Foot care knowledge and practices among Japanese nurses and care workers in home care and adult service center: a cross- sectional study.

BACKGROUND: Foot care knowledge and practices among nurses and care workers in the community greatly impact foot health maintenance and prevention of foot-related problems among older people. This study aimed to explore and examine the current foot care knowledge, practices, and perceptions among nurses and care workers at home care and adult day service center, along with their demographic characteristics and daily care for clients. METHODS: This study analyzed 232 randomly selected front-line nurses and care workers working at home care or adult day service center in one of the selected cities, Aichi Prefecture, Japan. Data were obtained using questionnaires and subsequently analyzed using descriptive statistics, t-tests, Chi-square tests, Wilcoxon rank-sum tests, and Spearman's rank correlation tests. RESULTS: Among the 305 surveyed, 232 (62 nurses; 170 care workers) provided data. Although 57 nurses (91.9%) and 142 care workers (83.5%) showed interest in foot care, 33 nurses (53.2%) and 133 care workers (78.2%) stated that foot care education was insufficient. Knowledge and practice scores were associated with working status.Higher accuracy differences in the early detection of foot problems and skin tears on lower limbs in knowledge category were observed between nurses and care workers. The nurses as well as the care workers had low accuracy rates of knowledge questions regarding the use of shoes and socks subscale.For practice, both nurses and care workers had low mean scores for checking client's shoes (2.0/5.0 and 2.1/5.0, respectively), method for reducing ingrown nail pain (2.6/5.0 and 1.9/5.0, respectively), and opportunity for discussing foot care with others (2.7/5.0 and 2.2/5.0, respectively). A significant correlation between knowledge and practice scores was observed among nurses (0.331, p < 0.05) and care workers (0.339, p < 0.001). CONCLUSIONS: Despite the presence of several barriers toward enhanced care delivery to clients needing it most, nurses and care workers clearly understood the importance of foot care. These findings indicate that foot care should be focused by nurses and care workers to improve the knowledge and practice of foot care and to suggest future implications that efficient and understandable tools are needed considering their current working situation.

Development of a nursing model for life adjustment in patients with lung cancer in Japan.

The aim of this study was to obtain basic data about the support for life adjustment in lung cancer patients in Japan. We identified factors that affect life adjustment in people with lung cancer, developed a model for life adjustment support of lung cancer patients, and investigated its validity. A survey was conducted using self-completed questionnaires, and responses were received by 203 individuals. Analysis of the responses revealed that life adjustment was regulated by six factors associated with positive self-evaluation: stress dissipation, fighting spirit, helplessness/hopelessness, full discussion with doctor about treatment, clarity of thought, and support network size. A model search with covariance structure analysis was conducted. The resulting model was revealed to have a goodness-of-fit index of 0.963, an adjusted goodness-of-fit index of 0.930, a comparative fit index of 0.974, and a root mean square error of approximation of 0.040. The findings suggest that improvements in quality of life can be expected by combining a positive self-evaluation in lung cancer patients and interventions to raise self-adjustment ability with the use of this Model, although it requires further testing.

Foot Problems and Their Associations with Toe Grip Strength and Walking Speed in Community-Dwelling Older Individuals Using Day Services: A Cross-Sectional Study.

Foot disorders in older individuals compromise balance and contribute to postural and gait instabilities, causing a decrease in the activities of daily living and quality of life. In this cross-sectional study, we analyzed the foot-related data of 160 frail older participants who attended day service centers in A prefecture in Japan to determine the prevalence of foot problems and their associations with toe grip strength and walking speed in frail older people. Multiple regression analysis was used to identify foot-related variables that correlated with toe grip strength and walking speed. The prevalence rates of skin dryness (Support level 88.2%, Care level 85.2% for men; Support level 84.9%, Care level 93% for women) and suspected and existing fungal infections in nails (Support level 94.1%, Care level 92.6% for men; Support level 98.1%, Care level 95.2% for women) were high in both sexes regardless of the level of care required. Furthermore, in both sexes, the prevalence rates of toe and arch deformities were significantly increased in the people who required care. Regression analysis revealed that some right-sided foot-related problems were significantly associated with right toe grip strength and walking speed. The decrease in toe grip strength was significantly associated with walking speed. Our study provides evidence that some specific conditions were associated with toe grip force and walking speed. This finding can contribute to future strategies to protect foot health in community-dwelling older individuals.

