Translation and validation of the Japanese version of the Birth Satisfaction Scale-Revised.

AIM: This study aimed to develop a Japanese version of the Birth Satisfaction Scale-Revised and evaluate its reliability and validity. METHODS: After translating the Birth Satisfaction Scale-Revised into Japanese, we conducted an Internet-based cross-sectional study with 445 Japanese-speaking women within 2 months of childbirth. Of these, 98 participated in the retest 1 month later. Data were analyzed using the COSMIN study design checklist for patient-reported outcome measurement instruments. Content validity was evaluated through cognitive debriefing during the translation process into Japanese. Confirmatory factor analysis was conducted to verify structural and cross-cultural validities. For hypothesis testing, we tested correlations with existing measures for convergent and divergent validities, and for known-group discriminant validity, we made comparisons between types of childbirth. Internal consistency was calculated using Cronbach's α, and test-retest reliability was evaluated using the intraclass correlation coefficient. RESULTS: For the Japanese-Birth Satisfaction Scale-Revised, the established three-factor model fit poorly, whereas the four-factor model fit better. Full metric invariance was observed in both the nulliparous and multiparous groups. Good convergent, divergent, and known-group discriminant validities and test-retest reliability were established. Internal consistency observations were suboptimal; however for vaginal childbirth, the Cronbach's α of the total score was .71. CONCLUSIONS: The Japanese-Birth Satisfaction Scale-Revised is a valid and reliable scale, with the exception of internal consistency that requires further investigation. If limited to vaginal childbirth, research, clinical applications, and international comparisons can be drawn.

Efficacy of Heparinoid Cream Containing Pseudo-Ceramide for Remission of Atopic Dermatitis.

PURPOSE: Atopic dermatitis (AD) is characterized by chronic inflammation, which frequently recurs, is exacerbated, and enters remission. A maintenance remission period is important for AD patients. We developed a formulation for use during AD remission, containing heparinoid and pseudo-ceramide that forms a lamellar structure. We evaluated the allergen permeability and examined the formulation's efficacy in maintaining remission in patients with AD. MATERIALS AND METHODS: Seventeen AD patients applied a cream containing 0.3% heparinoid and pseudo-ceramide (test cream group, n = 10), or a general cream containing 0.3% heparinoid (control cream group, n = 7) to their arm for four weeks after inducing remission with the application of a steroid cream for two weeks. RESULTS: The lamellar structure of the test cream was confirmed with small- and wide-angle x-ray scattering analysis and observation by transmission electron microscopy. The test cream inhibited the penetration of V8 protease significantly compared to the control cream in vitro. According to AD severity score by dermatologists, the effects remission maintenance of the test cream group were comparable to those of the control cream group. However, the test cream group had a significantly increased skin hydration value compared to the control cream group. A significant decrease in transepidermal water loss, an indicator of skin barrier function, was shown in the test cream group compared to the control cream group. CONCLUSION: The cream with lamellar structures containing heparinoid and pseudo-ceramides may inhibit allergen penetration. Moreover, skin properties improved during the remission period; thus, the formulation we developed was suitable for use during the AD remission period.

Early parenting program as intervention strategy for emotional distress in first-time mothers: a propensity score analysis.

The purpose of this study is to evaluate the effectiveness of a single session intervention designed to reduce emotional distress in first-time mothers. We held a parenting class for first-time mothers who had given birth at a university hospital in Tokyo, Japan. The program of the class consists of lectures on infant care and group discussion, which is a common form of intervention in Japan. The effectiveness of intervention is assessed according to differences in emotional distress experienced by class participants and nonparticipants, and analyzed by the use of a propensity score method to avoid self-selection bias. In order to be more confident about our results, we employ several variations of this method. Results from statistical analysis show that although the effectiveness of the intervention was limited, it was able to alleviate subjects' loss of self-confidence as mothers. Because this outcome shows a good degree of consistency across methods, it can be considered robust. Moreover, it is roughly consistent with previous studies. Effectiveness can probably be increased by developing a program that improves upon the intervention.

Prenatal diagnosis of persistent left and absent right superior vena cava.

We report a case of persistent left superior vena cava (LSVC) with absent right superior vena cava (RSVC) diagnosed prenatally. At 27 weeks' gestation, routine fetal ultrasonography showed an abnormal four-chamber view. Fetal echocardiography revealed a markedly enlarged coronary sinus in the four-chamber view. An absent RSVC and a persistent LSVC were demonstrated in the three-vessel view. No additional cardiac malformations were seen before birth. Postnatal imaging confirmed the prenatal diagnosis. The combination of persistent LSVC and absent RSVC without any other cardiac malformations is an extremely rare cardiac anomaly and less commonly detected in utero. Identification of a dilated coronary sinus in the four-chamber view, with atypical features in the three-vessel view, may lead to the antenatal diagnosis of this condition.

Life-threatening atrial tachycardia after the Senning operation in a patient with transposition of the great arteries.

