Improved Glycemic Control through Robot-Assisted Remote Interview for Outpatients with Type 2 Diabetes: A Pilot Study.

Background and Objectives: Our research group developed a robot-assisted diabetes self-management monitoring system to support Certified Diabetes Care and Education Specialists (CDCESs) in tracking the health status of patients with type 2 diabetes (T2D). This study aimed to evaluate the impact of this system on glycemic control and to identify suitable candidates for its use. Materials and Methods: After obtaining written informed consent from all participants with T2D, the CDCESs conducted remote interviews with the patients using RoBoHoN. All participants completed a questionnaire immediately after the experiment. HbA1c was assessed at the time of the interview and two months later, and glycemic control status was categorized as either "Adequate" or "Inadequate" based on the target HbA1c levels outlined in the guidelines for adult and elderly patients with type 2 diabetes by the Japan Diabetes Society. Patients who changed their medication regimens within the two months following the interview were excluded from the study. Results: The clinical characteristics of the 28 eligible patients were as follows: 67.9 ± 14.8 years old, 23 men (69%), body mass index (24.7 ± 4.9 kg/m2), and HbA1c levels 7.16 ± 1.11% at interview and two months later. Glycemic control status (GCS) was Adequate (A) to Inadequate (I): 1 case; I to A: 7 cases; A to A good: 14 cases; I to I: 6 cases (p-value = 0.02862 by Chi-square test). Multiple regression analyses showed that Q1 (Did RoBoHoN speak clearly?) and Q7 (Was RoBoHoN's response natural?) significantly contributed to GCS, indicating that the naturalness of the responses did not impair the robot-assisted interviews. The results suggest that to improve the system in the future, it is more beneficial to focus on the content of the conversation rather than pursuing superficial naturalness in the responses. Conclusions: This study demonstrated the efficacy of a robot-assisted diabetes management system that can contribute to improved glycemic control.

Health science students' attitudes towards healthcare teams: A comparison between two universities.

There have been few studies comparing the attitudes towards healthcare teams between different universities. This study analysed the differences in attitudes towards healthcare teams between health science students at Gunma University, Japan, which implements a comprehensive interprofessional education (IPE) programme, and Kanazawa University, a similar national university. Study populations were first- and third-year students at the Gunma University School of Health Sciences and the Kanazawa University School of Health Sciences. The present study was performed just after the IPE and multi-professional education subjects at Gunma University in the first term of the 2012 academic year. The first-year students were different cohort from the third-year students. The modified Attitudes Toward Health Care Teams Scale (ATHCTS) was used to measure attitudes towards healthcare teams. The overall mean score on the modified ATHCTS of students at Gunma University was significantly higher than that of those at Kanazawa University. In both first- and third-year students, the regression factor score of "patient-centred care" was significantly higher at Gunma University than at Kanazawa University. Based on the present study, it can be stated that IPE may foster the value of collaborative practice (CP) among health science students.

Development of a Family Support Scale for Diet Therapy for Male Workers with type 2 diabetes.

AIM: Dietary self-care for patients with type 2 diabetes can be improved with family support. The purpose of this study was to develop a scale to assess family support for diet therapy for male workers with type 2 diabetes and to examine its reliability and validity. METHODS: In this cross-sectional study, we collected data from 110 Japanese male workers with type 2 diabetes. Data were analyzed using exploratory factor analysis, reliability testing, and validity testing. RESULTS: The resultant Family Support Scale for Diet Therapy for Male Workers (FSS-DMW) with type 2 diabetes consisted of 31 items and a six-factor structure. The six factors explained 72.9% of the variance, and Cronbach's alpha for the total scale was .964. The scale correlated as expected with the Social Support Scale for Chronic Illness and the dietary subscale of the Japanese version of the Summary of Diabetes Self-Care Activities Measure. CONCLUSION: The FSS-DMW is a reliable and valid measure which can be used to assess family support for diet therapy for male workers with type 2 diabetes and has the potential to be used as a clinical instrument for family guidance.

Validation of the relationship consciousness of Japanese Patients with type 2 diabetes scale.

OBJECTIVES: The management of type 2 diabetes mellitus can be improved for individuals by developing relationships with other patients with diabetes. We created the Relationship Consciousness of Japanese Patients with Type 2 Diabetes Mellitus scale to measure the relationship consciousness of type 2 diabetes mellitus patients for other patients based on the Health Belief Model. METHODS: This was a cross-sectional study of Japanese patients with type 2 diabetes mellitus (n = 289). Data were analyzed via exploratory factor analyses, reliability tests, concurrent validity. RESULTS: The final scale obtained for the Relationship Consciousness of Japanese Patients with Type 2 Diabetes Mellitus scale comprised a six-factor structure with 36 items. All 36 items had a Cronbach's α coefficient of 0.893 and explained 59.38% of the total variance. The scale was significantly correlated with a related reciprocity consciousness scale. CONCLUSIONS: The Relationship Consciousness of Japanese Patients with Type 2 Diabetes Mellitus scale may be an important tool for nurses to assess the relationship consciousness of patients with type 2 diabetes mellitus. In addition, by understanding patients' relationship consciousness for others who share their disease, nurses can begin to recommend ways to establish relationships between patients that suit patients' particular relationship. consciousness levels and to provide better care in their clinical practice.