Culture and psychosocial function in british and Japanese people with an ostomy.

PURPOSE: We compared social and psychological adjustment to surgery ending with an ostomy in British and Japanese patients. METHODS: In response to a postal survey, 948 ostomy patients (464 British and 484 Japanese), selected at random from respective national databases, provided assessable data on the Ostomy Adjustment Inventory-23 (OAI-23), a validated scale for measurement of psychosocial adjustment to an ostomy. RESULTS: Analysis of variance revealed that country of residence (F1,876 = 50.9, P < .001) and time since surgery (F3,876 = 9.9, P < .001) significantly influenced psychosocial adjustment to an ostomy. British persons with an ostomy experienced higher psychosocial adjustment to an ostomy than did Japanese respondents. Multivariate analysis based on acceptance, social engagement, anxious-preoccupation, and anger also found that country of residence and time since surgery influenced psychosocial adjustment (Pillai's Trace: V = 0.22, F = 67.15, P < 0.001, and V = 0.05, F = 3.6, P ≤ .001, respectively). Acceptance and social engagement (discriminant coefficient = 0.92 and 0.56, respectively) made the largest contribution. CONCLUSION: Psychosocial functioning differed in British and Japanese persons with an ostomy, suggesting that culture influences psychosocial adjustment to life with an ostomy. These findings support the need for culturally informed ostomy care.

Association between Passive Smoking from the Mother and Pediatric Crohn's Disease: A Japanese Multicenter Study.

Smoking is a risk factor for adult-onset Crohn's disease (CD). Although passive smoking from family members is a major concern, especially in pediatric CD, the number of existing epidemiological studies is limited. This multicenter case-control study aimed to assess the effects of familial smoking on pediatric CD. We examined 22 pediatric CD cases and 135 controls. The subjects' mothers were given a self-administered questionnaire about family smoking before disease onset in the CD group or the corresponding period in the control group. Univariable logistic regression model was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs), whereas dose-response relationship analyses were performed for more in-depth evaluations. Univariable analyses indicated that passive smoking from the mother (OR, 2.09; 95% CI, 0.61-7.10) was not a significant, but a candidate risk factor for developing pediatric CD. In contrast, the dose-response relationship analyses revealed that passive smoking from the mother (OR, 1.17; 95% CI, 1.04-1.31) was significantly associated with pediatric CD. Therefore, passive smoking from the mother may be predominantly associated with the development of pediatric CD. Further follow-up studies comprising environmental measurements of passive smoking exposure doses and genetic factors interaction analysis are necessary.

Development and psychometric evaluation of the Ostomy Adjustment Inventory-23.

PURPOSE: This article describes the development of the Ostomy Adjustment Inventory-23 (OAI-23), a self-report, multidimensional scale designed to assess psychosocial adjustment in patients with ostomy. SUBJECTS AND SETTING: Five hundred seventy persons with a colostomy, ileostomy, or urostomy, who were randomly selected from 3 national databases, provided assessable data. RESULTS: The results indicate that the OAI-23 is reliable (the Cronbach alpha = .93, split-half = 0.91, and test-retest (r) = 0.83) and valid, correlating positively with Felton's Acceptance of Illness Scale (r = 0.72) and confirming expected improvements in adjustment consistent with increasing time since surgery (F 5,531 = 5.22, P < .001). Four factors (eigenvalue >or= 1) that accounted for 55.4% of the total variance emerged from factor analysis. CONCLUSION: The OAI-23 is a valid and reliable measure of psychosocial adjustment that will be of interest to both researchers investigating life after stoma surgery and clinicians making objective assessments of their patients' progress.

[Physical and mental health characteristics of female caregivers].

