Prevalence, associated factors and source of support concerning supportive care needs among Japanese cancer survivors.

BACKGROUND: The current study aimed to describe cancer survivors' supportive care needs in Japan, to identify associated factors of unmet needs, and to describe the source of support that are preferred and actually used by cancer survivors. METHODS: Using a web-based questionnaire, we examined unmet supportive needs and its associated factors among 628 adult Japanese cancer survivors. The questionnaire comprised 16 items representing five domains (medical-psychological, financial, social-spiritual, sexual, and physical needs). RESULTS: Prevalence of unmet need ranged from 5 to 18%, depending on different domains. The prevalence was high in medical-psychological and financial domains and relatively low in physical and sexual domains. Poor performance status, psychiatric morbidity and low income status were associated with unmet needs of most domains. Most cancer survivors preferred and actually sought support from their family and friends. Financial needs were preferred to be provided by non-medical professionals. Call for peer support was intense, especially for medical-psychological, social-spiritual, and sexual needs; however, peer support was not well-provided. CONCLUSIONS: This study illustrated characteristics of Japanese cancer survivors who are likely to have unmet needs. The study demonstrated need for expanded involvement of non-medical professionals and peer support, especially in the domains of medical-psychological, social-spiritual, financial and sexual needs.

Effects of the kampo formula tokishakuyakusan on headaches and concomitant depression in middle-aged women.

Objectives. To identify the correlates of headaches in middle-aged women and investigate the effects of Tokishakuyakusan (TJ-23), a formula of traditional Japanese herbal therapy Kampo, on headache and concomitant depression. Methods. We examined cross-sectionally the baseline records of 345 women aged 40-59 years who visited our menopause clinic. Among them, 37 women with headaches were treated with either hormone therapy (HT) or TJ-23; the data of these women were retrospectively analyzed to compare the effects of the treatment. Results. The women were classified into 4 groups on the basis of their headache frequency, and no significant intergroup differences were noted in the physical or lifestyle factors, except age. Multiple logistic regression analysis revealed that the significant contributors to the women's headaches were their age (adjusted OR 0.92 (95% CI 0.88-0.97)) and their depressive symptoms (adjusted OR 1.73 (95% CI 1.39-2.16)). Compared to women treated with HT, women treated with TJ-23 reported relief from headaches (65% versus 29%) and concomitant depression (60% versus 24%) more frequently. Improvement in the scores of headaches and depression correlated significantly with TJ-23 treatment. Conclusions. Headache in middle-aged women is significantly associated with depression; TJ-23 could be effective for treating both of these symptoms.

Changes in the duration and frequency of deviant stimuli engender different mismatch negativity patterns in temporal lobe epilepsy.

Mismatch negativity (MMN) is an event-related potential (ERP) component that reflects preattentive sensory memory functions. Previous research revealed that MMN is generated by distinct sources in the frontal and temporal lobes. Event-related potential abnormalities have been shown in the vicinity of seizure foci in epilepsy. Additionally, no published study has investigated the MMN in response to variations in both frequency and duration deviants in patients with temporal lobe epilepsy (TLE). The aims of this study were to compare MMN changes between the frontocentral sites and the mastoid sites and to compare MMNs related to deviant stimuli with different durations and frequencies in patients with TLE. We recorded MMNs elicited by duration and frequency changes of deviant stimuli from 15 patients with TLE and 15 healthy control subjects. We found that mean MMN amplitudes related to duration deviants were lower in patients with TLE at the mastoid sites relative to controls, whereas the MMN amplitudes at the frontocentral sites did not differ between the two groups. There were no MMN differences related to frequency deviants between TLE subjects and controls at the frontocentral sites or the mastoid sites. Mismatch negativity parameters related to duration deviants did not correlate with those related to deviant frequencies in the group with TLE. The present findings suggest selective impairments among multiple mismatch generators in TLE and suggest that processing of temporal information of auditory stimuli is selectively disturbed in TLE. Changes in MMN amplitudes related to duration deviants at the mastoid sites may represent deficits in time-dependent processing in TLE.

Distinct pre-attentive responses to non-scale notes: an auditory mismatch negativity (MMN) study.

