Development, reliability, and validity of a self-assessment scale for dementia care management.

BACKGROUND: This study aimed to develop a self-assessment scale for care management of people with dementia and examine its reliability and validity. METHODS: Based on Bloom's Taxonomy, previous research, and experts' opinions on dementia and care management, a scale consisting of 18 items was developed to assess care managers' attitudes, knowledge, and skills in their management of people with dementia. To examine the scale's reliability and validity, data were collected from 638 care managers. Construct validity using exploratory factor analysis, known-group validity, and internal consistency reliability of the scale were evaluated. RESULTS: Exploratory factor analysis supported the construct validity with a four-factor model and explained 59.1% of the total variance. Following were the four factors: Factor I 'Person centred care'; Factor II 'Understanding of disease characteristics, treatment and care'; Factor III 'Understanding of people with dementia and care management according to their characteristics'; and Factor IV 'Utilization of local resources surrounding people with dementia'. Regarding the known-group validity, results showed that the group with a qualified chief care manager scored significantly higher than the group without one on Factors I (P = 0.013) and III (P = 0.026). Cronbach's alpha coefficient for the 18 items was 0.928. CONCLUSIONS: The findings prove that the scale has acceptable reliability and validity, and can help care managers reflect on their practice. Future research is desirable to measure the validation of change in the scale.

The International Classification of Functioning, Disabilities, and Health categories rated as necessary for care planning for older patients with heart failure: a survey of care managers in Japan.

BACKGROUND: Establishing an information-sharing system between medical professionals and welfare/care professionals may help prevent heart failure (HF) exacerbations in community-dwelling older adults. Therefore, we aimed to identify the ICF categories necessary for care managers to develop care plans for older patients with HF. METHODS: A questionnaire was administered to 695 care managers in Hiroshima, Japan, on ICF items necessary for care planning. We compared the care managers according to their specialties (medical qualifications and welfare or care qualifications). Furthermore, we created a co-occurrence network using text mining, regarding the elements necessary for collaboration between medical and care professionals. RESULTS: There were 520 valid responses (74.8%). Forty-nine ICF items, including 18 for body functions, one for body structure, 21 for activities and participation, and nine for environmental factors, were classified as "necessary" for making care plans for older people with HF. Medical professionals more frequently answered "necessary" than care professionals regarding the 11 items for body functions and structure and three items for activities and participation (p < 0.05). Medical-welfare/care collaboration requires (1) information sharing with related organisations; (2) emergency response; (3) a system of cooperation between medical care and non-medical care; (4) consultation and support for individuals and families with life concerns, (5) management of nutrition, exercise, blood pressure and other factors, (6) guidelines for consultation and hospitalisation when physical conditions worsen. CONCLUSIONS: Our findings showed that 49 ICF categories were required by care managers for care planning, and there was a significant difference in perception between medical and welfare or care qualifications qualifications.

Unique response characteristics in persistent strains of Listeria monocytogenes exposed to low pH.

Some Listeria monocytogenes strains are persistent in food processing environments, where this pathogen may be subjected to various stresses. This study aimed to elucidate the response of persistent strains of L. monocytogenes to low pH and H2O2 exposure. Almost all of the persistent strains examined were highly susceptible to low pH, whereas H2O2 susceptibility was comparable to that of control strains. Two persistent strains isolated from the same sample, however, exhibited lower susceptibility to low pH. These findings suggest an acid-susceptible phenotype predominates in the habitat, indicating that environmental conditions contribute to the establishment of persistence. Representative strains exhibiting acid-susceptible and less acid-susceptible phenotypes were further investigated regarding acid response characteristics. Less acid-susceptible strains exhibited increased survival in acidified brain heart infusion (BHI) broth compared with acidified phosphate-buffered saline (PBS). These strains also exhibited increased survival in acidified PBS containing glucose and glutamate, which are involved in acid response mechanisms, compared with acidified PBS alone. However, neither acidified BHI broth nor exogenous glucose and glutamate increased survival of acid-susceptible strains. An adaptive acid tolerance response of the acid-susceptible phenotype was observed, but this was limited compared with that of the less acid-susceptible phenotype.

Oncoplastic Lower Eyelid Reconstruction Analysis.

