Association between the incidence of premature rupture of membranes in pregnant women and seismic intensity of the Noto Peninsula earthquake.

OBJECTIVES: The Noto Peninsula earthquake struck the coast of the Noto Peninsula, Japan on March 25, 2007, resulting in the death of one woman and injury to 356 people. A total of 684 houses were totally destroyed by this earthquake, and more than 2,500 people were forced to live at shelters. In this study, we have evaluated the association between the incidence of peripartum abnormalities and seismic intensity of the Noto Peninsula earthquake. METHODS: Demographic data, births, seismic intensity of the earthquake and the incidence of peripartum abnormalities between June 25, 2007 and January 31, 2008 were surveyed. The dataset included 126 pregnant women who lived in the disaster area. The seismic intensity of the earthquake was expressed on the scale (0-7, with 7 being the strongest measure) used by the Japan Meteorological Agency. The subjects of the analysis included 19.7% of the pregnant women affected by the disaster. RESULTS: Of the pregnant women included in this study, 7.9% had a premature rupture of membranes (PROM), with the percentage being significantly higher in the group that experienced a seismic intensity of 6 than in that experienced a seismic intensity of 5. CONCLUSIONS: Our epidemiologic study shows that the PROM among our study cohort was associated with seismic intensity, suggesting that the physical outcome was due to aftershocks of the earthquake at a seismic intensity ≥6. This outcome may result from the psychological stress caused by the earthquakes.

Low serum secretory immunoglobulin A level and sense of coherence score at an early gestational stage as indicators for subsequent threatened premature birth.

OBJECTIVES: The purpose of this study was to assess the validity of the candidate indicators secretory immunoglobulin A (s-IgA) and sense of coherence (SOC) as predictors of threatened premature birth. METHODS: This was a panel study conducted on women in their first and latter half of pregnancy during survey period. The survey period was from December 2005 to June 2006 and from December 2007 to June 2008. The women enrolled in the study were asked to complete the survey questionnaire and provide blood samples for the determinations of physiological indicators. The questionnaire consisted of questions related to the stress perception scale (SPS), SOC score as an indicator of modifiers of stress, demographic data, complications in a previous pregnancy, and the course of the current pregnancy. We used s-IgA and high-sensitivity C-reactive protein as a physiological stress indicator and a marker of infection, respectively. Seventy-two eligible subjects were included in the analysis. RESULTS: Twenty-eight (38.9%) subjects had undergone treatment for threatened premature birth, and 44 (61.1%) subjects had not. In the logistic analysis, we set the course of pregnancy as a dependent variable, and age, birth history, smoking habits, a history of miscarriage, premature birth or threatened premature birth, SPS, SOC, and s-IgA in the first half of pregnancy as independent variables. We found that low serum s-IgA levels and low SOC scores in the first half of pregnancy were associated with threatened premature birth. CONCLUSIONS: Our results suggest that low serum s-IgA level and SOC score at an early gestational stage are significant indicators for a threatened premature birth.

Relationship between the Noto-Peninsula earthquake and maternal postnatal depression and child-rearing.

OBJECTIVE: The aim of our study was to explore the relationship between a medium-scale earthquake and maternal depression and child-rearing in a depopulated community in the Noto Peninsula of Japan. METHODS: Three months after a major earthquake, self-rating questionnaires were distributed to women who were pregnant at the time of the earthquake or who became pregnant immediately thereafter, and who were receiving care at any of four major hospitals in the most devastated area. A total of 155 women who had given birth returned the completed questionnaire for analysis. Maternal postnatal depression among the participants was assessed using the Edinburgh Postnatal Depression Scale (EPDS). RESULTS: The EPDS score was significantly associated with decreased "satisfaction with delivery" (beta = -0.28, p = 0.01), increased artificial "lactation" (beta = 0.31, p = 0.002), and increased "trouble with infant care" (beta = 0.47, p < 0.001) in multivariate analysis. It was also significantly associated with increased "anxiety about earthquakes" (beta = 0.30, p = 0.001), and "anxiety about earthquakes" was significantly associated with increased "fear of the earthquake" (beta = 0.20, p = 0.04). CONCLUSIONS: Earthquake-related factors such as "anxiety about earthquakes" and "fear of the earthquake" did not have a direct effect on child-rearing factors; however, they did have a significant relationship with increased EPDS. Based on these results, we conclude that screening strategies for maternal depression in peri- and postnatal women under emergency circumstances are necessary.

