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1.
Health Qual Life Outcomes ; 19(1): 120, 2021 Apr 13.
Artigo em Inglês | MEDLINE | ID: mdl-33849571

RESUMO

OBJECTIVES: Moral distress occurs when professionals cannot carry out what they believe to be ethically appropriate actions because of constraints or barriers. We aimed to assess the validity and reliability of the Japanese translation of the Measure of Moral Distress for Healthcare Professionals (MMD-HP). METHODS: We translated the questionnaire into Japanese according to the instructions of EORTC Quality of Life group translation manual. All physicians and nurses who were directly involved in patient care at nine departments of four tertiary hospitals in Japan were invited to a survey to assess the construct validity, reliability and factor structure. Construct validity was assessed with the relation to the intention to leave the clinical position, and internal consistency was assessed with Cronbach's alpha. Confirmatory factor analysis was conducted. RESULTS: 308 responses were eligible for the analysis. The mean total score of MMD-HP (range, 0-432) was 98.2 (SD, 59.9). The score was higher in those who have or had the intention to leave their clinical role due to moral distress than in those who do not or did not have the intention of leaving (mean 113.7 [SD, 61.3] vs. 86.1 [56.6], t-test p < 0.001). The confirmatory factor analysis and Cronbach's alpha confirmed the validity (chi-square, 661.9; CMIN/df, 2.14; GFI, 0.86; CFI, 0.88; CFI/TLI, 1.02; RMSEA, 0.061 [90%CI, 0.055-0.067]) and reliability (0.91 [95%CI, 0.89-0.92]) of the instrument. CONCLUSIONS: The translated Japanese version of the MMD-HP is a reliable and valid instrument to assess moral distress among physicians and nurses.


Assuntos
Atenção à Saúde/ética , Pessoal de Saúde/ética , Pessoal de Saúde/psicologia , Princípios Morais , Psicometria/normas , Inquéritos e Questionários/normas , Traduções , Adulto , Grupo com Ancestrais do Continente Asiático/psicologia , Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , Análise Fatorial , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Psicometria/instrumentação , Reprodutibilidade dos Testes , Estresse Psicológico
2.
BMJ Open ; 10(12): e038585, 2020 12 10.
Artigo em Inglês | MEDLINE | ID: mdl-33303440

RESUMO

OBJECTIVE: This study aims to explore barriers to controlling gestational weight gain in pregnant Chinese women. DESIGN: Data were collected through semistructured interviews with pregnant women experiencing excessive gestational weight gain who struggled with weight management, and the data were examined using an interpretive content analysis. SETTINGS AND PARTICIPANTS: Fifty participants (≥18 years, with excessive gestational weight gain) were recruited when they visited the hospital for antenatal health checkups in Wuhan city (n=36) and Jinan city (n=14) between September and October 2018. RESULTS: Interpretive content analysis identified 75 barriers after examining diet, physical activity levels and general issues stemming from knowledge and beliefs, and physical, social, logistical, emotional and structural characteristics. Compared with reported deductive codes, this study inductively extracted 15 new codes. The most frequent codes showed that expectant grandparents greatly influenced pregnant women's lifestyles, through overprotection, traditional and conservative ideas and practices, and a lack of reliable knowledge or acceptable guidance on gestational weight control. CONCLUSIONS: This study provides a better understanding of the most important obstacles faced during decision making about gestational weight control in Chinese settings, especially the influence of traditional ideas/practices and expectant grandparents. Identifying the specific barriers to weight control should facilitate potential tailored supportive interventions. More efforts on health education for the whole family and a better use of maternal handbooks would be particularly beneficial.


