Issues commonly faced by nurses caring for international patients: A qualitative study.

AIM: To identify common challenges nurses face when caring for international patients, irrespective of specialty, medical facility, or nursing experience. BACKGROUND: Internationalization in medical facilities is progressing worldwide, and the number of international patients is increasing, as is evident in Japan. INTRODUCTION: Delivering high-quality nursing care to international patients can be challenging owing to language and socio-cultural barriers. Research examining the challenges faced by nurses in these situations is limited. It is necessary to clarify and analyze the current situation when interacting with international patients. METHODS: This study employed a qualitative design. Semistructured interviews were conducted with 11 registered nurses experienced in caring for non-Japanese patients. Qualitative content analysis was performed following Mayring's approach. RESULTS: We identified 56 subcategories, 23 categories, and 8 core categories for challenges faced by nurses interacting with international patients: language, religion or culture, medical culture, financial status, treatment continuity, care support, hospital protocols, and addressing requests or requirements for international patients. DISCUSSION: This study analyzed the religious, lifestyle, and cultural differences (along with the various language and communication barriers) faced by nurses who treat international patients. It also discussed the need for accessible, cross-cultural information in hospitals that have limited accommodations for international patients. CONCLUSION: Nurses could be more accommodating of patients' religions, lifestyles, and cultures by familiarizing themselves with relevant background information beforehand. IMPLICATIONS FOR NURSING POLICY: Differences in health care cultures across countries can lead to malpractice, as dealing with cultural differences is difficult for nurses who interact with international patients and they may not be fully informed about the challenges posed by such differences. It is important for nurses to share their experiences in dealing with international patients and prepare for the increasing number of international patients in the future.

Green tea and coffee consumption is inversely associated with depressive symptoms in a Japanese working population.

OBJECTIVE: To examine the association between the consumption of green tea, coffee and caffeine and depressive symptoms. DESIGN: Cross-sectional study. Consumption of green tea and coffee was ascertained with a validated dietary questionnaire and the amount of caffeine intake was estimated from these beverages. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale. Multiple logistic regression analysis was performed to compute odds ratios and 95% confidence intervals for depressive symptoms with adjustments for potential confounders. SETTING: Two workplaces in north-eastern Kyushu, Japan, in 2009. SUBJECTS: A total of 537 men and women aged 20-68 years. RESULTS: Higher green tea consumption was associated with a lower prevalence of depressive symptoms. Compared with participants consuming ≤1 cup/d, those consuming ≥4 cups green tea/d had a 51% significantly lower prevalence odds of having depressive symptoms after adjustment for potential confounders, with significant trend association (P for trend = 0·01). Further adjustment for serum folate slightly attenuated the association. Coffee consumption was also inversely associated with depressive symptoms (≥2 cups/d v. <1 cup/d: OR = 0·61; 95% CI 0·38, 0·98). Multiple-adjusted odds for depressive symptoms comparing the highest with the lowest quartile of caffeine consumption was OR = 0·57 (95% CI 0·30, 1·05; P for trend = 0·02). CONCLUSIONS: Results suggest that higher consumption of green tea, coffee and caffeine may confer protection against depression.

Effects of Capsinoid Intake on Brown Adipose Tissue Vascular Density and Resting Energy Expenditure in Healthy, Middle-Aged Adults: A Randomized, Double-Blind, Placebo-Controlled Study.

Capsinoids are some of the most promising ingredients to increase energy expenditure (EE) due to brown adipose tissue (BAT) activation. However, there is limited information regarding the effect of prolonged capsinoid ingestion (CI) on BAT activity and resting EE (REE) in healthy, middle-aged, normal to overweight subjects (Subhealthy) with distinct BAT characteristics. We examined the changes in BAT density (BAT-d), using near-infrared time-resolved spectroscopy, and REE/kg induced by daily CI. Forty Subhealthy [age, 43.8 (mean) years; BMI, 25.4 kg/m2] received either capsinoid (9 mg/day) or a placebo daily for 6 weeks in a double-blind design. Total hemoglobin concentration in the supraclavicular region ([total-Hb]sup), an indicator of BAT-d, and REE/kg were measured. The changes in post-intervention [total-Hb]sup were greater in the capsinoid group (CA-G) than in the placebo group (PL-G) [5.8 µM (+12.4%) versus 1.0 µM (+2.1%); p = 0.017]. There was a significant relationship between BAT-d and REE/kg; however, post-supplementation REE/kg was not significantly different between the two groups (p = 0.228). In the overweight subgroup, changes in REE/kg were greater in the CA-G than in the PL-G [0.6 cal/kg/min (+4.3%) versus -0.3 cal/kg/min (-2.1%); p = 0.021]. CI enhanced [total-Hb]sup, a reflection of BAT-d, showing a good correlation with REE in Subhealthy.

Serum vitamin B6, folate, and homocysteine concentrations and oxidative DNA damage in Japanese men and women.

OBJECTIVE: Higher vitamin B status has been linked to a lower risk for cancer, but the underlying mechanism remains elusive. The aim of the present study was to examine the association of pyridoxal, folate, and homocysteine (Hcy) with urinary 8-hydroxydeoxyguanosine (8-OHdG), a marker of oxidative DNA damage. METHODS: The participants were 500 employees (293 men and 207 women), ages 21 to 66 y, of two municipal offices in Japan. Serum pyridoxal and Hcy concentrations were measured using high-performance liquid chromatography (HPLC) method, and serum folate concentrations were measured using chemiluminescent immunoassay. Urinary 8-OHdG concentrations were measured using HPLC method. Multiple regression was used to estimate means of 8-OHdG for each tertile of pyridoxal, folate, and Hcy with adjustment for potential confounders. RESULTS: In multivariate analysis, 8-OHdG concentration was inversely associated with pyridoxal concentration in men (P for trend = 0.045) but not in women. The association in men was confined to non-smokers (P for trend = 0.033) or those who consumed no or < 20 g/d of ethanol (P for trend = 0.048). 8-OHdG concentrations were not appreciably associated with folate and Hcy concentrations. CONCLUSION: The results suggest that vitamin B6, but not folate and homocysteine, plays a role against oxidative DNA damage in Japanese men.

Polyunsaturated fatty acids in serum and homocysteine concentrations in Japanese men and women: a cross-sectional study.

BACKGROUND: Supplementation studies have suggested a role of n-3 polyunsaturated fatty acids (PUFAs) in homocysteine metabolism, but the evidence is limited and inconsistent among studies that measured blood levels of n-3 and n-6 PUFAs. We examined the association between blood levels of PUFAs and homocysteine in Japanese men and women. METHODS: The subjects were 496 employees (290 men and 206 women) of 2 municipal offices in Japan. Fatty acid composition in serum phospholipids and cholesterol ester (CE) was measured using gas-liquid chromatography. Multiple regression was used to calculate means of homocysteine concentrations according to PUFA tertile with adjustment for potential confounders. RESULTS: Serum homocysteine concentration decreased with increasing levels of total n-3 PUFA, eicosapentaenoic acid and docosahexaenoic acid (DHA) in serum phospholipids and CE with adjustment for age, sex and workplace. However, only DHA in serum phospholipids remained statistically significant after additional adjustment for other potential confounders including serum folate (P-trend = 0.04). N-6 PUFAs were not significantly associated with homocysteine concentrations. CONCLUSIONS: Higher proportion of DHA in serum phospholipids may be associated with lower homocysteine concentrations in Japanese men and women.