Health impact of disaster-related stress on pregnant women living in the affected area of the Noto Peninsula earthquake in Japan.

AIMS: The present study assessed the health impact of stress on women who were pregnant during, or immediately after, a major earthquake and were living in the disaster area. Inherent resistance against the stress induced by the earthquake was also assessed. METHODS: The panel study consisted of 99 women who provided responses before and after delivery (response rate, 77.9%). Psychological impact was assessed on the Edinburgh Postnatal Depression Scale (EPDS), and stress resistance was assessed on the Sense of Coherence Scale (SOC). RESULTS: In adjusted multivariate models, the significant earthquake factor that predicted postnatal depression (EPDS) was 'existing anxiety about an earthquake' (beta = 0.27, P = 0.01) and 'parity' (beta = -0.26, P = 0.02). The SOC during pregnancy significantly moderated between 'existing anxiety about an earthquake' and 'EPDS' (beta = -0.21, P = 0.02). During pregnancy the EDPS was a significant predictor of a physical abnormality during pregnancy or childbirth (odds ratio, 1.21; 95% confidence interval: 1.04-1.41). The SOC during pregnancy did not moderate between a physical abnormality and earthquake-related stress. CONCLUSIONS: Provision of an adequate support system and improvement of the SOC of young women affected by a disaster may be two ways of reducing the deleterious effects of disaster-related stress on maternal well-being.

Difficulties experienced by care managers who are care workers managing elder abuse cases in the Japanese long-term care insurance system.

The purpose of the present study is to describe the difficulties perceived by care managers in Japan when managing care in cases of abuse of elderly people in the home. Participants (n = 21) were female care managers who had handled an abuse case while working for an in-home care management service provider. Participants had a mean of 4.3 +/- 0.7 years of experience as a care manager. Interview data were collected from 2004 to 2005 and analysed according to the grounded theory approach. Seven categories and one core category of difficulties were extracted from the data. The core category was 'tacit control of care management by the abusive caregiver'. The other categories were as follows: the terrible situation of the people abused cannot be ignored; the long-term care insurance service is the only support for abused people; the abusive caregiver has the authority to cancel the contract; concerns that intervention might increase abuse; prioritising how to deal with the abuser rather than the abused is unavoidable; the abusive caregiver deciding the needs of the individual requiring care; and creating a care plan that is acceptable to the caregiver. Therefore, the present results suggest the necessity of not only treating the role of care managers as an important position within the care system that deals with elder abuse, but also highlight the need to establish a system that supports care managers in order to promote appropriate care management.

Relationship between sense of coherence in final stage of pregnancy and postpartum stress reactions.

OBJECTIVE: In this study, we evaluated postpartum stress using a postpartum depression scale and by measuring the level of a stress-related substance, to clarify the relationship between the stresscoping capabilities of women in the final stage of pregnancy and their postpartum stress reactions. METHODS: Between April 2004 and October 2004, 54 women participated in a question naire survey and the measurement of their secretory immunoglobulin A (s-IgA) level as a stress-related substance two times in the final stage of their pregnancy (prepartum) and in their early puerperium (postpartum) was carried out. The questionnaire used in the prepartum stage included the following parameters: "basic features", "Sense of Coherence (SOC)" and "Japanese version of the self-assessment depression scale" of Zung. The questionnaire employed in the postpartum stage included the following parameters: "course of delivery", "Self-evaluation of delivery experience", and "Postpartum depression scale". RESULTS: The depression score was higher and the s-IgA level was lower in the low-SOC score group than in the high-SOC score group, indicating that stress reactions were more intense in the low-SOC score group. CONCLUSION: It was revealed that stress reactions were more intense for women with a low SOC score. Moreover, the finding of a relationship between the low SOC score in the prepartum stage and depressive tendency suggests that women who are likely to develop depressive tendency can be predicted in the prepartum stage, and the significance of measuring SOC in the prepartum stage is thus suggested.

