Relationship among Falls, Fear of Falling, and Physical Activity Level in Patients on Hemodialysis.

OBJECTIVE: Patients on hemodialysis are highly susceptible to falls and fractures. Amplified apprehension regarding the fear of falling (FOF) constitutes a risk factor that restricts physical activity and escalates the probability of falls among the elderly population. This study aimed to elucidate the association between falls and FOF and physical activity in patients on hemodialysis. METHODS: A prospective cohort study was conducted across 9 centers. FOF was assessed using the Falls Efficacy Scale-International (FES-I). Physical activity was assessed using the Japanese version of the International Physical Activity Questionnaire short form. Subsequently, falls were monitored over a duration of 1 year. Logistic regression analysis was performed to evaluate the relationship between falls and FOF and physical activity. In addition, in the receiver operating characteristic analysis, the cutoff value of FES-I that predicts falls was determined using the Youden Index. A restricted cubic spline curve was utilized to analyze the nonlinear association between falls and the FES-I. RESULTS: A total of 253 patients on hemodialysis (70.0 [59.0-77.0] years old; 105 female [41.5%]) were included in the analysis. During the 1-year observation period, 90 (35.6%) patients experienced accidental falls. The median FES-I score was 36.0 (24.0-47.0) points, and patients with higher FES-I scores had more falls. Following adjusted logistic regression analysis, FES-I exhibited an independent association with falls (OR = 1.04; 95% CI = 1.01-1.06), but physical activity was not. The area under the receiver operating characteristic curve was 0.70 (95% CI = 0.64-0.77), and the FES-I threshold value for distinguishing fallers from non-fallers was determined as 37.5 points (sensitivity 65.6%, specificity 35.0%). A nonlinear relationship between falls and FES-I was observed. CONCLUSION: FOF was associated with the incidence of falls in patients on hemodialysis. IMPACT: The evaluation and implementation of interventions targeting the FOF may mitigate the risk of falls.

Early Ambulation Shortened the Length of Hospital Stay in ICU Patients after Abdominal Surgery.

The optimal time to ambulation remains unclear for intensive care unit (ICU) patients following abdominal surgery. While previous studies have explored various mobilization techniques, a direct comparison between ambulation and other early mobilization methods is lacking. Additionally, the impact of time to ambulation on complications and disuse syndrome prevention requires further investigation. This study aimed to identify the optimal time to ambulation for ICU patients after abdominal surgery and considered its potential influence on complications and disuse syndrome. We examined the relationship between time to ambulation and hospital length of stay (LOS). Patients were categorized into the nondelayed (discharge within the protocol time) and delayed (discharge later than expected) groups. Data regarding preoperative functioning, postoperative complications, and time to discharge were retrospectively collected and analyzed. Of the 274 postsurgical patients managed in the ICU at our hospital between 2018 and 2020, 188 were included. Time to ambulation was a significant prognostic factor for both groups, even after adjusting for operative time and complications. The area under the curve was 0.72, and the cutoff value for time to ambulation was 22 h (sensitivity, 68%; specificity, 77%). A correlation between time to ambulation and complications was observed, with both impacting the hospital LOS (model 1: p < 0.01, r = 0.22; model 2: p < 0.01, r = 0.29). Specific cutoff values for time to ambulation will contribute to better surgical protocols.

Influence of patients' walking ability at one-week post-proximal femur fracture surgery on the choice of discharge destination in Japan.

[Purpose] With the innovation of healthcare delivery systems, a need for early determination of patients' discharge outcomes arises after proximal femur fracture surgery, to reduce the burden on healthcare infrastructure. Several studies have examined the extent of walking ability early in the postoperative period to predict the outcome destination. In this study, as an additional validation of these studies, we examined the effect of walking ability on the hospital discharge prognosis of patients in the first week after proximal femur fracture surgery in Japan. [Participants and Methods] Medical records of 228 patients with proximal femur fractures, aged ≥75 years old, admitted between April 2015 and March 2019, were retrospectively analyzed. The objective variable was discharge destination. The main evaluation factor was walking ability one-week post-surgery. [Results] Good walking ability and the company of a relative living together one week post-surgery were significant determining factors of discharge destination. [Conclusion] The ability to walk and the presence of a co-resident one week after surgery increased the likelihood of proximal femur fracture patients to be discharged directly to home. Our findings may help rehabilitation professionals make better decisions regarding discharge destination.

