Sleep-wake rhythm and its association with lifestyle, health-related quality of life and academic performance among Japanese nursing students: a cross-sectional study.

BACKGROUND: Young adults are likely to have activities and go to bed late at night due to their age-dependent delayed endogenous circadian clock. The purpose of the present study was to clarify sleep-wake rhythm and its association with lifestyle, health-related quality of life, and academic performance among nursing students. METHODS: Self-reported questionnaires were distributed to undergraduate nursing students at six universities in Japan. Sleep-wake rhythm was assessed using the morningness-eveningness questionnaire. A quantitative design using the generalized linear mixed effect model was utilized to identify the factors related to the evening type among female nursing students (n = 447). RESULTS: About 18% of the participants were identified as the evening type. Evening type was associated with living alone, part-time job, and club activity. Sleep duration on weekdays was shorter, meal time duration was the shortest, and the percentages of students who skipped meals and those who gained body weight were higher in the evening type than in the morning type and intermediate type. Mental health-related quality of life was lower in the intermediate type and evening type than in the morning type, while there was no difference in physical health-related quality of life among these groups. The percentages of the nursing students who have experienced absence, tardiness, falling asleep during class, and/or interference with academic achievement were higher in the evening type than in other groups. CONCLUSIONS: The present study has important implications for nursing students' biological characteristics and lifestyle, which are associated with their health-related quality of life and academic performance.

Impact of sleep problems on daytime function in school life: a cross-sectional study involving Japanese university students.

BACKGROUND: The aims of this study were 1) to clarify the prevalence of sleep problems (insomnia, insufficient sleep, and delayed sleep-wake phase) among Japanese university students; 2) to examine sociodemographic characteristics, lifestyle, and sleep-related symptoms in each sleep problem; and 3) to evaluate the association between the above-mentioned sleep problems and daytime dysfunction in school life. METHODS: Self-report questionnaire surveys were conducted at eight universities in Japan, and we received 1034 valid answers (78% female). The questionnaire consisted of socio-demographic characteristics, information on lifestyle, sleep pattern, sleep-related symptoms, and daytime dysfunction in school life. Groups with insomnia, behaviorally induced insufficient sleep syndrome (BIISS), delayed sleep-wake phase (DSWP), and BIISS + DSWP were defined. To identify the association between sleep problems and daytime dysfunction in school life, the generalized linear mixed effect model was conducted. RESULTS: Sleep duration on weekdays was 5.9 ± 1.2 h, and 38.2% of the students had a sleep duration < 6.0 h. About 16% of the students were categorized as evening-type individuals. More than half of the students (56.1%) had excessive daytime sleepiness. Insomnia was associated with tardiness (aOR: 0.8, 95%CI: 0.7-0.9) and falling asleep during class (aOR: 1.6: 95%CI: 1.4-2.0). BIISS was associated with tardiness (aOR: 1.5, 95%CI: 1.1-2.2) and interference with academic achievement (aOR: 1.9, 95%CI: 1.3-2.6). DSWP and BIISS + DSWP were associated with absence (aOR: 3.4, 95%CI: 2.2-5.1 / aOR: 4.2, 95%CI: 3.2-5.6), tardiness (aOR: 2.7, 95%CI: 1.8-4.1 / aOR: 2.2, 95%CI: 1.6-2.8), falling asleep during class (aOR: 2.6, 95%CI: 1.4-4.8 / aOR: 7.6, 95%CI: 3.3-17.2), and interference with academic achievement (aOR: 2.6, 95%CI: 1.7-3.9 / aOR: 2.1, 95%CI: 1.6-2.8). CONCLUSIONS: Students with DSWP and BIISS + DSWP were significantly associated with daytime dysfunction in school life, i.e. absence, tardiness, falling asleep during class and interference with academic achievement. Students displaying BIISS + DSWP were considered to have a relatively more serious condition compared with those with only insomnia, DSWP, or BIISS. It is therefore of utmost importance that university students aim to prevent DSWP and BIISS which were associated with daytime function in school life.

Breaking bad news to cancer patients in palliative care: A comparison of national cross-sectional surveys from 2006 and 2012.

