Repetitive peripheral magnetic stimulation for preventing shoulder subluxation after stroke: a randomized controlled trial.

BACKGROUND: Shoulder subluxation caused by paralysis after stroke is a serious issue affecting shoulder pain and functional prognosis. However, its preventive treatment has not been fully investigated. AIM: To investigate the effects of repetitive peripheral magnetic stimulation (rPMS) on the prevention of shoulder subluxation. DESIGN: A single-center, parallel-group, prospective randomized, open-blinded, end-point study. SETTING: Convalescent rehabilitation ward. POPULATION: We included 50 inpatients in the convalescent rehabilitation ward with post-stroke, having upper limb paralysis, and the acromio-humeral interval (AHI) was within 1/2 finger-breadth. METHODS: A blinded computer-based allocation system was used to randomly assign patients into two groups: 1) conventional rehabilitation plus rPMS therapy (rPMS group, N=25); and 2) conventional rehabilitation alone (control group, N=25). Blinded assessors evaluated the patients before the intervention (T0), 6 weeks after (T1), and 12 weeks after (T2). The primary outcome was the change in AHIs from T0 to T1 between the groups. In contrast, the secondary outcomes were shoulder pain, spasticity, active range of motion, and Fugl-Meyer Assessment upper extremity (FMA-UE) score. RESULTS: Twenty-two patients in the rPMS group and 24 in the control group completed T1, whereas 16 in the rPMS group and 11 in the control group completed T2. The change in AHI was significantly lower in the rPMS group than in the control group ([95% CI, -5.15 to -0.390], P=0.023). Within-group analysis showed that AHI in the rPMS group did not change significantly, whereas it increased in the control group (P=0.004). There were no significant differences between T1 and T2 within or between the groups. Moreover, AHI did not show differences in patients with severe impairment but decreased in the rPMS group in patients with mild impairment (P=0.001). CONCLUSIONS: The rPMS may be a new modality for preventing shoulder subluxation. The association between motor impairment and the sustained effect needs to be further examined. CLINICAL REHABILITATION IMPACT: Applying rPMS to the muscles of the paralyzed shoulder after a stroke may prevent shoulder subluxation.

Feeding selectivity and a functional trade-off in a benthic fish with a continuous morphological variation: an experimental test.

BACKGROUND: Functional trade-offs through ecological specializations are hypothesized to become causes of adaptive phenotypic divergence under divergent natural selection, where intermediate phenotypes may have the lowest fitness. Evidence of phenotypic divergence in a trade-off between populations experiencing different environmental/ecological conditions is abundant. However, traits in divergent selection sometimes present non-discrete (unimodal) variability, including intermediate phenotypes, although the underlying mechanisms are poorly documented. A benthic cyprinid fish, Pseudogobio esocinus, in Lake Biwa, central Japan, exhibits a large non-discrete/continuous variation in mouthpart morphology (from wide to narrow) within a lake population. The variation is linked with individual diets (i.e., the compositions of two different types of prey) even at a single site, and thus the variability is hypothesized to persist under divergent selection for prey usage. As a first step toward understanding the persistence mechanisms, here I examined the presence of morphology-dependent feeding selectivity and a functional trade-off in a laboratory experiment. RESULTS: When each experimental fish was simultaneously provided the different types of prey (chironomid larvae and amphipods), the fish mostly utilized chironomid larvae as primary prey. However, compared with the wider-mouthed fish, the narrower-mouthed fish took a larger proportion of amphipods as secondary prey by changing feeding (attacking) behavior. The intermediate-mouthed fish had lower feeding efficiency than the extreme-mouthed fish, indicating potential disadvantage of the intermediate phenotype. CONCLUSIONS: This experimental result supports the presence of morphology-dependent feeding performance and a functional trade-off with potential impacts on trait variability, which may favor specializations rather than generalizations. In the wild, however, there may be some situations for relaxing the trade-off, such as temporally fluctuating prey availability that could also favor generalizations depending on the conditions, and thus, both extreme and intermediate phenotypes may persist/coexist in a single habitat. Although further examinations, especially focusing on feeding efficiency for each prey type separated from the effects of prey selectivity, are needed, this case represents an opportunity to consider the possible mechanisms of the persistence of phenotypic variation that is maintained without divergence even in a trade-off.

Double migration of the endangered Tricyrtis formosana (Liliaceae) in Japan.