BACKGROUND: Oncoplastic lower eyelid reconstruction is a challenging task due to the complicated structure of the eyelid and requirement of high operative accuracy. Poorly treated defects result in ectropion and ptosis which may lead to keratitis and corneal ulceration. Previous related studies do not include a detailed comparison of the common reconstructive methods of the lower eyelid in terms of results and complication rates. OBJECTIVE: The authors aim to demonstrate whether the choice of reconstruction affects the aesthetic and functional outcome of oncoplastic lower eyelid reconstruction. METHODS & MATERIALS: The authors performed a 10-year retrospective review of all oncoplastic lower eyelid reconstructions carried out in our hospital. Information on patient background, diagnosis and the choice of reconstructive method were evaluated. Postoperative photographs of each patient were then subjectively evaluated for color match, cosmesis, quality of shape, symmetry, and overall appearance. The authors hypothesized that the outcome is related to the main trajectory of the flap. Patients treated with local flaps of horizontal and vertical trajectories were then compared in terms of outcome and complication rates. RESULTS: Reconstructions based on a horizontal trajectory compared with a vertical trajectory resulted with lower rates of ectropion and ptosis occurrence. The results were statistically significant.

Active surveillance in response to the identification of a single carbapenemase-producing Escherichia coli at a Japanese university hospital.

This report described the experience of active surveillance culture implemented in response to the identification of a single carbapenemase-producing Escherichia coli in a Japanese university hospital. It revealed a horizontal transmission event and an additional asymptomatic carrier of carbapenemase-producing Escherichia coli with unique drug susceptibility and resistance gene profiles. Early implementation of active surveillance culture as a part of multifaceted infection control measures appeared to be useful to control further transmission of carbapenemase-producing Escherichia coli even in the low endemic facility. Further investigations on the timing and usefulness of active surveillance culture in the control of carbapenemase-producing Enterobacteriaceae would be warranted.

Successful Treatment of Infantile Hemangiomas With Propranolol in Low-Birth-Weight Infants.

BACKGROUND: Infantile hemangioma (IH) is a benign neoplasm that causes scarring and cosmetic problems after spontaneous regression. Therefore, aggressive treatments such as laser irradiation and corticosteroid have been used; however, recently, the effect of propranolol has been widely noticed. In this study, the authors applied propranolol to low-birth-weight infants with IHs and evaluated its effect. METHODS: Four low-birth-weight infants having IH were selected, with birth weights ranging from 582 to 814 g (average 703 g). The administration of propranolol was started within 4 days of hospitalization. The dosage of propranolol was increased from 0.5 to 2.0 mg/kg/day step by step. Vital signs and blood sugar level were checked prior to every administration of the drug. Continuous monitoring of electrocardiography and arterial oxygen saturation were performed during entire hospitalization.The outcomes were assessed by the patient's family and 2 board-certified plastic surgeons based on 5 parameters pertaining to clinical findings, using a scale of 1 to 10. Reduction rate of the hemangioma was calculated at the end of treatment and compared with the size prior to treatment. RESULTS: The authors could administrate propranolol without any severe side effects in all patients. Infantile hemangiomas gradually shrank soon after the authors started the treatment. Reduction ratios were 22.1% to 100% (average 48.72%), and the comprehensive evaluation of treatment was 7.5 to 10 (average 8.55) on a 10-point scale. CONCLUSIONS: With careful monitoring of their vital signs, propranolol could be a good treatment option even for IH in low-birth-weight infants whose birth weights were less than 1000 g.

The concentration of iodine in horse serum and its relationship with thyroxin concentration by geological difference.

In this study, iodine and thyroxin (T4) concentrations in the serum of 69 horses were investigated. Higher iodine concentrations were obtained from the horses housed in Chiba Prefecture. In contrast, T4 concentrations of horses at Shizuoka Prefecture were higher than those of horses at Chiba Prefecture. There was a significant correlation (r = 0.643, P < 0.001) between the iodine and T4 concentrations of horses at Saitama and Shizuoka prefectures. Although a significant correlation (r = 0.794, P < 0.001) was also observed in the investigation of all horses at Chiba Prefecture, the distribution area of the data was separated from the data of horses housed in Saitama and Shizuoka prefectures. A higher iodine concentration in the environment is expected in the sampling area at Chiba Prefecture. Thus, it was suggested that the concentrations of iodine in the serum of horses are influenced by geological differences. It was thought that equine serum is a useful sample for monitoring.