Assuntos
Ganho de Peso na Gestação , Gestantes , China , Dieta , Feminino , Humanos , Gravidez , Ganho de Peso
3.
BMC Health Serv Res ; 19(1): 487, 2019 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-31307438

RESUMO

BACKGROUND: Patient information sharing between hospitals and community pharmacies is generally insufficient. Since August 2013, the pharmacy department of Kyoto University Hospital has initiated and mediated a collaborative relationship between physicians and neighboring community pharmacies (e.g., sharing outpatient blood test results, holding regular meetings among professionals, delivery of tracing reports from community pharmacists to physicians about outpatients). METHODS: This study describes how community pharmacists have developed as a result of this professional collaboration (known as the "Kyoto University Hospital model") and attempts to grasp its current situation through interviews with pharmacists. The authors conducted semi-structured individual interviews with community pharmacists between June and December 2014. The interview data were analyzed using the constant comparative method. RESULTS: Twenty-one pharmacists working for 11 neighboring community pharmacies were interviewed, at which point theoretical saturation was achieved. The mean interview time was about 50 min. Among the participants, there were 15 women and 6 men; 10 were pharmacist managers and 11 were staff pharmacists. Through the analysis of the interview data, 13 categories were generated from 32 concepts. The results indicated that, through the Kyoto University Hospital model, community pharmacists shifted from a "Mindset of being the hospital's subcontractor" to "Being motivated to participate in team care." Specifically, their professional attitude shifted in a positive direction to "Being motivated to participate in team care", which was a departure from their previous feelings of inadequacy, related to their "Mindset of being the hospital's subcontractor" and how "Barrier to medicine counseling". CONCLUSIONS: Under the Kyoto University Hospital Model, hospital pharmacists encouraged active collaboration between physicians, hospital pharmacies, and community pharmacists by cultivating face-to-face relationships. This in turn helped community pharmacists become more conscious of their expert status, and thereby participate actively in patients' treatment.


Assuntos
Serviços Comunitários de Farmácia , Comportamento Cooperativo , Hospitais , Farmacêuticos , Atitude do Pessoal de Saúde , Feminino , Humanos , Entrevistas como Assunto , Masculino , Papel Profissional , Pesquisa Qualitativa
4.
BMC Palliat Care ; 18(1): 5, 2019 Jan 12.
Artigo em Inglês | MEDLINE | ID: mdl-30636631

RESUMO

BACKGROUND: Palliative care was a priority issue in the Cancer Control Act enacted in 2007 in Japan, and this has resulted in efforts being made toward educational goals in clinical settings. An investigation of how descriptions of palliative care for the treatment of cancer have changed in clinical practice guidelines (CPGs) could be expected to provide a better understanding of palliative care-related decision-making. This study aimed to identify trends in descriptions of palliative care in cancer CPGs in Japan before and after enactment of the Cancer Control Act. METHODS: Content analysis was used to count the lines in all relevant CPGs. We then compared the number of lines and the proportion of descriptions mentioning palliative care at two time points: the first survey (selection period: February to June 2007) and the second survey (selection period: February to December 2015). Descriptions from the CPGs were independently selected from the Toho University Medical Media Center and Medical Information Network Distribution Service databases, and subsequently reviewed, by two investigators. RESULTS: Descriptions were analyzed for 10 types of cancer. The proportion of descriptions in the first survey (4.4%; 933/21,344 lines) was similar to that in the second survey (4.5%; 1325/29,269 lines). CONCLUSIONS: After the enactment of the Cancer Control Act, an increase was observed in the number, but not in the proportion, of palliative care descriptions in Japanese cancer CPGs. In the future, CPGs can be expected to play a major role in helping cancer patients to incorporate palliative care more smoothly.


Assuntos
Guias como Assunto , Cuidados Paliativos/legislação & jurisprudência , Cuidados Paliativos/tendências , Humanos , Japão , Cuidados Paliativos/métodos , Pesquisa Qualitativa , Inquéritos e Questionários
5.
BMC Womens Health ; 18(1): 14, 2018 01 10.
Artigo em Inglês | MEDLINE | ID: mdl-29321019

