Factors related to changes in foot status and foot care in patients with diabetes mellitus participating in an exercise health education program

Purpose: To identify factors related to changes in foot status and foot care in patients with diabetes mellitus participating in an exercise program. Methods: The subjects were 21 patients with Type 2 diabetes mellitus (8 males, 13 females). The mean age of the patients was 62.3 ± 12.5 years old. Foot status, physical measurements and daily activities were monitored and several surveys were performed. Results: Changes in foot status were significantly positively correlated with walking at normal speed (r = 0.54, p < 0.05) and fast speed (r = 0.68, p p < 0.05). Foot care showed a significant negative correlation with burden of diet therapy (r = -0.48, p < 0.05) and a significant positive correlation with the self-efficacy of diet therapy (r = 0.65, p < 0.01). Conclusions: Subjects who were fast walkers showed greater changes in foot status. Poor foot care behavior is also related to greater changes in foot status. Regular interventions for foot care are important to improve self-care behavior during an exercise program.

Relationship between body mass index and course of pregnancy in women

Nutritional management and suitable weight control during pregnancy are very important. However, in clinical practice, it is difficult to determine in detail precisely what pregnant women are eating. We investigated nutritional balance and nutritional requirements in pregnant women and their relationship to the course of pregnancy. A Food Frequency Questionnaire Based on Food Groups (FFQg) was distributed to 223 women at 12 weeks gestation attending one obstetrics clinic. We observed the women’s statuses until delivery and obtained information on pregnancy, delivery, and newborn from their medical records. One hundred and forty-seven (65.9%) of the subjects had problem-free pregnancies. Only 2 (0.9%) subjects developed pregnancy-induced hypertension syndrome. Participants were classified by pre-pregnancy BMI (body mass index;kg/m2) as follows: 44 (19.7%) were underweight (BMI the three groups. However, the underweight group consumed significantly more fat than the normal group and gained significantly more weight before delivery than the others. Blood pressure was significantly higher in the overweight group than in the other groups at some points of gestation, although it remained within the normal range. Fat intake overall was more than the recommended value, especially in the underweight group. The relationship between course of pregnancy and nutritional intake was unclear. However, pre-pregnancy BMI may influence the course of pregnancy in terms of infant weight, gestational weight gain, and blood pressure.

Development of a Scale to Evaluate the Depressive State among Elderly Patients in General Wards

This study aims to develop a scale to evaluate depressive states among elderly patients in general wards, and verify the reliability and validity of the scale. Based on the results of interviews with nurses, we developed a draft of a scale comprised of 48 questions (NDE48). The Geriatric Depression Scale short version (GDS15), and the Zung Self-rating Depression Scale (SDS) were administered to 54 elderly patients. Two groups of nurses completed the NDE48 on different days. After performing an explanatory factor analysis, the NDE48 was simplified to a 16 question item scale (NDE16), comprising three factors. The correlation coefficient between GDS15 and NDE16 was 0.41 (p = 0.00191), and between SDS and NDE16 was 0.30 (p = 0.02633). Alpha coefficient of the total score of NDE16 was 0.88. For inter-rater reliability, the correlation coefficient was 0.57 (p = 0.00005). The findings suggest that the NDE16 will be highly useful when nurses evaluate depressive states among elderly inpatients.

Influence of smoking on postpartum depression in Japan

Aim: To investigate the influence of smoking on postpartum depression. Methods: One thousand fifty-one women, in a rural city in Aomori Prefecture, Japan, prospectively fulfilled the selection criteria and completed self-reporting questionnaires on postnatal depression at 5-6 days, 1 month, 4 months, 7 months and 12 months after childbirth, using the Edinburgh Postnatal Depression Scale (EPDS) and a life and social events scales including smoking habits. Results: Seven hundred seventy-seven women were non-smokers. Among two hundred seventy-four women who were smokers before becoming pregnant (26% of pregnant women), 241 women quit smoking during pregnancy and 33 women continued smoking. Smoking habits were significantly associated with sociopsychological states and we found that EPDS scores of smokers were significantly higher than EPDS of non-smokers. The EPDS scores of both non-smokers and smokers were higher at 5-6 days, but were stable from 1 month to 12 months, after childbirth. Fifty-one women who quit smoking after childbirth resumed smoking during he 1-12 month periods after childbirth. The EPDS scores of 51 women who resumed smoking were significantly reduced after they resumed smoking. Conclusion: The EPDS scores of smokers were higher than those of non-smokers and a smoking habit may help to alleviate postpartum depression.

