Factors associated with foreign-educated nurses' willingness to continue working in Japan: a qualitative study.

BACKGROUND: Japan has been accepting foreign nurse candidates since 2008 under Economic Partnership Agreements (EPAs). As globalisation progresses, nurses from diverse backgrounds are expected to play an active role in the medical field. Using an interview survey, this study examined the factors associated with EPA nurses' willingness to continue working in Japan. METHODS: We conducted semi-structured interviews from January 2022 to July 2023 with eight EPA nurses and one EPA nurse candidate working in Japan to investigate the factors associated with foreign-educated nurses' willingness to continue working in Japan. The interview guide included items on the status of the daily performance of their duties, what they found pleasurable in their nursing experience in Japan, difficulties they encountered in carrying out their nursing duties, and their expectations of the Japanese staff around them. Data were analysed using thematic analysis. RESULTS: From the interview data, seven themes were extracted. To continue working in Japan, it was important for EPA nurses to be able to communicate with patients and colleagues, maintain self-esteem and motivation, be resilient, have support from EPA peers and family members, be accepted by others such as patients and colleagues, and be satisfied with the support they received. CONCLUSION: The EPA nurses experienced many difficulties after becoming nurses and tended to be isolated because of their non-Japanese status. The results suggest that not only support from colleagues and supervisors but also a general understanding of EPA nurses from Japanese society is necessary. As globalisation accelerates, the Japanese nursing field needs to understand the diversity of the nursing profession and build a support system that will enable them to continue to take pride and feel motivated in their work.

Determination of intracellular tenofovir-diphosphate and emtricitabine-triphosphate concentrations in dried blood spots for pre-exposure prophylaxis adherence.

OBJECTIVES: We measured the intracellular concentrations of tenofovir-diphosphate (TFV-DP) and emtricitabine-triphosphate (FTC-TP) in dried blood spots (DBS) for pre-exposure prophylaxis (PrEP) adherence using sensitive liquid chromatography-tandem mass spectrometry (LC-MS/MS). METHODS: A total of 191 DBS were obtained from 85 participants who were receiving tenofovir disoproxil fumarate (TDF; 300 mg) and emtricitabine (FTC; 200 mg) as PrEP at the Sexual Health Clinic, National Center for Global Health and Medicine, Tokyo, Japan. DBS punch (3 mm) added to 25 µL of 50% methanol and 400 µL of internal standard solution was used for solid phase extraction. Chromatographic separation was achieved on an Atlantis Premier BEH C18 AX Column (50 mm × 2.1 mm i.d.; particle size 1.7 µm) using gradient elution (flow rate: 0.6 mL/min); injection volume: 7 µL and run time: 5.5 min. Calibration curves for the two drugs were linear in the range 0.05-12.5 ng/punch. RESULTS: We determined the intracellular TFV-DP and FTC-TP concentrations in 191 DBS obtained from 85 patients administered with TDF and FTC as PrEP. The analytical performance data (calibration curve and QC samples) for all the analytical runs met the acceptance criteria. Intracellular concentrations of TFV-DP and FTC-TP in the DBS remained stable for at least 24 h after oral administration. CONCLUSIONS: A multiplex LC-MS/MS method was successfully developed for DBS, which can be useful for monitoring the levels of TFV-DP and FTC-TP in individuals receiving PrEP.

Positive correlation between voriconazole trough concentrations and C-reactive protein levels in patients with chronic pulmonary aspergillosis: A retrospective cohort study.