A human papillomavirus type 16 vaccine by oral delivery of L1 protein.

To establish an edible HPV16 vaccine, we constructed a recombinant HPV16 L1-expressing Schizosaccharomyces pombe yeast strain (HPV16L1 yeast). A preliminary study revealed that freeze-dried yeast cells could be delivered safely, and were digested in the mouse intestine. The freeze-dried HPV16 L1 yeast was administered orally as an edible vaccine, with or without the mucosal adjuvant heat-labile toxin LT (R192G), to 18 female BALB/c mice. After the third immunization, none of the mice that received the edible HPV16 vaccine showed specific antibody responses, whereas all of the positive controls that were administered intranasally with 5 microg of HPV16-virus-like particles (VLP) had serum IgG, and genital IgA and IgG that reacted with HPV16-VLP in enzyme-linked immunosorbent assays (ELISAs). When a suboptimal dose (1 microg) of HPV16-VLP was administered to all the mice, including the negative control mice, 50% of the mice that were pre-immunized with the edible HPV16 vaccine showed positive serum IgG responses, while none of the negative controls showed any response. Vaginal IgG and IgA antibodies were also elicited in 33 and 39%, respectively, of the mice that were given with the edible HPV16 vaccine and the intranasal boost. All of the antibodies reacted more strongly to intact HPV16-VLP than to denatured HPV16-L1 protein suggesting that the edible vaccine primes for antibody responses against conformation-dependent epitopes. The inclusion of adjuvant in the vaccine formulation marginally increased the genital IgA response (P=0.06). HPV16-L1 protein in the yeast might induce tolerance in the vaccinated animals that could be recovered by intranasal boosting with a suboptimal dose of HPV-VLP. This freeze-dried yeast system may be useful as an oral delivery of HPV 16 L1 protein.

Increased secretion patterns of interleukin-10 and tumor necrosis factor-alpha in cervical squamous intraepithelial lesions.

Cytokines are released in response to infection of the uterine cervix by high-risk HPV. By using enzyme-linked immunosorbent assay, we measured the levels of tumor necrosis factor-alpha (TNF-alpha), interferon-gamma (INF-gamma), interleukin-6 (IL-6), and interleukin-10 (IL-10) in the cervical secretions of 120 cytologically normal or equivocal and 91 abnormal Japanese women. HPV infection of the cervical cells was typed by the LCR-E7 PCR method. The HPV DNA-negative samples were classified as either normal or inflamed, and the HPV DNA-positive samples were classified as HPV positive(+) n-ormal and as low- or high-grade squamous intraepithelial lesions (SILs). Compared with the normal cervices, all of the cytokines tested were elevated in inflamed, HPV+ normal, low-grade SILs (LSIL), and high-grade SILs (HSIL). The level of IL-10 was statistically higher in LSIL, and the level of TNF-alpha was higher in HSIL, relative to the cytokine levels in the inflamed and HPV+ normal samples (P <0.05; Mann-Whitney test). Multivariate analyses confirmed that increased levels of IL-10 were associated with LSIL (relative risk [RR]=3.9, 95% confidence interval [CI]=1.7-8.8) and that increased levels of TNF-alpha (RR=4.6, 95% CI=1.4-15) and age older than 40 years (RR=8.5, 95% CI=1.3-56) were associated with HSIL. The levels of INF-gamma and TNF-alpha (Th1-cytokines) correlated negatively with those of IL-6 and IL-10 (Th2-cytokines) in HPV+ normal and LSIL subjects, whereas no such correlation was observed for HSIL. The up-regulated secretion of IL-10 may inhibit immune responses against HPV infection in early cervical lesions, whereas up-regulated TNF-alpha and uncoordinated cytokine secretion (elevated both Th1 and Th2 cytokines) may reflect impaired or invalid responses in advanced stage lesions. The detection of IL-10 and TNF-alpha in cervical secretions may be a useful indicator of local immune responses and of the stage of the cervical lesions induced by HPV infection.