Factors Affecting the Length of Hospital Days After Laparoscopic Gastrectomy for Elderly Patients with Gastric Cancer.

PURPOSE: To clarify the factors affecting the length of hospitalization after laparoscopic gastrectomy based on the physical function, body composition, and postoperative course of the patients. METHODS: Of the patients with gastric cancer who underwent laparoscopic resection at the Ageo Central General Hospital, Japan, during 2018-2019, 51 underwent physical therapy. Data regarding the objective variables, such as length of postoperative hospital stay, and baseline attributes, such as age, body weight, body mass index (BMI), and corrected limb muscle mass, postoperative course (operation time, the estimated blood loss, the day before walking independently), preoperative physical function (grip strength, 6-min walking distance), and preoperative respiratory function (vital capacity [VC]%, one-second rate) were collected retrospectively from the medical records and analyzed using multiple regression plots. RESULTS: The most suitable hospital day model after surgery is one that incorporates the total postoperative course, respiratory function, physical function (R2 = 0.45, p < 0001), and operation time (ß = 0.12, p < 0.06). The information of the day before independent walking (ß = 0.68, p < 0.001) and % VC (ß = -0.19, p < 0.04) was extracted as factors. CONCLUSION: We concluded that the operation time, walking independence days, and % VC influence the postoperative length of hospital days.

Differences between the Sexes in the Relationship between Chronic Pain, Fatigue, and QuickDASH among Community-Dwelling Elderly People in Japan.

Chronic pain and fatigue have negative effects on the health, ADL, work, and hobbies of the elderly. As the proportion of people 65 years of age and older in the population increases, chronic pain and disability research regarding this group is receiving more consideration. However, little empirical evidence of the association between chronic pain, fatigue, and physical disability between the sexes is available. This study investigated the association between chronic pain, fatigue, and instrumental activities of daily living among community-dwelling elderly people by sex in Japan. Concerning the presence of chronic pain, 61% of males and 78% of females reported chronic pain, indicating that many elderly people living in the community suffer from chronic pain and fatigue on a daily basis. The number of sites of chronic pain was higher in females than in males (p = 0.016), with more chronic pain in the knees (p < 0.001) and upper arms (p = 0.014). Regarding chronic pain, males showed a higher correlation with QuickDASH-DS (rs = 0.433, p = 0.017) and QuickDASH-SM (rs = 0.643, p = 0.018) than females. Furthermore, fatigue also showed a higher correlation with QuickDASH-W (rs = 0.531, p = 0.003) in males than in females. These results indicate that the association between chronic pain, fatigue, and QuickDASH differed between the sexes among community-dwelling elderly people in Japan. A better understanding of the risk factors for elderly chronic pain and fatigue among sexes will facilitate the development of elderly healthcare welfare and policies.

Three-dimensional imaging of podocyte ultrastructure using FE-SEM and FIB-SEM tomography.

Podocytes are specialized epithelial cells used for glomerular filtration in the kidney. They can be divided into the cell body, primary process and foot process. Here, we describe two useful methods for the three-dimensional(3D) visualization of these subcellular compartments in rodent podocytes. The first method, field-emission scanning electron microscopy (FE-SEM) with conductive staining, is used to visualize the luminal surface of numerous podocytes simultaneously. The second method, focused-ion beam SEM (FIB-SEM) tomography, allows the user to obtain serial images from different depths of field, or Z-stacks, of the glomerulus. This allows for the 3D reconstruction of podocyte ultrastructure, which can be viewed from all angles, from a single image set. This is not possible with conventional FE-SEM. The different advantages and disadvantages of FE-SEM and FIB-SEM tomography compensate for the weaknesses of the other. The combination renders a powerful approach for the 3D analysis of podocyte ultrastructure. As a result, we were able to identify a new subcellular compartment of podocytes, "ridge-like prominences" (RLPs).

Factors Affecting Psychological Stress in Healthcare Workers with and without Chronic Pain: A Cross-Sectional Study Using Multiple Regression Analysis.