The Ryukyu Islands of Japan are a biodiversity hotspot due to geographical and historical factors. Tricyrtis formosana is a perennial herbaceous plant that commonly found in Taiwan. But only a few populations have been identified in a limited habitat on Iriomote Island, while populations of unknown origin occur near human settlements in an area on the main island of Okinawa. To better understand these populations of the phylogenetic uniqueness and intrinsic vulnerability, we conducted comparative analyses including (1) phylogeny and population structure with MIG-seq data, (2) photosynthesis-related traits of plants grown under common conditions and (3) transcriptome analysis to detect deleterious variations. Results revealed that T. formosana was split into two clades by the congeners and that Iriomote and Okinawa populations independently derived from ancestral Taiwanese populations in each clade. Photosynthetic efficiency was lowest in the Iriomote population, followed by Okinawa and Taiwan. Transcriptome analysis showed that the Iriomote population accumulated more deleterious variations, suggesting intrinsic vulnerability. These results indicate that each T. formosana population in Japan is phylogenetically unique and has been independently dispersed from Taiwan, and that the Iriomote population presents a high conservation difficulty with a unique photosynthesis-related characteristic and a larger amount of deleterious variations.

Morphological variation associated with trophic niche expansion within a lake population of a benthic fish.

Ecological theory suggests that generalist species should have traits with multiple adaptive peaks. Consequently, in heterogeneous environments such adaptive landscapes may lead to phenotypic divergence that becomes fixed in populations via reproductive isolation, thus driving speciation. However, contrary to this expectation, the process of ecological diversification in wild populations is not always associated with obvious trait divergence and reproductive isolation due to some ecological and geographic constrains. To examine the ecological conditions that promote (or inhibit) divergence is quite important to improve our understanding of the underlying mechanisms. Here we examine how the patterns of trait variation (divergence/non-divergence) are determined in relation to ecological niche expansion and gene flow using a benthic fish, Pseudogobio esocinus, in the Lake Biwa system, Japan. The fish exhibited various patterns of morphological variation in mouth parts among populations. Lake fish tended to have a smaller mouth compared with river fish and also showed remarkable individual variations within some local samples. Lake fish utilized chironomid larvae as the primary prey, as in riverine fish. But, fish with smaller and narrower mouths utilized significantly higher proportions of amphipods (a novel prey unique to the lake) as their secondary prey. Microsatellite analysis detected no genetic structuring in the Lake Biwa catchment, suggesting no reproductive separation among eco-morphologically divergent individuals. Our results exemplify population niche expansion associated with continuous eco-morphological variation without divergence, and provide insights into the role of non-discrete diversification for thriving in heterogeneous environments.

Patients' supportive care needs and psychological distress in advanced breast cancer patients in Japan.

OBJECTIVE: Few studies have investigated the prevalence of the unmet needs among advanced or recurrent breast cancer patients in Asian countries and little is known about the relation between their unmet needs and psychological distress/quality of life. METHODS: The participants (n = 87) comprised randomly selected ambulatory female patients with advanced or recurrent breast cancer attending the Outpatient Department of Oncology, Immunology and Surgery of Nagoya City University Hospital. The patients were asked to complete self-administered questionnaires assessing the level of their physical and psychological symptoms, supportive care needs and socio-demographic and biomedical factors. The association between the patients' perceived needs and psychological distress/quality of life was then analyzed statistically. RESULTS: The patients had a mean ± standard deviation of 11 ± 7.7 and a median of 10 unmet needs. The prevalence of the 17 most frequent unmet needs was over 50%, and almost all of these unmet need items belonged to the Psychological or the Health system and information domain. The total Short-form Supportive Care Needs Survey Questionnaire with cancer score was significantly associated with the indices of psychological distress and quality of life. Most of the Short-form Supportive Care Needs Survey Questionnaire with cancer domains except Sexuality domain were also significantly associated with all the indices of psychological distress. CONCLUSIONS: Psychosocial needs were strongly associated with psychological distress and quality of life. Quality of life and psychological distress may be improved if interventions for unmet needs, especially psychological and information needs, are made.

Patient's perceived need and psychological distress and/or quality of life in ambulatory breast cancer patients in Japan.

OBJECTIVE: A needs assessment can be used as a direct index of what patients perceive they need help with. The purposes of this study were to investigate the association between patients' perceived needs and psychological distress and/or quality of life (QOL) and to clarify the characteristics of patients with a high degree of unmet needs. METHODS: Randomly selected ambulatory female patients with breast cancer participated in this study. The patients were asked to complete the Short-form Supportive Care Needs Survey questionnaire, which covers five domains of need (health system and information, psychological, physical, care and support, and sexuality needs); the Hospital Anxiety and Depression Scale; and the European Organization for Research and Treatment of Cancer QLQ-C 30. RESULTS: Complete data were available for 408 patients. The patients' needs were significantly associated with both psychological distress (r=0.63, p<0.001) and QOL (r=-0.52, p<0.001). A multiple regression analysis revealed that employment status (without full-time /part-time job), duration since diagnosis (less than 6 months), advanced stage, and a lower performance status were significantly associated with higher total needs. Only sexuality needs were significantly associated with a younger age, while the other domains were significantly associated with duration since diagnosis, advanced stage, and a lower performance status. CONCLUSIONS: Moderate to strong associations exist between patients' needs and psychological distress and/or QOL. The characteristics associated with patients' needs are multi-factorial, and interventions to respond to patients' needs may be one possible strategy for ameliorating psychological distress and enhancing QOL.

