Systematizing Complaints About Healthcare and Services at University Hospitals: Content Analysis of Patient/Family Letters.

Patient/family complaints are a valuable source of information for providing patient-oriented healthcare. This study aimed to identify and systematize patient/family complaints about healthcare services, focusing on complaints caused by "things." A qualitative descriptive study was designed. Open data of patient and family voices published on the website of university hospital were collected from 27 hospitals for the period June 2020 to August 2020. From the collected data, we excluded praise and compliments, and complaints regarding "people." The results revealed 1,476 complaints, with 1,755 codes. Patient/family complaints were categorized into five domains (access to hospital or line of flow in the hospital, outpatient, inpatient, facilities/equipment, publicity/documents), 46 categories, and 150 sub-categories. A total of 545 codes were excluded to avoid duplication: [1] 253 related to hardware, [2] 222 related to operations, and [3] 70 related to maintenance. This study may provide useful data to inform future studies using patient/family complaints to improve healthcare services for hospitals aiming to provide patient-centered care.

Effect of 6-Week Sprint Training on Long-Distance Running Performance in Highly Trained Runners.

PURPOSE: Long-distance running performance has been reported to be associated with sprint performance in highly trained distance runners. Therefore, we hypothesized that sprint training could enhance distance running and sprint performance in long-distance runners. This study examined the effect of 6-week sprint training on long-distance running and sprint performance in highly trained distance runners. METHODS: Nineteen college runners were divided into control (n = 8) and training (n = 11) groups. Participants in the training group performed 12 sprint training sessions in 6 weeks, while those in the control group performed 12 distance training sessions. Before and after the interventions, maximal oxygen uptake (V˙O2max), O2 cost during submaximal running (290 m·min-1 and 310 m·min-1 of running velocity), and time to exhaustion (starting at 290 m·min-1 and increased 10 m·min-1 every minute) were assessed on a treadmill. Additionally, the 100-m and 400-m sprinting times and 3000-m running time were determined on an all-weather track. RESULTS: In the control group, no measurements significantly changed after the intervention. In the training group, the time to exhaustion, 100-m and 400-m sprinting times, and 3000-m running time improved significantly, while V˙O2max and O2 cost did not change. CONCLUSIONS: These results showed that 6-week sprint training improved both sprint and long-distance running performance in highly trained distance runners without a change in aerobic capacity. Improvement in the time to exhaustion without a change in V˙O2max suggests that the enhancement of long-distance running performance could be attributable to improved anaerobic capacity.

Heavy Resistance Training Versus Plyometric Training for Improving Running Economy and Running Time Trial Performance: A Systematic Review and Meta-analysis.

BACKGROUND: As an adjunct to running training, heavy resistance and plyometric training have recently drawn attention as potential training modalities that improve running economy and running time trial performance. However, the comparative effectiveness is unknown. The present systematic review and meta-analysis aimed to determine if there are different effects of heavy resistance training versus plyometric training as an adjunct to running training on running economy and running time trial performance in long-distance runners. METHODS: Electronic databases of PubMed, Web of Science, and SPORTDiscus were searched. Twenty-two studies completely satisfied the selection criteria. Data on running economy and running time trial performance were extracted for the meta-analysis. Subgroup analyses were performed with selected potential moderators. RESULTS: The pooled effect size for running economy in heavy resistance training was greater (g = - 0.32 [95% confidence intervals [CIs] - 0.55 to - 0.10]: effect size = small) than that in plyometric training (g = -0.13 [95% CIs - 0.47 to 0.21]: trivial). The effect on running time trial performance was also larger in heavy resistance training (g = - 0.24 [95% CIs - 1.04 to - 0.55]: small) than that in plyometric training (g = - 0.17 [95% CIs - 0.27 to - 0.06]: trivial). Heavy resistance training with nearly maximal loads (≥ 90% of 1 repetition maximum [1RM], g = - 0.31 [95% CIs - 0.61 to - 0.02]: small) provided greater effects than those with lower loads (< 90% 1RM, g = - 0.17 [95% CIs - 1.05 to 0.70]: trivial). Greater effects were evident when training was performed for a longer period in both heavy resistance (10-14 weeks, g = - 0.45 [95% CIs - 0.83 to - 0.08]: small vs. 6-8 weeks, g = - 0.21 [95% CIs - 0.56 to 0.15]: small) and plyometric training (8-10 weeks, g = 0.26 [95% CIs - 0.67 to 0.15]: small vs. 4-6 weeks, g = - 0.06 [95% CIs 0.67 to 0.55]: trivial). CONCLUSIONS: Heavy resistance training, especially with nearly maximal loads, may be superior to plyometric training in improving running economy and running time trial performance. In addition, running economy appears to be improved better when training is performed for a longer period in both heavy resistance and plyometric training.