[Multicenter surveillance of Pseudomonas aeruginosa strains for antimicrobials in Aichi prefecture in 2009].

We investigated the susceptibility to antimicrobials of 204 Pseudomonas aeruginosa strains isolated from 21 hospitals in Aichi prefecture from September to November 2009. MIC distributions of various antimicrobials were analyzed in terms of geographic region of isolation, patient status (outpatient or inpatient), and type of specimens that the strain was isolated from. The results were as follows. 1. Although more than 90% of strains were susceptible to all aminoglycosides and colistin, 80-90% of them were susceptible to beta-lactams and fluoroquinolones. MIC distributions of all antimicrobials measured were not significantly different between regions. 2. Only 1 strain (0.5%) was multi-drug resistant Pseudomonas aeruginosa (MDRP). Thirteen strains (6.4%) showed imipenem MIC > or = 16 microg/mL, and 16 strains (7.8%) showed ciprofloxacin MIC > or = 4 microg/mL. These strains tended to be more isolated from urine, respiratory tract specimens, or surgical specimens. 3. The MICs of tazobactam/piperacillin, panipenem, meropenem, doripenem, biapenem, sulbactam/cefoperazone, cefepime, and aztreonam were significantly higher in strains isolated from inpatients than in those from outpatients. MIC distributions of antimicrobials other than beta-lactams were not significantly different between situations where strains were isolated. 4. MIC distributions of piperacillin, all carbapenems, cefepime, gentamicin, and all fluoroquinolones were significantly different among samples from which strains were isolated. The strains isolated from blood showed lower MICs against all antimicrobials than those from other samples. No difference was found in MIC distributions when categorized according to bacteremic origin. The MICs were apparently elevated against beta-lactams, fluoroquinolones, and gentamicin in strains isolated from respiratory tract specimens, and against beta-lactams, and fluoroquinolones in strains isolated from urine. It was suggested that in P. aeruginosa surveillance, the results should be reported by stratifying with patient status, and type of specimens that the strain was isolated from and that regional surveillance should be useful with such stratification to establish antibiograms for empirical antimicrobial choice.

[Capsular types, virulence factors and DNA types of Klebsiella oxytoca strains isolated from blood and bile].

Klebsiella oxytoca is an opportunistic pathogen and is isolated at the second highest frequency among genus Klebsiella from hospitalized patients. According to previous reports, the major virulence factors of K. pneumoniae include capsules and several kinds of pill, whereas the virulence factors of K. oxytoca have not been well investigated. We noticed an increased frequency of K. oxytoca isolates from patients who had undergone a biliary tract operation in a general hospital from May through November, 2009. We then performed a PCR analysis of the virulence factors and an epidemiological analysis with capsular typing (serotyping) and pulsed field gel electrophoresis (PFGE) for K. oxytoca of 11 blood isolates and 10 bile isolates. As a result, serotypes of K9, K15, K26, K31, K43, K47, K55, K70, and K79 were identified in these strains, and K1 and K2 which are frequent serotypes in K. pneumoniae strains were not observed. Two blood isolates of the K55 serotype showed almost the same PFGE pattern, suggesting that these isolates were very closely related and caused cross-infection in a hospital ward. Strains of the K43 serotype were three blood isolates and 1 bile isolate, all of which showed different PFGE patterns. There were no common isolates among the blood and bile isolates. A PCR search revealed that fimH and mrkD genes which are relevant to type 1 and type 2 pili, respectively, were present in all strains, whereas kfuBC, an iron uptake gene, and cf29a were detected in only a few strains. Neither of the mucoid phenotype-related genes magA and rmpA was present in any strains. These results strongly suggest that type 1 and/or type 3 pili would have important roles in the pathogenesis of blood infection and bile infection caused by K. oxytoca.

Investigation of cadmium contamination using hair of the Japanese macaque, Macaca fuscata, from Shimokita Peninsula, Aomori Prefecture in Japan.