BACKGROUND: Voriconazole (VRCZ) is the first-line treatment for chronic pulmonary aspergillosis (CPA). VRCZ trough concentration monitoring is recommended for adequate therapy because VRCZ concentrations vary widely. However, factors associated with variations in VRCZ concentrations, especially in the same patient at different time points, have not been identified. The objective of this study was to identify factors influencing VRCZ trough concentrations. PATIENTS AND METHODS: This single-center retrospective study conducted at our institute between April 2014 and August 2016 included patients with CPA who received VRCZ. Patient trough concentrations were measured more than twice while the patients received the same dose using the same administration route (defined as one series). A step-wise method and multiple regression analysis were used to test the effects of patient characteristics on VRCZ trough concentrations. RESULTS: Sixty-nine series in 49 patients were analyzed. VRCZ was administered orally in 59 series, intravenously in 7 series, and by dry syrup in 3 series. The median VRCZ trough concentration and the median variation in VRCZ concentrations were 1.68 and 0.99 µg/ml, respectively. In the simple regression analysis, creatinine, alkaline phosphatase, C-reactive protein (CRP), and creatinine clearance significantly correlated with VRCZ concentrations. Multiple regression analysis demonstrated a significant positive correlation between CRP and VRCZ concentration (P < 0.0001). CONCLUSION: In patients with CPA, VRCZ concentration correlated with CRP levels in the same patients receiving the same dose of VRCZ at different time points.

Exhibition of antifungal resistance by sterol-auxotrophic strains of Candida glabrata with intact virulence.

Background: Candida glabrata is an emerging fungal pathogen in immune-compromised hosts. Previously undetected C. glabrata isolates were successfully recovered from clinical specimens by adding sterols to the growth medium. The clinical isolates are unable to synthesize ergosterol but can take up exogenous sterols under aerobic conditions. Objectives: This study characterizes the sterol-auxotrophic C. glabrata strains, examines the mutation(s) in sterol synthesis genes, characterizes the drug susceptibility and evaluates the virulence in a mouse infection model. Methods: Drug susceptibility of the C. glabrata strains was evaluated in a sterol-supplemented medium. The coding sequences of the sterol synthesis genes were analysed in six sterol-auxotrophic strains of C. glabrata. The fungal burden of mice infected with C. glabrata strain was determined. Results: The sterol-auxotrophic strains showed high-level resistance to both azoles and amphotericin B when sterols were supplied in the test medium. Additionally, the strains harbour missense mutations in either ERG1 or ERG7. Significant differences in fungal burden were not observed between the sterol-auxotrophic strain and the sterol-competent strain with the mice infection models. Conclusions: The sterol-auxotrophic C. glabrata strain investigated in this study seemed to maintain intact virulence, probably due to the supply of exogenous sterols from host organ(s). This suggests that exogenous sterol uptake develops antifungal resistance during infection.

Perception of childbirth experiences of Japanese women in Bali, Indonesia: a qualitative study.

BACKGROUND: Maternal healthcare services in Indonesia have seen dramatic improvements over the past 25 years and yet there is still room for improvement. The perception, by the women, of the perinatal care provided, is a vital input to further improving these services. This study examines how the perinatal care provided is experienced by Japanese women in Bali, using an interview survey. METHODS: We conducted semi-structured interviews, from August to October 2017, with 14 Japanese women living in Badung Regency and Denpasar City in Bali Province, Indonesia to report their perception of the perinatal care they experienced during their pregnancies. The interview guide included among others, the reasons for choosing specific (perinatal care) health facilities and their satisfaction with their experience of using the antenatal, delivery, and postnatal care services. The data were analysed using the qualitative content analysis method. RESULTS: From the interview data, 12 categories across five themes were extracted. Participants reported experiencing various concerns during their pregnancies such as difficulty in obtaining perinatal care related information. From the beginning of their pregnancies, participants gradually established trusting relationships with midwives, but in many situations, they were disappointed with their childbirth experiences, as they felt that the care provided was not woman-centred. Through their own efforts and with the support of family members and other Japanese residents, many women were able to eventually regard their childbirth experiences as positive. Nevertheless, some women could not overcome their negative impressions even years after childbirth. CONCLUSIONS: Participants desired close attention and encouragement from nurses and midwives. Our results suggest that Japanese women in Bali expected a woman-centred perinatal care and active support from nursing/midwifery staff during their pregnancies and postnatal care.