Anticipatory nausea among ambulatory cancer patients undergoing chemotherapy: prevalence, associated factors, and impact on quality of life.

The purposes of this study were to investigate the prevalence of anticipatory nausea (AN), its associated factors, and its impact on quality of life (QOL) among ambulatory cancer patients receiving chemotherapy. Patients were randomly selected to participate in this study, and were asked to complete the Morrow Assessment of Nausea and Emesis scale, the Hospital Anxiety and Depression Scale, the Short-form Supportive Care Needs Survey questionnaire, and the European Organization for Research and Treatment of Cancer QLQ-C30 questionnaire. Complete data were available for 214 patients. A total of 10.3% of the patients experienced very mild to severe AN. The presence of AN was significantly associated with most domains of the investigated patients' outcome, including psychological distress and perceived needs, with the exception of the health system and information domain of patients' needs, and the physical functioning domain of QOL. Anticipatory nausea was also associated with QOL even after adjustments for age, sex, performance status, and psychological distress. The prevalence of AN in ambulatory cancer patients who receive chemotherapy may not be as high as previously reported. However, given its potentially significant impact on relevant outcome, including QOL, AN should not be neglected in current clinical oncology practice. (Cancer Sci 2010; 101: 2596-2660).

Delirium training program for nurses.

BACKGROUND: Delirium is a common and serious clinical problem for hospitalized patients and is associated with an increased risk of morbidity and mortality and increased healthcare costs. OBJECTIVE: The objective of this study was to investigate the preliminary usefulness of a novel delirium training program to improve nurses' self-confidence in caring for patients with delirium. METHOD: One or more nurses were selected from each ward to become the "delirium-link nurses," and these nurses would then pass on their special training to the other nurses in their ward. RESULTS: The outcome was evaluated with a self-reported 15-item measure to assess self-confidence. A total of 390 nurses, including 32 delirium-link nurses, participated in this program. A significant effect was observed for 12 of the 15 items. CONCLUSION: This brief program can improve nurses' self-confidence in treating delirium patients; however, more work is needed to improve nurses' ability to detect delirium early.

Cancer patients' reluctance to discuss psychological distress with their physicians was not associated with underrecognition of depression by physicians: a preliminary study.

OBJECTIVE: To investigate the association between cancer patients' reluctance for emotional disclosure to their physician and underrecognition of depression by physicians. METHODS: Randomly selected ambulatory patients with lung cancer were evaluated by the Hospital Depression and Anxiety Scale (HADS), and those with scores over the validated cutoff value for adjustment disorder or major depressive disorder were included in this analysis. The data set included the responses to the 13-item questionnaire to assess four possible concerns of patients in relation to emotional disclosure to the treating physician ("no perceived need to disclose emotions," "fear of the negative impact of emotional disclosure," "negative attitude toward emotional disclosure," "hesitation to disturb the physician with emotional disclosure"). The attending physicians rated the severity of depression in each patient using 3-point Likert scales (0 [absent] to 2 [clinical]). Depression was considered to be underrecognized when the patients had a HADS score above the cutoff value, but in whom the depression rating by the attending physician was 0. RESULTS: The HADS score was over the cutoff value in the 60 patients. The mean age was 65.1 +/- 10.0, and 82% had advanced cancer (Stage IIIb or IV or recurrence). Depression was underrecognized in 44 (73%) patients. None of the four factors related to reluctance for emotional disclosure was associated with the underrecognition of depression by the physicians. None of the demographic or cancer-related variables were associated with depression underrecognition by physicians. SIGNIFICANCE OF RESULTS: The results did not support the assumption that patients' reluctance for emotional disclosure is associated with the underrecognition of depression by physicians.

Reliability and validity of the Japanese version of the Short-form Supportive Care Needs Survey questionnaire (SCNS-SF34-J).

