Insights from primary care workers supporting people at risk of suicide in local communities in Japan: A qualitative descriptive study.

AIM: To identify insights for supporting people at risk of suicide in the community based on primary healthcare workers' experiences. DESIGN: Qualitative descriptive design. METHODS: Semi-structured interviews were conducted with fifteen primary healthcare workers employed by Japanese municipalities between August and October 2019. The data were subjected to qualitative descriptive analysis. RESULTS: The analysis revealed eleven subthemes, clustered under the following three themes: (1) fostering 'opportunities for discovery' for people at risk of suicide by encompassing strategies such as increasing access to services and promoting a holistic understanding of the life cycle; (2) fostering 'meaningful connections' by searching for channels to reach the heart and taking approaches from different objectives; and (3) engaging in 'risk management', by understanding and coping with real-life struggles and implementing timely crisis intervention. CONCLUSION: Not only direct care targeting suicide prevention but also holistic care that includes atypical perspectives such as 'approaches from different objectives' may provide important insights for supporting people with suicide risk. IMPLICATIONS FOR PRACTICE: Beyond the limitations of existing suicide risk screening methods, this study highlights the importance of a holistic approach that sees people at risk of suicide in the context of their daily lives and aims to alleviate the difficulties in their lives that have brought them to the point of considering suicide. IMPACT: By describing support focused on the difficulties that people at risk of suicide face in their daily lives, this study identified insights for supporting people at risk of suicide in communities where screening and intervention are difficult. These findings will contribute to the relief of people at risk of suicide by stimulating suicide prevention measures in primary healthcare settings. REPORTING METHOD: This study complied with the COREQ guidelines. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Experience with Support at Workplaces for People with Young Onset Dementia: A Qualitative Evaluation of Being Open about Dementia.

Young-onset dementia (YOD) occurs at <65 years of age. Individuals with YOD experience social and psychological disturbances, including a loss of employment. This economic toll affects them, their families, and their caregivers. Employers have an increasing role in supporting affected employees in remaining employed, an important component of the "fight for their dignity". This study aims to clarify the workplace support experiences of employees with YOD. To assess the experiences of employers with at least one affected employee, we interviewed personnel from eight facilities for qualitative analysis. We identified 5 unique categories and 14 subcategories encompassing the following aspects: confusion at the workplace stemming from the uncertainty of the disease, sensitivity when recommending consultation and diagnosis, creating a system that considers safety and security, building consensus among employers, supporting employees with YOD and their families, and assisting the individual with YOD with activities of daily living. Employers should be open to addressing dementia-related issues in the workplace, including obtaining information from employees' physicians so that appropriate support can be provided. Appropriate support can include work accommodations, needs-based support, and meetings with families to build consensus for continued employment. This information can facilitate the creation of new training materials for employers.

Difficulties in suicide prevention facing primary healthcare workers based on the characteristics of people with suicide risk and healthcare systems.

AIMS: To clarify difficulties in suicide prevention that primary healthcare workers face based on the characteristics of people with suicide risk and healthcare systems. DESIGN: Qualitative descriptive design. METHODS: Semi-structured interviews were held with 15 primary healthcare workers employed by a Japanese municipality from August to October 2019. Data were subjected to qualitative descriptive analysis, performed in accordance with the COREQ guidelines. RESULTS: Analysis identified 11 subthemes and three themes. Theme 1, 'Failure to connect with support', included the subthemes of 'Obstacles to communication' and 'Refusal of support'. Theme 2, 'Support that cannot offer a solution', included the subthemes 'Dying by suicide even while receiving psychiatric treatment' and 'Resolved to dying'. Theme 3, 'Isolation', included the subthemes 'Loneliness despite being connected with others' and 'Lack of community development'. CONCLUSION: In relation to difficulties based on the characteristics of people with suicide risk, it is important to be aware of their unspoken views and to increase mental health literacy in society. Overcoming difficulties in relation to the primary healthcare system requires training and continuing education for professionals specializing in mental health and suicide prevention. To avoid isolating healthcare workers and ensure that those in need of treatment access support, systems should be established that enable collaboration with mental health specialists across organizations. IMPACT: Primary healthcare workers, who are often the first point of contact for people with suicide risk, play a key role in suicide prevention. The identified challenges they face include difficulties in connecting people with suicide risk with support, a sense of helplessness because some people die even while receiving treatment and difficulties in building communities that prevent isolation. These findings can contribute to measures for alleviating the difficulties primary healthcare workers face, reforming primary healthcare systems for suicide prevention and saving lives. PATIENT OR PUBLIC CONTRIBUTION: In this study, primary healthcare workers working in the study area participated as interviewees. They also confirmed the truthfulness of the study results, thereby ensuring the rigour of the data analysis.