A case of insulinoma effectively treated with low-dose diazoxide.

Diazoxide is a benzothiadiazine that can be effective in managing hypoglycemia in frail patients with surgical risk. We report here a case of insulinoma effectively treated with diazoxide, as our report will be helpful for similar cases.

[Denaturation of egg antigens by cooking].

Changes in egg protein contents by cooking were measured with an ELISA kit using Tris-HCl buffer in model foods including cake, meatballs, pasta and pudding made with whole egg, egg-white and egg-yolk. The egg protein contents were lowest in the deep-fried model foods of cakes and meatballs. Ovalbumin (OVA) was undetectable (<1 µg/g) and ovomucoid (OVM) was lowest in pouched meatballs, suggesting that processing temperature and uniform heat-treatment affect the detection of egg protein. Furthermore, egg protein contents were below 6 µg/g in the pouched meatballs and pasta made with egg-yolk, and OVA and OVM were not detected by Western blotting analysis with human IgE from patients' serum. On the other hand, processed egg proteins were detected with an ELISA kit using a surfactant and reductant in the extract buffer.

Effects of retinoic acids on the dendritic morphology of cultured hippocampal neurons.

Vitamin A-derived retinoic acids (RAs) are known to exert a variety of biological actions, including modulatory effects on cell differentiation and apoptosis. A recent study has demonstrated that 13-cis-RA and all-trans-RA suppressed neurogenesis in the dentate gyrus of the hippocampus in adult mice. The present experiments were performed to see whether 13-cis-RA and all-trans-RA could alter the dendritic morphology of cultured hippocampal neurons via RA receptors: retinoic acid receptor (RAR) and retinoid X receptor (RXR). High doses of 13-cis-RA and all-trans-RA exerted a negative effect on the cultured hippocampal neurons, while a low dose of 13-cis-RA but not all-trans-RA caused a positive effect. The negative changes induced by 13-cis-RA and all-trans-RA were antagonized by RXR antagonists and RAR antagonists, respectively. The positive changes induced by a low dose of 13-cis-RA were blocked by both RXR antagonists and RAR antagonists. These results suggest that RAs at high concentrations cause a negative effect on the dendritic morphology of cultured hippocampal neurons through RA receptors, while RAs at low concentrations exert a positive influence on cultured hippocampal neurons.

Risk factors for heatstroke among Japanese forestry workers.

We examined the risk factors for heatstroke among forestry workers in Japan during the summer. We distributed a questionnaire to 124 forestry workers to determine heatstroke symptoms, degree of sweating and hydration, as well as perceived hotness and amount of sunlight at work sites. Forty of the workers (32.3%) reported experiencing heatstroke symptoms. Thirteen and 21 of them reported such symptoms during July and August, respectively. Eleven workers experienced heatstroke at around 14:00; 5 and 4 developed symptoms at around 11:00 and 10:00, respectively. Groups with and without heatstroke symptoms significantly differed in terms of perceived hotness (p<0.05), sunlight (p<0.05), degree of sweating (p<0.01) and frequency of hydration (p<0.05) while working. Heatstroke symptoms developed in 60.6% of workers aged up to 50 yr, but in only 22.0% of those over the age of 51 (p<0.01). Multiple regression analysis selected the following key variables associated with the development of heatstroke symptoms (R(2)=0.236 and p=0.006): frequency of urination, hotness, BMI and years of forestry work (standard coefficients: +0.229, +0.194, +0.280 and -0.162, respectively). The results of the present study showed that one third of forestry workers developed some symptoms of early heatstroke during summer forestry work. Furthermore, the results indicate that a short duration of forestry service was one of the risk factors contributing to the onset of heatstroke, in addition to heat stress, loss of body water and electrolytes, and obesity.

The effect of heavy metals on nicotinamideN-methyltransferase activityin vitro relating to Parkinson's disease.