Atrial tachycardia (AT) is recognized as a risk factor of sudden death (SD) in patients with transposition of the great arteries (TGA) after atrial switch operation. A 20-year-old man with TGA who had undergone a Senning operation experienced a near-miss SD event 1 day after appearance of AT. He was successfully resuscitated by electrical defibrillation for documented ventricular fibrillation. An electrophysiological study showed three types of AT, and all of them were terminated by radiofrequency catheter ablation (RFCA). We consider that symptomatic AT against cardiac medications is indicated for RFCA therapy.

Antenatal three-dimensional sonographic features of Roberts syndrome.

INTRODUCTION: We present a fetus whose characteristics most likely represent Roberts syndrome. CASE REPORT: Prenatal diagnosis at 21 weeks and 1 day age of gestation was made employing conventional two-dimensional (2D) sonography, showing shortened upper and lower extremities. An umbilical cord cyst was also noted. Three-dimensional (3D) sonography revealed additional abnormalities which included bilateral hypoplastic and proximal implantation of the thumb, exophthalmic eyes, and suspected cleft lip. Shortened upper extremities, contracted legs, and an umbilical cord cyst were also clearly confirmed. Transparent X-ray mode uncovered the absence of radial and ulnar bones. Subtle fetal structures were readily discernible with 3D sonography so that the family could understand the fetal condition in utero. They underwent counseling, and opted for termination of the pregnancy. The sonographic findings were confirmed after delivery, supported by a 3D computed tomographic skeletal survey. CONCLUSION: To the best of our knowledge, this is the first report of Roberts syndrome employing antenatal 3D sonographic imaging.

Steroid pulse therapy for Kawasaki disease unresponsive to additional immunoglobulin therapy.

BACKGROUND: The optimal management of Kawasaki disease (KD) unresponsive to intravenous immunoglobulin (IVIG) therapy remains unclear. OBJECTIVE: To prospectively evaluate the efficacy and safety of intravenous methylprednisolone pulse (IVMP) therapy in KD cases unresponsive to additional IVIG. METHODS: KD patients who initially received IVIG (2 g/kg/24 h) and acetylsalicylic acid within nine days after disease onset were studied. Patients who did not respond received additional IVIG (2 g/kg/24 h), and those who still did not respond were given IVMP (30 mg/kg/day) for three days, followed by oral prednisolone. The response to treatment, echocardiographic findings and adverse effects were evaluated. RESULTS: Among 412 KD cases, 74 (18.0%) were treated with additional IVIG; 21 (28.4%) of the latter cases subsequently received IVMP followed by prednisolone. All cases became afebrile soon after IVMP infusion and did not have a high-grade fever during treatment with prednisolone for two to six weeks. Four weeks after disease onset, coronary artery lesions (CAL) were diagnosed according to the Japanese Ministry of Health and Welfare or the American Heart Association criteria in two of the 21 cases treated with IVMP plus prednisolone; among all 412 cases, three (0.7%) and eight (1.9%) had CAL according to each criteria, respectively. All CAL regressed completely one year after disease onset. Adverse effects of IVMP, such as hypothermia and sinus bradycardia, resolved spontaneously. CONCLUSIONS: In KD patients unresponsive to additional IVIG, IVMP promptly induced defervescence, and subsequent oral prednisolone suppressed recurrence of fever. IVMP followed by prednisolone therapy may prevent CAL, without severe adverse effects.

Formation of lysophosphatidic acid, a wound-healing lipid, during digestion of cabbage leaves.

Lysophosphatidic acid (LPA) is a lipid mediator that plays a role in the process of wound healing in animal tissues, including the digestive tract. We determined LPA in several foodstuffs, and found that cabbage leaves were the richest source of LPA. We also found that, at 22 and 195 nmol/g (wet weight), LPA and phosphatidic acid (PA) were respectively formed during mastication of raw cabbage leaves and that the resulting PA was converted to LPA by pancreatic phospholipase A(2). The lipid extract obtained from ground cabbage leaves promoted the proliferation of Swiss 3T3 fibroblasts and the motility of HGC-27 cells, stomach-derived epithelial-like cells, at physiologically relevant concentrations. These activities of cabbage lipids were inhibited by Ki16425, an LPA-receptor antagonist. LPA formed during the digestion of cabbage leaves may be one of the components in the beneficial effect of ingested cabbage on a damaged digestive tract.

Causal model structure analysis of emotional unrest in first time mothers faced with persistent infant crying 6-7 weeks postpartum.

