BACKGROUND: We investigated whether family histories of herpes zoster (HZ) are associated with the risk of incident HZ in a Japanese population. METHODS: A total of 12,522 Japanese residents aged ≥50 years in Shozu County participated in the baseline survey between December 2008 and November 2009 (the participation rate = 72.3%). They were interviewed at baseline by research physicians regarding the registrants' history of HZ. A self-administered questionnaire survey was conducted to evaluate the potential confounding factors. 10,530 participants without a history of HZ were followed up to ascertain the incidence of HZ during 3-years follow-up until the end of November 2012 with Japanese nationals. We estimated hazard ratios (HRs) of incident HZ according to first-degree family histories using the Cox proportional hazard regression after adjusting for age, sex, and other potential confounding factors. RESULTS: Compared to no HZ history of each family member, a history of brother or sister was associated with a higher risk of incident HZ while histories of father and mother were not. The multivariable HR (95%CI) of incident HZ for a history of brother or sister was 1.67 (1.04-2.69). When comparing to no family histories of all first-degree relatives, the multivariable HRs (95%CIs) were 1.34 (0.77-2.34) for a history of brother or sister alone, but 4.81 (1.78-13.00) for a history of mother plus brother or sister. As for the number of family histories, the multivariable HRs (95%CIs) were 1.08 (0.76-1.54) for one relative (father, mother, or brother or sister) and 2.75 (1.13-6.70) for two or more relatives. CONCLUSION Family histories of mother plus brother or sister and two or more first-degree relatives were associated with a higher risk of incident HZ.
Female ; Herpes Zoster/epidemiology* ; Humans ; Incidence ; Male ; Mothers ; Proportional Hazards Models

BACKGROUND: Although long maternal working hours are reported to have a negative effect on children's dietary habits, few studies have investigated this issue in Japan. Healthy dietary habits in childhood are important because they may reduce the risk of future disease. Here, we examined the relationship between maternal employment status and children's dietary intake in 1693 pairs of Japanese primary school 5th and 6th graders and their mothers. METHODS: The survey was conducted using two questionnaires, a brief-type self-administered diet history questionnaire and a lifestyle questionnaire. The analysis also considered mothers' and children's nutrition knowledge, attitudes toward diet, and some aspects of family environment. RESULTS: Longer maternal working hours were associated with children's higher intake of white rice (g/1000kcal) (β 11.4, 95%CI [1.0, 21.9]; working ≥8h vs. not working), lower intake of confectioneries (g/1000kcal) (β -4.0 [-7.6, -0.4]), and higher body mass index (BMI) (kg/m CONCLUSIONS Longer maternal working hours were significantly associated with higher intake of white rice and lower intake of confectioneries, as well as higher BMI among children. Even when a mother works, however, it may be possible to improve her child's dietary intake by other means such as nutrition education for children or enhancement of food environment.
Adult ; Child ; Child Health/standards* ; Diet/standards* ; Diet Surveys ; Employment ; Female ; Health Knowledge, Attitudes, Practice ; Humans ; Japan ; Life Style ; Male ; Middle Aged ; Mothers ; Nutritional Status ; Surveys and Questionnaires

A woman in her 60s was being treated for diabetes and hypertension but had impaired activities of daily living (ADL) due to severe obesity (150 kg). She was transported to the emergency department because of disturbance of consciousness in August 201X. Imaging findings showed decreased permeability of the whole right lung field. She was intubated and started on ceftriaxone plus levofloxacin for severe infection with respiratory failure. Erysipelothrix rhusiopathiae was detected in blood cultures, leading to a diagnosis of sepsis due to a large pressure ulcer on the posterior aspect of the thigh. We switched levofloxacin to clindamycin and continued medical treatment, and she was extubated on the 10th day of illness. However, type 2 respiratory failure was prolonged because of alveolar hypoventilation due to obesity and she required noninvasive positive pressure ventilation. Also, she had difficulty getting out of bed due to obesity, disuse syndrome, and pressure ulcer. Cooperation among staff from many professions, including respiratory nursing, intensive care nursing, wound, ostomy and continence nursing, physical therapy, and nutrition management, led to improvement of ADL and weight loss (to 109 kg), allowing her to be transferred out of the intensive care unit.