OBJECTIVE: The aim of the present study was to examine patterns of neural activity in response to variations in scale notes and alterations from a scale note to a non-scale note. METHODS: Event-related potentials (ERPs) were recorded in response to scale and non-scale violin notes using an odd-ball mismatch negativity (MMN) paradigm. Standard stimuli were set to the scale note A4 (440 Hz). Deviant stimuli included two scale notes (scale-B, B4 = 494 Hz; scale-C, C5 = 523 Hz) and a non-scale note halfway between them (non-scale, B4+42¢ = 506 Hz). RESULTS: MMN amplitude elicited by the non-scale was significantly larger than that elicited by the scale-B and scale-C, which did not differ significantly from one another. CONCLUSION: The current results suggest that the human brain may possess pre-attentive mechanisms for extracting relational aspects among sounds of the musical scale. SIGNIFICANCE: The results indicate that non-scale notes may be processed in a different way even in the pre-attentive stage than scale notes.

Aroma helps to preserve information processing resources of the brain in healthy subjects but not in temporal lobe epilepsy.

PURPOSE: Inhalation of ylang-ylang aroma has been shown to reduce the auditory P300, an event-related potential thought to reflect higher-order processing. Because olfactory function is sometimes disturbed in temporal lobe epilepsy (TLE), the objective of the present study was to determine whether the effect of ylang-ylang aroma on the auditory P300 was impaired in patients with TLE. METHOD: Fourteen subjects with TLE and 14 healthy controls participated in this study. Electroencephalograms were recorded during an auditory oddball task, and ylang-ylang aroma or odorless air was delivered through a mask. RESULTS: We found that the ylang-ylang aroma prolonged the latencies of P300 in both groups. The ylang-ylang aroma significantly reduced the P300 amplitudes of healthy subjects as described previously. However, in TLE patients, the P300 was unaffected by the aroma. CONCLUSION: The current results show that exposure to the ylang-ylang aroma reduced information processing resources in healthy subjects but had limited effects in patients with TLE. We suggest that impaired higher-order olfactory processing in TLE patients may inhibit the effects of the ylang-ylang aroma on the P300.

Mismatch negativity for speech sounds in temporal lobe epilepsy.

The mismatch negativity (MMN) is an electrophysiological trace of change detection, measured by electroencephalography (EEG), and is a reliable marker for pre-attentive auditory sensory memory. We used a phonetic oddball paradigm in patients with temporal lobe epilepsy (TLE) to elicit the MMN response at fronto-central sites and the mismatch positivity (MMP) response at mastoid sites. The MMN in 26 patients was compared with that of 26 age- and gender-matched healthy control participants. Electroencephalography responses were recorded during the presentation of speech sounds: the vowels 'a' and 'o' in alternation. Average waveforms were obtained for standard and deviant trials. We found that the MMP response at bilateral mastoid sites was reduced, whereas the MMN response at fronto-central sites did not change significantly. These results support the view that the MMN is generated by separable sources in the frontal and temporal lobes and that these sources are differentially affected by TLE.

Abnormal mismatch negativity for pure-tone sounds in temporal lobe epilepsy.

Auditory processing abnormalities in temporal lobe epilepsy (TLE) were assessed by investigating mismatch negativity (MMN) in a group of 20 TLE patients and 20 healthy control subjects. MMN is an event-related potential (ERP) component that reflects pre-attentive sensory memory function. A passive oddball paradigm using frequency changes in sinusoidal tones was employed to evoke MMN. MMN at frontocentral sites was enhanced in TLE patients relative to controls, while mismatch signals at mastoid sites (i.e., mismatch positivity; MMP) did not differ between the two groups. In the MMP temporal range, greater positivity at mastoid sites in response to standard stimuli was observed in TLE patients than in controls. Both MMN and MMP were significantly delayed in the TLE group. These findings demonstrate that TLE patients have impaired pre-attentive processing of pure-tone sounds. Enhanced frontocentral MMN may reflect hyperexcitability of the frontal lobes in compensation for dysfunction of the temporal lobes. Larger positivity at the mastoids in response to standard stimuli may be attributed to poor neuronal adaptation in the temporal lobe. Taken together, results suggest that evaluation of MMN/P is a useful physiological tool for identifying pre-attentive auditory memory dysfunction in TLE.