RESUMO

BACKGROUND: No studies illustrating the coping behaviors of mothers experiencing physical and mental subjective symptoms, or the factors that contribute to these behaviors, have been investigated. Therefore, the present study sought to develop a conceptual framework on the coping behaviors and contributing factors of mothers experiencing physical and mental subjective symptoms. METHODS: This qualitative study involved theoretical sampling and semi-structured interviews of mothers who were raising children under 3 years of age in Japan and had experienced physical and mental subjective symptoms since giving birth. Women who were pregnant, required regular medical exams, or had difficulty communicating in Japanese were excluded. All mothers were recruited via personal contacts, snowball sampling, and posters at a community center and nursery schools. Analysis was conducted using the constant comparative method. The interview data were extracted in contextual units based on analytical themes, and concepts were generated. Relationships between concepts were investigated and categorized. To confirm theoretical saturation and ensure the validity of the data, a study supervisor was appointed, four qualitative researchers examined the results, and the interview respondents underwent member checking. RESULTS: There were a total of 21 participants. Thirteen categories were created from 29 concepts identified from the analytical theme "What do mothers do when raising children under 3 years of age while experiencing physical and mental subjective symptoms?" While experiencing subjective symptoms, mothers raising children under 3 years of age tended to lead a child-centric lifestyle and were hesitant to visit the doctor, not only because of typical reasons such as time and costs, but also because of factors related to their child. Some circumstances occurring while experiencing physical and mental subjective symptoms led mothers to put their own needs first and attempt to cope on their own as much as possible. As a result, most mothers would only visit a doctor after becoming seriously ill. CONCLUSION: Mothers raising children under 3 years of age in Japan tend to put their own needs on hold when experiencing subjective symptoms. As a result, they attempt to cope on their own and, at times, only visit a doctor after becoming seriously ill.


Assuntos
Depressão/psicologia , Relações Mãe-Filho , Mães/psicologia , Poder Familiar/psicologia , Adaptação Psicológica , Adulto , Comportamento Infantil/psicologia , Pré-Escolar , Feminino , Humanos , Japão , Gravidez , Pesquisa Qualitativa
6.
Disaster Med Public Health Prep ; 11(6): 729-734, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28659215

RESUMO

OBJECTIVE: To explore how evacuees obtained health care information at their evacuation destinations after the Great East Japan Earthquake. METHODS: We conducted semi-structured interviews of 11 evacuees who moved to City A in Kyoto Prefecture following the Great East Japan Earthquake. The interviews explored how the evacuees obtained health care information, including the main factors of influence. The interviews were transcribed and analyzed to identify trends by using the constant comparative method. RESULTS: Four categories emerged from 6 concepts. Mother-children evacuees and family evacuees tended to obtain health care information in different ways. Family evacuees had moved as a family unit and had obtained their health care information from local neighbors. Mother-children evacuees were mothers who had moved with their children, leaving behind other family members. These evacuees tended to obtain information from other mother-children evacuees. At the time of evacuation, we found 2 factors, emotions and systems, influencing how mother-children evacuees obtained health care information. CONCLUSIONS: We found 2 different ways of obtaining health care information among mother-children evacuees and other evacuees. At the time of evacuation, 2 factors, emotions and systems, influenced how mother-children evacuees obtained health care information. Community-building support should be a priority from an early stage after a disaster for health care management. (Disaster Med Public Health Preparedness. 2017;11:729-734).


Assuntos
Terremotos/estatística & dados numéricos , Comportamento de Busca de Informação , Sobreviventes/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Acidente Nuclear de Fukushima , Humanos , Entrevistas como Assunto/métodos , Japão , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa
7.
Surg Endosc ; 31(9): 3664-3672, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28078458

