[Developing scales to evaluate community practices among municipal public health nurses: content, perceptions of public health nurses, and organizational environment].

Objectives　This study aimed to develop scales for evaluating the level of implementation of community practices and explore the perception of public health nurses in municipalities regarding their community practices.Methods　Draft scales were developed based on a literature review and interviews with municipal public health nurses. Subsequently, a questionnaire survey was conducted with municipal public health nurses across Japan in response to these draft scales. Respondents were recruited based on the municipality population size. Questionnaires were distributed to 2,074 individuals from 52 municipalities ensuring representation from diverse municipalities. Exploratory factor analysis was performed to determine the number of factors, while confirmatory factor analysis was performed to determine the factor structure. The reliability of the scales was assessed by calculating Cronbach's alpha coefficients, and their validity was tested by examining correlations with existing scales, namely the Moral Competence Scale for Public Health Nurses and the Professional Identity Scale for Public Health Nurses, and years of experience as a public health nurse.Results　A total of 721 (34.8%) valid respondents were included in the analysis. Three scales, methods of community practices (three factors, nine items), perceptions of public health nurses toward community residents through community practices (three factors, 10 items), and organizational environment supporting community practices (two factors, 11 items) were developed as indicators of the implementation of public health nurses' community practices. Cronbach's alpha coefficients for the three scales were 0.896, 0.913, and 0.868, respectively. As hypothesized, each subfactor exhibited a positive correlation with the existing scales. However, certain subfactors did not demonstrate any correlation with years of experience.Conclusion　The three scales developed in this study were individually examined for reliability and validity. These scales can be used independently or in combination, allowing public health nurses to select the most suitable scale(s) based on their objective.　A notable contribution of this study is the establishment of concrete indicators for evaluating community practices, addressing the previously vague nature of this evaluation. By incorporating the scale items into daily health practices, we anticipate that these indicators can be employed to evaluate community practices at the organizational and individual levels.

Comparison of the Effect of Bromfenac versus Betamethasone Ophthalmic Solutions in Patients with Diabetic Macular Edema.

PURPOSE: To examine the effect of 0.1% bromfenac (BF) ophthalmic solution and 0.1% betamethasone (BM) ophthalmic solution on diabetic macular edema (DME). METHODS: This was a prospective trial. Nineteen patients (mean age of 66.6 ± 10.1 years) with DME and mean retinal thickness within a diameter of 1 mm from the fovea (central subfield thickness: CST) of 250-500 µm were randomized and instilled with BF or BM. CST, best-corrected visual acuity (BCVA), and intraocular pressure (IOP) were measured at 4, 8, and 12 weeks after administration. RESULTS: CST at baseline (p = .128) and that at 4, 8, and 12 weeks of administration was not significantly different between the BF (10 patients) and BM groups (9 patients). In patients with glycated hemoglobin (HbA1c) <8.0%, CST, compared with baseline, was significantly decreased in the BF group (seven patients) at 8 (p = .025) and 12 weeks (p = .043) of administration. When compared with the baseline, no significant changes in BCVA were observed at any point in time in either group. Baseline IOP was comparable between the groups. In the BM group, the values of change in IOP from baseline significantly increased at 8 (p = .025) and 12 weeks (p = .044) of administration, with no significant changes in IOP over the 12 weeks of administration in the BF group. CONCLUSIONS: BF did not affect IOP even after 12 weeks of administration, suggesting its effect in reducing CST in DME with good glycemic control. TRIAL REGISTRATION: University Hospital Medical Information Network (UMIN-CTR); UMIN000026201, February 18, 2017; Japan Registry of Clinical Trials; jRCTs031180308, March 15, 2019.

[Gaining consensus on key terms in community health activities: A national survey using the Delphi method].