Effects of three Kampo formulae: Tokishakuyakusan (TJ-23), Kamishoyosan (TJ-24), and Keishibukuryogan (TJ-25) on Japanese peri- and postmenopausal women with sleep disturbances.

PURPOSE: To assess the effects of Kampo, a traditional Japanese adaptation of Chinese herbal medicine, on peri- and postmenopausal women with sleep disturbances. METHODS: Among the records of 1,523 peri- and postmenopausal women who are enrolled in the Health and Nutrition Education Program at the Tokyo Medical and Dental University, Menopause Clinic, during 1995-2009, about 151 women suffering from moderate to severe sleep disturbances were retrospectively analyzed. These women had received only health/nutrition education (control; n = 77) or received treatment with one of the three major Kampo formulae: Tokishakuyakusan (TJ-23; n = 42), Kamishoyosan (TJ-24; n = 16), or Keishibukuryogan (TJ-25; n = 16) according to their "Sho" or symptom patterns. Subjective sleep parameters, menopausal symptoms, health-related quality of life, body composition, blood pressure, and pulse rate were compared before and after the intervention. RESULTS: The TJ-25 group had significantly higher body weight, body mass index, body fat, lean body mass, resting energy expenditure, and relatively high blood pressure and heart rate at baseline than the other groups. After ~5-month follow up, TJ-23 reduced the sleep disruption frequency, increased lean body mass, and decreased diastolic pressure. TJ-24 alleviated subjective sleep disturbances; improved difficulties in initiating sleep, disrupted sleep, and non-restorative sleep; and relieved headache/dizziness. TJ-25 improved subjective sleep disturbances, alleviated perspiration, and reduced systolic/diastolic pressure and heart rate. CONCLUSIONS: Each of the Kampo formulae effectively alleviated sleep disturbances in Japanese peri- and postmenopausal women. Middle-aged female patients having sleeping disorder could successfully be treated using Kampo medicines.

Neuromagnetic mismatch field (MMF) dependence on the auditory temporal integration window and the existence of categorical boundaries: comparisons between dissyllabic words and their equivalent tones.

Previous duration-related auditory mismatch response studies have tested vowels, words, and tones. Recently, the elicitation of strong neuromagnetic mismatch field (MMF) components in response to large (>32%) vowel-duration decrements was clearly observed within dissyllabic words. To date, however, the issues of whether this MMF duration-decrement effect also extends to duration increments, and to what degree these duration decrements and increments are attributed to their corresponding non-speech acoustic properties remainto be resolved. Accordingly, this magnetoencephalographic (MEG) study investigated whether prominent MMF components would be evoked by both duration decrements and increments for dissyllabic word stimuli as well as frequency-band matched tones in order to corroborate the relation between the MMF elicitation and the directions of duration changes in speech and non-speech. Further, the peak latency effectsdepending on stimulus types (words vs. tones) were examined. MEG responses were recorded with a whole-head 148-channel magnetometer, while subjects passively listened to the stimuli presented within an odd-ball paradigm for both shortened duration (180-->100%) and lengthened duration (100-->180%). Prominent MMF components were observed in the shortened and lengthened paradigms for the word stimuli, but only in the shortened paradigm for tones. The MMF peak latency results showed that the words ledtoearlier peak latencies than the tones. These findings suggest that duration lengthening as well as shortening in words produces a salient acoustic MMF response when the divergent point between the long and short durations fallswithin the temporal window ofauditory integration post sound onset (<200 ms), and that theearlier latency of the dissyllabic word stimuli over tones is due to a prominent syllable structure in words which is used to generate temporal categorical boundaries.

Sense of coherence among patients with cardiovascular disease and cancer undergoing surgery.

The sense of coherence (SOC) among patients undergoing cardiovascular surgery was compared with that of patients undergoing surgery for gynecological and oral cancer by using the Japanese version of the SOC questionnaire. The patients in the former group were able to cope with their disease and manage the relationship between their lifestyle and the disease for a long time. Eventually, however, they opted for surgery because they were unable to obtain life insurance if they did not resort to treatments other than medicine. On the other hand, the patients in the latter group had to suddenly deal with a very stressful event (being diagnosed with cancer and having had to undergo surgery). However, their malignant tumors were completely excised during surgery because their cancer was at an early stage. The analysis revealed that the average SOC score of the former group was significantly higher than that of the latter group; furthermore, the score of the latter group was similar to the SOC score of the general population. A multiple regression analysis revealed that the principal determinants of the SOC scores were the diagnosis of the patients (the duration of their struggle with the illness) and their employment status. The SOC of employed persons was higher than that of unemployed persons.