Single Oral Administration of Anthocyanin Rescues Smoking-Induced Endothelial Dysfunction in Young Smokers but Facilitates Oxidative Stress in Non-Smokers

Objectives: Smoking causes endothelial dysfunction, but it still remains unclear whether oral administration of anthocyanin brings benefits to endothelial function and redox states in young healthy smokers. We tested the hypothesis that supplement anthocyanin may rescue endothelial dysfunction and redox states in young healthy smokers. Methods: Young healthy male non-smoker (n = 8) and smokers (n = 14) were enrolled to measure the derivatives of reactive oxygen metabolites (d-ROMs) and biological antioxidant potential (BAP) levels and brachial artery flow-mediated dilation (FMD) before and 2 hours after one cigarette smoking or resting under administration of blackcurrant supplements (anthocyanins 210 mg) or not. Results: FMD, d-ROMs, and BAP at baseline were similar between non-smokers and smokers. One cigarette smoking induced a decrease in FMD at 2 hours (9.0% ± 2.6% vs 7.5% ± 2.3%, p Conclusions: Single oral administration of anthocyanin rescued smoking-induced endothelial dysfunction in young healthy smokers, but facilitated oxidative stress in non-smokers. When anthocyanin is taken as supplements, it seems important to pay attention to the dose and timing of administration.

Diets of obese and non-obese older subjects

Aim: To compare diets between obese and non-obese in healthy older subjects. Methods: Forty-five obese and eighty-seven non-obese older subjects were recruited and their habitual factors that may contribute to obesity were assessed. Intakes of food by food-group in the obesity and non-obesity groups were checked using a visual type presentation of model nutriational balance chart (MNBC). Results: Average intake ratio of food relative to ideal food intake was significantly higher in the obesity group than the non-obesity group. The relationship of obesity and exercise or habitual activities was not significant. Conclusion: Food intake is a primary factor of obesity but regular exercise or habitual activities is not a key factor for obesity in older subjects. Since exercise habit is difficult to achieve in older subjects, particularly those who are obese, food control using the present visualtype MNBC would be one strategy forthe management of obesity.

Patients with disturbances in consciousness as observed by clinical nurses: Analysis of nursing records

The objective of the present study was to discuss patients with disturbances in consciousness by analyzing nursing records. Observations from clinical nurses as well as patients’ responses about their care were selected from nursing records. Nursing records from one week of patient care were examined for patients who were unable to speak during hospitalization within a neuro-surgery ward of the hospital. Selected records were classified into the following eight categories: results from monitoring;results from observation;opening and moving the eyes to stimulus;movement of the limbs to stimulus;vocalization to stimulus;facial expression to stimulus;patient’s response to care;and miscellaneous. Patients comprised two groups. One group encompassed eight patients with Japan Coma Scale (JCS) II and the other was a group of eight patients with JCS III. When nurses use the JCS to assess patients with disturbances in consciousness, patients who awaken to stimulus are classified as JCS II, while those who do not are JCS III. The total nursing records selected for JCS II were 1551 and 1160 for JCS III. The category of “results from monitoring” was the most selected category within nursing records and accounted for 42.8% of the JCS III group, while “results from observation” accounted for 38.4% of the JCS II group. Furthermore, results indicated that the categories of “results from monitoring”, “results from observation”, and “movement of the limbs for stimulus” had peaked after two to three days, and then abruptly decreased. There were only a few records for the categories of “vocalization to stimulus” and “facial expression to stimulus”, both for the JCS II and the JCS III groups. Even though patients could not verbally indicate their intentions due to problems with consciousness, it is essential for nurses to pay careful attention to the details of patients’ reactions.

