Relationship Between Oral Health, Quality of Life, and Comprehensive Health Literacy in Community-Dwelling Older Adults.

Background and purpose: Oral health affects systemic health and the importance of maintaining good oral health is acknowledged. The high prevalence of oral diseases is associated with low health literacy (HL). Therefore, the purpose of this study was to investigate whether comprehensive HL in community-dwelling older adults is associated with objective oral hygiene and oral health-related quality of life (OHRQoL). Methods: Participants aged ≥65 years completed a self-administered questionnaire. On the same day, data collected with the oral health assessment tool were used to assess participants' objective oral status. The questionnaire included the general oral health assessment index to measure OHRQoL and the short version of the European Health Literacy Survey Questionnaire to assess comprehensive HL. Data were analyzed by univariate and multiple logistic regression. Results: In total, 145 people consented to participate in this study, of whom 118 (81.4%) responded effectively. Of the 118 participants, 18% recorded a rating of "unhealthy" for oral cleanliness in objective oral hygiene. Multiple logistic regression analysis identified comprehensive HL as a related factor for both oral cleanliness and OHRQoL (odds ratio = 5.00 and 3.33, p < 0.01 and p < 0.05, respectively). Implications for Practice: These findings indicate that comprehensive HL changes clinical outcomes. Because older adults often have comorbidities as well as oral health problems, it is important for nurses to assess HL during follow-up for comorbidities and take the opportunity to provide personalized oral health guidance and improve OHRQoL.

An Exploratory Study on Changes in Patients in the Emergency Department due to Coronavirus Disease 2019 in Japan: A Single-center Retrospective Study.

Introduction: This study assessed changes in patients transported to an emergency and critical care center before and after the coronavirus disease 2019 (COVID-19) pandemic in Japan and examined problems that should be addressed in emergency medical care. Methods: This single-center retrospective observational study was conducted at a university hospital. The subjects were patients who were transported to a "tertiary emergency department" receiving advanced medical care. With January 16, 2020, as the cutoff date, 4,197 patients who were transported to the hospital from January 16, 2019, to January 15, 2021, were recruited. The patients were classified into nine disease groups using the International Classification of Diseases, Tenth Revision. The emergency department (ED) visit count in 2020 was compared with that in 2019 using Poisson regression. Results: The number of patients transported to the tertiary ED in 2020 decreased by 7.8% compared with that in 2019. The number of patients transported to the tertiary ED decreased compared with that in the previous year during the period when the number of confirmed COVID-19 cases in Japan increased and showed the opposite trend when the number of confirmed cases decreased. As per diagnostic classification, it decreased for all diagnoses except External causes, and significant decreases were observed in Infectious (47.5%), Non-COVID-19 respiratory (28.4%), and Trauma (25.2%). In External causes, the rate of change for suicide cases alone increased to 43.2%. Conclusions: While the number of confirmed cases increased, the number of tertiary ED patients associated with COVID-19 decreased temporarily. It is necessary to fully consider the burden on medical institutions 1-2 months after the number of infected people peaks. It is also necessary to closely monitor suicides associated with COVID-19 as a factor that will cause changes in emergency medical care in the future.

The effect of real-time monitoring of physical activity intensity in diabetic patients.

AIM: To evaluate the effects of an intensity display type accelerometer on diabetic patients' physical activity. METHODS: This was a two-arm, non-randomized controlled study. Both groups received information about the recommendation of 150 min/week moderate-to-vigorous physical activity (MVPA). The intervention group used an intensity display type accelerometer to monitor their physical activity intensity for 10 days at baseline and 3 months later. We compared intervention and control groups after 3 and 6 months. Primary outcomes were MVPA and number of steps over 7 days. Secondary outcomes were glycosylated hemoglobin (HbA1c), body mass index, and self-management. RESULTS: Of 62 participants, 30 and 32 were included in the intervention and control groups, respectively. Mean age in each group was 59.7 ± 10.8 and 58.8 ± 10.2 years, and mean HbA1c was 6.9 ± 0.9% and 6.9 ± 0.8%, respectively. There were no significant differences between the intervention and control groups at either time point, and no outcomes showed significant changes. In a subgroup analysis by physical activity intensity, MVPA of active individuals in the control group significantly decreased at 6 months from baseline. MVPA and number of steps among inactive individuals in the intervention group significantly increased at 6 months from baseline. Self-management of the intervention group showed a trend toward improvement, but HbA1c and body mass index showed no significant change. CONCLUSIONS: Monitoring physical activity intensity led to increased MVPA of inactive patients and maintained MVPA of active patients with diabetes mellitus. This straightforward intervention could be applied in clinical practice.

