Hiroaki Itoh

Objectives To translate and adapt the Compliance with Standard Precautions Scale (CSPS) into Japanese and validate it among Japanese nurses.Materials and Methods This was a two-phase study. First, we translated the original English CSPS into Japanese. The content validity index of the result was evaluated by experts, whereas the linguistic validity was ascertained by clinical nurses, from which we generated the CSPS-Japanese version. Second, the reliability and validity of the CSPS-Japanese version were evaluated using cross-sectional data from 248 nurses. Reliability was assessed using internal consistency (Cronbach’s alpha) and the 2-week test-retest reliability (intraclass correlation coefficient). Construct validity was established using confirmatory factors and Rasch analysis. Differences in self-reported compliance based on training experience were examined.Results The CSPS-Japanese version showed satisfactory reliability. The constructed model showed an acceptable fit index. Nurses with training experience had higher self-reported compliance.Conclusions The CSPS-Japanese version showed good reliability and validity, and this indicates that the tool constitutes an appropriate new self-administered evaluation method for Japanese nurses.

Per- and polyfluoroalkyl substances (PFAS) are persistent environmental pollutants, and have been detected in human blood. Although PFAS may increase the risk of breast cancer in humans, findings from previous epidemiological studies on the link between PFAS and breast cancer are controversial. Additionally, most studies of PFAS to date did not distinguish between isomers. Here, we examined the association of PFAS exposure and breast cancer risk in Brazilian women, who represent a racially and ethnically diverse group. We conducted a case-control study of 471 women with breast cancer and 471 matched controls attending hospitals in São Paulo, Brazil from 2001 to 2006. Plasma concentrations of PFAS congeners were measured using in-port arylation gas chromatography–isotope dilution mass spectrometry with electron capture negative ionization. Linear and branched PFAS isomers were isolated and quantified separately. We derived multivariable-adjusted odds ratios and 95% confidence intervals for breast cancer and hormone-receptor subtypes according to plasma PFAS concentration. In overall analyses, higher plasma concentrations of n-perfluoroheptane sulfonate (n-PFHpS), perfluoro-3-methyl-heptane sulfonate (3 m-PFOS), and n-perfluorononanoic acid were significantly associated with increased risk of breast cancer. Adjusted odds ratios for low, medium, and high n-PFHpS concentrations were 1.00, 1.28, and 2.00 (95% confidence interval = 1.15, 3.48), respectively (P for trend = 0.015). Furthermore, plasma 3 m-PFOS concentration and total perfluorooctanoic acid concentration were significantly associated with increased risk of breast cancer among mixed-ethnicity women. In Caucasian women, a higher plasma perfluoro-4-methyl-heptane sulfonate concentration was also associated with increased risk of breast cancer. Increased plasma n-PFHpS concentration was significantly associated with higher risk of hormone receptor-positive breast cancer but not with increased risk of hormone receptor-negative breast cancer. Several plasma PFAS appear to increase the risk of breast cancer. Our findings suggest the importance of isomer analysis, subgroup analysis by ethnicity, and breast cancer subtype analysis for accurately characterizing this risk. Not applicable.

The detailed comorbidity status of hospitalized elderly patients throughout Japan has remained largely unknown; therefore, our goal was to rigorously explore this situation and its implications as of the 2015 fiscal year (from April 2015 to March 2016). This study was based on a health insurance claims database, covering all insured policy holders in Japan aged ≥60 years (male: n = 2,135,049, female: 1,969,019) as of the 2015 fiscal year. Comorbidity status was identified by applying principal factor analysis to the database. The factors identified in male patients were [1] myocardial infarction, hypertension, dyslipidemia, and diabetes mellitus; [2] congestive heart failure (CHF), cardiac arrhythmia, and renal failure; [3] Parkinson’s disease, dementia, cerebrovascular disease, and pneumonia; [4] cancer and digestive disorders; and [5] rheumatoid arthritis and hip fracture. However, in female patients, the results obtained for the quaternary and quinary factors were the opposite of those obtained in male patients. In superelderly patients, dementia, cerebrovascular disease, and pneumonia appeared as the tertiary factor, and hip fracture and osteoporosis appeared as the quaternary factor. The comorbidities in the elderly patients suggest the importance of coronary heart disease and its related metabolic disorders; in superelderly patients, fracture and osteoporosis appeared as factors, in addition to dementia and pneumonia.