Mucosal immunoglobulin-A and -G responses to oncogenic human papilloma virus capsids.

Oncogenic human papilloma virus (HPV) infection is the most important risk factor for developing cervical cancer. It is known that serum antibody responses against these viruses are associated with persistent infection. We conducted an epidemiological study of 627 women to detect cervical mucosal immunoglobulin (Ig)A and IgG responses to oncogenic HPV capsids. Antibody reactivity and cervical HPV infection genotypes were examined by enzyme-linked immunosorbent assay (ELISA) using HPV types 16, 18, 31, and 45 virus-like particles, and a polymerase chain reaction-based method, respectively. HPV infection was defined as being positive for HPV DNA. Multivariate analysis revealed that a mucosal IgA response was associated with the HPV infection, whereas the IgG response was associated with high-grade cervical squamous intraepithelial lesions (SIL)/squamous cell cancer (SCC) and subject age (40-49 years). IgA was positive in 72% of women with oncogenic HPV infections, whereas IgG was positive in 64% of women with high-grade SIL/SCC. The longitudinal study demonstrated that the IgA response was elicited earlier than the IgG response, and the IgG response was barely induced in the preclinical HPV infection. However, once an IgG response was induced, it persisted longer after HPV clearance. The mucosal IgA response reflects current HPV infection, whereas an IgG response may be induced with the development of cervical lesions.

Spontaneous closure of traumatic macular hole.

PURPOSE: To investigate the mechanism by which traumatic macular hole closes spontaneously. DESIGN: Consecutive observational case series of three patients with unilateral traumatic macular hole who consulted medical staff at the Kansai Medical University between 1997 and 2000. METHODS: Three patients who sustained unilateral blunt trauma to the eye and developed traumatic macular hole were followed with ophthalmic examination, fundus photography, fluorescein angiography, and optical coherence tomography (OCT). RESULTS: Case 1 was an 11-year-old boy. He had neither a macular hole nor prominent macular edema at his first consultation, but a macular hole opened 3 weeks later. OCT showed macular edema and a full-thickness macular hole. The tissue around the edge of the macular hole protruded inward toward the center and finally closed spontaneously 18 weeks later. Case 2 was a 19-year-old man. He had a tiny rough-edged macular hole at his first consultation with a local ophthalmologist. OCT showed macular hole enlargement and worsening of the macular edema during follow up. The macular hole finally closed 4 months after injury. Case 3 was a 15-year-old boy. He had a tiny rough-edged macular hole at his first consultation with a local ophthalmologist. The macular hole finally closed 6 months after injury. CONCLUSION: Macular hole can be a result of severe damage from ocular concussion or damage to the retina. For 6 months following injury, traumatic macular hole should probably be observed rather than surgically repaired, because of the possibility that the macular hole may close spontaneously.

[Roles of nursing counseling room in home medical care].

The hospital inaugurated the service of visiting nursing in 1985 and the scope of the service was subsequently expanded to patients at the terminal stage and patients under artificial respiratory management. At present, however, the service of visiting nursing is restricted to the assistance to visiting medical care as a result of the diversification of the services of Nursing Counseling Room and the provision of better services at the visiting nursing station established in the city. The author reviewed the roles of the Nursing Counseling Room based on the experiences of discharge arrangements made in 2000 and 2001 in a patient with terminal disease, a patient with neurological refractory disease under artificial respiratory management and a child also under artificial respiratory management. Experiences in these patients made us realize the necessity of acting on the department of welfare of the municipal government, coordinating with the visiting nursing station, effectively holding conferences to discuss discharge and the necessity of the home doctor. We are determined to work to find solutions for these challenges.