OBJECTIVE: The aims of this study were to determine the effects of heavy metals such as manganese on nicotinamideN-methyltransferase (EC 2.1.1.1) (NNMT) activity and to consider the possibility of involvement of NNMT activation in the pathogenesis of heavy metal induced Parkinson's disease. METHODS: NNMT activity in supernatants separated from brain, liver and kidney homogenates of 5 elderly male Wistar rats by centrifugation were measured by high performance liquid chromatography system with fluorescence. NNMT activity under the conditon of 0.5 or 5.0 mM Mn(2+), Fe(2+), Cu(2+) or Cd(2+) was compared with control (no metal ion existence). RESULTS: NNMT activities in rat brain, liver and kidneys were significantly decreased by Cu(2+), and those in the liver and kidneys were significantly decreased by Cd(2+). Mn(2+) reduced NNMT activity only in the liver. Fe(2+) had no effect on NNMT activity. CONCLUSIONS: No metal increased NNMT activity in this study, contrary to our hypothesis. Further study is needed to clarify the reason why the effects of Mn(2+) and Fe(2+) which have a high relevance to Parkinson's disease on NNMT activity differ from those of Cu(2+) and Cd(2+).

Effect of shift work on mental state of factory workers.

This paper examines the effects of shift work on the mental state of factory workers. As an indicator of the workers' mental condition, the authors used a scoring system (referred to below as the 'depression tendency score') based on the SRQ-D investigative report. The depression tendency score of the men was higher among the shift worker group than among the regular day worker group (p < 0.01). The depression tendency score of the male back-to-back shift workers was higher than that of the male regular day workers among skilled workers (p < 0.05). Among the women, no notable difference in depression tendency score was observed between the regular day worker group and the shift worker group. However, the depression tendency score of the female two-shift workers was higher than that of the female regular day workers among skilled workers (p < 0.05). We conclude that the mental health of men is easily affected by back-to-back shift work and that of women is affected by two-shift work because of the difference in modern societal/home role between man and woman.

Changes in health habits of female shift workers.

This paper examines the effects of shift work on the lifestyles of female factory workers. As an indicator of healthy lifestyle habits, we used a scoring system (referred to below as the 'health score') based on Lester Breslow's health habits. The 'health score' of the women was higher than that of the men, but the shift workers' score was lower than that of the non-shift workers (p<0.01). In addition, the score of workers who had changed from non-shift work to double-shift work was remarkably low (p<0.01). These results suggest that, while the female shift workers manage to maintain relatively healthy lifestyles in comparison with the males, they have more difficulty maintaining these habits than do female workers who do not perform shift work. It can be concluded that, in addition to heightening women's consciousness of their own health, surrounding entities such as the work environment, the home, and the community in general need to pay due care to Japan's female shift workers.

[Effects of exposure to occupational hand-arm vibration on maintenance of postural balance].

