Self-management behavior concerning physical activity of Japanese type 2 diabetes patients, characterized by sex, daily energy intake and body mass index.

OBJECTIVES: We assess differences in physical activity self-management behavior in association with dietary intake and BMI between the sexes in patients with type 2 diabetes. METHODS: Patients with type 2 diabetes (n = 145) completed a self-administrated questionnaire. Patients were classified into four groups by BMI and dietary intake: non-obesity and non-overeating (NO/NOE); non-obesity and overeating (NO/OE); obesity and non-overeating (O/NOE); obesity and overeating (O/OE). Differences in physical activity self-management behavior between the four groups were determined by the analysis of variance using a Tukey-Kramer post hoc test. RESULTS: Male O/OE group showed higher HbA1c (p = 0.001) than the other groups. Male NO/OE group had higher steps/day than O/NOE (p = 0.036) and score of "Exercising to stimulate the enjoyment of eating" was higher than O/OE (p = 0.031). Female NO/OE group showed higher HbA1c (p = 0.001) than NO/NOE and O/NOE. CONCLUSIONS: BMI and dietary intake were associated with frequencies of physical activity self-management strategies in men. Self-management behavior peculiar to male NO/OE group is "Exercising to stimulate the enjoyment of eating". Health professionals should assess sex, BMI, and dietary intake of patients and endeavor to improve individuals' ability to regulate their caloric balance based on physical activity level.

Development of a Questionnaire for the Reflective Practice of Nursing Involving Invasive Mechanical Ventilation: Assessment of validity and reliability.

AIM: To develop the Questionnaire for Reflective Practice of Nursing Involving Invasive Mechanical Ventilation (Q-RPN-IMV), a Japanese self-evaluation instrument for ward nurses' IMV practices. DESIGN: Cross-sectional survey. METHODS: Participants were 305 ward nurses from five hospitals in Japan with nursing involving invasive mechanical ventilation. Items concerning the process of nursing practice, including the thought process related to ventilator care, were collected from the literature and observation and interviews with five IMV specialists. Construct validity, concurrent validity, internal consistency and test-retest reliability were tested. RESULTS: Initially, 141 items were collected and classified into three domains (i.e., observation, assessment and practice). Examination of exploratory factor analysis yielded five factors in the observation domain, six factors in the assessment domain and six factors in the practice domain. The data exhibited internal consistency, stability and concurrent validity. Items of practical content, including thoughts on ventilator care, are useful for preparing educational programmes.

Time-Dependent Changes in Psychosocial Distress in Japanese Patients with Implantable Cardioverter Defibrillators.

This prospective study clarified changes in the mood states of Japanese patients with implantable cardioverter defibrillators as well as factors related to the mood states. Using a longitudinal repeated-measure design, 29 patients with implantable cardioverter defibrillators completed the Profile of Mood States-Short Form Japanese Version questionnaire before discharge and 1, 4, 7, and 13 months after implantation. One month after discharge, the mood states of the patients with implantable cardioverter defibrillators improved. From 7 to 13 months after discharge, moods deteriorated; 13 months after discharge, moods were equivalent to those at the time of discharge. No relationship with defibrillation experience was detected in this study, but employment, age, sex, and lack of experience of syncopal attack were factors related to poor mood states for patients with implantable cardioverter defibrillators. Therefore, Japanese patients with implantable cardioverter defibrillators with any factor deteriorating their mood state should be monitored so that their mood state does not deteriorate again between six months and one year after implantation.

Computer-supported indirect-form lifestyle-modification support program using Lifestyle Intervention Support Software for Diabetes Prevention (LISS-DP) for people with a family history of type 2 diabetes in a medical checkup setting: a randomized controlled trial.

AIMS: To investigate the effect of a computer-supported indirect-form lifestyle-modification program using Lifestyle Intervention Support Software for Diabetes Prevention (LISS-DP), as a clinically feasible strategy for primary prevention, on diet and physical activity habits in adults with a family history of type 2 diabetes. METHODS: This was a two-arm, randomized controlled trial: (1) lifestyle intervention (LI) group (n=70); (2) control (n=71). Healthy adults aged 30-60 years with a history of type 2 diabetes among their first-degree relatives were recruited. LI group received three times of lifestyle intervention using LISS-DP during six-month intervention period via mail. RESULTS: Lifestyle intervention group showed significantly greater decrease in energy intake six months after baseline, compared to control (-118.31 and -24.79 kcal/day, respectively, p=0.0099, Cohen's d=0.22), though the difference disappeared 1 year after from baseline. No difference was found in physical activity energy expenditure. CONCLUSIONS: A computer-based, non-face-to-face lifestyle intervention was effective on dietary habits, only during the intervention period. Further examination of the long-term effects of such intervention and physical activity is required.

Illness experience: living with arrhythmia and implantable cardioverter defibrillator.