OBJECTIVE: Most cancer patients experience the time when a doctor must "break the bad news" to them, a time when it is necessary for patients to call upon their self-determination to aid in the battle with cancer. The purpose of our study was to clarify the percentage of times doctors deliver bad news to patients at the end of life in each of four different situations, and to define the most common recipients of this bad news. We compare these results for two timepoints: 2006 and 2012. METHODS: The study had a national cross-sectional design consisting of self-completed questionnaires sent to all hospitals that provide cancer care. We mailed them to hospital directors in January and February of 2012, requesting a reply. The results of the same survey in 2006 were employed as a point for comparison. RESULTS: A total of 1224 questionnaires were returned during 2012. 1499 responses collected in 2006 were employed as reference data. Some hospital characteristics had changed over that interval; however, the new data obtained were representative for patients being treated in Japanese cancer care hospitals. In hospitals with 300-499, there were significant differences between 2006 and 2012 in the providing information about ("disclosure of cancer diagnosis," "therapeutic options for treatment," and "a life-prolonging treatment"). In addition, the likelihood of doctors delivering bad news to patients and family members (as opposed to family members only) at the end of life increased from 2006 to 2012. SIGNIFICANCE OF RESULTS: Our results suggest that the overall incidence of bad news being disclosed has increased, especially in hub medical institutions for cancer care. Advanced treatment options or domestic legislation may have influenced the frequency or type of bad news.

Relationship of psychological characteristics and self-efficacy in gastrointestinal cancer survivors.

To characterize gastrointestinal cancer survivors' ability to psychologically adjust, we examined the relationship between psychological characteristics (quality of life (QOL), anxiety, depression, and post-traumatic stress symptoms) and self-efficacy (perceived ability to initiate coping strategies). Forty-seven subjects (32 males and 15 females) were recruited from outpatient clinics or general surgical wards after readmission for therapy unrelated to cancer. All had undergone treatment for gastrointestinal cancer. Japanese version of the Functional Assessment of Cancer Therapy--General (FACT-G), Japanese version of Hospital Anxiety and Depression Scale (HADS), Japanese version of Impact of Event Scale--Revised (IES-R), and The Self-Efficacy Scale for Advanced Cancer (SEAC) were administered. Correlation analyses revealed a statistically significant positive correlation between three subscales of SEAC and QOL (total of FACT-G value) and a significant negative correlation between anxiety, depression (the total of HADS value), post-traumatic stress symptoms (the total of IES-R value), and SEAC. In multiple regression analysis, the influence from Affect Regulation Efficacy (subscale of SEAC) was the largest in anxiety and post-traumatic stress symptoms while the influence from Activities of Daily Living Efficacy (subscale of SEAC) was the largest in QOL and depression. Our findings revealed that a strong relationship between self-efficacy and psychological adjustment, and that there should be several psychological intervention forms performed at various treatment stages to enhance self-efficacy in this population of gastrointestinal cancer survivors. These results also imply the effectiveness of interventions on self-efficacy for gastrointestinal cancer survivors and the influence of psychological factors such as QOL, anxiety, depression, and post-traumatic stress symptoms.

[Relationship between the job characteristics of home-visiting nurses and their job-related burden and intention to continue working].

The purpose of this survey was to clarify the relationship between the job characteristics of visiting nurses, their workload and their intent to continue their work. The self-administered questionnaire survey targeted visiting nurses at a home-visit nursing care agency in Fukuoka prefecture. The results revealed the following points. Nurses who felt that there was "a discrepancy between what they thought their job description would be and the reality," that there was "a lot more work besides visiting homes," that there were "so many situations that require them to make a decision" or that there were "so many complex nursing skills" were more likely to find their workload burdensome. The more positive they felt about "the future prospects of the nursing agency," "the number of nurses at work" or "their wages," the more likely they were to have the intention of working continuously. The survey also suggested that a raised level of labor-management awareness for managers would help improve the incentive to work for visiting nurses, and the realization of systematic continuing education as a proactive measure to alleviate reactions to difficult realities would also help nurses maintain the desire to work continuously.

Quality of life in gynecological inpatients undergoing surgery.

This study investigates the changes in the quality of life (QOL) of gynecological patients undergoing surgery, and the relationship between these changes and clinical/demographic factors. Ninety patients were examined on three occasions using the Japanese version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-core30 (EORTC QLQ-C30). Although the global QOL and physical function decreased before discharge, the emotional function was lowest before surgery. There was no difference between the benign and malignancy groups in most QOL subscales. With regard to the relationship between global QOL and physical function before discharge and other demographic/clinical factors, multiple regression analysis suggested that these were explained by employment status, benign/malignancy, region of tumor, chemotherapy, postoperative complication, and psychological symptoms during hospitalization.

Sense of coherence among patients with cardiovascular disease and cancer undergoing surgery.