The cadmium (Cd) contents in hair of macaques (n = 45, Macaca fuscata) living on the Shimokita Peninsula were investigated. The mean Cd contents in the hair of Japanese (n = 34, 5.01 µg/g) and macaques (3.05 µg/g) tendency to be higher than those of animals living other areas. The Cd contents of hair of wild macaques were significantly (p < 0.01) lower than that of humans, although three were no significant difference between Cd contents of humans and that of the macaque in captivity. The hair of the macaque was suggested as a useful sample for measurement of Cd contamination in the environment.

Development and appropriateness of a scoring method for International Classification of Functioning, Disabilities, and Health assessment in older patients with heart failure: a Delphi survey of expert panel in Japan.

OBJECTIVE: The number of older patients with heart failure (HF) is increasing in Japan and has become a social problem. There is an urgent need to develop a comprehensive assessment methodology based on the common language of healthcare; the International Classification of Functioning, Disability and Health (ICF). The purpose of this study was to develop and confirm the appropriateness of a scoring methodology for 43 ICF categories in older people with HF. DESIGN: Cross-sectional survey. We applied the RAND/University of California at Los Angeles (UCLA) Appropriateness Method with a modified Delphi method. SETTING AND PARTICIPANTS: We included a panel of 26 multidisciplinary experts on HF care consisting of home physicians, cardiovascular physicians, care managers, nurses, physical therapists, a pharmacist, occupational therapist, nutritionist and a social worker. MEASURES: We conducted a literature review of ICF linking rules and developed a questionnaire on scoring methods linked to ICF categories in older people with HF. In the Delphi rounds, we sent the expert panel a questionnaire consisting of three questions for each of the 43 ICF categories. The expert panel responded to the questionnaire items on a 1 (very inappropriate) - 9 (very appropriate) Likert scale and repeated rounds until a consensus of 'Appropriate' and 'Agreement' was reached on all items. RESULTS: A total of 21 panel members responded to all the Delphi rounds. In the first Delphi round, six question items in four ICF categories did not reach a consensus of 'Agreement', but the result of our modifications based on panel members' suggestions reached to a consensus of 'Appropriate' and 'Agreement' on all questions in the second Delphi round. CONCLUSION: The ICF-based scoring method for older people with HF developed in this study was found to be appropriate. Future work is needed to clarify whether comprehensive assessment and information sharing based on ICF contributes to preventing readmissions.

Selection of Comprehensive Assessment Categories Based on the International Classification of Functioning, Disability, and Health for Elderly Patients with Heart Failure: A Delphi Survey among Registered Instructors of Cardiac Rehabilitation.

The development of a comprehensive assessment tool based on the International Classification of Functioning, Disability, and Health (ICF) for elderly patients with heart failure is urgently required. In this study, we classified the ICF categories relevant to heart failure in the elderly through a Delphi survey (3-step questionnaire survey) of 108 Registered Instructors of Cardiac Rehabilitation in the Hiroshima Prefecture. Questionnaires were conducted using postal mail or a web-based platform. The survey was conducted three times, and the survey results were provided as feedback to the participants in the second and third rounds. More than 80% of the respondents selected categories according to the ICF core set methodology. Data were collected from December 2018 to March 2019, with 67, 54, and 46 participants in the first, second, and third rounds, respectively. A total of 58 ICF items were adopted based on the results: 27 body function items, 4 body structure items, 20 activity and participation items, and 7 environmental factor items. This study is characterised by the inclusion of a large number of ICF items for mental function. This result seems to be influenced by the increasing interest in cognitive dysfunction in elderly patients with heart failure. The ICF categories selected for this study allow for a comprehensive assessment of clients for occupational therapy. The findings of this study are expected to provide a basis for an outcome measure to determine the effectiveness of occupational therapy for these patients.

Prevalence of Listeria monocytogenes in retailed meat in the Tokyo metropolitan area.

