choking. Logistic regression analysis (backward elimination method) revealed four factors related to eating regular food: vitality index, appetite, number of remaining teeth, and choking frequency. Causal relationships were not obtained because this was a cross-sectional study. The findings of this study suggest that a regular consistency of food positively influences the health of older individuals.

Objectives The frequency of periodontitis among elderly is increasing in Japan. This study aimed to quantify the periodontitis-associated bacteria in subgingival plaques from elderly patients with periodontitis and from periodontally healthy subjects. Methods Subgingival plaque samples were collected from independent subjects (mean age=71.1 years, n =518). All samples were subjected to real-time PCR analysis to assess the presence of Porphyromonas gingivalis . In addition, we tested for Tannerella forsythia , Eubacterium saphenum and Streptococcus oralis in the earliest 95 samples; and performed fimA gene classification of P. gingivalis in the latest 49 samples. Results P. gingivalis and T. forsythia comprised a significantly higher proportion of total bacteria in subjects with periodontitis (1.1% and 5.1%) than periodontally healthy subjects (0.3% and 1.4%, respectively). The proportion of E. saphenum was low in both groups, whereas that of S. oralis was higher in periodontally healthy subjects. In 24 of 49 samples, fimA genotypes were detected and classified. Genotypes Ib ( n =5) and II ( n =7) were identified in those of subjects with periodontitis ( n =15); while those of healthy subjects ( n =9) were found to belong to genotypes I ( n =2), II ( n =2), III ( n =2) and IV ( n =3). In 4 out of the 5 subjects in whom P. gingivalis was detected at healthy sites, the fimA genotypes were identical between periodontitis and healthy sites, but the mean proportion of P. gingivalis was significantly higher at periodontitis sites (3.0%) than at healthy sites (0.5%) ( P Conclusions This study suggests that an increase in P. gingivalis and T. forsythia may be associated with periodontitis in the elderly, and we have identified characteristic pathogenic fimA genotypes that target this vulnerable group.