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Factors Affecting Psychological Stress in Healthcare Workers with and without Chronic Pain: A Cross-Sectional Study Using Multiple Regression Analysis.

Background and Objectives: Pain affects psychological stress and general health in the working population. However, the factors affecting psychological job stress related to chronic pain are unclear. This study aimed to clarify the structural differences among factors affecting psychological job stress in workers with chronic pain and those without pain. Materials and Methods: A stepwise multiple regression analysis revealed the differences in structure between the psychological stress of workers with chronic pain and those with no pain. Psychological job stress by the Brief Job Stress Questionnaire was used as the dependent variable, with psychological state (depression and anxiety), specifically that characteristic of chronic pain (pain catastrophizing); information on the nature of the pain (intensity and duration); and number of years of service as independent variables. Selected independent variables were evaluated for collinearity. Results: In the model with psychological stress as a dependent variable (chronic pain: r2 = 0.57, F = 41.7, p < 0.0001; no-pain: r2 = 0.63, F = 26.3, p < 0.0001), the difference between the experiences of workers with chronic pain and those with no pain was that chronic pain was associated with depression (Beta = 0.43, p < 0.0001) and no pain with anxiety (Beta = 0.34, p < 0.0001). In the model with chronic pain-related depression as a dependent variable (r2 = 0.62, F = 41.7, p < 0.0001), job-life satisfaction (Beta = -0.18, p = 0.0017) and magnification (a dimension of pain catastrophizing; Beta = 0.16, p < 0.0001) were significant. Conclusions: The results of this study suggest that the psychological characteristics of chronic pain, such as depression and magnification, should be considered when evaluating and intervening in the job stress of workers with chronic pain.

The relationship between pain psychological factors and job stress in rehabilitation workers with or without chronic pain.

BACKGROUND: Pain is affected by pain psychological factors (PPFs), whereas relationship between PPFs and job stress are unclear. OBJECTIVE: This study aimed to elucidate the relationship between PPFs and job stress in workers. METHODS: The study participants were the staff of the rehabilitation department of a core hospital. After undergoing a preliminary survey (38/43, 88% response rate), the rehabilitation workers were divided into the chronic pain group (CPG, n = 18) and the nonpain group (NPG, n = 13). RESULTS: Depression, anxiety, and magnification in the CPG were significantly associated with depressed mood and total stress response. Anxiety in the NPG was also significantly associated with all stress responses, except irritability and feelings of anxiety. Furthermore, all subscales of the Pain Catastrophizing Scale in the NPG were significantly and negatively associated with the vigor of stress responses. CONCLUSIONS: Chronic pain in workers was associated with severe job stress, and increased job stress worsened the state of chronic pain. Pain catastrophizing may be associated with early job stress in a person with no pain. This finding revealed a difference between the CPG and NPG and may be important for managing workers with job stress or pain.

Validation of the shoulder36 for the activities of daily living with shoulder disorders.

[Purpose] The Shoulder36 (V 1. 3) is a regional questionnaire in Japan that has not been validated as a functional evaluation of the shoulder via a thorough comparison with other questionnaires (e.g., QuickDASH). The purpose of this study was to test the reliability, validity, and responsiveness of the Shoulder36 (V 1. 3). [Subjects and Methods] A series of 46 patients with upper extremity disorders completed the Shoulder36 (V 1. 3) and the QuickDASH Japanese version (QuickDASH-JSSH). The reliability of the Shoulder36 was assessed for consistency and validity. The correlation coefficients between the Shoulder36 (V 1. 3) and the QuickDASH-JSSH were obtained. [Results] The total of the Cronbach's alpha coefficients for the Shoulder36 (V 1. 3) was 0.98. The intraclass correlation coefficients for the six domains of the Shoulder36 (V 1. 3) were similarly high, ranging from 0.81 to 0.94. The correlations between the six domains of the Shoulder36 (V 1. 3) and the three domains of the QuickDASH subscales ranged from -0.43 to -0.78. [Conclusion] The Shoulder36 (V 1. 3) was able to evaluate the relationship between activities of daily living and shoulder joint function with the same degree of accuracy but in more detail than QuickDASH-JSSH. Therefore, it should prove to be a valuable asset in physiotherapy plans and have multiple research applications.