This study was conducted to determine the prevalence of Listeria monocytogenes in retailed meats, comprising beef, chicken, and pork, in the Tokyo metropolitan area. A total of 379 samples of retailed meat were collected from 1998 to 2003, most of which were obtained by simultaneously purchasing the three classes of meat from a shop and then making another simultaneous purchase of meat from the same shop a few weeks later. The prevalence of L. monocytogenes was 28.0%, and the serotypes isolated were mainly 1/2a, 1/2b, 1/2c, and 4b. Comparison of the prevalence of each serotype among the classes of meat showed a predominant distribution of serotypes 1/2a, 1/2b, and 4b in chicken, while serotype 1/2c was dominant in pork. A total of nine cases considered to be due to persistence and/or cross-contamination were found. Most of the strains involved in persistence and/or cross-contamination were of serotypes 1/2c or 4b. These results suggest that contamination in retailed meat in Japan is at almost the same level as in other countries and that chicken has the highest potential as a source of contamination and infection. In addition, we suggest that the ecological niche of serotype 1/2c is distinct from those of 1/2a, 1/2b, and 4b, which may explain why human hosts have less opportunity to be exposed to serotype 1/2c and why there is a lower rate of isolation of this serotype from cases of human listeriosis.

The Oxidative Stress Markers of Horses-the Comparison with Other Animals and the Influence of Exercise and Disease.

Diacron-reactive oxygen metabolite (d-ROM) and biological antioxidant potential (BAP) levels in the serum of horses were measured (ponies, n = 15; thoroughbred, n = 31; other full-sized horses, n = 7). The mean d-ROM levels in horses were significantly higher (p < 0.001) than those in dairy cattle (n = 25) and dogs (n = 31). However, d-ROM levels in horses were lower than the standard levels reported in humans. When d-ROM and BAP levels were plotted graphically, the points for horses with a disease (ringbone in 1 Japanese sports horse, cellulitis in 1 thoroughbred, melanoma in 1 Lipizzaner) fell outside the group of points for other (non-diseased) horses. A similar separation was seen (using data from other authors) for a horse with Rhodococcus equi, a horse following castration surgery, and a mare following delivery. These results, comparing horses, other animals, and humans, are interesting from the standpoint of comparative medicine, and they contribute to the sparse literature available on d-ROM and BAP levels in animals. Because the level of d-ROM and BAP levels were changed depending on the situation of health, those indexes are promising as indices of health in horses.

Genetic variation of mitochondrial DNA in Phalacrocorax carbo in Japan.

A Japanese resident bird, Phalacrocorax carbo hanedae (Japanese name: Kawa-u), was threatened with extinction due to deterioration of its habitat in the 1970s, but the population has since recovered thanks to environmental protection measures. This study analyzed the genetic diversity of 18 Kawa-u individuals living in the basins of the Abe and Warashina rivers in Shizuoka Prefecture, Japan. We obtained seven haplotypes of mitochondrial D-loop sequences and compared them with 49 European P. carbo D-loop haplotypes. We identified four new haplotypes but no clear genetic evidence distinguishing the Kawa-u as a distinct subspecies of P. carbo. Our results suggest the need for further surveillance of the P. carbo genetic lineage, regardless of the geographical distribution.

Genetic variation of Listeria monocytogenes isolates from domestic and imported foods in Japan.

Phylogenetic analyses were carried out on a total of 118 Listeria monocytogenes isolates from foods or food processing environments, and 7 isolates from listeriosis patients in Japan to evaluate the genetic variation in the pathogen in this country. Isolates of serotypes 1/2a, 1/2b and 4b were mainly examined to assess the risk of exposure of humans to L. monocytogenes from foods in Japan. The nucleotide sequences of the part of the iap gene that contains the region encoding the threonine-asparagine repeat units were determined in order to construct phylogenetic trees of the isolates investigated. A phylogram showed high genetic diversity among lineage 2 isolates, while the lineage 1 isolates showed clonal characteristics. The results of the genetic analyses suggested the presence of rare putative lineage 3 isolates and epidemic clone I (ECI) isolates in foods in Japan. The results showed that ECI was also isolated from listeriosis patients. The genetic variation in L. monocytogenes in Japan reported here suggests the necessity of monitoring the pathogen in foods and environments in addition to surveillance of listeriosis patients.

Sequence-Based Characterization of Listeria monocytogenes Strains Isolated from Domestic Retail Meat in the Tokyo Metropolitan Area of Japan.

