Association between the Cognitive-Related Behavioral Assessment Severity Stage and Activities of Daily Living Required for Discharge to Home in Patients with Stroke: A Cross-Sectional Study.

This study aimed to characterize cognitive function examined using Cognitive-related Behavioral Assessment (CBA) in activities of daily living (ADLs). According to CBA severity at discharge, 791 patients were assigned to five groups (most severe, severe, moderate, mild, and normal). The total scores for Functional Independence Measure (FIM) motor items were compared for each group. Multiple logistic regression analysis was performed to clarify the association between CBA severity and independence in ADL items. Independence in each ADL according to CBA severity was 0-4.8%, 26.8-45.0%, 84.3-91.0%, and 97.2-100% for all ADLs in the most severe to severe, moderate, mild, and normal groups, respectively. Significant differences were found in the FIM motor score according to CBA severity between the groups (p < 0.01). A mild or normal CBA was associated with a higher odds ratio (OR) for dressing the upper body (OR = 21.90; 95% confidence interval (CI), 13.50-35.70), bladder management (OR = 11.60; 95% CI, 7.21-18.60), transfers to the bed/chair/wheelchair (OR = 18.30; 95% CI, 11.40-29.40), transfers to the toilet (OR = 18.30; 95% CI, 11.40-29.30), and walking (OR = 6.60; 95% CI, 10.60-26.10). A CBA severity greater than mild (23 points) was associated with independence in ADLs that are important for discharge to home.

Effects of watershed land use on coastal marine environments: A multiscale exploratory analysis with multiple biogeochemical indicators in fringing coral reefs of Okinawa Island.

The analytical spatial scale and selection of biogeochemical indicators affect interpretations of land-use impacts on coastal marine environments. In this study, nine biogeochemical indicators were sampled from 36 locations of coral reefs fringing a subtropical island, and their relationships with watershed land use were assessed by spatial autoregressive models with spatial weight matrixes based on distance thresholds of a few to 30 km. POM-relevant indicators were associated with agricultural and urban lands of watersheds within relatively small ranges (6-14 km), while the concentrations of inorganic nutrients were associated with watersheds within 20 km or more. The macroalgal δ15N showed a strong relationship with agricultural lands of watersheds within 7 km and urban/forest lands of watersheds within 24 km. These results demonstrate significant effects of land use on the coral reef ecosystems of the island, and the importance of appropriate combinations of analytical scales and biogeochemical indicators.

Prenatal intervention program for Japanese first-time fathers to adapt to the paternal role: A mixed methods study.

This study aimed to develop a prenatal intervention program focused on the formation of paternal identity for adapting to the paternal role. The intervention program allowed participants to create a postpartum schedule using a uniquely developed paternity portfolio. Pre and postintervention effects were evaluated using a convergent design of mixed methods. This intervention effect was quantitatively evaluated between the two groups. To qualitatively examine the intervention's effects, participants were interviewed for effective prenatal education, and their paternal role behaviors were identified by the intervention. Details of actual postpartum paternal role behavior and effective prenatal education were collected. Obtained data were inductively analyzed and compared with those in the proposed prenatal intervention program. There were 10 pairs in the intervention group and 31 pairs in the control group. Intergroup comparison of evaluation data showed no significant difference. However, qualitative results clarified the effective nursing intervention, confirming the achievement of intervention goals by all participants. Intervention expressions were adjusted based on the results, and a revised prenatal intervention program was developed.

Postpartum maternal function and parenting stress: Comparison by feeding methods.

AIM: This cross-sectional and longitudinal study explored primiparous mothers' functioning and parenting stress on the basis of infant-feeding method over the first 6 months postpartum. METHODS: Participants were Japanese primiparae who delivered live singleton infants (N = 1120). Questionnaires, completed at 1, 2, 4, and 6 months postpartum, included demographics, feeding method, frequency of feedings, time required from infant's feeding to falling asleep, mother's sleep time, Postnatal Accumulated Fatigue Scale, and the original Japanese version of Parenting Stress Short-Form Scale. Chi-square tests and Welch F tests for one-way analysis of variance were conducted. RESULTS: Exclusively breastfeeding mothers fed their infants more frequently, but required less time from infant's feeding to falling asleep than either mixed or formula-feeding mothers. Mixed feeding mothers required more time for infant feeding and reported more severe fatigue and greater parenting stress than breastfeeding mothers at 1 and 2 months postpartum. Exclusively formula-feeding mothers required more time to get their infant back to sleep and reported greater parenting stress than the other groups at 6 months postpartum. Nearly 25% of mothers continued breastfeeding exclusively through the first 6 months postpartum. Mothers often changed feeding methods, with many exclusively breastfeeding by 6 months. CONCLUSION: Feeding methods may affect maternal functioning and parenting stress across the postpartum period.

