Japanese public health nurses classified based on empathy and secondary traumatic stress: variable-centered and person-centered approaches.

BACKGROUND: Healthcare providers frequently help traumatized people and are regularly exposed to indirect trauma from their work, resulting in negative psychological responses, such as secondary traumatic stress. Empathy has been associated with patient's quality of care and secondary traumatic stress among healthcare providers. However, the relationship between dispositional empathy and secondary traumatic stress has not been fully elucidated. This study used person- and variable-centered approaches to explore the nature of this relationship. METHODS: A total of 1,006 Japanese public health nurses working in the Tohoku region and Saitama prefecture completed questionnaires that included scales assessing dispositional empathy, secondary traumatic stress, and burnout. First, we examined predictors of secondary traumatic stress using multiple linear regression analysis. Then, we conducted a latent profile analysis to classify participants into unique groups based on four subscales of dispositional empathy (i.e., empathic concern, perspective taking, personal distress, fantasy) and secondary traumatic stress. Finally, we compared the mean values of the study variables across these groups. RESULTS: The multiple regression indicated that in those working in Saitama prefecture, lifetime traumatic experiences, work-related distress, and personal distress were positively related to secondary traumatic stress, but perceived support was negatively related to secondary traumatic stress. Latent profile analysis extracted four unique subgroups. Group 1 displayed the highest secondary traumatic stress levels. Group 2 was characterized by the highest level of empathic concern, personal distress, and fantasy and the lowest perspective taking. Group 3 had a moderate secondary traumatic stress level. Group 4 had the lowest secondary traumatic stress and personal distress scores. In these four groups, the burnout scale (exhaustion, cynicism, and professional efficacy) showed a pattern similar to the secondary traumatic stress scale. CONCLUSIONS: Our person-centered approach showed that this sample of public health nurses could be classified into four unique groups based on their empathy and secondary traumatic stress scores. Although this group of public health nurses was not large, one group displayed high personal distress levels and high secondary traumatic stress levels. Further research is needed to determine effective interventions for this group.

Validity and reliability of the Secondary Traumatic Stress Scale-Japanese version.

AIM: This study assessed the validity and reliability of the Secondary Traumatic Stress Scale-Japanese Version. METHODS: The original Secondary Traumatic Stress Scale was translated into Japanese, and Japanese items were back-translated to English to confirm the accuracy of the translation. A total of 870 public health nurses from the Tohoku region in Japan completed the Secondary Traumatic Stress Scale-Japanese Version. An exploratory factor analysis was conducted to identify the number of components. Moreover, 351 public health nurses from the Saitama prefecture in Japan also completed the scale. A confirmatory factor analysis was performed with the factor structure identified in the exploratory factor analysis. RESULTS: The exploratory factor analysis identified two components: one associated with client-related distress and the other with trauma-related distress. The confirmatory factor analysis confirmed the two-factor structure. The two-factor structure model was better than the three-factor model presented in the original validation study for the English version of the scale. The two-factor model had good internal consistency for the overall product and the subscales. Pearson correlations showed that this model had good convergent validity against the Maslach Burnout Inventory, a psychological measure similar to the Secondary Traumatic Stress Scale. Finally, the two-factor model had good discriminant validity against the Maslach Burnout Inventory. CONCLUSION: This study identified two components of the Secondary Traumatic Stress Scale-Japanese Version that differ from the three components found in the original English version. The differences in the factor structure might indicate that the factor structure was culturally influenced.

Novel mathematical model to estimate ball impact force in soccer.

To assess ball impact force during soccer kicking is important to quantify from both performance and chronic injury prevention perspectives. We aimed to verify the appropriateness of previous models used to estimate ball impact force and to propose an improved model to better capture the time history of ball impact force. A soccer ball was fired directly onto a force platform (10 kHz) at five realistic kicking ball velocities and ball behaviour was captured by a high-speed camera (5,000 Hz). The time history of ball impact force was estimated using three existing models and two new models. A new mathematical model that took into account a rapid change in ball surface area and heterogeneous ball deformation showed a distinctive advantage to estimate the peak forces and its occurrence times and to reproduce time history of ball impact forces more precisely, thereby reinforcing the possible mechanics of 'footballer's ankle'. Ball impact time was also systematically shortened when ball velocity increases in contrast to practical understanding for producing faster ball velocity, however, the aspect of ball contact time must be considered carefully from practical point of view.

Immortalization of erythroblasts by c-MYC and BCL-XL enables large-scale erythrocyte production from human pluripotent stem cells.