Thought Processes of Nurses in Nursing Assessment: Analysis of Nursing Problems and Patient Strengths, Patient Information

Aims: The purpose of this study was to clarify the thought processes of nurses in performing nursing assessment. Methods: The participants comprised 20 nurses working in a surgery ward. Patient information on a case, including presenting illness, vital signs, and other findings from admission until 09:00 on the day after surgery, was shown to the participants. After reading the case report, the nurses presented their assessments. Based on these assessments, nursing problems, patient strengths, and patient information were identified. Nursing problems and patient strengths were described by various words and sentences, and were classified according to similar content. Results: The number of nursing problems ranged from 1 to 8 and patient strengths from 0 to 6 for each nurse. The mean number of nursing problems was 4.7 ± 1.8, and the mean number of patient strengths was 2.2 ± 1.4. The main nursing problems were respiratory complications, postoperative wound pain, and anxiety, and the main patient strength was family cooperation. Patient information as evidence of respiratory complications included history of smoking, chest radiography results, postoperative vital signs, sputum color and properties. Patient information as evidence of postoperative wound pain included complaints of pain, epidural anesthesia, use of patient-controlled anesthesia and its effect. Patient information indicating family cooperation included family structure, preoperative visits by family, and presence of family while providing informed consent. Significant differences were seen in the number of nursing problems and patient strengths according to cognitive style. Conclusions: Postoperative complications were the nursing problems most commonly extracted by nurses. To clarify nursing problems and patient strengths, the nurses made assessments on the basis of information such as patient complaints, vital signs, and test results. However, extracted nursing problems and patient strengths were diverse, suggesting that nursing problems and patient strengths as determined by nurses differed between individual nurses.

Factors Influencing Behavior of Taking Medicine in Elderly Patients Undergoing Hemodialysis

Purpose: The elderly are often faced with multiple diseases, in particular hemodialysis (HD) which requires many kinds of medication. This study examined the factors influencing the behavior of taking medicine in elderly patients undergoing HD. Subjects and Methods: The subjects comprised 70 outpatients > 65 years undergoing HD (48 male and 22 female). The mean age of the patients was 72.5 ± 4.4 years. The mean duration of dialysis history was 6.1 ± 5.2 years. We performed a questionnaire survey using Medication Assessment Tool, The Kidney Disease Quality of Life (QOL)-Short Form and Acceptance for Dialysis Instrument. Result: Two factors related to poor behavior of taking medicine: dialysis history < 2 years and poor acceptance of dialysis. The multiple regression analysis showed patient satisfaction (β = –0.329, p < 0.01) and symptoms/problems (β = –0.273, p<0.05) as significant independent variables relating to behavior of taking medicine. Conclusion: Poor behavior of taking medicine is related to a short dialysis period, poor acceptance and poor satisfaction of dialysis therapy in elderly patients.

Application of Dual-Energy Computed Tomography for Breast Cancer Diagnosis

The present study aimed to investigate the possibility of using dual-energy computed tomography (CT) before therapy to discriminate between normal breast tissue and tumor tissue in patients with breast cancer, without the need to use a contrast medium. The following patient data were extracted by interview and from the hospital’s radiology information system: height, weight, age, menstrual cycle, CT images of normal tissue and tumors with or without contrast medium, and the histopathological diagnosis of the aspiration biopsy. The median age of the 43 participants was 56 years (range, 30 - 80 years). The CT values were evaluated using a clinical analytical program based on the three-material decomposition technique. Breast cancer was classified into ductal carcinoma in situ, invasive ductal carcinoma, invasive lobular carcinoma, fibromatosis-like metaplastic carcinoma, and apocrine carcinoma. In all conditions, regardless of contrast medium, the CT values of tumor tissues were higher than those of normal breast tissue, indicating the effectiveness of dual-energy CT (DE-CT) in the diagnosis of breast cancer. By contrast, DE-CT showed limited potential for distinguishing ductal carcinoma in situ from invasive ductal carcinoma. There have only been a few reports regarding CT examination of breast cancer, and it is expected this study encourage the development of DE-CT imaging to improve tumor detection in patients with breast cancer.