Development and evaluation of the sedentary behavior and light-intensity physical activity questionnaire.

[Purpose] To describe our newly developed Sedentary Behavior and Light-Intensity Physical Activity Questionnaire and examine its reliability and validity. [Participants and Methods] We identified and selected self-reported items through a literature review and interviews with 11 inactive individuals. Thirty-one individuals with lower limb prostheses and an expert panel assessed the content validity of the integrated items and identified 17 items. Patients who had undergone lower limb surgeries were regarded as inactive individuals, and 112 patients completed the questionnaire twice for test-retest reliability and wore an accelerometer for criterion validity. The ethics committee of Kyushu University approved this study (2019-126 and 2019-273). [Results] Item analysis was revised to the Sedentary Behavior and Light-Intensity Physical Activity Questionnaire-10 (six light-intensity physical activity and four sedentary behavior items) because of the floor effect. The test-retest correlation coefficient showed high reliability. Moderate to weak correlation coefficient was observed between the questionnaire and accelerometer (light-intensity physical activity: 0.43 and sedentary behavior: 0.20), and the Bland-Altman plots indicated no bias. [Conclusion] The Sedentary Behavior and Light-Intensity Physical Activity Questionnaire-10 had acceptable validity and reliability among inactive individuals and it could be used for studying light-intensity physical activity.

Relationships of accelerometer-determined physical activity with obesity, hypertension, diabetes, dyslipidemia, and health-related quality of life in patients after liver transplantation.

The contribution of physical activity (PA) to the prevention of metabolic abnormalities following liver transplantation (LT) has not been well documented. We aimed to assess PA in post-LT patients and to quantify its relationships with the development of postoperative metabolic abnormalities and health-related quality of life (HRQOL). We recruited 111 patients who had undergone LT ≥ 6 months previously. PA was measured by accelerometry, and HRQOL was evaluated using SF-8. PA was quantified as the number of steps per day, and the time spent performing moderate-to-vigorous PA and light PA per week. The prevalence of hypertension, diabetes, and dyslipidemia increased more than twofold following LT. The proportion of the participants with a sedentary lifestyle (<5000 steps/day) was 36%. Logistic regression analysis showed that postoperative hypertension and obesity were associated with preoperative body mass index and the number of steps taken (in 2000 steps/day increments). Preoperative diabetes was associated with obesity, and PA was associated with physical function-related HRQOL scores. Thus, increasing the number of steps taken per day has the potential to reduce hypertension and obesity, and PA could improve physical function-related HRQOL in patients following LT.

Prospective study of objective physical activity and quality of life in living donor liver transplant recipients.

AIM: The aims of this study were to: (a) describe the physical activity (PA) and quality of life (QOL) in living donor liver transplant (LDLT) recipients pre-operatively and at 3 months and 6 months post-operatively; (b) compare PA and QOL at 6 months post-operatively with a healthy control group; and (c) explore pre-operative factors that predict PA changes. METHODS: Patients over 20 years of age who were undergoing LDLT were recruited. PA was measured based on the number of steps/day and time spent performing moderate-to-vigorous PA (MVPA) during 1 week using an accelerometer. QOL was assessed based on a physical (PCS) and mental (MCS) component summary of the eight-item Short-Form Health Survey. The LDLT and healthy control groups were matched for age (±3 years) and gender. Pre-operative factors predicting a change in PA were calculated using a generalized linear mixed model. RESULTS: Twenty-four patients completed the study. By 6 months post-LDLT, the MCS and PCS were comparable to those in the control group. The number of steps (3,887 steps/day) and MVPA (29.3 min/week) showed significant improvement by 6 months post-operatively, but remained much lower compared with those in the control group. The multivariate analysis showed that younger age (p < .01, p = .04) and higher skeletal muscle mass (SMM; p < .01, p = .03) were predictors of improvement in number of steps and MVPA. CONCLUSION: This study suggests the need for pre-operative interventions by healthcare professionals that focus on outcomes such as improving low SMM to facilitate post-operative PA recovery.

Cross-cultural adaptation, reliability and validity of the Japanese version of the Hospital for Special Surgery Hip Replacement Expectations Survey.