Relationship between respiratory muscle endurance and dyspnea during high-intensity exercise in trained distance runners.

We hypothesized that the trained distance runners, who have a relatively high respiratory muscle endurance, but not high respiratory muscle strength, have lower dyspneic sensations during submaximal running. Twenty-one male collegiate distance runners participated. Incremental respiratory endurance tests (IRET) and maximal inspiratory mouth pressure (PImax) measurements were performed under resting conditions. A submaximal exercise test was also performed on a treadmill at two different speeds (16 and 18 km/h) for 4 min each, and the subjects reported the rate of dyspnea (range: 0-10). The time to endpoint during the IRET, an index of respiratory muscle endurance, ranged from 9.4 to 18.8 min, and PImax, as an index of inspiratory muscle strength, ranged from 74.1 to 137.0 cmH2O. The dyspnea rating during running at 16 and 18 km/h ranged from 1 to 6 and from 4 to 8, respectively. The relative exercise intensity was approximately 80 % of peak oxygen uptake (VO2peak) at 16 km/h and 90 %VO2peak at 18 km/h. The time to endpoint during the IRET was significantly negatively correlated with dyspnea during running at 18 km/h (r = -0.459, P = 0.040), but not at 16 km/h (r = -0.161, P = 0.470). There was no significant correlation between PImax and dyspnea during running at 16 km/h (r = -0.003, P = 0.989) or 18 km/h (r = 0.070, P = 0.755). These results suggest that dyspneic sensations during high-intensity running are related to respiratory muscle endurance, but not inspiratory muscle strength, in trained distance runners.

Patients' and families' opinions via suggestion boxes for improving hospital care for cancer patients: Analysis of 3419 cases over 11 years.

BACKGROUND: There has been a paradigm shift in cancer treatment from curing disease to both curing disease and caring for patients. In terms of care for patients, the opinions of patients and their families are important for improving medical services. AIM: The opinions of patients and families were collected at Shizuoka Cancer Center (SCC) and examined from the standpoint of characteristics, response status, and temporal changes. METHODS: Patients' and families' opinions submitted to suggestion boxes at SCC over an 11-year period (2005-2015) were analyzed. Opinions were categorized as complaints or compliments, with sub-categories including "facilities, goods, and medical care," "people," "time," and "other." The status of facilities' response to complaints was categorized as "responded," "did not respond", and "difficult to respond". RESULTS: Changes in the number of opinions and content over time were examined. In total, 3419 opinions were collected; 69.1% were complaints, and 30.5% were compliments. Of the complaints, 53.4% were related to "facilities, goods, and medical care" (mainly focusing on "poor product quality" and "shortage of goods"), 38.7% were related to "people," and 7.7% to "time." Of the compliments, 82.4% were about "people," all of which concerned facility staff. Facilities' responses to complaints were as follows: "responded" (42.4%), "did not respond" (14.3%), and "difficult to respond" (43.3%). CONCLUSION: Understanding patients' and families' opinions is effective for strengthening trust between patients and healthcare professionals, promoting holistic care.

Relationship Between Body Segment Mass and Running Performance in Well-Trained Endurance Runners.