In order to determine the relationship between exposure to hand-arm vibration through the use of vibration tools and dysfunction in the maintenance of postural balance, 106 male forestry workers were examined by stabilometry for deflection in the center of gravity and in the air conduction hearing levels. A questionnaire survey was also conducted among the workers in order to obtain details regarding their age, the types of tools used by them, and the duration for which they had used a chain saw. The vibration acceleration of a chain saw has been limited to a level of 3 G or less since 1976 in accordance with the notification from the Japanese Forestry Agency and the Ministry of Labor. In fact, chain saws with significantly reduced vibration acceleration in comparison with those used before 1976 have been available. Therefore, in 2000, we conducted a test on forestry workers who were divided into two groups-workers who had used a chain saw for 25 years or more (25-yr-or-more group) and workers who had used a chain saw for 24 yr or less (24-yr-or-less group). Compared to the 24-yr-or-less group, the 25-yr-or-more group exhibited significantly higher levels of average deflection in the center of gravity, expressed as the enveloped (aENV) and rectangular (aREC) areas, and in the hearing levels at 500, 1000, 2000, 4000 and 8000 Hz. For the aENV, the correlation coefficients revealed significant relationships between the hearing levels at 4,000 Hz, the duration of use of a chain saw, and age. Since the duration of use of a chain saw exhibited a significant relationship with age, it was necessary to eliminate the effect of age on the aENV. Subsequently, we divided all the workers into age groups spanning ten years each (from 20 to 70 yr) and compared the aENV among the same age groups in both the 25-yr-or-more and the 24-yr-or-less groups. The averages of the aENV for each age group were higher in the 25-yr-or-more group than in the 24-yr-or-less group. In particular, a significant difference was observed in the group of workers in their 40s. Moreover, the average of aENV value was significantly higher in the 25-yr-pr-more group than in the 24-yr-or-less group among the workers between 46 and 68 yr, with their ages being congruent in both groups. While investigating the impact on the workers who had used chain saws, it might be difficult to examine the effect of occupational vibration independent of the noise load. Nevertheless, this study suggests the possibility that a decrease in the maintenance of postural balance has a stronger relationship with exposure to thumping vibration in the past than with the age factor.

[Formaldehyde exposure levels and exposure control measures during an anatomy dissecting course].

The evaporation of formaldehyde from cadavers can produce high exposures among students and instructors. A possible causal role for formaldehyde has been considered likely for tumor of the nasopharynx and the nasal cavities in human beings. Due to this reason, Japan Ministry of Education, Culture, Sports, Science and Technology (MEXT) has set a guideline, which includes--decrease in gaseous formaldehyde in gross anatomy dissection laboratories and a guide to medical students about the toxicity of formaldehyde and protective method to avoid damages to skin, mucous, membrane, etc, in 2002. To understand what effective plans should be regarding the awareness of students about this notification, this study measured the gaseous formaldehyde concentrations in the anatomy dissection room and also analyzed the formaldehyde-related symptoms, and frequency of using protective measures. The study was conducted over a period of 3 months during the anatomy dissection exercise. We found that immediately after removing the cadavers' plastic covering, formaldehyde concentrations in the dissection room increased sharply. The concentration reached a peak point of 0.62 ppm after 10 minutes of starting of the class. This was much above the recommended level of 0.5 ppm set by Japan Society for Occupational Health. After 30 minutes of achieving the peak the formaldehyde level started decreasing gradually to a level of 0.11 ppm. Formaldehyde-related symptoms were observed in 59% of students. They had experienced symptoms of irritation of eyes, nose, throat, airways, skin, and headache during the course. Ocular discomfort was found significantly higher in the contact lenses users compared to the spectacle users or the normal eye sight group. Although, the guidelines about toxicity of formaldehyde and its protective measures to prevent damages to skin, mucous membrane etc. were informed to every student, only 52% of the students used both the mask containing activated carbon and the rubber gloves in every practical class without fail. Environmental Health Criteria 89 of International Program of Chemical Safety states, "It must be regarded that formaldehyde fluid is not absorbed directly into tissues through the skin". So the students may be allowed in some cases to touch the cadaver, treated by formaldehyde content fixative, by bare hands to understand the feel of certain organs and tissues. These results support that the rules of health supervision including necessity to use of protective measures, monitoring of indoor air formaldehyde etc. should be adhered by students and instructors in anatomy dissection room during the practical class.

Effects of decreasing air temperature on peripheral thermal reactions in males and females.