Introduction: The purpose of this study was to identify the current status, issues, and training needs of nurses in terms of the appearance care for patients who undergo cancer therapy. Methods: Self-administered anonymous surveys were mailed to a total of 2,025 nurses. Potential respondents included five nurses who work at various departments in all the 400 Designated Regional Cancer Centers and Hospitals in Japan, or who accessed the Appearance Care Research Network website voluntarily and registered for study participation. Survey items included demographics and the 94 items concerning appearance care for changes associated with cancer therapy. The data analysis included descriptive statistics and logistic regression analysis to identify correlates of the provision of appearance care. Textual responses were qualitatively and descriptively analyzed. Results: Seven hundred and twenty six (35.9%) usable responses were returned. The respondents had a mean age of 42.5 (a range of 24 through 62) years. As a result of the survey, 93 out of 94 care items were carried out by respondents. Correlates of healthcare professionals’ appearance care provision included “collecting information from various sources” and “having confidence in providing care.” Seventeen categories of issues related to appearance care were created, including various items such as “appearance care is not standardized, and recognition level is different between healthcare professionals.” Discussion: Based upon the identified issues and needs of this study, an effective training program will be developed for healthcare professionals who provide appearance care for patients undergoing cancer therapy.

Objectives: To reveal nursing competence acquired by nursing students via role-playing (RP) exercises and define the learning points necessary for acquiring practical nursing skills.Methods: Qualitative content analysis was performed using debriefing sheets (DSs) for adult nursing RP. There were 109 participants.Results: The DSs of 69 individuals who met the selection criteria were used as base data, and 1179 data items were extracted. The results showed that the structure included 3 main themes, 8 subthemes, 31 categories, and 121 subcategories.Conclusion: The results indicated that participants noticed the underlying elements that make up practical nursing skills, analyzed them using advance organizers based on previously learned knowledge, and applied the acquired practical nursing skills to newly proposed strategies for continuous self-management for adult patients with chronic disease and their families. One aspect of nursing competence, "ability to improve nursing quality," could not be extracted; the elucidation of this acquisition process is a task for future research.

Introduction : Intravenous rt-PA therapy for acute ischemic stroke patients within 4.5 hours after onset is approved and effective, but is difficult to implement in depopulated areas because of geographical conditions and lack of medical specialists.
Methods : From February 2013 to February 2014, 75 acute ischemic stroke patients were transferred to our hospital, four (5.3%) of which were subjected to the “drip and ship” method of rt-PA infusion using a telemedicine system for emergency medicine (k-support). We examined the time course after onset and the treatment outcome of these four cases
Results : Four cases had rt-PA infusion started in the depopulated area. ln one case, recanalization of occluded vessels was demonstrated resulting in improved clinical symptoms.
Conclusion : The “drip and ship” method of rt-PA infusion using a telemedicine system for emergency medicine (k-support) may be a safe and ideal treatment in depopulated areas.

Purpose: This study aimed at identifying difficulties among post thoracic esophagectomy cancer patients during outpatient follow-up. Methods: Patients who had radical esophagectomy at a cancer center hospital in Japan were prospectively observed and were interviewed by a certified nurse assigned at esophageal surgical outpatient division. Their responses were documented in medical records and were analyzed by content analysis method. This study was approved by the study hospital's research ethics committee. Results: The data from 66 patients were obtained. Content analysis yielded 221 extracts, 25 categories, and 65 codes of difficulties, including: concerns or signs/symptoms associated with dietary intake, physical activity, and anxiety. Implications: The majority of post-thoracoabdominal esophagectomy patients experienced multiple dysfunctions and symptoms after discharge. The results underscore the significance of nurses' role in assessing and instructing patients to address these issues.

Background: Patients having thoracic esophagectomy, a standardized treatment for esophageal cancer patients in Japan, are known to have various postsurgical signs and symptoms for a period of time. The current status of nursing interventions at outpatients need to be clarified. Purpose: This study aimed at identifying the nurses' interventions for cancer patients at the outpatient setting who previously had thoracic radical esophagectomy. Methods: Patients who had esophagectomy at a cancer center hospital in Japan were prospectively observed and interviewed by outpatient nurses between January 2009 and December 2010. Their documented responses in medical record were prospectively investigated and were qualitatively analyzed via content analysis method. This study was approved by the study hospital's research ethics committee. Results and discussion: The data analysis of nursing interventions for 66 patients yielded 372 extracts, 12 categories, and 74 codes. Nurses were assessing patients' signs and symptoms affected by postsurgical changes, and were utilizing patients' active self-monitoring skills. The results also showed the significance of facilitating postsurgical recovery in relation to nutritional intake and physical activity in patients' daily life. Implications: Based upon the study results, the development of a systematic program is underway, which facilitates esophageal cancer patients' postsurgical recovery.