Work-related experiences of people living with young-onset dementia in Japan.

Dementia that occurs before age 65 years is defined as young-onset dementia (YOD). YOD develops during the prime of a person's working life and has a major impact on not only work but life in general. Therefore, Japan is promoting measures to support work and social participation, taking into account the characteristics of people living with YOD. Given the rarity of YOD, few studies have examined the difficulties faced by people living with YOD during this life stage or the kinds of support they require. We believe that studying these difficulties and support requirements will contribute to prolonging the careers of people living with YOD and to providing them support during social, emotional and economic crises. This qualitative study aims to clarify the experiences of working-age Japanese people living with YOD to examine, from their perspective, possibilities for employment support. For this study, people living with YOD who were currently working were recruited by snowball sampling. This study was conducted in Japan between September 2018 and February 2019. A semi-structured interview was conducted, and the contents were transcribed and analysed using Colaizzi's qualitative methodology. Four categories were derived: (a) crisis from continuing to work, (b) seeking support, (c) overcoming challenges to work and (d) reaffirming a sense of purpose by resuming work and social participation. Participants were able to continue working and socialising by letting others know about their illness and seeking support. In the process of reaffirming a sense of purpose by resuming work and social participation, participants continued working or transitioned to socially active lives after leaving their job thanks to the support of work colleagues and medical and healthcare/welfare professionals who understand YOD. The results indicate a need for awareness raising in the workplace to promote understanding of such professional support and its significance.

Temperament and professional quality of life among Japanese nurses.

Aim: To investigate associations between temperament and professional quality of life among Japanese nurses. Design: A descriptive-correlational study using self-administered anonymous questionnaires. Methods: Questionnaires were collected from 1,267 nurses. We used analysis of covariance to examine associations between tendencies of temperament (depressive, cyclothymic, hyperthymic, irritable and anxious) and professional quality of life subscales (compassion satisfaction, burnout, compassion fatigue) first for all participants and then again after dividing the participants into two groups based on years of experience. Results: Nurses' professional quality of life was associated with innate temperament and years of experience. Nurses with any of depressive, cyclothymic, irritable, or anxious tendencies showed significantly lower compassion satisfaction and higher burnout and compassion fatigue than those without these tendencies. Nurses with hyperthymic tendencies showed significantly higher compassion satisfaction and lower burnout than those without the tendency.

[Work environment that support workers with diseases to maintain a work-treatment balance in Ishikawa prefecture: relationship with company scale and type of industry].

OBJECTIVES: We investigated the support environments in companies in Ishikawa prefecture that aim to maintain a balance between work and treatment of their employees' diseases. The relationships between these strategies, company size, and type of industry were examined. METHODS: In 2016, as a part of a survey, questionnaires were sent to 1,491 companies with ≥ 50 employees. Of the 688 companies who responded (response rate, 46.1%), 624 companies who provided complete main survey data were included in the final analysis. The questionnaire acquired responses on systems for arranging working hours and sick leave, the role of occupational health physicians, and the outcomes of support that was offered over the last 3 years. The targeted diseases were mental health problems, such as depression, and physical diseases. Responses were compared according to the size of the company and type of industry. RESULTS: A total of 409 companies (65.5%) reported their experiences of helping employees maintain a balance between treatment and work over the last 3 years. Employees with depression received the most support. In 36.7% of the companies, some employees had retired due to their disease over the last 3 years, with the highest proportion in medical care and welfare businesses. Further, 66% of the companies had a support system to help employees with diseases, and the proportion of companies with flexible working hours and sick leave increased with the number of employees. The proportion of companies with shorter working hours and hourly paid leave was lower in the manufacturing industry and transportation/traffic business. The proportion of companies in which an occupational health physician interviewed employees who took sick leave and returned to work was 22%. CONCLUSIONS: Almost 70% of the companies reported supporting workers during their disease treatment. There were some differences in arranging these support systems between companies of varying sizes and type of industry. The enablement of companies to support workers with diseases so that they keep working and receive treatment requires consideration of company characteristics.

