Association between Physical Activity Levels and Body Composition among Healthy Older Japanese Adults during a Snowy Winter: A Cross-Sectional Study.

BACKGROUND: Despite a long average lifespan, increased life expectancy does not guarantee higher quality of life. METHODS: To contribute in understanding some determinants of healthy life expectancies in older Japanese individuals in a snowy winter region, we investigated the indicators of health. Local residents (n = 124) in the city of Iwamizawa volunteered for health examinations from January 2016 to March 2016. We recorded activity via daily steps for 2-week periods. In addition, we measured body composition, grip strength, and assessed nutritional status. RESULTS: Analysis of body composition and daily activity indicated that women who walked more than 4000 steps had lower fat mass and increased muscle mass. Men with >3.0 metabolic equivalents (METs) when walking had lower body fat. CONCLUSION: For healthy older Japanese individuals in this snowy winter region, walking >4000 steps daily for women and exercise of >3.0 METs for men may indicate health-promoting activities.

Factors Affecting Bone Mineral Density Among Snowy Region Residents in Japan: Analysis Using Multiple Linear Regression and Bayesian Network Model.

BACKGROUND: As the onset of osteoporosis leads to reduced activities of daily living and may result in patients being bedridden, efforts to prevent decreased bone density are necessary. Various studies on the relationship between sex, age, nutrients, and exercise habits and bone mineral density have been conducted to date. However, for snowy region residents, the magnitude of influence of various factors affecting bone mineral density and the influence level have not been clarified. OBJECTIVE: This study aimed to clarify the degree of influence and factors influencing bone mineral density based on survey results on health conditions and lifestyle habits in heavy snow areas. METHODS: A total of 354 citizens who visited a drugstore in the target area were included in a study that included using the brief-type self-administered diet history questionnaire on lifestyle and exercise habits. Height, weight, body composition, and bone densitometer values were analyzed using multiple regression to calculate their association with bone mineral density. In addition, a Bayesian network model was used to determine the influence level of each factor as a conditional probability. RESULTS: Multiple regression analysis revealed that age, sex, fracture, and calcium intake significantly influenced bone mineral density. In addition, the result of Bayesian network analysis suggested that age and sex affected bone mineral density, whereas nutrients and exercise habits might not have a direct impact. However, calcium intake and the T-score were significant factors affecting the presence or absence of fracture experiences, suggesting that adequate calcium intake is essential for preventing fractures. CONCLUSIONS: In the multiple regression analysis, age, sex, fracture, and calcium intake were selected as factors; however, in the Bayesian analysis, only age and sex affected bone mineral density while nutrients did not. In addition, the fact that calcium intake and the T-score were shown to affect bone fracture history suggests that calcium intake is an important measure that can prevent bone fractures. Overall, these results suggest that measures such as ensuring a bone fracture-free environment and providing nutritional advice for calcium intake can be effective in preventing bone loss.

Skin colour assessment of replanted fingers in digital images and its reliability for the incorporation of images in nursing progress notes.

AIMS AND OBJECTIVES: To determine whether nurses can accurately assess the skin colour of replanted fingers displayed as digital images on a computer screen. BACKGROUND: Colour measurement and clinical diagnostic methods for medical digital images have been studied, but reproducing skin colour on a computer screen remains difficult. DESIGN: The inter-rater reliability of skin colour assessment scores was evaluated. In May 2014, 21 nurses who worked on a trauma ward in Japan participated in testing. METHODS: Six digital images with different skin colours were used. Colours were scored from both digital images and direct patient's observation. The score from a digital image was defined as the test score, and its difference from the direct assessment score as the difference score. Intraclass correlation coefficients were calculated. Nurses' opinions were classified and summarised. RESULTS: The intraclass correlation coefficients for the test scores were fair. Although the intraclass correlation coefficients for the difference scores were poor, they improved to good when three images that might have contributed to poor reliability were excluded. Most nurses stated that it is difficult to assess skin colour in digital images; they did not think it could be a substitute for direct visual assessment. However, most nurses were in favour of including images in nursing progress notes. DISCUSSION: Although the inter-rater reliability was fairly high, the reliability of colour reproduction in digital images as indicated by the difference scores was poor. Nevertheless, nurses expect the incorporation of digital images in nursing progress notes to be useful. This gap between the reliability of digital colour reproduction and nurses' expectations towards it must be addressed. CONCLUSIONS: High inter-rater reliability for digital images in nursing progress notes was not observed. Assessments of future improvements in colour reproduction technologies are required. RELEVANCE TO CLINICAL PRACTICE: Further digitisation and visualisation of nursing records might pose challenges.