Objectives　The purpose of this study was to define the terminology used in community health activities by systematically establishing agreement among public health nurses and related professionals, to aid them in effectively cooperating with other professionals.Methods　We extracted the major terms described in "Guidelines for Public Health Nurses' Activities in the Region," which was issued by the Director of Health Bureau, Ministry of Health, Labor and Welfare; and conducted 2 iterations on the proposed definition of the terms using the Delphi method. The survey targeted 800 stakeholders from the following 4 professions: public health nurses in managerial positions in local governments, clerical staff in local governments, public health nursing professors at educational institutions, and social welfare council staff. Respondents indicated their degree of agreement with the definition of the terms using a 4-point Likert scale. We tallied the answers indicating "I agree" or "Mostly agree." A 70% term agreement was considered "conformed." A free text box for each proposed definition was also available so that respondents could share their opinions and offer alternatives.Results　The first survey received 231 responses. The conformity of their definitions ranged from 83.9%-96.9% (mean=91.5%). Although all definitions exceeded the consensus level, we examined their adequacy with reference to the definitions and opinions from the free text. Various opinions were obtained from those engaged in each occupation. The second round included 117 consenting stakeholders from the first survey, yielding 90 responses. Their degree of conformity ranged from 86.7%-98.9% (mean=94.6%). Therefore, we determined the definitions had reached a robust agreement. We revised the definitions of some terms with reference to the opinions from the free texts and finalized the definitions. Finally, we defined 23 terms-such as region, community diagnosis, and policy.Conclusion　All terms had a conformity of more than 85%, thus bringing into alignment those community health terms that had varying interpretations among related occupations earlier. By including the opinions of those from the related occupations who collaborate with public health nurses, the definitions of these terms could be established and shared. These definitions can be used in public health nursing practice, education, service, and research-among those in involved these related occupations.

Formation of bioactive N-doped TiO2 on Ti with visible light-induced antibacterial activity using NaOH, hot water, and subsequent ammonia atmospheric heat treatment.

Titanium (Ti) treated with NaOH and hot water, and heated in an ammmonia (NH3) gas atmosphere for 1 or 3h exhibited in vitro apatite formation within 7days when soaked in simulated body fluid (SBF). Moreover, the treated Ti decomposed methylene blue and showed excellent bactericidal activity against Escherichia coli under visible light irradiation. The surface treatment resulted in the formation of a fine network of N-doped anatase-type titania (TiO2-xNx) on the Ti surface, which was responsible for both the apatite formation in SBF and the visible light-induced antibacterial activity. These preliminary results highlight the efficacy of our simple method for producing novel bioactive Ti with visible light-induced antibacterial activity, which could be applied to orthopaedic and dental implants without the risk of infection.

Formulation study on retinoic acid gel composed of iota-carrageenan, polyethylene oxide and Emulgen® 408.

In the present study, all-trans retinoic acid (RA) gels formulated with various compositions of polyethylene oxide (Emulgen®) and iota-carrageenan (ι-CG) were prepared and their physicochemical properties were evaluated. The compression energy, which is the work required to compress the product through a fixed distance, increased with increasing amount of ι-CG or Emulgen®. The adhesion energy and displacement decreased with increasing amount of ι-CG or Emulgen® due to the progression of gel formation. From the results of the sensory tests, the properties of RA gels such as adhesiveness, gel strength and spreadability seemed to be adjustable depending on the condition of skin by varying the components of RA gels. Through photostability study, the expiration date and storage conditions of RA gels were determined as "4°C for 28 d with no exposure to light."

Two-generation reproduction toxicity study in rats with methoxychlor.

A two-generation reproduction toxicity study was conducted in rats with a reference estrogenic pesticide, methoxychlor, to validate the sensitivity and competency of current guidelines recommended by the United States Environmental Protection Agency; Japanese Ministry of Agriculture, Forestry and Fisheries; and Organisation for Economic Co-operation and Development for predicting reproductive toxicity of the test compound based on estrogenic endocrine disrupting effects. Both sexes of SD rats were exposed to methoxychlor in the diet at concentrations of 0, 10, 500 and 1500 ppm for two successive generations. The present study has successfully detected estrogenic activities and reproductive toxicities of methoxychlor, as well as its systemic toxicity. Body weights, body weight gains and food consumption of both sexes of animals were suppressed significantly in the 500 and 1500 ppm groups. Typical reproductive toxicities observed in females of these groups included, but were not limited to, prolonged estrous cycle, reduced fertility, decreased numbers of implantation sites and newborns, decreased ovary weights and/or increased incidences of cystic ovary. Uterine weights of weanlings increased significantly in these groups, suggesting that the sensitivity of this parameter for predicting estrogenic ability of the test compound is comparable to that of the uterotrophic assay. Reproductive toxicities of methoxychlor seemed less potent in males than in females. Methoxychlor delayed preputial separation and significantly reduced sperm counts and reproductive organ weights of males of the 500 and/or 1500 ppm groups; however, most males that failed to impregnate females in the same group showed normal fertility when they were re-mated with untreated females. Neither systemic nor reproductive toxicities appeared in the 10 ppm group.

