The relationship between performance feedback from supervisors and subordinates' work engagement among employees in elderly care facilities: structural equation modeling.

Despite the increasing need for nursing care services, the turnover rate of care workers is high in Japan. Since the most common reason for quitting nursing care jobs was problems with interpersonal relationships at work, creating psychosocially safe working environments is urgent. This study aimed to investigate the mediating effects of trust in supervisors (TS) on the association between positive feedback (PF)/negative feedback (NF) and work engagement (WE) based on the job demands-resources theory and conservation of resources theory. We conducted anonymous cross-sectional surveys of 469 employees at elderly care facilities in Japan. Structural equation modeling was used to investigate the causal relationships between the variables. The results showed that PF had significant positive effects on WE, directly and indirectly through TS. By contrast, NF had a nonsignificant positive effect on TS or WE. Tucker-Lewis Index [TLI] was 0.917, Comparative Fit Index [CFI] was 0.927, Root Mean Squared Error of Approximation [RMSEA] was 0.096, and Standardized Root Mean squared Residual [SRMR] was 0.042. The study results indicate that sufficient PF is needed to improve subordinates' WE through TS in elderly care facilities.

Direct clipping using underwater inversion method for colonic diverticular bleeding.

Video 1Endoscopic direct clipping using an underwater inversion method for diverticular bleeding in the descending colon.

Development of anti-centromere antibody-positive autoimmune hepatitis after childbirth.

This is the first case involving the development of anti-centromere antibody (ACA)-positive autoimmune hepatitis (AIH) after childbirth that triggered nailfold bleeding. A 32-year-old woman visited a dermatologist presenting with nailfold bleeding 6 months after the delivery of her second baby. Blood tests revealed liver dysfunction, and she was admitted to our hospital. Tests for hepatitis virus, antinuclear antibody, and anti-mitochondrial antibody were negative. She had no history of alcohol consumption or oral medication. Because of nailfold bleeding, we performed tests for ACA, anti-Scl-70 antibody, anti-RNA polymerase III antibody, and anti-U1 RNP antibodies; only ACA was positive. A liver biopsy was performed for the diagnosis of liver dysfunction. Histological examination of the liver biopsy specimen showed moderate infiltration of inflammatory cells, interface hepatitis, bridging fibrosis, and bile duct injury. The AIH international score was 17, and thus, we diagnosed AIH. Oral prednisolone (PSL) 0.6 mg/day/body weight was initiated. Two weeks post-treatment, the liver enzyme levels normalized and the nailfold bleeding disappeared. In case of nailfold bleeding complicated with liver dysfunction post-childbirth, ACA-positive AIH should be considered as a differential diagnosis.