[Japan Environment Health and Children's Study Publications from the University of Occupational and Environmental Health, Japan].

The Japan Environment Health and Children's Study (JECS) is an ongoing cohort study designed to evaluate the impact of various environmental factors on children's health. In this study, more than 100,000 pregnant women were recruited in 15 regional centers throughout Japan. Within the University of Occupational and Environmental Health, the departments of Pediatrics, Obstetrics and Gynecology, Environmental Health, and the School of Health Sciences collaborate with the JECS University of Occupational and Environmental Health Subunit Center in advancing research in this study. Several original articles based on JECS and written by our unit members were published in recent years. The aim of this review is to summarize these studies by JECS and University of Occupational and Environmental Health Subunit Center based on the data from JECS. We introduce research articles covering the following categories; environmental health, occupational health, and maternal and child health. Studies found associations between concentrations of metals and maternal health, such as premature birth, placenta previa and placenta accrete, associations between metals and IgE, dietary differences among occupational groups, associations between work-related factors and dietary behaviors, associations between job changes and pregnancy/delivery, mental and physical stress among pregnant women and influence on work, associations between sleep and gestational diabetes, and associations between an ability to push up in the prone position and infant development. This review may promote the development of new research, such as collaborative research projects, including clinical and social medicine, epidemiological studies and laboratory investigations.

[Cancer Family Care Learning Materials for Japanese General Ward Nurses].

Families of cancer patients are also subject to care, and early intervention is necessary. In general hospital wards, nurses have difficulty in performing satisfactory nursing care for families of cancer patients due to limited time to get involved. Their priority is to provide essential care for patients, thus it is inevitable that they cannot offer intervention for patients' families. In recent years, overtime work by nurses has been regarded as a problem, and implementation of in-service education within the working hours is recommended. Based on these backgrounds, we developed "Learning materials for nurses, with a view to standardized care for the families of cancer patients hospitalized in general wards". In this paper, we report on this learning program and the development process.

Postal contact with participating children and its impact on response rate: Japan Environment and Children's Pilot Study.

BACKGROUND: Communication with participating children and its effect on participation outcome is one of the most important but untouched issues in birth cohort studies. The purpose of this study was to assess the effect of postal communication with the participating preschool children on the response rate to postal questionnaires. METHODS: One hundred and five mother-preschool child pairs from the Japan Environment and Children's Study (JECS) pilot cohort were included. During the 6 month study period, letters addressed to the children were enclosed with our biannual questionnaires, and the response rate transition was observed. Additionally, the participants were allocated to two groups. One of these was sent the letter with the individual name of the child at the top, and the other without it. The response rates of the two groups were compared using chi-squared test. Parents' impressions of the letters and the changes in their motivation to complete the questionnaires were surveyed using an evaluation form. RESULTS: The overall response rate was 83.8%, which was lower than the previous survey period. Response rate was not significantly different between the two letter types. The duration before questionnaire return was not changed. Despite their favorable impression based on parent evaluation, the letters were not associated with the parents' motivation to respond. CONCLUSION: Letters to participating preschool children had no effect on response rate, but the long-term impact of its favorability still remains to be evaluated. A similar trial at later ages may be more effective.

[Implementation of Objective Structured Clinical Examination I of the Department of Nursing--Introduction of Simulation-Based Education].

The Department of Nursing of the university revised its curriculum for students admitted in 2012 or later, including the introduction of integrated subjects. With the aim of improving the practical clinical skills of students and integrating knowledge, skills, and techniques, the following integrated subjects: Objective Structured Clinical Examination (OSCE) I held in the first term of the third-year (15 hours as one credit), and OSCE II held in the second term of the fourth year (30 hours as one credit), were adopted, and simulation-based education was introduced. In this report, we summarized our experience of a simulation education system for nursing students in the year 2014 aiming to improve students' skill of wheelchair transfer of a patient with left hemiplegia and patient's living environment. Many positive responses, such as usefulness in future nursing training, were obtained upon the introduction of the simulation education system. Issues to be addressed in the future, including lack of sufficient time to practice and availability of rooms, were also noticed.

Giving social support at work may reduce inflammation on employees themselves: a participatory workplace intervention study among Japanese hospital nurses.

Previously, we reported that the participatory workplace intervention was effective in reducing stress-related inflammatory markers among 31 Japanese female nurses. During the analysis, we recognized that our intervention might have increased prosocial behaviors like giving social support to others in some participants. Based on this assumption, we ran a secondary analysis, which examined the effect of giving social support on inflammatory markers, autonomic nervous activity (ANA), and perceived job stress (PJS) before and after the intervention. A group of participants who had increased scores on giving social support (n=13) showed significant decreases in interferon-γ, interleukin-6, and interleukin-12/23p40 after the intervention. Another group of those who had decreased/unchanged in the scores (n=17) did not show changes in these markers. Regarding ANA and PJS, no significant changes were observed in both groups. This study presented insight that giving social support at work may provide health benefits towards employees themselves, via decreasing inflammation.