Corneal nerve fiber pathology in Japanese type 1 diabetic patients and its correlation with antecedent glycemic control and blood pressure.

UNLABELLED: Aims/Introduction: Morphological changes to corneal C-fibers in Japanese type 1 diabetic patients were visualized by corneal confocal microscopy (CCM). The effects of prior glycemic control and blood pressure on morphological parameters were clarified. MATERIALS AND METHODS: Corneal nerve fibers were visualized by CCM in 38 Japanese type 1 diabetic patients (14 with and 24 without neuropathy) and 38 controls. Morphological parameters were compared and related to annual mean HbA1c, blood pressure, and serum lipid levels of previous years prior to CCM examination. RESULTS: Compared with controls, diabetic patients had reduced corneal nerve fiber length (CNFL; 9.80 ± 0.38 vs 13.65 ± 0.88 mm/mm(2); P < 0.001), reduced density (CNFD; 25.32 ± 1.04 vs 36.62 ± 2.37/mm(2); P < 0.0005), lower frequency of beading (22.38 ± 0.73 vs 30.44 ± 1.03/0.1 mm; P < 0.0001), and increased tortuosity (3.13 ± 0.09 vs 1.74 ± 0.06; P < 0.0001). These changes were found in patients without neuropathy. There was no difference in nerve branches between controls and diabetic patients. The mean annual HbA1c level for the 7-10 years prior to CCM examination was an independent predictor of reduced CNFL and CNFD; HbA1c levels obtained 1-3 months and 1 year prior to CCM, as well as blood pressure 3, 5, and 6 years prior to CCM, were independent predictors of reduced beading frequency. CONCLUSIONS: Corneal confocal microscopy is a novel, noninvasive technique to evaluate morphological changes of corneal C-fibers in type 1 diabetes. Antecedent hyperglycemia and blood pressure have different time-dependent effects on CNFL and CNFD and the frequency of beading. (J Diabetes Invest, doi: 10.1111/j.2040-1124.2011.00157.x, 2011).

Association of systemic health and functional outcomes with changes in hard exudates associated with clinically significant macular oedema over the natural course of the disease.

AIM: Hard exudates associated with clinically significant macular oedema (CSMO) do not always increase without laser photocoagulation and can generally be classified as regressing or progressing. We studied the systemic differences and functional outcomes between the two groups. METHODS: In this retrospective observational controlled study, we compared blood pressure, biochemical parameters and best corrected visual acuity (BCVA) between 26 patients with regressed hard exudates with CSMO (group A) and 27 patients with progressing hard exudates with CSMO (group B). The eyes had no history of ophthalmic treatments including laser therapy for diabetic retinopathy or maculopathy until the end of the study. RESULTS: Group B had significant increases in the mean total cholesterol (TC) (p=0.0194) and mean low-density lipoprotein (LDL) cholesterol (p=0.0147) after at least 6 months of follow-up compared with group A. The final mean BCVA was significantly (p=0.0189) higher in group A than group B. A separate within-group analysis showed a significant (p=0.0015) decrease in BCVA from baseline in group B at the final visit. CONCLUSION: For hard exudates associated with CSMO, strict lipid-lowering therapy, especially regulation of elevated TC and LDL, before a decrease in visual acuity might result in better macular anatomical outcomes and visual preservation through the natural course of the disease.