RESUMO

BACKGROUND: Proximal gastrectomy is not widely performed because the procedure is complicated, particularly under laparoscopy. We developed a simple laparoscopic technique of hand-sewn esophagogastrostomy with an anti-reflux mechanism. This study aimed to evaluate and compare the postoperative body weight loss (BWL) and quality of life (QOL) following laparoscopic proximal gastrectomy (LPG) and laparoscopic total gastrectomy (LTG) in patients with upper gastric cancer. METHODS: We retrospectively analyzed patients with stage I upper gastric cancer undergoing LPG or LTG at Kyoto University Hospital between March 2006 and June 2014. The main outcome measures were the % BWL 1 year after gastrectomy, postoperative anastomotic stricture, and reflux esophagitis. Additionally, patient-reported outcomes were evaluated using the Post-Gastrectomy Syndrome Assessment Scale (PGSAS)-45 in patients presenting at the outpatient clinic and exhibiting no recurrence. RESULTS: A total of 62 patients were included in this study (LTG, n = 42 vs. LPG, n = 20). The % BWL at 12 months in the LPG group was less than that in the LTG group (-16.3 vs. -10.7%). Multivariate analysis revealed that LPG was associated with less BWL (P = 0.003). Anastomotic stricture occurred more frequently in the LPG group than in the LTG group (0 vs. 25%). One patient in each group exhibited grade B severity of reflux esophagitis (based on the Los Angeles classification). In the questionnaire survey, LPG was better than LTG in terms of diarrhea and dissatisfaction with symptoms. In terms of reflux symptoms, patients in the LPG group experienced less acid and bile regurgitation symptoms compared with those in the LTG group. CONCLUSIONS: LPG with hand-sewn esophagogastrostomy results in less postoperative BWL and better QOL than LTG despite higher rates of anastomotic stricture.


Assuntos
Adenocarcinoma/cirurgia , Gastrectomia/métodos , Laparoscopia/métodos , Qualidade de Vida , Neoplasias Gástricas/cirurgia , Perda de Peso , Adulto , Idoso , Anastomose Cirúrgica/métodos , Esôfago/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estômago/cirurgia , Resultado do Tratamento
8.
J Public Health (Oxf) ; 37(3): 498-505, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25104840

RESUMO

BACKGROUND: This study aimed to determine the prevalence and predictors of working-age individuals who did not follow-up for possible hypertension that was detected in the population-based screening. METHODS: We conducted a retrospective cohort study, using the database of health insurance claims and health checkups from several health insurance societies for employees in Japan. Screened participants aged ≥20 years, with possible hypertension (systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg) and without known antihypertensive treatment, were included. The outcome was lack of clinical follow-up for possible hypertension within 6 months of the latest screening. Multivariate logistic regression analysis was performed to identify predictors. RESULTS: Among 17,173 participants (15,793 males and 1380 females) who were identified as possible hypertensives, 89.7 and 82.3% of them, respectively, did not consult physicians for screened possible hypertension. Predictors of no clinical follow-up for males included younger age, lower body mass index (BMI), lower hemoglobin A1c and milder hypertension. Predictors for females included younger age, lower BMI and being insured. CONCLUSIONS: Approximately 80% of participants failed to consult physicians even with positive screening results. Younger individuals with lower BMI are at high risk of no clinical follow-up.


Assuntos
Determinação da Pressão Arterial/psicologia , Hipertensão/diagnóstico , Cooperação do Paciente/estatística & dados numéricos , Adulto , Idoso , Pressão Sanguínea , Determinação da Pressão Arterial/estatística & dados numéricos , Feminino , Humanos , Hipertensão/psicologia , Japão/epidemiologia , Masculino , Programas de Rastreamento/psicologia , Programas de Rastreamento/estatística & dados numéricos , Pessoa de Meia-Idade , Cooperação do Paciente/psicologia , Estudos Retrospectivos , Adulto Jovem
9.
Diabetes Res Clin Pract ; 105(2): 176-84, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24947442

RESUMO

AIMS: Although people screened as being hyperglycaemic often fail to follow up with physicians for clinical assessment, epidemiologic findings on the frequency and predictors of not following up (hereafter, "no follow-up") are lacking. The purpose of this study was to examine the no follow-up rate with physicians after screening for diabetes and predictors of no follow-up. METHODS: We assessed cases of no follow-up with physicians within six months after screening based on medical claims data from employee-based social health insurance programs in Japan, for people aged 20 to 68 years from 2005 to 2010. RESULTS: Among 3878 screened participants with hyperglycaemia, 2527 (65%) did not follow up with their physicians within six months after screening. Multiple logistic regression analysis revealed that younger age and lower blood glucose level predicted no follow-up among both men and women, while lower body mass index and negative proteinuria also predicted no follow-up among men. Treatment for dyslipidaemia facilitated follow-up among both genders, and treatment for hypertension or depression facilitated follow-up among men. CONCLUSIONS: Approximately two thirds of individuals screened as having hyperglycaemia did not follow up with their physicians within six months after screening. Predictors of no follow-up were younger age and milder hyperglycaemia. Being on treatment for co-morbidities tended to facilitate follow-up.