BACKGROUND: The Hospital for Special Surgery Hip Replacement Expectations Survey (HSS-THRES) is used in many countries to determine patient expectations before surgery. This study aimed to assess the reliability and validity of the Japanese version of HSS-THRES. METHODS: A total of 134 patients scheduled for total hip arthroplasty (THA) underwent a self-administered preoperative survey questionnaire. Patient's expectation and quality of life (QOL) were measured using the Japanese version of HSS-THRES, overall expectations for THA, Oxford hip score (OHS), and EuroQol-5D (EQ-5D). Some patients completed the Japanese version of HSS-THRES and the overall expectations for THA after a ten-day interval. Cross-cultural adaptation was validated by an expert committee comprising health professionals, a methodologist, language experts, and orthopedic specialists. The internal consistency was evaluated by the Cronbach α coefficient. The test-retest reliability was examined using the intraclass coefficient correlation (ICC) and the Bland and Altman analysis. To test the construct validity, nine priori hypotheses were tested by correlation analysis between the Japanese version of HSS-THRES and two QOL scales, and by examining the association with demographic variables. RESULTS: A total of 116 patients completed four scales. Patients were predominantly female (75.9%), with an average age of 62.2 ± 11.7. In the cross-cultural adaptation, all patients responded to the questionnaire without problems. The Japanese version of HSS-THRES showed good internal consistency (Cronbach α: 0.9). ICC was 0.94 and Bland-Altman analysis indicated no bias. The correlation between Japanese HSS-THRES and overall expectations for THA was high (r = 0.67). Similarly, the correlation with the OHS was higher than that with EQ-5D. A total of 77.8% of the hypotheses were confirmed. CONCLUSIONS: The Japanese version of HSS-THRES showed good cultural acceptability, high reliability, and validity to evaluate preoperative expectations for THA patients.

Effect of long-chain Fatty acids on the binding of triflupromazine to human serum albumin: a spectrophotometric study.

Human serum albumin (HSA) in the blood binds long-chain fatty acids (LCFAs), and the number of bound LCFAs varies from 1 to 7 depending on the physical condition of the body. In this study, the influence of LCFA-HSA binding on drug-HSA binding was studied using triflupromazine (TFZ), a psychotropic phenothiazine drug, in a buffer (0.1 M NaCl, pH 7.40, 37°C) by a second-derivative spectrophotometric method which can suppress the residual background signal effects of HSA observed in the absorption spectra. The examined LCFAs were caprylic acid (CPA), lauric acid (LRA), oleic acid (OLA), and linoleic acid (LNA), respectively. Using the derivative intensity change of TFZ induced by the addition of HSA containing LCFA, the binding mode of TFZ was predicted to be a partition-like nonspecific binding. The binding constant (K M(-1)) showed an increase according to the LCFA content in HSA for LRA, OLA, and LNA up to an LCFA/HSA molar ratio of 3-4. However, at higher ratios the K value decreased, i.e. for OLA and LNA, at an LCFA/HSA ratio of 6-7, the K value decreased to 40% of the value for HSA alone. In contrast, CPA, having the shortest chain length (8 carbons) among the studied LCFAs, induced a 20% decrease in the K value regardless of its content in HSA. Since the pharmacological activity of a drug is closely related to the unbound drug concentration in the blood, the results of the present study are pharmaco-kinetically, pharmacologically, and clinically very important.

New method of manometric measurement of gastroduodenal motility in conscious mice: effects of ghrelin and Y2 depletion.

Since no previous studies have reported dual measurements of stomach and duodenal motility in conscious mice, we developed a manometric method to measure the gastroduodenal motility in the physiological fed and fasted states of conscious mice. By this method we measured, for the first time, the gastroduodenal motility in Y2 knockout mice and analyzed the effects of ghrelin on the gastroduodenal motility in conscious mice. To evaluate this new method, we provide the comparison on the effects of CCK-8 examined by present and previous methods. In the fasted state of mice, phase III-like contractions with frequencies of 7.8 +/- 0.5 contractions/h in the antrum and 6.6 +/- 0.7 contractions/h in the duodenum were observed. This fasted pattern was disrupted and replaced by the fed pattern after feeding, with an increase of the motor index (MI) immediately after feeding. Intravenous injection of ghrelin induced the fasted pattern in the duodenum when injected in the fed state and increased %MI (114.3 +/- 9.8%) compared with saline-injected controls (64.4 +/- 9.6%) in the antrum. Intravenous injection of CCK-8 disrupted phase III-like contractions in both antrum and duodenum, which were replaced by fed-like motor patterns accompanied with the elevation of baseline pressure. In Y2 knockout mice, the frequency of phase III-like contractions was decreased in the antrum compared with wild-type mice and the immediate increase of MI after feeding seen in wild-type mice was disrupted in Y2 knockout mice. Our model provides a new method for studies of gastrointestinal motility in various mouse models, including transgenic and knockout ones.