Nutritional Status and Body Composition of Independently Living Older Adults in a Snowy Region of Japan.

Lifestyle diseases, which are associated with nutrition, account for 30% of elderly requiring long-term care. To increase health expectancy among Japan's rapidly aging population, we investigated the nutritional status and body composition of elderly adults living in a region subject to heavy snowfall, to identify pertinent health indicators. The dietary habits of 288 local residents aged ≥50 years were analyzed using body composition and a brief-type self-administered diet history questionnaire. Body mass index of all residents was normal. Basal metabolic rate (BMR) and muscle mass were reduced in the older group. Dietary habits did not differ with age among men, but older women had significantly higher dietary intake. BMR and muscle mass declined with age, even when dietary intake was sustained. Despite sufficient dietary intake, independently living older adults demonstrate less efficient use of food with age. Interventions to reduce excessive sodium and protein intake are required.

The relationship between tooth eruption and ingestion of 15 food items among children aged 18-20 months.

Objectives　If children in formative stages ingest foods that are too hard or too soft, they can experience delays in oral cavity functions. Therefore, it is important for young children to receive foods of appropriate hardness in relation to their chewing ability. We investigated the relationship between the ingestion of 15 different food items and tooth eruption among children aged 18-20 months.Methods　Caregivers from Japanese municipalities who took their children for an 18-month health check-up were given an anonymous questionnaire. Questionnaires were only given to caregivers who provided direct consent and were returned by mail upon completion. The questions inquired about the ingestion of 15 different food items in an attempt to elucidate a correlation between the degree of food hardness that children can chew, tooth eruption, and development of oral functions. A chi-squared test and Fisher's exact test were used to evaluate the relationship between the ingestion of the 15 food items and tooth eruption. The Hokkaido University Human Research Ethics Committee approved this study.Results　Of the 501 caregivers who received the questionnaire, there were 210 responses (40.9%) and 202 (40.3%) of those were used in the analysis. Thirty children (14.9%) had non-eruption of the premolars. Children without absolute eruption of the premolars ate pork and/or beef steak more frequently than those who had their first four premolars.Conclusion　Our results suggest that at least 10% of children at the standard tooth eruption age experience delays in oral cavity maturation. This percentage indicates some children consume hard foods inappropriate for premolar development. We propose that caregivers prepare fresh greens and meat of suitable hardness according to the chewing ability of developing children.

Diversity changes of microbial communities into hospital surface environments.

Previous works have demonstrated considerable variability in hospital cleanliness in Japan, suggesting that contamination is driven by factors that are currently poorly controlled. We undertook 16S rRNA sequence analysis to study population structures of hospital environmental microbiomes to see which factor(s) impacted contamination. One hundred forty-four samples were collected from surfaces of three hospitals with distinct sizes ("A": >500 beds, "B": 100-500 beds, "C": <100 beds). Sample locations of two ward types (Surgical and Internal) included patient room bed table (multiple) (4BT), patient overbed table (multiple) (4OT), patient room sink (multiple) (4S), patient room bed table (single) (SBT), patient overbed table (single) (SOT), patient room sink (single) (SS), nurse desk (ND), and nurse wagon (NW). Total DNA was extracted from each sample, and the 50 samples that yielded sufficient DNA were used for further 16S rRNA sequencing of hospital microbiome populations with cluster analysis. The number of assigned bacterial OTU populations was significantly decreased in hospital "C" compared to the other hospitals. Cluster analysis of sampling locations revealed that the population structure in almost all locations of hospital "C" and some locations in the other hospitals was very similar and unusually skewed with a family, Enterobacteriaceae. Interestingly, locations included patient area (4OT, 4BT, SBT) and nurse area (ND), with a device (NW) bridging the two and a place (4S and SS) shared between patients or visitors. We demonstrated diversity changes of hospital environmental microbiomes with a skewed population, presumably by medical staff pushing NWs or sinks shared by patients or visitors.