The sense of coherence (SOC) among patients undergoing cardiovascular surgery was compared with that of patients undergoing surgery for gynecological and oral cancer by using the Japanese version of the SOC questionnaire. The patients in the former group were able to cope with their disease and manage the relationship between their lifestyle and the disease for a long time. Eventually, however, they opted for surgery because they were unable to obtain life insurance if they did not resort to treatments other than medicine. On the other hand, the patients in the latter group had to suddenly deal with a very stressful event (being diagnosed with cancer and having had to undergo surgery). However, their malignant tumors were completely excised during surgery because their cancer was at an early stage. The analysis revealed that the average SOC score of the former group was significantly higher than that of the latter group; furthermore, the score of the latter group was similar to the SOC score of the general population. A multiple regression analysis revealed that the principal determinants of the SOC scores were the diagnosis of the patients (the duration of their struggle with the illness) and their employment status. The SOC of employed persons was higher than that of unemployed persons.

Emotional state and coping style among gynecologic patients undergoing surgery.

The aim of the present study was to investigate changes in emotional state and the relationship between emotional state and demographic/clinical factors and coping style among gynecologic patients undergoing surgery. Using the Japanese version of the Profile of Mood States (POMS), 90 patients (benign disease: 32, malignancy: 58) were examined on three occasions: before surgery, before discharge, and 3 months after discharge. They were also examined using the Coping Inventory for Stressful Situations (CISS) on one occasion before discharge. The scores for the subscales depression, anger, and confusion were the highest after discharge while those for anxiety were the highest before surgery. The average scores of the POMS subscales for all subjects were within the normal range. With regard to the relationship between these emotional states and other factors, multiple regressions showed that the principal determinants of anxiety before surgery were religious belief, psychological symptoms during hospitalization and emotion-oriented (E) coping style; further, it was found that depression after discharge could be explained by chemotherapy, duration of hospitalization, and E coping style. The principal determinants of anger after discharge and vigor before surgery were length of education and E coping style, and severity of disease, chemotherapy, E coping style and task-oriented coping style, respectively. Those of post-discharge fatigue and confusion were length of education, psychological symptoms, and E coping style. In summary it is suggested that the following should be taken into account in patients undergoing gynecologic surgery: anxiety before surgery, depression, anger, and confusion after surgery, including coping styles.

Anxiety and depression of patients with digestive cancer.

This study sought to characterize the psychological status of digestive cancer patients, and to investigate the relationship between psychological characteristics and clinical factors. Subjects were 85 inpatients scheduled to undergo surgery for digestive cancer and 26 control patients. The Japanese versions of Hospital Anxiety and Depression Scale (HADS) and Zung's Self Rating Depression Scale (SDS) were administered for all subjects before surgery, before discharge, and 6 months after discharge. Changes in HADS and SDS scores across the three examination days for three groups of subjects (advanced-phase, early phase, and control groups) were compared. The mean scores of anxiety and depression were significantly higher in the advanced-phase group than in the other two groups. Examination day showed a significant effect on depression; depression increased from before surgery to before discharge, and did not return to the preoperative level at 6 months after discharge, but no significant effect on anxiety. As for the relationship between psychological trends and clinical factors, anxiety in the 'middle age' and 'chemotherapy' groups was more severe than in the 'elderly' and 'no chemotherapy' groups. Depression in the 'medical treatment equipment', 'chemotherapy', and 'long-term hospitalization' groups was more severe than in the 'no equipment', 'no chemotherapy', and 'standard-term hospitalization' groups. These results suggest that we should pay careful attention to cancer patients undergoing surgery, especially young patients who are constantly at risk of anxiety, and assess their depression taking into account their disease and treatment conditions, especially after the time when their discharge is determined.

[Quality of life and psychological traits of patients undergoing surgery for gastrointestinal cancer].

The purpose of this study was to assess the pre- and post-operative quality of life (QOL) of patients with gastrointestinal cancer and to investigate the relationship between QOL and various psychological and clinical factors. Eighty-five patients who underwent surgery for gastrointestinal cancer and 26 control patients undergoing surgery for digestive diseases other than cancer were interviewed. Two tests were administered to assess QOL and psychological status, respectively: the Japanese-language version of the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C 30 and the Japanese-language version of the Hospital Anxiety and Depression Scale (HADS). Each test was administered before surgery, before discharge and 6 months after discharge. Changes in EORTC QLQ-C 30 sub-scale scores over time were compared among advanced-phase, early-phase, and control patients. All groups showed significant changes in subscale scores of QOL. The scores of the advanced-phase group indicated worse QOL than the early-phase and control groups in many areas. The results suggest that QOL in gastrointestinal cancer patients is variable over time and is influenced by various clinical factors including the depression and anxiety.