UNLABELLED: First time mothers faced with a continuously crying infant, who do not know how to stop their child from crying, are at risk of developing anxiety and other types of Emotional Unrest. Because continuous Emotional Unrest may lead to an emotional crisis, it is important for healthcare providers to understand causal factors associated with Emotional Unrest among first time mothers faced with a persistently crying infant 6-7 weeks postpartum. METHODS: A cross-sectional survey was carried out on a study population of 217 first time mothers with infants aged 6-7 weeks. A self-administered questionnaire was used to measure Emotional Unrest, Neigh- borhood Social Organization, Effective Parenting Support, Understanding of Crying and the Effect of Infor- mation Available on Crying, Current Parenting Environment and Characteristics of the Mother and Child. Potential causal factors for Emotional Unrest were explored using structural equation modeling. RESULTS: One hundred and thirty two (60.8%) of the mothers experienced persistent crying in the period 6-7 weeks after the birth of their child and 108 (49.7%) mothers experienced Emotional Unrest. Factor analysis revealed five important constructs to be causal factors of Emotional Unrest: Effective Parenting Support, Effective Assistance with Regard to Crying, Confused by Information, Neighborhood Social Organi- zation and Feelings of Fatigue and Anxiety. Structural equation modeling indicated that Effective Parenting Support, Effective Assistance with Regard to Crying, Confused by Information and Neighborhood Social Organization affect Feelings of Fatigue and Anxiety, which then leads to Emotional Unrest. CONCLUSION: This study demonstrated that it will be necessary in future for health-care workers to pro- vide early intervention, such as accurate information about crying as well as concrete and appropriate response measures for dealing with crying. Furthermore, in motherhood/parenting classes and the dis- charge guidance conducted at birthing centers, it will be necessary to provide guidance on what kind of effective support and local area resources are available to parents following the birth of their child. [Asian Nursing Research 2009;3(1):1-14].

The basic problems of bed-fence-covers in hospitals for preventing accidents based on the investigation into the actual conditions: for developing the safer bed-fence-cover for elderly patients.

The basic problems of bed-fence-covers in hospitals were listed for preventing relevant accidents based on the investigation into actual conditions in a hospital in Kawasaki City. There were many elderly aged patients with dementia, higher brain dysfunction or psychosis in the hospital. They sometimes fell into the gaps of bed-fences, resulting in serious accidents. It was due not only to the structure of the bed-fences, but also to the characteristics of patients. Therefore the authors listed up the problems concerning the accidents to recognize them; (i) as physical conditions, (1) they could not move by themselves because of paralysis or decrease of fitness, (2) they could not feel when they were pinched by the gaps because of decrease of sense, (3) they moved irregularly or violently without their intention, and (ii) as mental conditions, (1) they took dangerous behaviors because of dementias, (2) they could not control their behaviors because of higher brain dysfunctions, (3) they could not control their feelings and moved violently because of mental disorders. The authors intend to develop safer bed-fence-covers to prevent these accidents for the elderly patients.

A trial product of a new safety belt for a wheelchair user and its evaluation based on the actual investigation of fall accidents related to wheelchairs in a hospital.

Old-aged patients, especially when they cannot keep stable sitting postures on wheelchairs, may get hurts seriously by falls. Preventing fall accidents is one of the most important subjects for keeping ADL of old-aged persons. We investigated the fall accidents related to from wheelchairs that occurred in a hospital (Asao General Hospital of Rehabilitation), and tried to make a new type of safety belts for old-aged wheelchair users based on the investigation. The results of trials using the product was evaluated by the care givers. The number of fall accidents in the hospital amounted to 226 cases within a year. It is noticed that the patients removed their belts by themselves intentionally or unintentionally, which is the most important point of the accidents. The evaluators of new belts were 91 care givers. The evaluation items were (1) the convenience for caregivers to fasten and remove the belts, (2) the ability of holding the patient on the wheelchair, (3) the safeness to prevent the fall from wheelchair (including the disability of removing a belt by the user), (4) the appearance when the usually used belts and the new belts were used, and only for the new belts, (5) the hygienic aspect and (6) the utility of the pocket. The new belts got better marks than the usually used belts. We intend to further improve the trial product (new belt) to be safer, more effective and more comfortable, based on the evaluation.

[Methylprednisolone pulse therapy in Kawasaki disease].

A role of intravenous methylprednisolone pulse (IVMP) therapy has not been established for Kawasaki disease (KD) patients unresponsive to initial intravenous immunoglobulin (IVIG) therapy. We conducted a control study in 22 KD patients unresponsive to initial IVIG to compare IVMP with additional IVIG. IVMP induced faster but temporary resolution of fever and more adverse effects such as bradycardia. For the last four years, 62 KD patients unresponsive to initial IVIG have been treated with additional IVIG, and 17 unresponsive to additional IVIG with IVMP, followed by oral prednisolone. Among of them, coronary artery lesions were detected in two patients, but regressed in 6 months. This protocol may be useful for eradication of coronary artery lesions.

Changes in breast skin temperature during the course of breastfeeding.

Breast skin temperature was measured during breastfeeding in 11 mothers on a total of 47 occasions, using a Coretemp CM-210 (Terumo Corp, Tokyo, Japan), to examine the changes of breast skin temperature during the course of breastfeeding. In both breasts, the breast skin temperature was significantly higher than the baseline skin temperature from the beginning of suckling up to 5 minutes after completion of suckling, and the mean breast skin temperature before breastfeeding between 4 days and 8 weeks postpartum was significantly higher than that on the first 1 to 2 days postpartum. These results show that the breast skin temperature increases between the first 1 to 2 days and 4 to 5 days postpartum and that breast skin temperature remains high during suckling and up to 5 minutes after the completion of suckling. These findings will be useful for educating mothers during the perinatal period on the normal course of breastfeeding by individual instruction or in classes.