ATP bioluminescence values are significantly different depending upon material surface properties of the sampling location in hospitals.

BACKGROUND: Our previous study into assessing hospital cleanliness in Japan by two common methods, ATP bioluminescence and the stamp agar method, revealed considerable variability in the data of both methods (BMC Research Notes, 7: 121, 2014). To investigate the reason(s) for the variability, we reanalyzed the data (n = 752) from the point of view of the material surface properties of sampling sites. METHODS: Data obtained from surfaces with unknown properties and different purposes such as floor were omitted, and the remaining data (n = 488) were used for this study. The material surface properties on sampling sites were divided into six categories: melamine coated (n = 216), vinyl chloride (n = 16), stainless steel (n = 144), wood (n = 63), and acrylonitrile-butadiene styrene resin coated (n = 48). The data between individual material properties were compared. RESULTS: The ATP values of high-touch places were significantly different depending on the type of surface, but no significant difference in stamp values between material properties was seen, indicating that in contrast to stamp values, ATP-accumulation more depends on the physical properties of the material surface such as electronic charges or roughness. To confirm this, we assessed a degree of roughness on vinyl chloride material surface (disutilized floor samples actually used for each of the hospitals) by observation with scanning electron microscope (SEM). As a result, SEM observation similarly revealed considerable roughness on the materials, which may allow microbes to contaminate the materials without noticing it. CONCLUSION: Material properties must be considered when evaluating hospital cleanliness with ATP values, and provide a strong warning into evaluating hospital cleanliness.

Facilitating patients with disorders of consciousness to sit without trunk support: a qualitative study.

AIMS AND OBJECTIVES: This study aimed to clarify why and how clinical nurses facilitate sitting without trunk support among patients with disorders of consciousness. BACKGROUND: Recent attention has focused on encouraging patients with disorders of consciousness to sit without trunk support, but no reports describe this intervention among patients with poor awareness and physical disuse. DESIGN: Qualitative research design. METHODS: We enrolled five clinical nurses with interventional experience in rehabilitating patients with disorders of consciousness to sit without trunk support. Participant observation and semi-structured interviews were used to collect data. The data were analysed by text-mining method. RESULTS: Three reasons for nursing in the sitting position were identified: to raise the patient's body to assess the recovery of activities of daily living, to adjust their circadian rhythm and encourage the will to sit, and to make it easier to breathe. Five practices were identified: moving the patient to the prone position to sit in safety and comfort, developing postural stability by improving the flexibility of the lower limbs, improving the flexibility of the hip joints, developing trunk balance and encouraging hand use for stability, and ensuring safety by terminating the sitting practice when symptoms of respiratory failure, heart failure, or excessive tiredness developed. CONCLUSIONS: The rationale for nursing patients with disorders of consciousness to sit without trunk support was to establish a foundation for independent living. This was achieved by preparing patient's disused body for activity by improving the flexibility of hip joint in the prone position. This represents a new intervention for patients with disorders of consciousness that could facilitate independent living. RELEVANCE TO CLINICAL PRACTICE: This study provides empirical and practical evidence from nurses who perform novel clinical interventions that specifically promote independent living. Further accumulation of quantitative clinical results and physiological verification are required.