Impressions of Hazmat Suits Based on Color

Background: Commonly, skin and clothing surface contamination screening (radiation survey) is performed for residents of an area to confirm the levels of residual contamination after nuclear power disasters. Examiners for such a screening often wear white radiation hazmat suits. However, it has been reported that examinees tend to feel tension or anxiety. In this study, we focus on the color of the radiation hazmat suit as one measure to reduce residents’ tension or anxiety. This study aims to determine the common conceptions of radiation hazmat suits based on color. Methods: An anonymous self-administered questionnaire survey was conducted with a total of 262 participants consisting of nursing students, administrative staff of a university, general citizens, and mothers raising their children in the Tohoku region in Japan. The common impressions of radiation hazmat suits, which are typically white, were measured using the Multiple Affective States Scale. This scale can measure the affective state brought about by clothing. The color of white (W) was defined as a standard color commonly used for hazmat suits;in order to determine the common impressions of radiation hazmat suits based on color, the following additional colors were shown to the participants: salmon pink (P), ivory (I), and light green (G). Results: There were no sex differences regarding common impressions of radiation hazmat suits. For white radiation hazmat suits, a high score reflecting the characteristic of “capable” was obtained, while the scores for “cheerful” and “calm” were low, and those for “depressed” and “tense” were high. The colors that showed the highest score for “calm” as a positive affirmative state were I and P. W and P reflected a high “ashamed” score, and the “tense” score for G was higher for the participants in their 20s than for those in their 30s and older. Conclusions: Results show that the color of hazmat suits provokes far greater feelings of anxiety and tension on participants than previously thought. Radiation hazmat suits may be further improved based on the results of this study.

Antibacterial Effect of Lavender （Lavandula） Flavor （Volatile）

The objective of this study was to test the essential oil-emitted flavor （volatile） of lavender by bacteria killing potency using Escherichia coli, methicillin-resistant Staphylococcus aureus （MRSA）, enterohemorrhagic E. coli O157：H7, Pseudomonas aeruginosa and Candida albicans. Antibacterial activity was assessed by creating of the bacterial growth curve in the liquid medium cultivation and the growth inhibition on the agar plate cultivation. Citronellal, one of compounds in Rosa rugose oil, was used as a positive control for comparison in activity. The results showed that lavender and citronellal flavor （volatile） or oil respectively demonstrated bacteria killing effect in both analytical manners. However, P. aeruginosa resisted bacteria killing potency of lavender （citronellal） oil or oil-emitted flavor. It could be concluded that both lavender oil-emitted flavor and oil showed bacteria killing potency. Lavender oil （or oil-emitted flavor） will be expected to apply for the patient waiting room to disinfect in air along with the mental relaxation of the patient.

Identification of Questionnaire Improvements to Assess Familial Support in Malignant Brain Tumor Patient

BACKGROUND: To support decision-making for patients with malignant brain tumors, it is necessary to understand family needs during the hospitalization period. The assessment sheets and checklists generally used in the ward focus on the patient’s condition with only a few items related to family information. Many checklists are not tailored to the patient’s disease and therefore do not address changes in condition and neurological symptoms. Thus, based on previous research, this study aimed to extract items that clinical nurses consider necessary for the family members of patients with malignant brain tumors by filling out a self-administered assessment. METHODS: For the 92 self-made questions, the Delphi method was performed three times for the panelists;consensus was reached on the necessity of a family self-administered information gathering item. The patients’ families answered questions using a 1 - 5 rating scale to assess support required, with 5 being necessary and 1 being unnecessary. In the analysis of the 3rd survey, the consensus rate was calculated as follows: out of 5 options for each question, scores of 5 and 4 were combined and judged to be necessary. The average value was calculated as 87.3% and this value was used as the criterion for agreement. RESULTS: In the final round, answers from 45 panelists were obtained, and consensus was obtained for 47 questions. The 47 questions were extracted using the Delphi method based on reasonable condition settings and yielded reliable results. CONCLUSION: The data collected in this study can contribute to support programs aimed at helping families of patients with malignant brain tumors.