[Eye movement in patients with schizophrenia].

To clarify the cognitive function of schizophrenia, the exploratory eye movement was investigated using S-shaped figures in patients with schizophrenia and their relatives. As a result, the exploratory eye movement has been found to be a biological marker that reflects a specific and trait factor of schizophrenia. Using the exploratory eye movement combined with brain functional imaging, the pathology of schizophrenia that the neural network centering on thalamus was damaged is being clarified. Moreover, the disease gene of schizophrenia may be discovered especially on the chromosome 22 using the exploratory eye movement as an endophenotype. In addition, the exploratory eye movement can be given as a powerful candidate of diagnostic tool for schizophrenia.

Spiritual needs in cancer patients and spiritual care based on logotherapy.

BACKGROUND: The suitability of Frankl's logotherapy for the spiritual care (psychotherapy) of cancer patients in Japan is suggested. Using Functional Assessment of Chronic Illness Therapy-Spiritual (FACIT-Sp, Japanese version), the Purpose in Life test (PIL test, Japanese version), and WHO-Subjective Inventory (WHO-SUBI, Japanese version), we attempted to elucidate the complicated structure of spirituality in cancer patients in order to identify possible approaches to their spiritual care and means of evaluating such care. MATERIALS: Two hundred and ninety-eight cancer patients participated in the study. All three tests were taken at the same time, and the results were evaluated by principal component analysis. RESULTS: It was demonstrated that all the subscales employed in the present study could be represented by a two-dimensional structure (two principal components), and that the FACIT-Sp and PIL tests have similar contents. DISCUSSION: FACIT-Sp (Japanese version) is very similar in conception to the PIL test, which was prepared in accordance with logotherapy. The results suggest that this test can serve as an adequate evaluation scale for measuring the effectiveness of spiritual care based on Frankl's logotherapy.

Abnormal regional cerebral blood flow in systemic lupus erythematosus patients with psychiatric symptoms.

OBJECTIVE: Single-photon emission computed tomography (SPECT) studies have demonstrated decreased regional cerebral blood flow (rCBF) in systemic lupus erythematosus (SLE) patients. However, no study has done voxel-based analysis using statistical parametric mapping (SPM) that can evaluate rCBF objectively, and the relationship between rCBF and psychiatric symptoms has not been well investigated. Using L,L-ethyl cysteinate dimer (99mTc ECD) SPECT and SPM, we aimed to clarify the association of rCBF changes with psychiatric symptoms in SLE patients whose magnetic resonance imaging (MRI) showed no morphological abnormalities. METHOD: Twenty SLE patients and 19 healthy volunteers underwent 99mTc ECD SPECT. Data were collected from August 2000 to March 2003. SLE was diagnosed according to American College of Rheumatology criteria, and psychiatric symptoms were diagnosed according to ICD-10 criteria. On the basis of the modified Carbotte, Denburg, and Denburg method, the patients were classified into 3 groups: a group with major psychiatric symptoms (hallucinosis, delusional disorder, and mood disorder), a group with minor psychiatric symptoms (anxiety disorder, dissociative disorder, and emotionally labile disorder), and a group without psychiatric symptoms. Gross organic lesions were ruled out by brain MRI. Group comparisons of rCBF were performed with analysis using SPM99. RESULTS: SLE patients without MRI lesions showed decreased rCBF in the posterior cingulate gyrus and thalamus. The reduction in rCBF was overt in patients with major psychiatric symptoms. CONCLUSION: Our study indicated that SLE patients may have dysfunction in the posterior cingulate gyrus and thalamus and that this may be associated with the severity of psychiatric symptoms.

Human auditory evoked mismatch field amplitudes vary as a function of vowel duration in healthy first-language speakers.