Psychological state, quality of life, and coping style in patients with digestive cancer.

The purpose of this study was to assess the relationships between psychological characteristics such as anxiety and depression, quality of life (QOL) and coping style among patients with digestive cancer. The subjects were 85 in-patients who were scheduled to undergo initial surgery for gastrointestinal cancer. The following psychological tests were administered: Japanese versions of the Hospital Anxiety and Depression Scale, Zung's Self-Rating Depression Scale, the European Organization for Research and Treatment of Cancer (EORTC) QLQ C30 and the Coping Inventory for Stressful Situations. The first 3 tests were performed on three occasions: before surgery, before discharge and 6 months after discharge. The results showed that there was no change over the 3 test administration days for the average scores of anxiety and that the scores of depression increased from before surgery to before discharge and did not return to presurgery levels at 6 months after discharge. Changes in each subscale score of the EORTC QLQ C30 across the 3 days displayed two typical trends. Relationships between the abovementioned trends and individual coping styles showed that the higher the score of "emotion-oriented coping style," the greater the deterioration in QOL subscales. It was suggested that focusing on a patient's coping style, particularly emotion-oriented coping style, is important and that patients likely to adopt a more emotion-oriented coping style should receive special consideration.

Quality of life and lifestyle among city dwellers participating in the medical programs.

In order to offer health education to the general population, taking into account not only their physical health but also their QOL (quality of life), it is necessary to clarify what guidance should be provided in the sight of QOL. In this study, the relationship between QOL and lifestyle was investigated in 615 Japanese (402 males, 213 females; ranging in age from teens to nineties; mean age, 43.4 +/- 16.3 years) undergoing medical checkups. After informed consent was obtained, subjects completed a questionnaire incorporating the Medical Outcome Study 36-item Short Form Health Survey as a QOL scale in addition to questions concerning individual and lifestyle factors. The results showed that most individual factors and lifestyle factors evaluated were related to QOL. In particular, the physical health QOL of elderly subjects, females, and single subjects, was lower than that of other subjects. Moreover, subjects who ate 'irregular meals' and had 'less than 6 h sleep' reported lower mental health QOL scores than those who ate 'regular meals' and had '6 h or more sleep'. Smoking and alcohol consumption were not as significantly related to QOL as anticipated. Taking these findings into account, it is clear that it is necessary to offer medical and health services focusing on meals and sleep for medical program attendants in order to improve QOL.

Assessment of peri-operative quality of life in patients undergoing surgery for gastrointestinal cancer.

The purpose of this study was to assess the pre- and postoperative quality of life (QOL) of patients with gastrointestinal cancer and to investigate the relationship between QOL and various psychological and clinical factors. Eighty-five patients who underwent surgery for gastrointestinal cancer and 26 control patients undergoing surgery for digestive diseases other than cancer were interviewed. Two tests were administered to assess QOL and psychological status respectively: the Japanese-language version of the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and the Japanese-language version of the Hospital Anxiety and Depression Scale (HADS). Each test was administered before surgery, before discharge, and 6 months after discharge. Gastrointestinal tumors were localized to the stomach, colon, or rectum in 88% of cases and classified as advanced stage or early stage according to staging protocols. Changes in EORTC QLQ-C30 subscale scores over time were compared among advanced stage, early stage, and control patients. All groups showed significant changes in subscale scores of QOL; the scores of the advanced-stage group indicated worse QOL than the early-stage and control groups in a lot of areas. The physical function (PF2) QOL subscore was influenced by diagnosis, postoperative complications, medical equipment at discharge, and the length of admission and negatively correlated with depression and anxiety. These results suggest that QOL in gastrointestinal cancer patients is variable over time and is influenced by various clinical factors. Therefore, consideration of these clinical factors is paramount to the optimal care of gastrointestinal cancer patients.

Early detection of postoperative delirium and confusion in a surgical ward using the NEECHAM confusion scale.

The early detection and prevention of postoperative delirium and confusion has become an important issue in surgical ward management. With the aim of determining an objective technique for early detection of delirium, 64 patients admitted to a surgical ward before surgery were examined using the NEECHAM confusion scale. On the 2nd postoperative day they were tested again and divided into 3 groups on the basis of their NEECHAM scores: high risk, low risk, and no risk, for confusion. The trends of the NEECHAM scores in the 3 groups were compared, and the relationship between the NEECHAM scores and suspected clinical risk factors for delirium was investigated. Use of NEECHAM scaling enabled medical staff to identify cases of possible confusion early, indicating that the NEECHAM confusion scale should be useful for the detection of postoperative delirium and confusion in the surgical ward.