Efficacy of bromfenac sodium ophthalmic solution in preventing cystoid macular oedema after cataract surgery in patients with diabetes.

PURPOSE: To compare the efficacy of bromfenac sodium ophthalmic solution (BF) and a steroidal solution (ST) administered prophylactically against cystoid macular oedema and anterior-chamber inflammation after phacoemulsification and intraocular lens implantation and to assess macular thickness changes using optical coherence tomography (OCT). METHODS: In this prospective study, 62 eyes of 62 patients were randomized to either the BF group (n=31) or the ST group (n =31). The average perifoveal thickness (AFT) was measured by OCT preoperatively, and 1 day and 1, 2, 4 and 6 weeks postoperatively. The best-corrected visual acuity, intraocular pressure and flare in the anterior chamber were recorded at each visit. The same method was used to compare patients with non-proliferative diabetic retinopathy (NPDR) in the BF (n = 16) and ST (n =11) groups. RESULTS: In the analysis of all patients, flare in the anterior chamber was significantly (p = 0.007) lower in the BF group 2 weeks postoperatively. In patients with NPDR, the anterior chamber flare values were significantly lower in the BF group at 4 weeks (p = 0.0009) and 6 weeks (p = 0.005). The AFT values were significantly lower in the BF group at 4 weeks (p < 0.0001) and 6 weeks (p < 0.0001). No adverse events occurred in either group. CONCLUSION: BF suppressed anterior chamber inflammation and increasing retinal thickening after cataract surgery in patients with NPDR.

[Domiciliary non-invasive positive pressure ventilation (NPPV) care].

A breakdown of 28 patients on domiciliary NPPV from September. 3, 2007 through July 31, 2009 includes 11 patients with chronic obstructive pulmonary disease, 7 patients with neuro-muscular disease, 4 patients with pulmonary tuberculosis sequela, 4 patients with conjestive heart failure, a patient with bronchiectasis and a patient with pulmonary interstitial pneumonia. Sixteen patients of them started NPPV at home. All of domiciliary NPPV patients had very severe conditions and frequent exacerbations. An avoidance of exacerbation led to improve a prognosis. Actually, a domiciliary pulmonary care team should do a pulmonary rehabilitation for them. It needs a special knowledge and artistic skills for their stable and high quality of life at home. Not only all of the team members should be an expert, but also the patient and family members who belong to the team should be an expert as well. We should educate them how to assess their symptoms and act patho-physiologically.

Formulation study of intravesical oxybutynin instillation solution with enhanced retention in bladder.

A formulation study of intravesical oxybutynin (OB) preparations was carried out in order to improve the effectiveness in intravesical instillation therapy for spastic neurogenetic bladder. Sodium hyaluronate (HYA) was introduced to enhance the muco-adhesiveness of the instillation preparation, and the physicochemical properties of the OB formulation were evaluated in comparison with a conventional formulation containing hydroxypropylcellulose (HPC). The viscous properties and in vitro adhesiveness increased with the amount of the polymeric additives, and retention properties of OB in rabbit bladder were comparable after addition of 0.4% HYA and 1.0% HPC. HYA was able to enhance the intravesical retention properties of OB instillation solution to a lesser degree than HPC, it seemed to be a useful additive in the OB instillation due to its safety and mucosal-protective effect.

Localization of aquaporin-2, renal morphology and urine composition in the bottlenose dolphin and the Baird's beaked whale.