[Workplace preparedness and recognition of the continued employment of employees with early onset dementia].

OBJECTIVES: This study aimed to clarify workplace recognition regarding working continuation of employees with early onset dementia. METHODS: An anonymous self-administrated questionnaire was emailed to a prefecture consisting of 1,293 workplaces with 50 or more employees. Survey items assessed demographics, workplace regulations supporting employees, coworker acceptance of employees with early onset dementia, and recognition and dealing with employees with early onset dementia. The possibility of employees with early onset dementia continuing work was compared for demographics, workplace regulations supporting employees, and cooperation in the workplace. RESULTS: Responses were received from 375 workplaces, and 273 valid responses were analyzed. In total, 133 workplaces (48.7%) answered that there was a high possibility of continuing employment for employees with early onset dementia and 135 workplaces (49.5%) were aware of early onset dementia. Less than 10% of workplaces reported examination of managing employees with early onset dementia, implementation/planning of training and information dissemination to managers or employees. Factors related to the possibility of continuing employment were number of employees (< 100, p = .015, odds ratio = 2.02), workplace regulations supporting employees with early onset dementia (p = .011, odds ratio = 2.22), and workplace coordination with occupational health staff (p = .004, odds ratio = 2.16). CONCLUSIONS: There is a general need for training and information regarding early onset dementia in the workplace. For smaller companies, external advice and support in providing systems suitable to each workplace is necessary.

Prediction of the Oral Pharmacokinetics and Food Effects of Gabapentin Enacarbil Extended-Release Tablets Using Biorelevant Dissolution Tests.

The purpose of this research was to establish an in vitro dissolution testing method to predict the oral pharmacokinetic (PK) profiles and food effects of gabapentin enacarbil formulated as wax matrix extended-release (ER) tablets in humans. We adopted various biorelevant dissolution methods using the United States Pharmacopeia (USP) apparatus 2, 3 and 4 under simulated fasted and fed states. Simulated PK profiles using the convolution approach were compared to published in vivo human PK data. USP apparatus 2 and 4 underestimated the in vivo performance due to slow in vitro dissolution behaviors. In contrast, biorelevant dissolution using USP apparatus 3 coupled with the convolution approach successfully predicted the oral PK profile of gabapentin enacarbil after oral administration of a Regnite® tablet under fasted state. This approach might be useful for predicting the oral PK profiles of other drugs formulated as wax matrix-type ER tablets under fasted state.

Involvement of Tumor Lymphatic System in Translocation of Intratumorally Injected Liposomes.

The tumor microenvironment is one of the key factors contributing to the efficiency of drug delivery to a tumor. It has been reported that lymphangiogenesis is induced in certain tumors. Because the lymphatic system functions as a drainage one, it is possible that tumor lymphatic vessels alter not only the tumor microenvironment, but also the distribution of drug nanocarriers accumulated in the tumor tissue. Herein, we aimed to elucidate the involvement of the tumor lymphatic system in the translocation of intratumoral liposomes to regional lymph nodes by using vascular endothelial growth factor (VEGF)-C-overexpressing B16F10 tumor-bearing mice (B16/VEGF-C). When the amount of polyethylene glycol (PEG)-modified liposomes in lymph nodes (cervical, brachial, axillary, and inguinal lymph nodes) was measured after the radiolabeled liposomes had been intratumorally injected into B16/VEGF-C-bearing mice or wild-type B16-bearing mice, the accumulation of liposomes in the axillary and inguinal lymph nodes was significantly higher on the tumor-implanted side of B16/VEGF-C-bearing mice than on that of the B16-bearing ones. On the other hand, the accumulation of liposomes in these lymph nodes on the control side (no implantation) of either type of tumor-bearing mice was very low; and no difference could be observed between the 2 sides. Furthermore, the intratumoral distribution of liposomes was observed to be located near the lymphatic vessels. These results indicate that the tumor lymphatic system contributed to the extrusion of a portion of PEG-modified liposomes from the tumor tissue, suggesting that tumor lymphangiogenesis would be one of the key factors to determine the intratumoral distribution of liposomes and their subsequent fate.