Factors affecting maternal confidence among older and younger Japanese primiparae at one month post-partum.

AIM: To compare the factors that affect maternal confidence at 1 month post-partum between older (≥35 years old) and younger (20-34 years old) primiparous Japanese mothers. METHODS: A multicenter prospective study of mothers who gave birth to live singleton infants in Japan was conducted. Following ethics approval, the participants completed questionnaires 1 day before discharge and 1 month after childbirth. The questionnaires included the Postpartum Maternal Confidence Scale, demographics and background information, prenatal and obstetric data, situational variables and perceptions of daily life, and social support. The obstetric data were extracted from the hospital medical records. Data from the older primiparae (n = 479) and the younger primiparae (n = 1033) were analyzed by using multiple stepwise regressions, controlling for the delivery mode. RESULTS: Maternal confidence at 1 month post-partum was positively associated with emotional support for the older primiparae and appraisal support and exclusive breastfeeding for younger primiparae. In both groups, feeling overwhelmed by daily life, a lack of communication with their partner about the parenting role, and a lack of prior experience in caring for babies were negatively related to maternal confidence. Family budget instability was negatively related to maternal confidence in the younger group. CONCLUSION: Providing care that is based on an understanding of the unique support needs of first-time mothers in different age groups could promote more effective parenting.

Predictors of depressive symptoms in older Japanese primiparas at 1 month post-partum: A risk-stratified analysis.

AIM: Older maternal age has become more common in Japan. Studies suggest that older maternal age and primiparity are associated with post-partum depression. The present study aimed to identify predictors of post-partum depression in older Japanese primiparas at 1 month post-partum. METHODS: Participants were 479 primiparas aged 35 years and over, drawn from a prospective cohort study. Data were collected using self-report questionnaires. Depression was measured with the Japanese version of the Edinburgh Postnatal Depression Scale. Stepwise logistic regression analysis was conducted on binary outcome variables of depression at 1 month post-partum, along with a stratified analysis based on the risk status of depression. RESULTS: Five predictors were identified: (i) the depression score during hospital stay; (ii) financial burden; (iii) dissatisfaction with appraisal support; (iv) physical burden in daily life; and (v) concerns about infant caretaking. Stratified analysis identified dissatisfaction with instrumental support in the low-risk group, and the Child-care Value Scale score as unique predictors in the high-risk group. CONCLUSION: These results highlight the importance of early assessment of depressive symptoms and the provision of continuous care.

Age-specific determinants of post-partum fatigue in primiparous women.

AIM: Post-partum fatigue is a serious concern for mothers worldwide. The aim of this study was to identify age-specific determinants of self-perceived fatigue after childbirth among Japanese primiparous women. METHODS: A multicenter prospective cohort study was conducted in Japan. The degree of fatigue was assessed using the Postnatal Accumulated Fatigue Scale during the hospital stay after childbirth. Associated factors were stratified into two age groups (<35 or ≥35 years old); data were analyzed using stepwise multiple regression. RESULTS: In the younger group, significant determinants of post-partum fatigue included: anticipated difficulties in child-rearing after discharge; perception of inadequate sleep conditions; dissatisfaction with childbirth; shorter sleep and meal times; longer duration between feeding and infant bedtime; unemployment; and having hyperemesis gravidarum. In the older group, significant determinants of post-partum fatigue included: anticipated difficulties in child-rearing after discharge; perception of inadequate sleep conditions; shorter meal times; formula feeding; and dissatisfaction with childbirth. CONCLUSION: Primiparous mothers who anticipated new life with their infants to be difficult and who had an irregular lifestyle tended to report higher levels of fatigue during the post-partum hospital stay. Nurses and midwives should assess maternal sleep and eating conditions, providing support to ensure adequate maternal rest. Special efforts should be made to reduce anxiety about new life with infants among younger primiparous women who had experienced hyperemesis gravidarum.

Objective sleep of older primiparous Japanese women during the first 4 months postpartum: an actigraphic study.