OBJECTIVES: This study was performed to determine the effects of decreasing ambient temperature on peripheral blood flow and body temperature of males and females in a thermal neutral zone for references to the thermal standard of office workers. METHODS: Peripheral blood flows of the hand and feet, and body temperatures and so on of male and female subjects were measured in a climatic chamber. Air temperature was maintained at 28.5°C at the beginning. After this, air temperature was decreased linearly to 21.0°C over a period of 60 minutes. Finally, air temperature was maintained at 21.0°C. RESULTS: Blood flows and skin temperatures of male and female subjects became similar or showed no significant difference at beginning and the end of the experiment. Skin blood flow of the hand and skin temperatures of the hand and fingers decreased, and these values in females were lower than in males, when air temperature was decreased linearly in a thermal neutral zone. However, there were no remarkable differences between males and females in sublingual and mean skin temperatures during the experiment. CONCLUSION: Minimum air temperature at the thermal standard for offices in Japan is 17°C, which may be too low to be comfortable or neutral. Even in a neutral thermal condition, it is better that office workers are provided some protection such as a blanket or clothing, to protect peripheral body parts from cooling in winter, as there are individual differences in physiological thermal reactions.

A survey of urinary hippuric acid and subjective symptoms among occupational low toluene exposed workers.

Biological monitoring of toluene exposure by urinary hippuric acid determination and a subjective symptom survey by self-administered questionnaire were performed in 20 workers at low toluene exposure in factories to evaluate the health hazard including dysfunction of nervous system. Environmental monitoring was carried out using toluene gas detection tubes. Urine samples were collected three times a day in order to measure hippuric acid: first before the commencement of work, then at the end of forenoon work, and lastly at the end of afternoon work. Toluene vapor concentrations of throughout the workday ranged from 15.3 to 31.4 ppm. The urinary hippuric acid concentrations correlated with the toluene concentrations of ambient air (r = 0.58, p = 0.01). The subjective symptoms increased in close association with the exposure to toluene; the prevalence rate of subjective symptoms "during work" in the exposed group was 15 times higher than the rate of the non-exposed group (p < 0.0001). The prevalence rate of subjective symptoms "off-work" in the exposed group was 2.4 times higher than the rate of the non-exposed group (p < 0.0001), and also the prevalence rate of "nineteen symptoms off-work which are apparently related to central nervous system (CNS) and autonomic nervous system (ANS)" in the exposed group was 1.8 times higher than the rate of the non-exposed group (p < 0.05). From these results, these subjective symptoms, which have been believed to be complained in high organic solvent exposure should be reassessed and reconsidered in evaluating the nervous system dysfunction and local irritation in relatively low toluene exposed workers.

Pepsin-resistant 16-kD buckwheat protein is associated with immediate hypersensitivity reaction in patients with buckwheat allergy.

BACKGROUND: Buckwheat is becoming popular in many countries as a health food and the incidence of buckwheat allergy is increasing in Asia. The ingestion of small amounts sometimes provokes an anaphylactic reaction. However, it remains controversial which is the major allergen responsible for such reactions. METHODS: The patients whose sera are positive for buckwheat-specific IgE antibody measured by the CAP system fluorescein-enzyme immunoassay (CAP-FEIA) were classified into two subgroups depending on the history of immediate hypersensitivity reactions (IHR). Major buckwheat allergens were identified with immunoblotting, ELISA and N-terminal amino acid sequencing. Various treatments such as pepsin digestion were added to characterize the proteins. RESULTS: We found that the 24-kD protein that had previously been reported to be a major allergen reacted to IgE antibodies present in sera from almost all subjects (19/20) regardless of symptoms. On the other hand, 16- and 19-kD proteins were bound with IgE antibodies present in sera from 9 of the 10 patients with IHR including 8 patients with anaphylaxis but not in sera from buckwheat-specific IgE-positive subjects without IHR. After pepsin treatment, the 16-kD protein but not the 19- and 24-kD proteins remained undigested and preserved the capacity of IgE binding. This pepsin-resistant 16-kD protein had no homology with the 24-kD protein by the N-terminal amino acid sequencing. CONCLUSIONS: The 16-kD buckwheat protein was resistant to pepsin digestion and appeared to be responsible for IHR including anaphylaxis, while the pepsin-sensitive 24-kD protein was responsible for CAP-FEIA but not IHR.