We investigated the association between the period of exposure and changes in urinary excretion of chromium and nickel among rotating shift workers in a stainless-steel plant. The study participants were composed of two groups: the workers who were occupationally exposed to metals (“exposed group”) and those who were not occupationally exposed to metals (“unexposed group”). The exposed and unexposed groups consisted of 56 and 40 male rotating shift workers, respectively. Urine samples were collected immediately before and immediately after the day shift, evening shift, and night shift. Urinary chromium and nickel were measured using inductively coupled plasma mass spectrometry. To correct for variations in urine dilution, urinary metal concentrations were expressed as a ratio to urinary creatinine concentration. In the exposed group, post-shift urinary excretion of chromium was significantly higher than pre-shift excretion. However, although urinary chromium excretion clearly increased after the day and night shift [63% (p < .0001) and 87% (p < .0001), respectively], urinary chromium excretion after the evening shift was only slightly higher than that measured before the evening shift (8%, p = .028). Similar patterns were found for urinary nickel excretion (p = .0001, 0.20, and 0.18 for the day, evening, and night shifts, respectively). Non-uniform urinary excretion of metals between the day shift, evening shift, and night shift were observed in the exposed group; specifically, urinary metal excretion increased only slightly during the evening shift. In the unexposed group, no significant increase or decrease was found in median urinary chromium or nickel excretion (p= .63–0.87). Work shift-specific permissible exposure level would be necessary.

Although a high number of wet compresses are prescribed daily in medical institutions in Japan, our understanding of the national burden of the cost of wet compresses and the details regarding their prescription is far from complete. We investigated the national burden of the annual pharmaceutical cost of wet compresses prescribed in Japan and estimated the predictors of this cost using nationwide health insurance claims data. We extracted the records on wet compress products from summary table files obtained from the second version of the “NDB Open Data Japan” website and calculated the annual pharmaceutical cost of wet compresses by patients’ 5-year age group, sex, and prefecture. We also conducted an ecological study treating each prefecture as an individual unit and multiple linear regression analyses using the age-standardized cost of wet compresses per resident as a dependent variable. The annual pharmaceutical cost of wet compresses prescribed in Japan in fiscal year 2015 was 149.0 billion Japanese yen (1.18 billion euros; 1.33 billion USD). Multiple linear regression analyses showed that the number of orthopedists and rehabilitation physicians per 100,000 residents were significantly positively associated with the annual pharmaceutical cost of wet compresses per resident (P = 0.042 and P = 0.008, respectively). The annual pharmaceutical cost of wet compresses prescribed in Japan has a considerable impact on the nation’s limited healthcare resources. The number of orthopedists and rehabilitation physicians per 100,000 residents may be independent predictors of the wet compress cost in Japan.

Objective: This study aimed to identify the influence of nursing practice environments and respiratory unit nurses’ demographic characteristics on nurses’ self-rated ability to care for patients with chronic respiratory diseases, particularly COPD.Design: Cross-sectional study.Methods: Self-administered questionnaires were sent to 464 nurses in advanced treatment hospitals and other hospitals. A total of 257 nurses (55.4% response rate) returned completed answers. Questions were on areas such as demographic information and the Practice Environment Scale of the Nursing Work Index, which assesses nursing practice environments and self-rated ability across seven areas: “understanding disease”, “understanding patients”, “respiratory rehabilitation”, “helping patients and families”, “protecting the rights of patients and families”, “cooperating with other health workers”, and “being a role model”.Results: A good relationship between nurses and physicians was positively associated with all aspects of self-rated nursing ability except “understanding disease” and “helping patients and families”. A specialist qualification in chronic care nursing, chronic respiratory nursing, palliative care, or intensive care, or being a certified therapist of respiration, was positively associated with all aspects of self-rated nursing ability except “protecting the rights of patients and families” and “cooperating with other health workers”. The nursing supervisor’s capacity was positively related to “cooperating with other health workers” and “being a role model”. Years of experience in working on a respiratory disease unit was positively associated with “being a role model”.Conclusions: A specialist qualification and a better relationship with attending physicians enabled nurses to provide high-quality nursing for patients with chronic respiratory diseases.

Even if patients with terminal cancer hope to spend the rest of their lives at home, they are often unable to leave the hospital early due to their family caregivers’ anxiety. This study aimed to investigate in Japan the discrepancies between the supports needed by and actually provided by palliative care unit nurses (PCUNs) to the family caregivers for discharge of patients with terminal cancer. In this cross-sectional study, self-administered questionnaires including 6-point Likert-type scales assessing the reasons for difficulties in transition to home-based care were distributed to 1227 PCUNs. Using paired t tests, the differences between the scores on perceived importance and actual supports to family caregivers were examined. The supports actually provided were classified by factor analysis. The relationships between the PCUNs’ characteristics and mean scores on the supports in each category were examined using multiple regression analysis. A total of 1023 (83.4%) completed questionnaires were returned. Scores on the actually provided supports for discharge to family caregivers were consistently and significantly lower than the corresponding scores on perceived importance for all 57 items (P < .001). Factor analysis revealed that the supports actually provided to the family caregivers had a 4-factor structure. Multiple regression analyses revealed that gaining experience in palliative care, receiving necessary training, cooperating with palliative care staff, and cooperating with local service providers were significantly associated with higher levels of actual supply of supports to family caregivers. Our findings suggest that PCUNs need to be encouraged to provide further support to family caregivers for the discharge of patients with terminal cancer.