Criteria for Determining the Need for Admission of People with Dementia to Dementia Nursing Wards of Psychiatric Hospitals in Japan

Purpose: This study aims to establish criteria to determine the need for admission of people with dementia to dementia nursing wards of psychiatric hospitals—based on the experience of nurses working in dementia nursing wards. Methods: Semi-structured interviews were conducted with nurses who had worked in dementia nursing wards of psychiatric hospitals for more than 3 years, to collect data related to the “condition at the time of admission and the process of hospitalization of dementia patients”. Data were analyzed using the content analysis approach. Focusing on “What is the condition of patients with dementia admitted to the dementia nursing ward?”, we created codes according to similarities in the meaning, and classified these into categories where they were evaluated to fully fit in. Results and Discussion: The analysis yielded 4 categories, and 44 codes. The four categories are as follows: [Appearance of a state where self-control is difficult] which expresses a state where behavioral and psychological symptoms of dementia (BPSD) have appeared, and the remaining three categories [Insufficient support provided], [Appearance of symptoms that make living difficult], and [Appearance of physical symptoms that require treatment] express the states that may trigger the appearance of BPSD. These show that the appearance of BPSD is a criterion for determining hospitalization. By providing support to prevent the states described in the 44 codes, nurses may help people with dementia avoid being hospitalized in dementia nursing wards in psychiatric hospitals.

Rapid Detection Method for Enteroaggregative <i>Escherichia coli</i>Using Simple Clump Formation and Aggregative Assay

Enteroaggregative Escherichia coli (EAggEC) strains cause the persistent diarrhea in infants and compromised hosts in developing countries. These strains are currently defined as E. coli that adheres to HEp-2 cells in an aggregative adherence (AA) pattern. In this study, we compared 4 different rapid methods for the detection of EAggEC using a PCR assay, clump formation test, glass slide adherence assay, and the HEp-2 cell adherence assay. Out of 683 E. coli strains isolated from diarrheal stool samples, we detected 17 aggR and/or clump-positive strains, and identified 2 aggR-positive, clump-negative strains and 2 aggR-negative, clump-positive strains. All the aggR positive and clump positive strains also showed positive results in glass slide adherence and HEp-2 cell adherence assays. From all these results, we suggest the following procedure for the rapid identification of EAggEC strains: first, screen E. coli strains with the clump formation test and subsequently perform the glass slide adherence assay to observe AA for confirmation.

Stress Coping and Issues among Evacuees Four Years after the Nuclear Disaster in Fukushima: An Interview Study

Purpose: The purpose of the present study was to clarify issues related to the evacuation process, including stress coping, psychological conditions, and health problems, through interviews with long-term evacuees 4 years after the Great East Japan earthquake and nuclear disaster. Methods: Group interviews focusing on stress and health conditions were conducted with eight older adults at a meeting space in Y city in Fukushima Prefecture, Japan, in May 2015. Two months later, based on the results of the first group interview, four (two men, two women, age range, 60 - 70 years) of those eight individuals participated in 60-min individual semi-structured interviews and were assessed according to the Tri-axial Coping Scale revised for the elderly. The interviewees were asked about their anxiety and hardships, escape routes, and other points of importance. Results: Stress coping scores were higher for males than for females, especially that for “Catharsis”. The “Giving up” score was higher among these participants than the general population. In the interviews, the participants described how evacuees from “Q” area were experiencing high levels of stress because of problems communicating with their neighborhoods and receiving compensation from the government and Tokyo Electric Power Company. Conclusion: Evacuees experienced hardships immediately after the earthquake, including issues related to compensation from the government and communication with their neighborhoods. Men showed higher scores for “Avoidance-like thinking” and “Giving up” than for other factors related to stress coping, suggesting that they might not use “Catharsis” as a means of coping with stress. The results also suggested that men experienced repeatedly that alone, they made little headway or could not do something. The present study suggests the importance of providing support to long-term evacuees so that original residents can better understand their situation.