The level of Listeria monocytogenes contamination of domestic retail meat in Tokyo, Japan, was assessed by comparison of isolates from 2004 to 2007 with those isolated before 2003. The overall prevalence of L. monocytogenes among these samples significantly diminished over time (1998-2003, 28.0%; 2004-2007, 17.6%) reflecting a significant decrease in the frequency of contamination of beef. Serotype 1/2a was isolated most frequently, reflecting a change in the predominant serotype in pork from 1/2c to 1/2a. We performed a simple genetic subtyping method based on 3 genes, iap, sigB, and actA, as well as traditional multilocus sequence typing to classify the allele types (ATs). No extensive variation among sequence types was detected. However, increased genetic diversity among the ATs of the 3 genes in the 2004-2007 isolates was evident. We identified AT 26 of the iap gene, which was not previously reported in Japanese isolates, and 6 ATs of the sigB gene, including 4 with nonsense mutations not currently registered in L. monocytogenes DNA databases. sigB is an evolutionally conserved gene that plays a role in the stress response. Our results indicate that the sigB gene may be relatively unstable among L. monocytogenes strains circulating in Japan.

Serum bromine concentrations in horses in Japan.

This study investigates bromine (Br) concentration and its relationship with iodine concentration in serum samples of 86 horses. The mean serum Br concentration in horses pastured on green grass near the seashore was significantly higher (P<0.001) than that in horses pastured in a sand paddock. A significantly negative correlation (r=-0.479, P<0.01) between the serum Br and iodine concentrations was evident in the horses that pastured on green grass. The concentrations of several elements such as sodium and potassium were virtually constant in the serum. In addition, there were elements present below the detection limit of the analytical instruments used. In contrast, it was suggested that geological differences have a marked influence on serum Br concentrations in animals. Thus, we hypothesized that serum Br concentration in horses is a possible indicator reflecting geological differences.

Application of Kuhnt-Szymanowski Procedure to Lower Eyelid Margin Defect after Tumor Resection.

BACKGROUND: Lower eyelid reconstruction after tumor removal is always challenging, and full-thickness defects beyond half of the eyelid length require a flap from a part other than the remaining lower eyelid, such as the temporal area or the cheek. OBJECTIVE: We aimed to report our experience of applying Smith-modified Kuhnt-Szymanowski, one of the most popular procedures for paralytic ectropion, for reconstructing oblong full-thickness lower eyelid margin defect. MATERIALS AND METHODS: We performed Smith-modified Kuhnt-Szymanowski on 5 cases of oblong full-thickness lower eyelid margin defect after skin cancer removal. The mean age of patients was 80.0 years. The horizontal widths of the defects ranged from half to two-thirds of the lower eyelid length and the vertical width ranged from 5 to 9 mm. RESULTS: We obtained good functional and esthetic results in all cases. No patients developed ectropion or lower eyelid distortion, and all patients were satisfied with their results. CONCLUSIONS: We utilized the procedure for morphological revision as a reconstructive procedure for eyelid margin defect by considering the defect as a morphological deformity of the eyelid margin; thus, donor tissue was not required to fill the defect and we could accomplish the reconstruction simply, firmly, and less invasively.

Sequential transition of the injury phenotype, temperature-dependent survival and transcriptional response in Listeria monocytogenes following lethal H2O2 exposure.

The food-borne pathogen Listeria monocytogenes is present persistently in food processing environments, where this bacterium is exposed to various stress factors, including oxidative stress. This study aimed to elucidate the temperature-dependent response of L. monocytogenes to H2O2 exposure and the phenotypic changes in colony formation by H2O2-treated bacteria. Survival curves indicated an increase in the resistance to H2O2 in L. monocytogenes as the temperature decreased during the stress exposure procedure. Transcriptional induction of genes with key roles in response to H2O2, including sigB and kat, was observed at 37°C, but not at 20°C, whereas other stress response genes were induced at both temperatures. Following H2O2 exposure, L. monocytogenes produced small colony phenotypes and the colony size decreased in a stress exposure duration-dependent manner. Resuscitated cells with no ability to form colonies in the absence of sodium pyruvate were also found. Our findings show the possibility that a sequential transition in the injury phenotype from small colony phenotype to resuscitated cells occurred during the course of exposure to H2O2. The higher H2O2 resistance at 20°C than 37°C suggests further investigation of the response to H2O2 exposure under the lower temperatures, including refrigeration temperature, which may contribute to elucidation of bacterial survival over extended time periods in food-processing environments.