Effects of participatory workplace improvement program on stress-related biomarkers and self-reported stress among university hospital nurses: a preliminary study.

Although participatory workplace improvement programs are known to provide favorable effects on high stress occupations like nursing, no studies have confirmed its effect using biomarkers. The aim of this study was to determine whether a participatory workplace improvement program would decrease stress-related symptoms as evaluated by biomarkers and self-reported stress among hospital nurses. Three actions to alleviate job stress, which were determined through focus group interviews and voting, were undertaken for two months. A total of 31 female Japanese nurses underwent measurement of inflammatory markers, autonomic nervous activity (ANA), and perceived job stress (PJS) at three-time points; before the program (T1), within a week after the completion of the program (T2), and three months after the program (T3). A series of inflammatory markers (Interferon-γ, Interleukin (IL)-6, and IL-12/23p40) decreased significantly at T2, and IL-12/23p40 and IL-15 significantly decreased at T3 compared to T1, while ANA and PJS remained unchanged. Our participatory program exerted beneficial effects in reducing inflammatory responses, but not for ANA and PJS. Further investigations with a better study design, i.e., a randomized controlled trial, and a larger sample size are warranted to determine what exerted beneficial effects on inflammatory markers and why other outcomes remained unchanged.

[Health effects and psychological stress in pregnant women engaged in work outside the home].

Modern society demands working conditions in which pregnant women can successfully deliver children and maintain a professional position. The aim of this study is to investigate the effects of work on the health and psychological stress in working women and their newborns. We reviewed twenty-eight publications and found that health problems in working women occur at high rates. However, there is no report investigating the mechanism by which health problems occur, or describing the precise working conditions and symptoms in pregnant women who are engaged in work outside the home. In addition, the literature uses subjective evaluations, including psychological tests, to quantify stress and anxiety, but no biochemical analyses of stress-related substances were conducted. We suggest that a standard index to represent working conditions and job category, as well as an investigation of the workload of house-keeping, is needed to understand the total work effort by pregnant women in modern times. Finally, measurement of stress-related biological markers may be effective in the investigation from various perspectives of occupational stress in pregnant women.

[Themes and trends in nursing research on cancer patients' families].

The purpose of this study was to identify trends in nursing research on cancer patients' families published within the past 12 years (1996-September 2007, present) and examine their research themes. Five core categories were identified: 1) cancer nursing at home, 2) terminal care in a general ward, 3) family's experience in a terminal period and after bereavement, 4) family's experience and care during treatment, and 5) family systems. Findings showed that the following areas of research are being conducted: nursing research on a variety of therapies and care environments, research on nurses' awareness of the families of cancer patients and how this affects treatment, interventional research on how to implement study findings, and research activities based on family nursing.

[A study of the factors that affect parental acceptance of children's disabilities--a literature review].

The process of parental acceptance of a child's disability is complex and involves a myriad of factors, including the nature of the child's disability, factors related to the parents and societal factors. Despite the type of disability and the severity of that disability often being the most significant factors related to the process of acceptance, the majority of previous studies have combined multiple disabilities into a single category. For example, the point at which parent and child begin to live together with a disability marks a "beginning." The nature and timing of this beginning differs depending on the disability and thus has a large impact on the process of acceptance. Moreover, despite acceptance patterns diverging between sexes, the majority of previous studies have sampled only mothers and not fathers. Future research needs to use a more detailed analysis of disability type and its severity, and examine the modality of telling a patient and his or her family of a disability. Further studies also need to sample both mother and father, and consider the familial and social aspects of the process of parental acceptance.

[Process of parental acceptance of a child's disability: literature review].

This study used a literature review to examine the process of parental acceptance regarding disability in a child. Our results identify two main theoretical concepts, stages of grief and chronic sorrow, which describe the emotional responses that parents express following the diagnosis of a child's disability. Stages of grief involve a long-term process through which parents struggle to accept their child's condition, eventually leading to acceptance of their child's disability. Alternately, chronic sorrow describes parental life-long sadness throughout their child's lifetime, periodically repeating at critical times in their child's development. Researchers in Japan have developed a disability acceptance model that combines both concepts. This study found that analysis and interpretation of the parental acceptance process varied with each researcher. It is essential for health care professionals who provide support to children with disabilities to understand the process which parents as primary caregivers undergo to accept the conditions of their child's disability. Knowledge of the main theoretical concepts will give them a broader perspective of the parental acceptance experience. Additional systematic studies are recommended to further understand this issue.

[An investigation of factors affecting job satisfaction among psychiatric nurses--focussed on stress-coping and a character tendency].