The lack of knowledge about the mechanism of erythrocyte biogenesis through self-replication makes the in vitro generation of large quantities of cells difficult. We show that transduction of c-MYC and BCL-XL into multipotent hematopoietic progenitor cells derived from pluripotent stem cells and gene overexpression enable sustained exponential self-replication of glycophorin A(+) erythroblasts, which we term immortalized erythrocyte progenitor cells (imERYPCs). In an inducible expression system, turning off the overexpression of c-MYC and BCL-XL enabled imERYPCs to mature with chromatin condensation and reduced cell size, hemoglobin synthesis, downregulation of GCN5, upregulation of GATA1, and endogenous BCL-XL and RAF1, all of which appeared to recapitulate normal erythropoiesis. imERYPCs mostly displayed fetal-type hemoglobin and normal oxygen dissociation in vitro and circulation in immunodeficient mice following transfusion. Using critical factors to induce imERYPCs provides a model of erythrocyte biogenesis that could potentially contribute to a stable supply of erythrocytes for donor-independent transfusion.

[Psychological trauma risks among disaster workers: perspectives on their mental health following the Great East Japan Earthquake].

Following the March 11, 2011 Great Japan East Earthquake and the Fukushima Daiichi Nuclear Power Plant accident, disaster workers have been working day and night for recovery efforts. A large part of disaster workers, i.e., Self-Defense Force, police, fire department, and coast guard personnel, were highly acknowledged by the Japanese public for searching nearly 19,000 dead or missing victims. This recognition will be beneficial for their psychological recovery. On the other hand, dentists and government employees also took a large role in these mortuary missions, but their work was hardly known to the people. Furthermore, local government employees became victims of public criticisms. Similar phenomenon has been seen among Fukushima nuclear plant workers. These workers have experienced a whole array of traumatic stress, including near-death work experiences, irradiation fear, loss of their properties and their loved ones. The electric company has been blamed by the public for their disaster responses, so the public portrays these employees as disaster perpetrators. However, this trend is leading to serious discriminations and harassments, and adversely affecting their mental health. We all hope the recovery efforts to complete as soon as possible. However, when people criticize these workers, their burden of psychological trauma will continue to grow, and their recovery process will be impeded. It is crucial for the society to recognize these hard-working people and to show appreciation and support for their dedications.

[Complexities of the stress experienced by employees of the Fukushima nuclear plants].

Fukushima Daiichi Nuclear Power Plants suffered serious damage by the Great East Japan Earthquake and Tsunami. The employees of the plant worked very hard to stabilize the nuclear reactor and to prevent any secondary accidents. They were in one of the most severe situations in this disaster, but they were the people who hesitated most to request help for themselves. We started visiting the Fukushima Daini Plant office that was used as the frontline base for Daiichi Plant workers since July, 2011. These visits were held once or twice a month and we offered mental health support to the employees. We have completed interview with the total number of 339 plant workers by April, 2012. We offered several ways of mental support including clinical treatment, continuous counseling, or one time advice, depending on mental condition of each interviewee. Complexity of huge disaster and individuality of suffering from it were discussed in this article. Like local residents, many plant workers also experienced death/missing of family, loss of housing, refuge life, and dispersion of family. Furthermore, they have been suffering from various kinds of criticism and slander against Tokyo Electric Power Company. Many workers, even though they were not in management positions, seemed to have guilty conscience and sense of responsibility that forced them to stay in the risky working site. We could find some struggling coexistence of sense of guilt (as a causer of disaster) and sense of victim in their mind. It was suggested that continuous effort to listen and pay attention to their talk is important in order to support their mission to stabilize the power plant and to prevent them from over-stress and burnout.

Characterization of teleost Mdga1 using a gene-trap approach in medaka (Oryzias latipes).

MAM domain containing glycosilphosphatidilinositol anchor 1 (MDGA1) is an IgCAM protein present in many vertebrate species including humans. In mammals, MDGA1 is expressed by a subset of neurons in the developing brain and thought to function in neural cell migration. We identified a fish ortholog of mdga1 by a gene-trap screen utilizing the Frog Prince transposon in medaka (Japanese killifish, Oryzias latipes). The gene-trap vector was inserted into an intronic region of mdga1 to form a chimeric protein with green fluorescent protein, allowing us to monitor mdga1 expression in vivo. Expression of medaka mdga1 was seen in various types of embryonic brain neurons, and specifically in neurons migrating toward their target sites, supporting the proposed function of MDGA1. We also isolated the closely related mdga2 gene, whose expression partially overlapped with that of mdga1. Despite the fact that the gene-trap event eliminated most of the functional domains of the Mdga1 protein, homozygous embryos developed normally without any morphological abnormality, suggesting a functional redundancy of Mdga1 with other related proteins. High sequential homology of MDGA proteins between medaka and other vertebrate species suggests an essential role of the MDGA gene family in brain development among the vertebrate phylum.