PURPOSE: To describe the illness experience of patients living with arrhythmia and implantable cardioverter defibrillator (ICD) and evaluate their experience after implantation of the device for gaining insight on care suitable for their condition. METHODS: In this qualitative descriptive study, we conducted semi-structured interviews of 22 outpatients who were visiting certified implant facilities. RESULTS: Three categories and seven subcategories emerged from the interviews. The ICD patients were (1) Bewilderment Stemming from Arrhythmia and ICD Implant, (2) Facing the Reality of Arrhythmia, the ICD and Being Able To Continue Life, and (3) Giving Meaning to Living With Arrhythmia and an ICD. The ICD patients first experience bewilderment in the form of [Uncertainty about One's Own Bodies], [Fear of Arrhythmia Ending My Life], and [Dissatisfaction with Unforeseen Results of the ICD]. After discharge from the hospital following ICD implantation, they slowly resumed their own lifestyles and [Facing the Reality of the ICD and Being Able to Continue Life] and [Confirming and Managing Lifestyle Activities]. As they recognized, objectified, and faced changes in their lifestyles, they began to practically see themselves as living with arrhythmia which required ICD-aided treatment, [Giving Meaning to One's Illness] and [Recognition of One's Disease]. And so, they reknit their lives integrated with arrhythmia and an ICD. We expressed these results in a schematic model as "Learning to Live with Arrhythmia and the ICD". CONCLUSION: These results can be used to provide a perspective for assessing care to help patients adapt to life after ICD implantation.

A modified simple questionnaire to estimate dietary energy intake for the Japanese.

To produce a simple food questionnaire for estimating total energy intake and intake of three major nutrients which medical or health care staff such as nurses can rapidly use for the determination of health guidance for individuals. The study group comprised 116 normal healthy subjects (mean age ± S.D. = 40.0 ± 17.8 years), 76 women and 40 men. Using findings based on our previous research and experiences and the simple food questionnaire (MHW-FQ) that the "Kenkoh Shihyoh Sakutei Iinkai" established by the then Ministry of Health and Welfare developed in 1975, we produced a modified version of the MHW-FQ and named it M-MHW-FQ. The study presented here was conducted for the statistical determination of the usefulness of M-MHW-FQ. M-MHW-FQ yielded much better results than MHW-FQ as evidenced by improved correlation coefficients, which ranged between 0.56 and 0.75. The findings showed that, despite its simplicity, M-MHW-FQ yielded relatively accurate results and was satisfactory for the rapid estimation of total energy intake including that of three major nutrients. This study provides evidence that our simple questionnaire, M-MHW-FQ, is useful for the rapid estimation of individual total dietary energy intake and nutrient balance. We expect that our questionnaire can make a significant contribution to an improvement in lifestyle-related diseases.

Cultural adaptation and validating a Japanese version of the readiness for interprofessional learning scale (RIPLS).

Readiness for interprofessional education (IPE) can be an important factor to evaluate because of the influences of attitudes toward the outcomes of interprofessional learning activities. However, a dearth of Japanese evaluation tools hinders its evaluation. The readiness for interprofessional learning scale (RIPLS) was selected, because it has been validated in different countries and its items reflected our local situation best. This research aimed to develop and validate a Japanese version of the original 19-item RIPLS. We developed a Japanese RIPLS employing forward/backward translation. Reliability of the Japanese version was studied using classical test theory and structural equation modeling to construct a model to inform curriculum development. We obtained a 0.74 Cronbach's α, which indicates adequacy. Subscales of "interprofessional education opportunities" (α = 0.90) and "uniqueness of profession" (α = 0.60) have relatively little weight compared to "teamwork and collaboration" (α = 0.92). A one-way structure suggests that readiness for interprofessional learning starts with "teamwork & collaboration" followed by changes in "learning opportunities" and subsequently "uniqueness of profession" (root mean square error of approximation = 0.06, comparative fit index = 0.93). This Japanese RIPLS can be used in undergraduate health sciences students with appropriate caution. Further development of the subscales and a client-centered subscale would be beneficial to fully achieve its potential. The need for further research into its reliability and validity is identified. Recommendations are provided for cross-cultural adaptation and for establishing validity across different contexts.

Development of an evaluation scale for self-management behavior related to physical activity of patients with coronary heart disease.