Previous auditory studies demonstrated that vowel shortening elicited a more prominent mismatch component than its lengthening in event-related potentials (ERP) and magnetoencephalography (MEG). Based on these findings, the current study investigated whether the magnetic mismatch field (MMF) component would be generated by vowel shortening of various degrees to determine a neuronal response threshold of pre-attentive deviation detection. Behavioral pre-test data revealed that while listening to Japanese short-duration (100%: reference), long-duration (180%), and other in-between duration-synthesized types, healthy native speakers of Japanese failed to clearly categorize 140-124% durations as either short or long words, while categorizing 108-116% durations as short words and 148-172% durations as long. Following these results, MEG responses were recorded with a whole-head 148-channel magnetometer, as subjects listened to 100% standard and five deviant durations (124, 132, 140, 148, 180%). MEG results showed that the above-32% duration decrements (180-->100%, 148-->100%) elicited a more prominent MMF than the others, the MMF amplitudes increasing linearly to the degree of duration deviance, and that neuronal responses correlated with behavioral word-categorization accuracy.

Functional MRI mapping of brain activation during visually guided saccades and antisaccades: cortical and subcortical networks.

Antisaccade tasks require a subject to inhibit a saccade toward a briefly appearing peripheral target and instead to immediately generate a saccade to an equivalent point in the opposite hemifield. Using functional magnetic resonance imaging (fMRI), we investigated the neural networks required to inhibit reflexive saccades and to voluntarily generate saccades. The results demonstrated that saccade and antisaccade tasks often bilaterally activate frontal, parietal and supplementary eye fields, lenticular nuclei and occipital cortex. Additional activation of bilateral dorsolateral prefrontal cortices, supramarginal gyri, anterior cingulate cortices and thalamus was observed during antisaccade tasks. These results indicate that fronto-parietal and fronto-striato-thalamo-cortical circuits are involved in antisaccade tasks. The fronto-parietal circuit is thought to be related to the planning of saccadic eye movements that involve attentional control, while the fronto-striato-thalamo-cortical circuits connect to cortical region as a feedback network. We speculate that the abnormalities in spatial attention and eye movement control observed in schizophrenia stem from dysfunctions in the fronto-parietal and fronto-striato-thalamo-cortical circuits.

[Reliability and validity of the functional assessment of chronic illness therapy-spiritual (FACIT-Sp) Japanese version in cancer patients--a preliminary study].

The reliability and validity of the Functional Assessment of Chronic Illness Therapy-Spiritual well-being (FACIT-Sp), Japanese version, which was developed in the United States for a simple survey of QOL related to spirituality, was evaluated. The survey simultaneously covered FACIT-Sp and HADS, an anxiety and depression scale, using 64 cancer patients as the subjects of the study. In the evaluation of its intrinsic conformity, the Cronbach alpha reliability coefficient of the sub-scale ranged from 0.80 to 0.91 and the evaluation of validity by factor analysis indicated satisfactory factorial appropriateness. The correlation coefficients for the sub-scales were all below 0.7, indicating that each scale is independent. The correlation with HADS depression and anxiety scales was -0.54 and -0.56, respectively, showing that the emotional and spiritual scales are independent of each other. The findings suggest that The Japanese version of FACIT-Sp is associated with satisfactory reliability and validity and is an effective tool in the study of spirituality among cancer patients.

Reliability and validity of the Functional Assessment of Chronic Illness Therapy-Spiritual (FACIT-Sp) for Japanese patients with cancer.

The reliability and validity of the Japanese version of the Functional Assessment of Chronic Illness Therapy-Spiritual (FACIT-Sp) scale were assessed. This scale was developed in the United States to assess quality of life (QOL) in relation to spirituality. Two surveys were conducted on each of 306 cancer patients. In addition to the FACIT-Sp, the Hospital Anxiety and Depression Scale (HADS) was administered. Cronbach's alpha reliability coefficient, an evaluation of internal consistency, for the FACIT-Sp subscales ranged from 0.81 to 0.91. There were no significant differences between the patients evaluated using the FACIT-Sp subscale and the HADS subscale with regard to degree of religious feelings. The correlation coefficients between the FACIT-Sp and the HADS depression and anxiety scales indicated a moderate correlation. These findings suggest that the Japanese version of the FACIT-Sp scale is satisfactory in terms of reliability and validity and is a useful tool in the study of spirituality among Japanese cancer patients.