The effect of fatigue on the underwater arm stroke motion in the 100-m front crawl.

The purpose of this study was to indicate the effect of fatigue on the underwater right arm stroke motion during the 100-m front crawl. The arm stroke motions of eight male competitive swimmers were captured three-dimensionally at 60 Hz in the positions of 15 m and 65 m from the start. The hand velocity, the arm angular velocities and the relative contribution of the arm angular velocities to the hand velocity were computed at each instant during the arm stroke motion. A significant decrease of the hand velocity and the peak angular velocity of shoulder adduction were observed in the second half than in the first half. The contribution of shoulder adduction was especially large in the pull phase and subsequently that of shoulder horizontal abduction became dominant in the push phase. However, in the second half, the contribution of shoulder adduction tended to decrease while that of shoulder internal rotation tended to increase. Thus, it is quite likely that the arm stroke motion of swimmers were driven to be influenced by induced fatigue and resulted in an increase in the contribution of shoulder internal rotation to compensate the decreased contribution of shoulder adduction angular velocity.

The continuous measurement of the springboard reaction force in gymnastic vaulting.

A new method was established for the continuous measurement of force applied from a springboard to a gymnast in vaulting (board reaction force). Male gymnasts performed a handspring vault using a springboard mounted on force platforms. A high-speed video camera sampled the springboard motion at 500 Hz. The springboard was initially partitioned into 29 segments. The force due to the accelerative motion of the springboard was determined by summing the forces of the individual segments. The board reaction force acting on the gymnast was calculated by subtracting the force due to the accelerative motion of the springboard and weight from the force recorded by the force platform. The new method succeeded in illustrating transient changes of the board reaction force. The horizontal and vertical components of the peak values of the board reaction force were three and two times greater respectively than the average values. A series of tests was conducted to determine whether the number of segments of the springboard model could be reduced without affecting accuracy. A model consisting of only four segments produced almost the same accuracy as the 29-segment model. The simplified model is recommended as a more efficient method to measure board reaction force.

The effect of muscle fatigue on instep kicking kinetics and kinematics in association football.

The aim of this study was to examine the effect of leg muscle fatigue on the kinetics and kinematics of the instep football kick. Fatigue was induced by repeated, loaded knee extension (40% body weight) and flexion (50% body weight) motions on a weight-training machine until exhaustion. The kicking motions of seven male players were captured three-dimensionally at 500 Hz before and immediately after the fatigue protocol. The significantly slower ball velocity observed in the fatigue condition was due to both reduced lower leg swing speed and poorer ball contact. The reduced leg swing speed, represented by a slower toe linear velocity immediately before ball impact and slower peak lower leg angular velocity, was most likely due to a significantly reduced resultant joint moment and motion-dependent interactive moment during kicking. These results suggest that the specific muscle fatigue induced in the present study not only diminished the ability to generate force, but also disturbed the effective action of the interactive moment leading to poorer inter-segmental coordination during kicking. Moreover, fatigue obscured the eccentric action of the knee flexors immediately before ball impact. This might increase the susceptibility to injury.

Segmental dynamics of soccer instep kicking with the preferred and non-preferred leg.

Detailed time-series of the resultant joint moments and segmental interactions during soccer instep kicking were compared between the preferred and non-preferred kicking leg. The kicking motions of both legs were captured for five highly skilled players using a three-dimensional cinematographic technique at 200 Hz. The resultant joint moment (muscle moment) and moment due to segmental interactions (interaction moment) were computed using a two-link kinetic chain model composed of the thigh and lower leg (including shank and foot). The mechanical functioning of the muscle and interaction moments during kicking were clearly illustrated. Significantly greater ball velocity (32.1 vs. 27.1 m . s(-1)), shank angular velocity (39.4 vs. 31.8 rad . s(-1)) and final foot velocity (22.7 vs. 19.6 m . s(-1)) were observed for the preferred leg. The preferred leg showed a significantly greater knee muscle moment (129.9 N . m) than the non-preferred leg (93.5 N . m), while no substantial differences were found for the interaction moment between the two legs (79.3 vs. 55.7 N . m). These results indicate that the highly skilled soccer players achieved a well-coordinated inter-segmental motion for both the preferred and non-preferred leg. The faster leg swing observed for the preferred leg was most likely the result of the larger muscle moment.

Parkinsonism induced by atypical neuroleptics in a patient with severe iron deficiency.

Although still controversial, iron deficiency has been indicated as one of the risk factors for developing neuroleptic-induced extrapyramidal symptoms (EPSs), including akathisia, dystonia, and neuroleptic malignant syndrome. Here we report our experience of iron supplementation and alternating neuroleptics for treating Parkinsonism in a schizophrenic female patient having severe iron deficient anemia.