OBJECTIVETo assess intake of folate/folic acid and food sources in Japanese female dietitians.

SUBJECTS AND METHODSWe evaluated folate consumption based on four season 7 consecutive day weighed diet records (WDRs) provided by 80 Japanese female dietitians and compared the results with data from a national survey. We then selected informative foods for folate intake on the basis of 2,240 WDRs according to contribution and multiple regression analyses.

RESULTSDaily folate consumption (mean±SD) among Japanese dietitians was 413±158 μg from raw foods and 343±128 μg from cooked foods. Average residual rate after cooking was 84±8%. Folate intake in summer was lower than that in other seasons by analysis of variance. According to contribution and multiple regression analyses, the major contributors were vegetables, fruit and green tea.

CONCLUSIONSDaily folate intake among Japanese female dietitians was far greater than the 200 μg recommended daily allowance for the Japanese. Irrespective of selection methods and raw/cooked foods, major folate sources were found to be green tea along with vegetables and fruit.

Regional cooperation in palliative medicine involves multidisciplinary team care. It is very important for cancer patients to choose an appropriate place of stay during their end-of-life period. As the Nagoya Memorial Hospital does not have a palliative care ward, collaborating with other facilities offering palliative care and home care becomes pivotal. Therefore the Higashi-Nagoya home care social gathering was organized to improve communication and cooperation among regional health care professionals. Through discussions during this social gathering, the communication tools for cooperation in palliative care were outlined in November, 2015. We reviewed the outcome of 35 patients referred from our hospital using the communication tools for cooperation in palliative care: 25 patients were referred to chronic care hospitals including palliative care facilities, and 10 patients received palliative care at home; 23 died in the palliative care ward, 6 died at home, and 4 died at our hospital. A questionnaire survey conducted among the community health care professionals revealed that the introduction of this tool would be useful in providing accurate information on the prognosis of patients, level of understanding between the patients and their family, and patients’ views on life and death. Using the communication tool for communication would contribute to realizing seamless palliative care in the region surrounding our hospital, which would in turn lead to local team work and shared responsibilities to provide optimal palliative care.

Methods: HFCs were obtained from patients with LSS who had undergone decompression surgery. The cells were stimulated with TGF-β and pretreated with either the p38 mitogen-activated protein (MAP) kinase inhibitor SB203580 or the p44/42 MAP kinase inhibitor FR180204. IL-6 secretion in the cell culture medium and IL-6 messenger RNA (mRNA) expression levels were analyzed using an enzyme-linked immunoassay and real-time polymerase chain reaction, respectively. Results: TGF-β administration resulted in a dose- and time-dependent stimulation of IL-6 release. Treatment with SB203580 and FR180204 markedly suppressed TGF-β–induced IL-6 secretion from HFCs. Moreover, these inhibitors suppressed IL-6 mRNA expression in response to TGF-β stimulation. Conclusions Our findings indicate that TGF-β induces IL-6 protein secretion and gene expression in HFCs through the activation of p38 or p44/42 MAP kinases. These results suggest a potential association between IL-6–mediated inflammatory response and tissue hypertrophy in LSS, and we provide insights into molecular targets for therapeutic interventions targeting LSS-related inflammation through our analysis of the MAP kinase pathway using HFCs.

Methods: HFCs were obtained from patients with LSS who underwent surgery. HFCs were stimulated by tumor necrosis factor-α (TNF-α) and a p38 MAP kinase inhibitor, SB203580. Phosphorylation of the p38 MAP kinase was analyzed by western blotting. The concentration of interleukin-6 (IL-6) in the conditioned medium was measured by enzyme-linked immunoassay and IL-6 messenger RNA expression levels were determined by real-time polymerase chain reaction. Results: TNF-α induced the phosphorylation of p38 MAP kinase in a time-dependent manner, which was suppressed by the p38 MAP kinase inhibitor, SB203580. TNF-α also stimulated IL-6 release in both a time- and dose-dependent manner. On its own, SB203580 did not stimulate IL-6 secretion from HFCs; however, it dramatically suppressed the degree of IL-6 release stimulated by TNF-α from HFCs. Conclusions This is the first report suggesting that TNF-α stimulates the gene expression and protein secretion of IL-6 via p38 MAP kinase in HFCs. A noted association between tissue hypertrophy and inflammation suggests that the p38 MAP kinase inflammatory pathway may be a therapeutic molecular target for LSS.

Objective: The purpose of this study was to clarify the job types and related factors that physicians and nurses feel easy to consult about pediatric cancer patients’ and their families’ end of life care. Design and methods: We conducted a self-reported questionnaire survey for physicians and nurses who have experienced at least one case of end of life care of childhood cancer. In the survey, we asked participants about whether they feel easy to consult about 15 job types such as palliative care team, certified nurse specialist in child health nursing, physicians and nurses of the same team. Results: A total of 427 physicians and nurses participated in this study. More than 70% of the respondents felt that it felt easy to consult with three job types such as “Nurses of the same team” and “Physicians of the same team”. Job types of the respondents were the main related factors in the most job types. Physicians felt easier to consult with person in each job type than nurses. Consideration: It was suggested that it would be necessary to consider the systems that allow individual professionals to feel easy to consult with persons in each job type, such as specifying consultation methods and procedures for each job type, and introducing inter-professional education.