(19)F NMR spectroscopic characterization of the interaction of niflumic acid with human serum albumin.

The interaction of a non-steroidal anti-inflammatory drug, niflumic acid (NFA), with human serum albumin (HSA) has been investigated by (19)F nuclear magnetic resonance (NMR) spectroscopy. A (19)F NMR spectrum of NFA in a buffered (pH 7.4) solution of NaCl (0.1 mol L(-1)) contained a single sharp signal of its CF(3) group 14.33 ppm from the internal reference 2,2,2-trifluoroethanol. Addition of 0.6 mmol L(-1) HSA to the NFA buffer solution caused splitting of the CF(3) signal into two broadened signals, shifted to the lower fields of 14.56 and 15.06 ppm, with an approximate intensity ratio of 1:3. Denaturation of HSA by addition of 3.0 mol L(-1) guanidine hydrochloride (GU) restored a single sharp signal of CF(3) at 14.38 ppm, indicating complete liberation of NFA from HSA as a result of its denaturation. These results suggest that the binding is reversible and occurs in at least two HSA regions. Competitive (19)F NMR experiments using warfarin, dansyl-L: -asparagine, and benzocaine (site I ligands), and L: -tryptophan and ibuprofen (site II ligands) revealed that NFA binds to site I at two different regions, Ia and Ib, in the ratio 1:3. By use of (19)F NMR with NFA as an (19)F NMR probe the nonfluorinated site I-binding drugs sulfobromophthalein and iophenoxic acid were also found to bind sites Ia and Ib, respectively. These results illustrate the usefulness and convenience of (19)F NMR for investigation of the HSA binding of both fluorinated and nonfluorinated drugs.

Effects of inorganic ions on the binding of triflupromazine and chlorpromazine to bovine serum albumin studied by spectrometric methods.

The effects of inorganic salts, NaCl, NaBr, NaI, Na2SO4, KCl, KBr, KI, on the binding constants (Ks) of psychotropic phenothiazine drugs, triflupromazine (TFZ) and chlorpromazine, to bovine serum albumin (BSA) were examined by using second-derivative spectrophotometry. All of the salts examined, with the exception of Na2SO4, decreased the K values significantly, depending on the concentration of the salt, e.g., the decrease in the K values of both drugs were about 40% for 0.1 M NaCl. The results obtained with Na2SO4 indicated that neither Na+ nor SO4(2-) had any affect on the binding of the phenothiazines to BSA. Based on the Na2SO4 results and the finding that the effect of each potassium salt on binding was quite similar to that of the corresponding sodium salt, the effects of these halogen salts can be considered to be derived from their anions, although the phenothiazines are positively charged at pH 7.4. The effectiveness of the anions was determined to occur in the following order: I->>Br->Cl-; these results coincided with the published order of the binding affinity of these anions to albumin. The 19F-NMR spectra of TFZ in the presence of each of these halogen salts revealed a concentration-dependent decrease in the intensity of the signal at 13.8 ppm that had previously been assigned to the TFZ bound to Site II. Consequently, the effects of these anions on the binding of positively charged phenothiazine drugs are thought to be local steric effects caused by the binding of these anions to Site II.

Metamorphosis-dependent transcriptional regulation of xak-c, a novel Xenopus type I keratin gene.

Anuran larvae transform their epidermis to the adult counterpart during metamorphosis. The major event of this process is the proliferation of larval epidermal basal cells and their differentiation into adult ones. The present study isolated novel type I keratin cDNA dubbed xak-c (Xenopus adult keratin-c) that was exclusively expressed in adult epidermal basal cells. The gene started its expression in the larval epidermis at the onset of metamorphosis. Thyroid hormone (TH) induced the precocious expression of the gene in the epidermis of premetamorphic tadpoles. To study the transcriptional regulation of this gene in relation to epidermal metamorphosis, a 2.8 kb 5'-flanking region of xak-c was cloned and its promoter activity was investigated. Gene constructs were made so as to contain the xak-c promoter region and gene of EGFP or luciferase as a reporter gene and were transfected into various types of cells, which revealed that the 5'-flanking region had an epidermal cell-specific transcriptional activity in both anurans and mammals. Larval skin tissues of Xenopus were transfected with the constructs and cultured in the presence and absence of TH, which showed that the promoter region is responsive to TH, although the region did not contain the consensus TH response element-like sequence. In sharp contrast, the promoter region did not respond to TH in the adult skin, clearly indicating that the cloned region contains specific sequences that respond to metamorphosis-dependent transcription factor(s).