The Concept of Sleep Ability and its Effect on Diabetes Control in Adults With Type 2 Diabetes.

OBJECTIVES: Few published studies have examined the effects of various components of sleep on the control of type 2 diabetes. This study aimed to construct a concept of sleep ability and examine its effect on diabetes control in adults with type 2 diabetes. METHODS: Participants were 37 outpatients, 41 to 73 years of age, who had type 2 diabetes. Participants monitored their sleep for 14 days using a sleep meter, and they completed questionnaires concerning quality of life (Problem Areas in Diabetes), self-care (Self-Care Agency Questionnaire) and sleep quality (Pittsburgh Sleep Quality Index). Data on glycated hemoglobin levels and body mass index were also collected. Canonical correlation analysis and exploratory selection were used to investigate the relationships between the variables involved in diabetes control and sleep ability. RESULTS: Using canonical correlation analysis and exploratory selection, sleep ability was found to be composed of the Pittsburgh Sleep Quality Index score, objective total sleep time, wake after sleep onset, bedtime standard deviation, wake-up time standard deviation and the absolute value of the difference between subjective and objective sleep efficiency. A significant correlation was found between components of diabetes control (glycated hemoglobin levels, body mass index, quality-of-life evaluation from Problem Areas in Diabetes and self-care evaluation from the Self-Care Agency Questionnaire) and sleep ability (canonical correlation coefficient [RC] =0.755, p=0.006). CONCLUSIONS: The significant elements of sleep ability represented the quality, quantity, maintenance, regularity and recognition of sleep, and each element made a large contribution to diabetes control. We conclude, therefore, that improving sleep ability may lead to good diabetes control.

[Approach to easing occupational stress for high-stress workers: applying the brief job stress questionnaire to workplace mental health promotion].

We investigated job stress among 442 employees from 19 divisions in a Japanese company using the Brief Job Stress Questionnaire. Job stress of the employees was estimated by the score for total health risk. Among the 19 divisions, two divisions showed over 120 points of mean total health risk score. Intervention with a stress-reduction program was carried out in these 2 divisions. First, to assess the job stress, health care staff interviewed all workers in the 2 divisions. Second, the results of the interviews were reported to the divisions' managers. Third, the managers applied the best remedy for job stress in their workplaces. In addition, occupational health staff conducted mental health education as well as individual interviews for the workers from the 2 divisions. At reevaluation one year later, both divisions showed a decreased general health risk (under 120 points). No sick leaves for depression occurred within the 2 divisions during the intervention. The results of the present study suggest that the intervention was effective in easing occupational stress for high-stress workers. The stress reduction program also seemed to have helped managers to change their recognition of occupational mental health and enabled close cooperation with occupational health staff, which may improve mental health in the workplace.

Seasonal and long-term change in lead deposition in central Japan: evidence for atmospheric transport from continental Asia.

Long-range transport of air pollution from continental Asia is currently an important issue concerning the Japanese environment, especially in regions susceptible to acidification due to low buffering capacity, such as Murakami, Niigata prefecture, located on the west coast of central Japan. Evidence for long-range transport was obtained through lead and lead isotopic analysis of 84 archived precipitation filters, showing seasonal changes in lead deposition from May 1999 to May 2002. Lead deposition was highest in winter and spring (November through May) each year and lowest in summer. Computed 72-h back trajectories showed that in winter air masses were predominantly transported from the northwest, passing over northern China and eastern Russia, whilst in summer air masses predominantly originated from the southeast passing over Japan. Lead isotopic analysis showed higher (208)Pb/(206)Pb during winter, indicating that lead originated from a different source. A plot of (207)Pb/(206)Pb vs. (208)Pb/(206)Pb identified a thorogenic component, which is excess (208)Pb compared to a standard lead growth curve, indicative of certain lead ores and coals in continental Asia. The data provided evidence of long-range transport of lead from continental Asia to Japan. Bark pockets included within the trunks of two Japanese cedar trees harvested near Murakami, dating between 1972 and 1982, exhibited lead isotope ratios indicative of Japanese-sourced lead. In contrast, current (2003) bark showed thorogenic ratios, consistent with a relative decline in Japanese-sourced and increase in continental-sourced lead.

Preventive effect of traditional herbal formulae against experimental hypercholesterolemia in rats with special reference to blood lipoprotein cholesterol levels.