Assuntos
Hiperglicemia/diagnóstico , Programas de Rastreamento , Pacientes Desistentes do Tratamento/estatística & dados numéricos , Adulto , Glicemia/metabolismo , Diabetes Mellitus/prevenção & controle , Feminino , Seguimentos , Hemoglobina A Glicada/metabolismo , Humanos , Hiperglicemia/sangue , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
10.
Midwifery ; 30(7): 877-84, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24656329

RESUMO

OBJECTIVE: midwifery homes (similar to birth centres) are rich in midwifery wisdom and skills that differ from those in hospital obstetrical departments, and a certain percentage of pregnant women prefer birth in these settings. This study aimed to understand the organisation of the perinatal environment considered important by independent midwives in non-hospital settings and to clarify the processes involved. DESIGN: semi-structured qualitative interview study and constant comparative analysis. PARTICIPANTS: 14 independent midwives assisting at births in midwifery homes in Japan, and six independent midwives assisting at home births. SETTING: Osaka, Kyoto, Nara, and Shiga, Japan. FINDINGS: midwives assisting at non-hospital births organised the birth environment based on the following four categories: 'an environment where the mother and family are autonomous'; 'a physical environment that facilitates birth'; 'an environment that facilitates the movement of the mother for birth'; and 'scrupulous safety preparation'. These, along with their sub-categories, are presented in this paper. KEY CONCLUSIONS: independent midwives considered it important to create a candid relationship between the midwife and the woman/family from the period of pregnancy to facilitate birth in which the woman and her family were autonomous. They also organised a distinctive environment for non-hospital birth, with preparations to guarantee safety. Experiential knowledge and skills played a major part in creating an environment to facilitate birth, and the effectiveness of this needs to be investigated objectively in future research.


Assuntos
Centros de Assistência à Gravidez e ao Parto , Meio Ambiente , Parto Domiciliar/métodos , Tocologia/métodos , Adulto , Idoso , Feminino , Humanos , Japão , Pessoa de Meia-Idade , Pesquisa Qualitativa
11.
Qual Life Res ; 21(2): 335-40, 2012 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-21643874

RESUMO

PURPOSE: We compared Japanese versions of the EORTC QLQ-C15-PAL and QLQ-C30 to assess the utility of the former survey for terminal-phase cancer patients. METHODS: We used QLQ-C30 scores from the survey prior to each patient's death and extracted QLQ-C15-PAL data. We determined intraclass correlation coefficients (ICCs) of the five QLQ-C15-PAL subscales: physical functioning, emotional functioning, fatigue, nausea and vomiting, and global health status/quality of life (QOL) and assessed equivalent-form reliability. Regression analysis was used to determine the extent to which QLQ-C15-PAL items explained the QLQ-C30 score. RESULTS: Our study included 32 of 91 cancer patients receiving palliative care who could self-administer the questionnaire. The ICC between the QLQ-C15-PAL and QLQ-C30 scores was 0.93 or higher. The proportion of variance (R-squared) for each subscale was 0.87 or higher. CONCLUSION: We examined the validity and reliability of the Japanese version of the QLQ-C15-PAL. We found an 87% or higher chance that the QLQ-C15-PAL could explain the original QLQ-C30 score. Therefore, QLQ-C15-PAL appears to be useful for assessing the QOL of terminal-phase cancer patients.


Assuntos
Neoplasias/psicologia , Cuidados Paliativos/psicologia , Psicometria/métodos , Qualidade de Vida , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Nível de Saúde , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Neoplasias/terapia , Reprodutibilidade dos Testes , Perfil de Impacto da Doença , Inquéritos e Questionários , Adulto Jovem
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