OBJECTIVE: In Japan, research into physical conditions or illnesses of female caregivers focusing on biological markers in biological materials such as blood and urine has been limited. Therefore, the present study was conducted to clarify the physical and mental characteristics of female caregivers in comparison with the general population, using biological markers and self-answered questionnaires. METHODS: The subjects were 161 female in-home primary caregivers for persons requiring care at level 3 or more or less than 3 if suffering from dementia (caregiver group). The control group consisted of females matched 1 : 1 in the same decade of life who received medical checkups in K city. The survey period was from December 2005 to April 2007. The methods were self-answered questionnaires, including lifestyle, caregiving conditions, the Pittsburgh Sleep Quality Index (PSQI) and frequency of taking food, and common parameters for lifestyle diseases using blood and urine and blood pressure, taken by trained investigators at the subjects homes. RESULTS: Average age was 62.8 +/- 11.9 years in the caregiver group and 63.2 +/- 12.4 years in the control group. 46.0% had 5 or more years experience in caregiving and 8.7% had less than 1 year. The required care level most common was 5 at 33.8%, with levels 3 and 4 the next most common. 46.0% of the caregiver group had hypertension, significantly higher than the 34.2% in the control group. The prevalence of glucose intolerance and hypo-HDL-cholesterolemia was also high in the caregiver group, but without significant difference. The caregiver group had lower HDL-cholesterol values than the control group. In lifestyle, the two groups differed in exercise, PSQI, proportion of energy from carbohydrates and estimated 24-hour excretion of sodium (Na) in urine. In particular, it was clear that Na was undesirable for caregiver,s even using urine samples for examination. Although more in the caregiver group described themselves as unhealthy, fewer of them received annual health checkups than in the control group. More in the caregiver group felt stress about their health or aging or depression, with few opportunities for diversion. CONCLUSIONS: Hypertension, the most important risk factor for brain and cardiovascular disease, is significantly high in caregivers, suggesting the need for preventive measures. Similar findigns were also obtained with other biological markers and more in the caregiver group felt stress about their health or aging or depression, pointing to a nee for health support.

[Evidence base research of social support (convoy) for elderly people who live in Hanshin urban area].

UNLABELLED: The aim of this study was to find the relative factor between social support and mental health of elderly people living in the Hanshin urban area. Using a self-rated questionnaire under informed consent, we tried to clarify the types of social support for elderly people and the relationship between social support and life development or mental health at the time of the Great Hanshin Earthquake. RESULTS: 477 (male: 146, female 331) people responded. Those who had support from their family, friends and/or neighbors showed a better mental score, but the group receiving 10% or less social support tended to suffer from depression more frequently.

[Evidence base research of social support (convoy) for elderly people who live in Hanshin urban area].

UNLABELLED: The aim of this study was to find the relative factor between social support and mental health of elderly people living in the Hanshin urban area. Using a self-rated questionnaire under informed consent, we tried to clarify the types of social support for elderly people and the relationship between social support and life development or mental health at the time of the Great Hanshin Earthquake. RESULTS: 477 (male: 146, female 331) people responded. Those who had support from their family, friends and/or neighbors showed a better mental score, but the group receiving 10% or less social support tended to suffer from depression more frequently.

Prognostic items for the last 10 and 3 days of life of cancer patients at home.

BACKGROUND: Prognostic indices are needed to optimize end-of-life care for cancer patients at home, but few prognostic indices predict the last 10 days. OBJECTIVE: The purpose of this study was to identify predictors for the last 10 and 3 days of life in patients with lung, gastric, or colorectal cancer at home. METHODS: Symptoms and signs were initially identified by literature review, and questionnaire was developed. Evaluation of these items and identification of additional items were then performed by 72 visiting nurses using the 3-round Delphi approach. RESULTS: The evaluation of 31 third-round responses is reported. The items for gastric and colorectal cancers were almost same; these cancers were treated as gastrointestinal cancer. To predict the last 10 and 3 days, there were 6 and 0 specific items for lung cancer, respectively, and 5 and 13 specific items for gastrointestinal cancer, respectively. There were 9 common items to predict the last 10 days and 29 common items to predict the last 3 days. CONCLUSION: The specific and common items that could be used to predict the last 10 and 3 days in patients with lung or gastrointestinal cancer were identified. The prognostic items for the last 3 days of life were more numerous among the gastrointestinal cancers than those for the last 10 days. IMPLICATIONS FOR PRACTICE: Specific prognostic items for each cancer are useful for visiting nurses to offer individualized care to patients and families. Using the specific and common prognostic items, end-of-life care may be improved.