To investigate the effect of traditional herbal formulae (Zhong Yao) against experimental hypercholesterolemia, we assayed serum lipoprotein levels and hepatic function in rats administered herbal formulae under cholesterol rich diet. Two kinds of herbal formulae; prescription 1 (Bupleurum chinense and other 9 kinds of herbs) and 2 (Camellia sinensis and other 5 kinds of herbs) were prepared. All of 35 rats were separated into 4 groups, group P fed under cholesterol rich diet for 15 days and administered the prescriptions for 2 days, group Q administered the prescriptions for 17 days under the same diet, group R fed under the same diet but no prescriptions, and group S fed under regular diet. In rats administered prescription 1, serum low density lipoprotein cholesterol levels in group Q were preserved as well as standard group S. Such a preservation was not observed under administration of prescription 2. Regarding choleretic function, serum total bilic acid levels measured in group P were extremely increased when prescription 1 was administered for only 2 days after stopping the cholesterol rich diet. In study on telomerase activity of liver extracts to assess hepatocyte function, significantly higher level of activity was noted in group Q administered prescription 1. From these results, it was suggested that prescription 1 had much preventive effect against hypercholesterolemia in rats, probably due to its choleretic function.

Sexual harassment of female nurses by patients in Japan.

PURPOSE: To determine the prevalence and details of sexual harassment of female nurses by patients and nurses' reactions in Japanese hospitals. METHODS: A research survey with a self-administered questionnaire was conducted. Questionnaires were distributed to hospital nurses, and 473 of 600 (78.8%) questionnaires were returned. A content analysis was done with descriptive data from the questionnaires. FINDINGS: The proportion of female nurses who have ever been sexually harassed by patients was 55.8%. Sexual harassment was prevalent in the hospital environment and some details were serious. Conversely, nurses tended to react passively and moderately and, in many cases, they did not attempt to stop the patients. Relatively few incidents were reported to the appropriate supervisors. CONCLUSIONS: This sample of Japanese hospital nurses were at high risk for sexual harassment, and administrators tended to underestimate the problem. No effective policies to combat this situation have yet been established in Japanese hospitals.

A prospective cohort study of lower-extremity pressure ulcer risk among bedfast older adults.

OBJECTIVE: To estimate the incidence and identify risk factors for lower-extremity pressure ulcers in bedfast older adult patients. DESIGN: Prospective cohort study. SETTING: A 500-bed long-term-care facility in Japan. PATIENTS: A total of 259 patients who were aged 65 years or older, confined to bed, and without lower-extremity pressure ulcers at enrollment participated in the study. MAIN OUTCOME MEASURES: Incidence of occurrence, wound characteristics, and risk factors for lower-extremity pressure ulcers. The incidence of lower-extremity pressure ulcers per 100 person-years was 16.8 (n = 33). The most common sites of lesions were the toes and heels. Cox regression analysis indicated that 3 factors were independently related to new lower-extremity pressure ulcer risk: low ankle-brachial index value (hazards ratio 0.075; 95% confidence interval [CI], 0.023-0.242), length of bedfast period (hazards ratio 1.010; 95% CI, 1.004-1.015), and male gender (hazards ratio 2.951; 95% CI, 1.450-6.009). Receiver operating characteristic curve analysis showed the area under the curve was 0.760 (95% CI, 0.675-0.844) for the ankle-brachial index. Therefore, an ankle-brachial index cutoff level of 0.8 provided high sensitivity and adequate specificity. CONCLUSION: Lower-extremity pressure ulcers are a significant problem in bedfast older adult patients aged 65 years or older. Bedfast older adult patients who developed lower-extremity pressure ulcers in this study were believed to have arteriosclerosis; the patients' ulcers exhibited features of ischemic ulcers. The findings of the present study suggest that bedfast older adult patients with a low ankle-brachial index value, a long bedfast period, or male gender should be closely monitored for lower-extremity pressure ulcer development on admission to long-term-care facilities. In particular, the ankle-brachial index is recommended as a screening tool in this practice setting.

Long-term survivors after resection of carcinoma of the head of the pancreas: significance of histologically curative resection.

BACKGROUND/PURPOSE: The prognosis of patients with pancreatic cancer is said to have not been improved markedly by any procedures in the past 20 years. Since 1973, we have gradually extended the area of dissection when performing curative resection for pancreatic cancer to improve the resection rate and prognosis. Nineteen patients have survived for 3 years or more, and the 5-year survival rates of patients with cancer of the head of the pancreas were 23.9% for macroscopically curative resection and 34.3% for histologically curative resection. METHODS: We histologically observed surgical specimens, cut into 3- to 5-mm sections and compared the histologic characteristics of the 19 patients who survived for 3 years or more with those of 41 patients who died of cancer within 3 years (excluding 6 operative and hospital deaths), in order to find the conditions required for long-term survival. RESULTS: The following conditions were associated with long-term survival: (1) tumor diameter 3 cm or less; (2) either absence of lymph node metastasis or metastasis limited to the n(1) group; (3) degree of invasion of the anterior pancreatic capsule of zero (s0); and (4) either no retropancreatic invasion (rp0) or exposed retropancreatic invasion (rpe) with no cancer invasion of dissected peripancreatic tissue ew(-). CONCLUSIONS: At present, because the rpe rate is more than 70%, resection of the pancreas, including the superior mesenteric vein and the retropancreatic fusion fascia, is essential for a curative resection, because the retropancreatic tissue between the back of the pancreas and this fascia is anatomically considered to be in the position of the subserosal tissue in the gallbladder or stomach. Combined resection of the superior mesenteric artery may further improve the results of resection for pancreatic cancer, from the anatomical viewpoint.