BACKGROUND: To provide patients with effective self-management education that takes their lifestyle into account, medical personnel need to provide education and evaluation of self-management behaviors which patients can apply to their daily life. AIM: This study aimed to assess the reliability and validity of the evaluation scale for self-management behavior related to physical activity of patients with coronary heart disease (ES-SMBPA-CHD). METHODS AND RESULTS: Outpatients with coronary heart disease (n = 76) completed a self-administered questionnaire supported by a previous study of ours. The ES-SMBPA-CHD was divided into two domains, the first dealing with self-management behavior to enhance physical activity in daily life and the second with behavior to maintain the level of physical activity. Factor analysis showed that the first part comprised four factors and the second five. The ES-SMBPA-CHD was associated with the International Physical Activity Questionnaire (IPAQ) subscales and activity energy expenditure (measured by Lifecorder EX). Cronbach's α coefficient was between 0.71 and 0.90. The intraclass test-retest correlation coefficient of the subscale was between 0.75 and 0.93. CONCLUSIONS: The ES-SMBPA-CHD is reasonably reliable and valid and is expected to prove useful for the assessment of patients' self-management behavior and for individualized instruction.

Development of an evaluation scale for self-monitoring by patients with heart failure.

Many chronic heart failure patients are hospitalized repeatedly because many of them are still uncertain about the methods necessary for managing their own health. "Self-monitoring" is a useful concept for breaking through this vicious cycle. However, there are no suitable tools to measure aspects of self- monitoring. This study aimed at the development of an evaluation scale for self-monitoring by patients with chronic heart failure based on the concept of self-monitoring. Outpatient with chronic heart failure completed a self-administered scale comprises 2 domains and covers 38 items. Domain 1 deals with "awareness" and "measurement" of aspects of self-monitoring, domain 2 with "interpretation" of aspects of self-monitoring. The reliability and validity of this scale were thoroughly evaluated. Of the 167 patients asked to participate in the study, 142 gave valid responses. Factor analysis showed that the domain1 comprised six factors (21 items) and the domain2 four factors (16 items). Cronbach's α coefficient was 0.91 for domain1, 0.89 for domain2. The intra-class correlation coefficient of total score was 0.74 for domain1, 0.67 for domain2. Concurrent validity with the Heart Failure Self-care Behavior Scale was demonstrated. The scale is reasonably reliable and valid, and was proved to be useful for assessing conditions related to patient self-monitoring. Since it has become an indicator that shows to what degree patients can perceive their own health status, and nurses have been utilizing it to provide individual support to reduce the risks of exacerbated heart failure.

Gender differences of dietary self-management behavior affecting control indices in type II diabetes.

AIM: To establish effective dietary self-management behavior for type II male and female diabetics, by focusing on how dietary intake and dietary self-management affect control indices of type II diabetics. METHODS: The study group comprised 170 type II diabetics, 93 men (mean age, 63.1+/-8.8 years old) and 77 women (mean age 63.4 +/- 10.2 years old). The final analyses of data collected from subjects comprised three control indices of type II diabetics, several factors related to control indices, and several items on a dietary self-management behavior questionnaire. Multiple regression analyses used control indices as dependent variables, and related factors as independent variables. Multiple regression analyses were also used for the relationships between dietary intakes as dependent variables and dietary self-management factors as independent variables. RESULTS: Males showed a significant correlation between total energy intake per standard body weight per day and body mass index, and a significantly positive correlation between body mass index and waist circumference. Carbohydrate intake was significantly related to HbA1c. Other results showed characteristic relationships between various questionnaire items and "total energy intake, lipids intake, and carbohydrate intake", respectively. Females showed significant correlation between carbohydrate intake and both body mass index and waist circumference, as well as characteristic correlations between various questionnaire items and both reductions and increases in carbohydrate intake. CONCLUSION: Our study discloses significant differences in dietary self-management behavior between males and females with type II diabetes. We anticipate that educational support using findings of our study can make a significant contribution to improvement in control indices of type II diabetics.

Development of an evaluation scale for self-management behavior related to physical activity of type 2 diabetic patients.

OBJECTIVE: The aim of this study was to assess the reliability and validity of an evaluation scale for self-management behavior related to physical activity of type 2 diabetic patients (ES-SMBPA-2D). RESEARCH DESIGN AND METHODS: Outpatients with type 2 diabetes (n = 146) completed a self-administered questionnaire supported by a semistructured interview based on a literature review. The content, factor, and concurrent validity and internal consistency and reproducibility of the scale were analyzed. Pearson's correlation coefficients for the ES-SMBPA-2D and International Physical Activity Questionnaire (IPAQ) subscale scores were calculated to evaluate the concurrent validity. RESULTS: The ES-SMBPA-2D was divided into two parts, the first dealing with self-management behavior to enhance physical activity in daily life and the second with behavior to maintain the level of physical activity. Factor analysis showed that the first part comprised four factors and the second five. The ES-SMBPA-2D correlated with the IPAQ subscales. Cronbach's alpha coefficient was between 0.56 and 0.90, and the intraclass test-retest correlation coefficient of the subscales was between 0.60 and 0.88. CONCLUSIONS: The ES-SMBPA-2D is reasonably reliable and valid and is expected to prove useful for the assessment of patients' self-management behavior and for individualized instruction.