PURPOSE: Provision of supportive care to meet patients' individual needs is instrumental to enhancing their quality of life. We therefore need an appropriate assessment tool to measure such needs. The purpose of this study was to examine the psychometric property of the Japanese version of the Short-form Supportive Care Needs Survey questionnaire (SCNS-SF34-J). SUBJECTS AND METHODS: The forward-backward translation method was used to develop the Japanese version of SCNS-SF34, originally developed by Boyes et al. in Australia. Randomly selected ambulatory female patients with breast cancer participated in this study. They were asked to complete the SCNS-SF34-J and the European Organization for Research and Treatment of Cancer QLQ-C 30. The validity and the reliability of SCNS-SF34-J were evaluated statistically. RESULTS: Complete data were available from 408 patients. A five-factor solution that accounted for 74.6% of the total variance was reproduced. The results confirmed the five-factor structure found in the original SCNS development study, consisting of Health system and Information needs, Psychological needs, Physical needs, Care and Support needs, and Sexuality needs. Cronbach's alpha coefficients, which are the measures of the internal consistency, were above 0.85 for all of five subscales. Significant correlations were also found for corresponding subscales in each of the instruments. The anticipated differences in supportive care needs between groups divided by the patient characteristics, such as the disease stage, were found to be significant. CONCLUSION: The results indicated that SCNS-SF34-J is a valid and reliable tool for assessing the supportive care needs of Japanese cancer patients.

Patient-perceived barriers to the psychological care of Japanese patients with lung cancer.

OBJECTIVE: Although cancer patients frequently experience psychological distress, few cancer patients with psychological distress receive appropriate psychological care. The purpose of this study was to investigate the type and frequency of barriers to receive psychological care in patients with lung cancer. METHODS: Randomly selected ambulatory patients with lung cancer participated in the study. A self-administered questionnaire developed for this study was used to assess patient-perceived barriers toward psychological care provided in a medical context. Factor analysis indicated that this scale mapped four domains; emotional communication with their physicians, psychiatric consultation, psychotropic medication and counseling. The patients' demographic factors and levels of past and current psychological distress were also assessed to reveal potential factors associated with patient-perceived barriers to psychological care. RESULTS: Complete data were available from 100 patients. The mean (SD) age of the patients was 65.4 (9.8) years; more than 80% were male, and 77% suffered from advanced stage lung cancer. Lack of correct information and/or misunderstanding of treatments was found to be a major barrier for all four treatment options in common. Negative opinions toward the use of psychotropics were more frequent than those toward counseling. Patients with severe psychological distress were significantly more likely to report a reluctance to undergo psychiatric consultation than those without psychological distress. CONCLUSIONS: Lung cancer patients commonly experienced concerns to utilize psychological care. Encouragement from physicians to discuss emotional aspects and the provision of sufficient information regarding psychological care may be useful to alleviate such concerns. Medical staff should also be aware that severe psychological distress may itself be related to a reluctance to undergo psychiatric consultation.

Cancer patients' reluctance to disclose their emotional distress to their physicians: a study of Japanese patients with lung cancer.

PURPOSE: To explore cancer patients' concerns about emotional disclosure (ED) to their physicians, and to investigate the factors associated with them. SUBJECTS AND METHODS: Randomly selected ambulatory patients with lung cancer participated in this study. An 18-item questionnaire to assess patients' beliefs regarding ED to their physicians was developed for this study. Factor analysis was used to extract the underlying factors of this scale. Patients were asked to answer this questionnaire along with other self-administered questionnaires. RESULTS: Complete data were available from 104 patients. Four factors were extracted by factor analysis: 'Hesitation to disturb the physicians by ED', 'No perceived need for ED', 'Negative attitude towards ED', and 'Fear of a negative impact of ED'. All factors reached standards of internal consistency. The prevalence of the above concerns, in that order, among the patients was 68, 67, 46, and 20%. Patients with high distress levels were significantly more likely to endorse 'Negative impact' (p=0.02). Older patients were more likely to report 'Negative attitude' (p=0.06), whereas male patients were more likely than females to report 'Hesitation' (p=0.05). CONCLUSION: Knowledge of such patient-related barriers should better prepare physicians to build good communication channels with their cancer patients.

Mental health literacy in Japanese cancer patients: ability to recognize depression and preferences of treatments-comparison with Japanese lay public.

BACKGROUND: Insufficient knowledge about mental illness and its treatment has been shown to constitute a major barrier to its adequate care for mental illness in the lay public (LP). We therefore examined Japanese cancer patients' (CP) ability to recognize depression and their preferences of its treatments. PARTICIPANTS AND METHOD: One hundred lung CP and 300 LP were selected at random to participate in the study. Structured interviews using a vignette of a person with both cancer and depression were conducted with CP, and those using a vignette of a person with depression were carried out with LP, respectively. RESULTS: Only 11% of CP recognized the presence of depression in the vignette, while 25% of LP did (p<0.001). There were few significant differences in the preference for standard psychiatric treatments between CP and LP: standard treatments such as antidepressants (CP: 39%, LP: 36%) were less often rated as helpful, whereas non-standard treatments such as physical activity (CP: 85%, LP: 66%) were most often rated as helpful. CONCLUSIONS: The results indicated that cancer patients' knowledge about mental illness and its treatment were insufficient. Psychological education may reduce patient-related barriers to seek and to utilize optimal mental health care in cancer patients.