This longitudinal study was designed to examine objective sleep parameters of older primiparous Japanese women during the first 4 months postpartum using actigraphy. The participants were 18 older primiparae (Mean (SD) = 37.06 (2.62) years, range 35-44 years) who gave birth to healthy neonates at one of three urban Japanese hospitals. Objective sleep quality was measured using actigraphy for 48 h at 1, 2 and 4 months postpartum. The Friedman test was used to test for differences in sleep parameters across time. Sleep duration (SMIN) increased significantly from 2 months (Mean (M) = 301.94 min) to 4 months (M = 372.78 min). Sleep efficiency (SE) increased significantly from 1 month (73.52%) to 2 (86.66%) and 4 months (89.05%). Waking after sleep onset (WASO) decreased significantly from 1 month (M = 114.64 min) to 2 (M = 40.18 min) and 4 months (M = 38.36 min) and long waking episodes (LWEP) significantly decreased from 1 month (4.67) to 2 (2.69) and 4 months (3.12). Persistent postpartum sleep problems can be a sign of postpartum depression as well as health problems among infants.

Comparing older and younger Japanese primiparae: fatigue, depression and biomarkers of stress.

This cohort study of primiparae was conducted to answer the following questions: Do older (≧ 35 years) and younger (20-29 years) Japanese primiparous mothers differ when comparing biomarkers of stress and measures of fatigue and depression? Are there changes in fatigue, depression and stress biomarkers when comparing older and younger mothers during the postpartum period? The Postnatal Accumulated Fatigue Scale and the Edinburgh Postnatal Depression Scale were administered in a time-series method four times: shortly after birth and monthly afterwards. Assays to measure biomarkers of stress, urinary 17-ketosteroids, urinary 17-hydroxycorticosteroids and salivary chromogranin-A, were collected shortly after delivery and at 1 month postpartum in both groups and a third time in older mothers at the 4th month. Statistical testing showed very little difference in fatigue, depression or stress biomarkers between older and younger mothers shortly after birth or 1 month later. Accumulated fatigue and depression scores of older mothers were highest 1 month after delivery. Additional cohort studies are required to characterize physical/psychological well-being of older Japanese primiparae.

Predicting early post-partum depressive symptoms among older primiparous Japanese mothers.

AIM: The number of older primiparas is increasing in Japan. These women have been shown to be more vulnerable to post-partum depression. This study aimed to identify factors for predicting post-partum depressive symptoms during hospitalization after childbirth in Japanese primiparas aged 35 years and over. METHODS: The present authors used the data of 479 primiparas aged 35 years and over from a prospective cohort study. Data were collected using self-report questionnaires on the day before hospital discharge. The questionnaire consisted of: demographics and background information; depressive symptoms; fatigue; maternal confidence and maternal satisfaction; child-care values; physical symptoms; perceptions of daily life during hospitalization; concerns about child care and daily life; and infant feeding. Additionally, vital records data were obtained from the hospitals. A stepwise logistic regression analysis was performed on the binary outcome variable of depressive symptoms, measured by the Japanese version of the Edinburgh Postnatal Depression Scale. Women who scored 9 or more were considered to be at high risk for post-partum depression. The authors obtained informed consent from all participants and institutional ethics approvals before initiating the study. RESULTS: The following six variables reliably predicted the risk of post-partum depression: emergency cesarean section, lower satisfaction with birth experience, higher physical burden in daily life, long-term complications with the newborn, more concerns about newborn caretaking after discharge, and more concerns about one's own life after discharge. CONCLUSION: Recognition of women with these factors will help nurses to identify those at risk for developing post-partum depression and to provide appropriate care during hospitalization after childbirth.

Fragmented sleep and fatigue during postpartum hospitalization in older primiparous women.

The objective of this cross-sectional study was to investigate the associations among sleep characteristics, feeding variables, and fatigue among older Japanese primiparas (≥ 35 years old) during hospitalization after childbirth. A convenience sample of 16 participants who had given birth to a single newborn were recruited from maternity wards, and before discharge they completed a sleep assessment and questionnaires. Sleep characteristics were assessed using actigraphs. Diaries of daily activities recorded infant caregiving and subjective hours of sleep. The degree of fatigue was assessed using self-administered questionnaires. Although participants' sleep was found to be significantly fragmented by the average number of feeds per night, sleep loss in this sample was not severe compared with previous actigraph studies of young Japanese mothers. Lower percentages of sleep efficiency (percentage of sleep between going to bed and waking up) and parameters of fragmented sleep were significantly correlated with higher degrees of fatigue. Nurses and other healthcare providers should observe mothers' sleep and assess levels of fatigue. Assistance should be offered to mothers who are tired, so that they can have less fragmented sleep during the night.

Postpartum experiences of older Japanese primiparas during the first month after childbirth.