The relation between stress, stress coping behavior and job satisfaction was investigated for psychiatric nurses who work in the northern part of Kyushu and the Chugoku district of Japan. As a result, the people with high job satisfaction had a tendency for the stress coping ability to be high, the daily stress of the people with low job satisfaction was high, and a relation with the character which is the individual characteristic was also seen. In the relation between stress management factor and job satisfaction, those who can have change of action by a hobby, amusement, etc., those with a strong tolerance to stress and the people with social support showed a tendency for job satisfaction to be high. The people especially with a high degree of satisfaction with their professional status showed the tendency for the stress management factor to be high. On the contrary, the people with a high stressor of daily hassles showed the tendency for job satisfaction to be low. Moreover, anger, nervousness and the people with a tendency to take a Type A action pattern showed the tendency for job satisfaction to be low. From these findings, it is suggested that a stressor or not only coping behavior but character tendency is related to job satisfaction.

[Factors influencing student nurses' emotions toward children and their concept of motherhood].

The purpose of this study is to investigate the factors influencing the emotions of student nurses toward children in order to apply the results to their practical training, since the opportunity for contact with children has been decreasing in recent years due to the declining birth rate. 278 student nurses completed a self-administered anonymous questionnaire that consisted of their background, such as living with children and experience of contact with children, their learning process, such as finished lectures and nursing training in child and maternal care or not, 28 items from Hanazawa's scale of emotions toward children, and 27 items for the concept of motherhood. The obtained data was analyzed using the SPSS 12.0J for Windows with the Spearman's correlation coefficient, Mann-Whitney U test and Kruskal Wallis test. The valid recovery was 121 (43.5%). The negative point for the concept of motherhood was significantly lower in the group that had finished nursing training in child and maternal care than in the group without such training. On the other hand, living with children and experience of contact with children did not influence their emotions toward children or concept of motherhood. The results of this study suggest that the experiences that student nurses have some deliberate and active contacts with children and mothers during their nursing training in child and maternal care have an influence on their concept of motherhood.

[The preparatory education of electronic patient record for nursing students before practical nursing training].

Preparatory education has been provided for both nursing students and teachers to understand the electronic patient record (EPR) since 2004 when EPR was introduced to the hospitals where students are allocated to undertake their work experience. First, the training and management board contacted our medical information department for an appointment and sent us a working group. They taught the nursing training staff how to use EPR and how to assign students to the proper patient record in the EPR system. Second, as preparatory education for the students, they explained the procedure for the use of EPR and the protection of personal information. Students practiced with training in the EPR system, focusing on the functions which are used frequently in practical tasks. As a result of this preparatory education, students understood the protection of personal information very well, although their understanding of the operation and management of the equipment was relatively poor and adversely affected their practice. We need to review our education contents more often. We also need to examine the present state of understanding of EPR and the problems of teaching in practical nursing training.

The association between maternal psychological stress and inflammatory cytokines in allergic young children.

Background. Previous studies have shown that psychological stress is linked to asthma prevalence. Parental psychological stress may potentially influence inflammatory responses in their allergic children. The purpose of this study is to clarify the association between maternal psychological status and inflammatory response of allergic young children. Methods. The study subjects were 152 young allergic children (median age: 13 months) who had not shown any allergic symptoms in the past one month. mRNA expression levels of the inflammatory response genes IL-6, IL-8, IL-10 and IL-22 were quantified by qRT-PCR. Maternal psychological status was assessed by standardized questionnaires: the Centre for Epidemiological Studies Depression Scale (CES-D) for depression and the Japanese Perceived Stress Scale (JPSS) for perceived stress. Results. A significant positive association was observed between maternal CES-D scores and IL-6 mRNA expression in the children with asthma. The JPSS scores were also positively associated with IL-8 mRNA expression in asthmatic children and IL-6 mRNA expression in children with allergic rhinitis. Similar trends were observed among children positive for house dust mite-specific IgE, but these associations were not significant. Conclusion. This study supports the hypothesis that maternal psychological stress affects the inflammatory response in their allergic children.

[A study of various causes of influence on inter-child emotions--from a survey conducted on postpartum mothers].

This research was conducted as a self-reporting anonymous survey of 185 postpartum mothers in hospitals in order to clarify the causes of influence on the inter-child emotions of mothers, who are usually the main fosterers of the child. SPSS 12.0 J for Windows was used for statistical analysis, and the relationship between points of inter-child emotion and each questioned item was analyzed with Mann-Whitney U test and Kruskal-Wallis test. As a result, the following causes of influence on inter-child emotions were found: the existence of a key person, having a concrete birth plan during pregnancy, that it was a desired pregnancy, and that the mother was satisfied with her delivery. From this result, the following supports are thought to be important to realize: the importance of puberty education or contraception counseling, the establishment of a support system for mothers, and consistent support during pregnancy to postpartum at medial institutions where parturition is carried out.