Objectives: Radon (222Rn) is a noble gas found in the water of hot spring spas (“onsen”). In Japan, the Hot Springs Law and the Guideline of Analytical Methods of Mineral Springs (revised) classify springs containing 74 Bq/kg of radon as “hot springs” and those with levels exceeding 111 Bq/kg as “medical springs”, also called “radioactive springs”. According to the notification article (the Nature Conservation Bureau of the Ministry of the Environment in Japan), bathing in a radioactive springs may alleviate the effects of gout, arteriosclerosis, and hypertension as well as chronic conditions such as cholecystitis, gallstones, and skin and gynecological diseases. Drinking water from these springs may treat gout, chronic digestive disorders, chronic cholecystitis, gallstones, neuralgia, muscle pain, and arthralgia. To determine exposure doses from radioactive springs, it is important to establish an easy and accurate method of measuring radon concentration in water and humid air in bathing areas. Methods: This study measured the concentration of airborne radon using an activated charcoal detector (PICO-RAD: AccuStar Labs), desiccant (Drierite; 8 mesh of anhydrous calcium sulfate: W.A. Hammond Drierite Company, Ltd.), a liquid scintillation counter (LSC LB-5: Hitachi Aloka Medical, Ltd.), and 2,5-diphenyloxazole(DPO) + 1,4-bis (5-phenyl-2-oxazolyl) benzene(POPOP) toluene solution (Wako Pure Chemical Industries, Ltd.) were used as the liquid scintillator. Results and Conclusions: This study evaluated radon exposure doses due to radioactive spring at a spa in Komono town, Mie prefecture. After water was piped from hot spring storage tanks into bathtubs, only 5.3-18.0% of the radon remained in the water. Two days later, only 0.25% remained, likely due to radioactive decay and increased diffusion into the air from bathing and recirculating filters. Thus, we investigated radon levels in the humid bathroom air around the radioactive hot spring and determined the total radon exposure from spa water and air. The total exposure dose was calculated assuming a two-day stay, during which customers used the bath for some number of hours. Our findings confirm the safety and efficacy of the hot spring facility. This study was supported in part by a grant from the Daido Life Welfare Foundation.

Objectives: Radon (222Rn) is a noble gas and a component of water in many hot spring spas. The Hot Springs Law and the Guideline of Analytical Methods of Mineral Springs (revised edition) of Japan classify springs containing 74 Bq/kg or more of radon as “hot springs” and those with radon levels exceeding 111 Bq/kg as “medical springs”, also called “radioactive springs”. Komono Town, one of the foremost spa and health resort destinations in Mie Prefecture, is the site of many radioactive springs. For the purpose of regional vitalization of this area through radioactive springs, it is necessary to confirm the safety and effectiveness of their use. To evaluate the exposure dose due to radioactive spring usage, it is important to measure radon concentration in air, especially in high-humidity air such as in bathing rooms. Methods: The concentration of radon in air was analyzed using an activated charcoal detector (PICO-RAD; AccuStar Labs) with a desiccant (Drierite; 8-mesh anhydrous calcium sulfate; W.A. Hammond Drierite Company, Ltd.) and a liquid scintillation counter (LSC LB-5; Hitachi Aloka Medical, Ltd.). A DPO (2,5-diphenyloxazole) + POPOP (1,4-bis- (5-phenyl-2-oxazolyl)-benzene) toluene solution (Wako Pure Chemical Industries, Ltd.) was used as a liquid scintillator. Activated charcoal detectors were set up in and around the radioactive spring facilities. Results and Discussion: In a radioactive spring facility, radon concentration in air in the bathing room and changing room were relatively high at about 50 Bq/m3. In the corridor on all floors and at the entrance, these values were approximately 10-30 Bq/m3, indicating that radon in hot spring water diffuses into the air and spreads within the facility. Outdoors, radon concentration was 12.5 Bq/m3 at a campsite near the discharge point of the radioactive spring.   Exposure dose is calculated under the assumption of a two-day stay, during which the visitor will use the bath for several hours. The results obtained show that the exposure dose at the hot spring facility is lower than the exposure dose from daily environmental radiation or medical devices. These conclusions are considered sufficient to confirm the safety of the hot spring facility.