This study examined the distribution pattern of aquaporin-2 (AQP2), relative medullary thickness (RMT) and urine properties in the bottlenose dolphin Tursiops truncatus and Baird's beaked whale Berardius bairdii. Immunohistochemical studies revealed that AQP2 was localized in the collecting tubules/ducts of both species' renicules, as in terrestrial mammals. The collecting ducts with AQP2 were thinner and arranged more densely in the dolphin than in the whale. RMT values in the renicule were moderate in both species, but were significantly higher in the dolphin (6.0 +/- 0.9) than the whale (4.9 +/- 0.7). Urine of the bottlenose dolphin is comparatively concentrated (osmolality: 1715.7 +/- 279.4 mOsm kg(-1), Na(+): 490.1 +/- 87.9 mmol l(-1), Cl(-): 402.7 +/- 79.6 mmol l(-1), K(+): 80.7 +/- 25.8 mmol l(-1), urea nitrogen: 703.5 +/- 253.9 mmol l(-1)), while urine of the dead Baird's beaked whale is less concentrated (osmolality: 837.5 +/- 293.8 mOsm kg(-1), Na(+): 192.9 +/- 81.5 mmol l(-1), Cl(-): 159.9 +/- 71.4 mmol l(-1), K(+): 44.3 +/- 29.5 mmol l(-1), urea nitrogen: 270.7 +/- 120.3 mmol l(-1)). These data suggest it is possible that the differences in these renal morphological features may be related in some way to the difference in urine composition between the species, although further studies are necessary.

Vitamin B6 suppresses apoptosis of NM-1 bovine endothelial cells induced by homocysteine and copper.

Hyperhomocysteinemia is an important risk factor for atherosclerosis. We previously reported that formation of early atherosclerosis in the rat aorta was associated with hyperhomocysteinemia and reduction of antioxidant activity caused by low concentration of vitamin B(6)in vivo. In the present study, we examined effects of vitamin B(6) on apoptosis of bovine endothelial cells (NM-1 cells) treated with homocysteine and copper. Homocysteine and copper induced extracellular hydrogen peroxide, intracellular ROS and cellular lipid peroxide levels. Cell viability was reduced to 30% compared to that of control cells. On the other hand, pyridoxal treatment as well as EDTA treatment increased viability of NM-1 cells treated with homocysteine and copper to about 60%, and significantly decreased extracellular hydrogen peroxide, intracellular ROS and cellular lipid peroxide levels. The treatment of catalase recovered cell viability and reduced the level of extracellular hydrogen peroxide and intracellular ROS. Cell death by homocysteine and copper was confirmed to be due to apoptosis by evaluation of DNA fragmentation and by TUNEL assay. However, apoptosis of NM-1 cells induced by homocysteine and copper was due to a caspase-independent pathway as it was not inhibited by the caspase inhibitor, Z-VAD-fmk. Apoptosis of NM-1 cells induced by homocysteine and copper accompanied with mitochondrial permeability but not cytochrome c release. These results suggest that pyridoxal treatment suppresses apoptosis of NM-1 cells induced by homocysteine and copper, most likely through antioxidant effects.

Antioxidant activity of vitamin B6 delays homocysteine-induced atherosclerosis in rats.

Elevated plasma homocysteine is a risk factor for atherosclerotic disease. In the present study, we have examined whether the oxidative stress due to a low level of vitamin B6 accelerates the development of homocysteine-induced atherosclerosis in rats. First, the effect of homocysteine thiolactone intake (50 mg/kg per d) on vascular integrity, lipid peroxide concentration, endothelial NO synthase (eNOS) expression and biochemical profiles was examined at day 1, day 21 and day 42 (five rats per group). The histochemical staining of the rat aorta showed no change at day 1 and day 21, but the subendothelial space was observed to be enlarged in rat aorta at day 42 with exposure to homocysteine thiolactone. Expression of eNOS was observed in rat aorta at day 42, but not at day 1 and day 21. Serum lipid peroxide concentration and biochemical profiles including glucose cholesterol and triacylglycerol showed no change at any day. Second, the effect of homocysteine thiolactone intake in the presence and absence of vitamin B6 on vascular integrity was examined at day 1 and day 14 (five rats per group). Aortic lesions were observed in vitamin B6-deficient rat aorta at day 14 but not in vitamin B6-supplemented rats. The expression of eNOS was also observed in vitamin B6-deficient rat aorta at day 14. Serum lipid concentrations of the vitamin B6-deficient group significantly increased compared with concentrations of the vitamin B6-supplemented group, though serum concentration of homocysteine did not change between both groups. These results suggest that the oxidative stress caused by a low level of vitamin B6 accelerates the development of homocysteine-induced atherosclerosis in rats.