This study aimed to describe the postpartum experiences of older Japanese primiparas during the first month after childbirth. The participants were 21 primiparous women over 35 years of age who gave birth to a healthy child at three urban hospitals. Data were collected from July 2011 to April 2012 through a semi-structured interview about postpartum experiences after discharge. Data were analysed using content analysis. We obtained Institutional Review Boards' approval and written informed consent from all participants prior to study initiation. Thirteen themes of postpartum experiences were extracted. The findings revealed that the mothers' experiences varied greatly and were highly personal. Also, participants described common experiences, unique child-care support needs and the strengths of older primiparas. Understanding the postpartum experiences of older primiparas assists health-care professionals to identify better ways to provide appropriate support.

Older Japanese primiparas' experiences at the time of their post-delivery hospital stay.

The purpose of this study was to gain a deeper understanding of the postpartum experiences of older primiparas at the time of their postpartum hospital stay. Participants were Japanese primiparas aged 35-44 years who gave birth, without abnormalities for either the mother or child. Data were obtained using a semi-structured interview with 22 participants. Thirteen themes emerged through content analysis. We found that there were distinctive experiences, which included 'the health and growth of the baby: relief and continued anxiety', 'awareness of strengths and of concerns of primiparas', 'meaning of the pregnancy and childbirth experience' and 'developing one's own child-care approach'. Findings suggest that nursing care during the post-delivery hospital stay should use the unique strengths of older primiparas to enable their smooth transition to maternal role attainment.

Efficacy and safety of intravenous daptomycin in Japanese patients with skin and soft tissue infections.

Daptomycin is a lipopeptide antibiotic active against gram-positive organisms and recently approved for marketing in Japan. This study investigates the efficacy and safety of daptomycin in Japanese patients with skin and soft tissue infections (SSTIs) caused by methicillin-resistant Staphylococcus aureus (MRSA) for regulatory filing in Japan. Overall, 111 Japanese patients with SSTI were randomized in this open-label, randomized, active-comparator controlled, parallel-group, multicenter, phase III study. Patients received intravenous daptomycin 4 mg/kg once daily or vancomycin 1 g twice daily for 7-14 days. Efficacy was determined by a blinded Efficacy Adjudication Committee. Among patients with SSTIs caused by MRSA, 81.8 % (95 % CI, 69.1-90.9) of daptomycin recipients and 84.2 % (95 % CI, 60.4-96.6) of vancomycin recipients achieved a successful clinical response at the test-of-cure (TOC) visit. The microbiological success rate against MRSA at the TOC visit was 56.4 % (95 % CI, 42.3-69.7) with daptomycin and 47.4 % (95 % CI, 24.4-71.1) with vancomycin. Daptomycin was generally well tolerated; most adverse events were of mild to moderate severity. The measurement of daptomycin concentration in plasma revealed that patients with mild or moderate impaired renal function showed similar pharmacokinetics profiles to patients with normal renal function. Clinical and microbiological responses, stratified by baseline MRSA susceptibility, suggested that patients infected with MRSA of higher daptomycin MIC showed a trend of lower clinical success with a P value of 0.052 by Cochran-Armitage test. Daptomycin was clinically and microbiologically effective for the treatment of MRSA-associated SSTIs in Japanese patients.

Developing the Maternity Portfolio to promote maternal role attainment in women who have undergone artificial reproductive treatment.

AIM: The purpose of this study was to develop the Maternity Portfolio to promote maternal role attainment in women who underwent artificial reproductive treatment. METHODS: The following procedures were undertaken to develop the Maternity Portfolio: (i) a literature review was conducted to identify studies and articles related to maternal diary or portfolio usage; (ii) the research members discussed objectives and usages of the Maternity Portfolio; (iii) a trial product was developed in collaboration with two pregnant women (one following artificial reproductive treatment and one infertility patient) and seven nurses, and after feedback was completed, the product was revised; and (iv) the final product of the Maternity Portfolio was patented. RESULTS: The final Maternity Portfolio product consisted of a 40-page booklet; it contained an information section and a patient comments section. Following artificial reproductive treatment, this booklet can be provided to women during the first trimester. Women would then be instructed to bring the Maternity Portfolio to their prenatal checkups, where a nursing intervention program would be conducted by certified nurses. Through this program and the Maternity Portfolio, participating women are expected to obtain necessary information and maternal role attainment. CONCLUSIONS: The Maternity Portfolio was developed to promote maternal role attainment for women who have undergone artificial reproductive treatment. The intervention study with the Maternity Portfolio is a work in progress; therefore, a future evaluation of the study will clarify both positive and negative aspects, which should facilitate refinement of the functions and qualities of the Maternity Portfolio.

Evaluation of the training course for a nursing intervention programme to promote maternal role attainment in pregnant Japanese women who have undergone assisted reproductive technology.