Objective: The non-medical needs of patients, such as values and personal preferences, are likely to be omitted from advance care planning (ACP) discussions because of a lack of readiness and awareness on the part of healthcare professionals. The aim of the present study was to identify core components perceived by multidisciplinary healthcare professionals to improve person-centered ACP conversations with older people.Methods: The study participants were healthcare professionals (physicians, nurses, and care managers) working in different cities. This qualitative study was performed online using eight individual in-depth interviews and one subsequent focus group composed of eight healthcare professionals. The interviews and focus group discussion were audio-recorded online and transcribed verbatim. The aim of the analysis of the individual in-depth interviews was to summarize the transcribed results, create a conceptual framework for person-centered ACP conversation, and provide meaningful interpretations of the focus group participant discourse. The qualitative data were then analyzed by inductive manual coding using a qualitative content analysis approach.Results: Five themes capturing the core components for successful person-centered ACP were extracted from the ideas voiced by participants: Placing highest value on patient autonomy and human life; uncovering patient’s true feelings and desires; sharing collected information on patients’ end-of-life wishes with other team members; relaying patients’ wishes to the physician; and handling conflicts among patients, relatives, and healthcare professionals.Conclusion: The results provide guidelines for the future development of novel, value-based, person-centered ACP practice for multidisciplinary healthcare professionals.

  The purpose of this study was to clarify effects of the water fall bath on muscle blood flow, muscle hardness at the shoulder and body temperature after muscle contraction in human.   The subjects of this study were eight young males (average 20.4years old). Blood flow and hardness in middle fiber of trapezius were measured using the monitor of spectroscopy and a handy battery-run device, skin blood flow rate using the laser doppler flowmetry, and tympanic temperature using the thermistor during control period 10 minutes, for five minutes during four conditions (40°C water fall bath, massage using the knocking machine, 40°C hot pack and rest) after muscle contraction and moreover 30 minutes. Subjects wore a swimming trunk while these experiments. The ambient temperature and relative humidity were set to 27°C, 42% in control room.   During the water fall bath, the muscle blood flow was tend to increased compared with after muscle contraction. The skin blood flow was increased and the muscle hardness was decreased significantly. During the massage, the skin blood flow was increased and the muscle hardness was decreased significantly. During the hot pack, the muscle hardness was decreased significantly. The tympanic temperature was no changed in three conditions except from the rest.   These findings suggest that water fall bath is lessened the muscle hardness causing increase of the muscle and the skin blood flows. Therefore, the water fall bath can use one of the method to relief muscle fatigue.

Objectives: The study purpose was to examine quality-of-life (QOL) of pediatric cancer patients at end-of-life and related factors using a QOL proxy rating scale from the nurse’s perspective. Methods: We conducted a survey in October 2015−February 2016. The subjects to be surveyed were nurses who were primarily in charge of patients with childhood cancer at end-of-life. We investigated 22 items of the Good Death Inventory for Pediatrics (GDI-P) and their related factors. Results: In total, 53 proxy evaluate questionnaires were completed from 18 centers. Among the eight factors of GDI-P, “Relief from physical and psychological suffering” was the lowest. The total score of GDI-P was positively correlated with the structure and process of care (r=0.58). Although there was a bias in the number of cases, in the case of the place of death was the intensive care unit, the total score of GDI-P was lower than home and the general ward. Conclusions: It was suggested that the top priority in improving QOL was relief from suffering and the structure and process of care were related to QOL.

The purpose of this study was to clarify feasibility of a booklet for families of children dying with incurable cancer. Of 267 pediatric oncology specialists, 76 (28%) participated in this cross-sectional survey. Ninety-three percent of participants answered that they were “likely to use” the booklet, and 86% percent answered that they believed the booklet was “helpful” for families. Some participants described various advantages of its use as follows: “able to communicate something that is difficult to put into words,” “easy to understand for families,” “families can read whenever they choose to,” and “able to grasp the direction of dying.” In contrast, other participants described points of attention of use as follows: “optimal timing to bring out,” “acceptance of families,” “direction as interdisciplinary team,” “confidential relationship between families and interdisciplinary team,” “disinclination among health care providers,” and “information volume of the booklet.” Thus, our results validated feasibility of the booklet. In conclusion, pediatric oncology specialists should provide their support of utilizing the booklet for families and assessing each family condition and advantage/attention of using the booklet.

The purpose of this study was to clarify the changes in the sense of difficulty hospital staff felt toward palliative care before and after a palliative care team of the pediatric hospital started in-hospital consultation. A self-administered questionnaire about the difficulty, consisting of 21 items in five areas, was used to conduct a survey in 2015 for the pre-consultation period, and in 2018 for the post-consultation period. Responses were obtained from 222 people in the pre-consultation period (response rate of 70.9%) and from 384 people in the post-consultation period (response rate of 87.3%). Over 70% of the respondents were nurses and midwives. A lower sense of difficulty was observed in three of the items including “relief of painful symptoms”, “family care during caregiving”, and “support when oneself and surrounding staff feeling inadequate and lost”. Further, a significant decrease was observed in the sense of difficulty in six items reported by nurses and midwives in departments receiving the interventions. Eleven of the 16 cases in which the palliative care team intervened involved multiple requests for intervention for 2 patients with pain control difficulties, suggesting that the consultation activities contributed to the decrease in the sense of difficulty experienced by nurses and midwives.