This study evaluated the effectiveness of a 2 day training course for a nursing intervention programme to promote maternal role attainment in pregnant Japanese women who have undergone assisted reproductive technology. Participants were 12 Japanese nurses with more than 3 years of clinical experience at reproductive institutions. The effectiveness of the training course was evaluated by assessing the following: (i) understanding of the nursing intervention programme; (ii) attitudes of nurses towards women who are pregnant following assisted reproductive technology; and (iii) self-efficacy for implementing the programme. The training course was effective in increasing basic understanding of the programme and in assisting self-evaluation of the attitudes of participants towards pregnant women. However, acquisition of effective interview skills and changes to make the programme clinically feasible are still needed. Findings suggest that researchers who use this training programme may need to evaluate and include training of nurses in interview skills suitable for their working environments.

Correlation of oral allergy syndrome due to plant-derived foods with pollen sensitization in Japan.

BACKGROUND: The clinical features of patients with oral allergy syndrome (OAS) due to plant-derived foods related to pollen allergy have been rarely reported in Japan. OBJECTIVES: To evaluate the characteristics of OAS and to investigate whether pollen sensitizations are correlated with the prevalence of OAS in Japan. METHODS: We measured specific IgE antibodies against 5 pollens in 622 outpatients (277 males and 345 females; mean age, 37 years) with atopic dermatitis, urticaria, angioedema, and food allergy during a 2-year period. Furthermore, OAS is diagnosed based on anamnesis and positive skin prick test reactions to suspected foods. RESULTS: Eighteen of the 436 patients (4.1%) sensitized to pollens were diagnosed as having OAS. Rates of specific IgE antibody-positive responses against Japanese cedar, ragweed, orchard grass, mugwort, and alder pollen were 69.8%, 35.3%, 29.1%, 24.1%, and 19.6%, respectively. The prevalence of OAS showed a significant positive correlation with sensitization to alder (P < .001). In addition, the most frequent causative foods were found to be apple, peach, and melon. The prevalence of OAS due to apple showed a significant positive correlation with sensitization to alder (P < .001) pollen, due to peach showed a significant positive correlation with sensitization to alder (P < .001) and orchard grass (P < .05) pollen, and due to melon showed a significant positive correlation with sensitization to alder (P < .005), orchard grass (P < .05), and ragweed (P < .05) pollen. CONCLUSION: Sensitization to pollens from species in the Betulaceae family is most strongly implicated in causing OAS in Japan.

[Anaphylaxis due to peach with negative ImmunoCAP result to peach allergens, including rPru p 1, rPru p 3, AND rPru p 4: a report of two cases].

We report two cases of anaphylactic reactions to peach with negative result of ImmunoCAP to peach. Case 1 is a 35-year-old man, who felt an itch in his oral cavity immediately after ingesting a whole fresh peach. He rapidly developed generalized urticaria, dyspnea, vomiting, and loss of consciousness. He recovered after treatment at a local hospital, thereafter he was referred to our hospital because ImmunoCAP conducted for screening allergens revealed a negative test result to peach and the cause of anaphylaxis remained unclear. He had a history of pollinosis. He reported that he previously felt an itch on his oral cavity after ingesting melon, watermelon, apple, and strawberry. Serum total IgE was 436 IU/ml. CAP-RAST revealed negative results to peach, strawberry and kiwi. Skin prick tests (SPTs) with raw peach pulp, canned peach pulp, strawberry and kiwi were positive. Case 2 is a 30-year-old woman who felt an itch on her oral cavity accompanied by blepharedema, rhinorrhea, generalized urticaria, nausea, abdominal pain and diarrhea after eating peach. She had a history of pollinosis. She reported that she previously developed urticaria after ingesting an apple. Serum total IgE was 85 IU/ml. ImmunoCAP revealed negative results to peach and apple. SPTs with canned yellow peach, strawberry and apple were positive. Consequently, the two patients were diagnosed with anaphylaxis due to peach, and allergic symptoms have never recurred since they avoided ingesting peach. Furthermore, in two patients ImmunoCAP to rPru p 1, rPru p 3, and rPru p 4 were negative. However, in IgE-immunoblotting of peach, serum IgE antibodies of two patients were bound to approximately 10 kDa proteins. Meanwhile, the cross-reactivity between Rosaceae fruits, such as peach, apple, apricot, and plum, has been reported. These results suggest that in patients, who are suspected of having peach anaphylaxis and show a negative ImmunoCAP result to peach, the additional testing, such as SPT with peach, should be performed for diagnosis.