This study examined the relationship between body segment mass and running performance in endurance runners. The total (muscle, fat, and bone masses), lean (muscle mass), and fat masses of the leg, arm, and trunk segments in 37 well-trained endurance runners were measured using dual-energy X-ray absorptiometer. The relative segment mass was calculated by normalizing the absolute mass to body mass. There were no significant correlations between absolute total, lean, and fat masses of all 3 segments and personal best 5000-m race time. No significant correlations were also observed between all 3 relative masses of the arm segment and personal best 5000-m race time. In contrast, medium positive correlations were observed between the relative total and lean masses of the leg segment and personal best 5000-m race time (r = .387 and .335, respectively, both P ≤ .031). Furthermore, large negative correlations were observed between the relative total and lean masses of the trunk segment and personal best 5000-m race time (r = -.500 and -.548, respectively, both P ≤ .002). These findings suggest that a mass distribution with smaller leg mass and greater trunk mass may be advantageous for achieving better running performance in endurance runners.

Association between patellar tendon moment arm and running performance in endurance runners.

A shorter joint moment arm (MA) may help maintain the necessary muscle force when muscle contractions are repeated. This beneficial effect may contribute to reducing the energy cost during running. In this study, we examined the correlation between patellar tendon MA and running performance in endurance runners. The patellar tendon MA and quadriceps femoris muscle volume (MV) in 42 male endurance runners and 14 body size-matched male untrained participants were measured using a 1.5-T magnetic resonance system. The patellar tendon MA was significantly shorter in endurance runners than in untrained participants (p = 0.034, d = 0.65). In endurance runners, shorter patellar tendon MA correlated significantly with better personal best 5000-m race rime (r = 0.322, p = 0.034). A trend toward such a significant correlation was obtained between quadriceps femoris MV and personal best 5000-m race time (r = 0.303, p = 0.051). Although the correlation between patellar tendon MA and personal best 5000-m race time did not remain significant after adjusting for the quadriceps femoris MV (partial r = 0.247, p = 0.120), a stepwise multiple regression analysis (conducted with body height, body mass, patellar tendon MA, and quadriceps femoris MV) selected the patellar tendon MA (ß = 0.322) as only a predictive variable for the personal best 5000-m race time (adjusted R2  = 0.081, p = 0.038). These findings suggest that the shorter patellar tendon MA, partially accorded with the smaller quadriceps femoris size, may be a favorable morphological variable for better running performance in endurance runners.

The effectiveness of vibratory stimulation in reducing pain in children receiving vaccine injection: A randomized controlled trial.

BACKGROUND: Although vaccine injections are important, children experience pain and discomfort upon their administration. BUZZY®, a vibratory stimulation tool with an ice pack, was reported to be an effective tool for reducing the pain caused to children during injection administration; its mechanisms were explained by gate control theory. However, the evidence is inadequate because of insufficient methodology in previous reports. Therefore, we aimed to assess whether the application of vibration would significantly reduce children's pain during vaccine injections. METHODS: A single-blind randomized controlled trial recruiting children aged ≤6 years who were receiving vaccine injections was conducted between August and December 2019. If the children's parents consented to their participation, BUZZY® was attached to the child's arm prior to vaccination. BUZZY® was switched on before injection in the intervention group but not in the control group. The vaccination procedure was recorded, and researchers and parents assessed each child's pain using validated pain scales. Researchers conducted their assessment using video data to ensure blinding. Parents were administered a questionnaire after the children's vaccination. Data were analyzed using the t-test or chi-square test. RESULTS: We analyzed 118 children (intervention group = 62, control = 56). No between-group difference was observed according to the researchers' assessment (mean score = 6.98 and 7.63, respectively; p = 0.25); however, a significant difference was found based on the parents' assessment (mean score = 7.39 versus 8.46; p = 0.02). Most responses received to open-ended questions were positive comments for this study. CONCLUSIONS: We revealed that the effect of vibration is not significant in reducing vaccine injection pain among children. Further studies are needed to examine the other components of BUZZY®, which include its cooling effect, and the effect of BUZZY® itself in terms of whether children will undergo vaccination without resistance and have reduced trauma related to vaccination.

Comparison of the relative muscle volume of triceps surae among sprinters, runners, and untrained participants.

Muscle hypertrophy is considered more prominent in fast-twitch than in slow-twitch muscles. This leads to the hypothesis that the relative muscle volume of the medial gastrocnemius (MG) and lateral gastrocnemius (LG) becomes larger than that of the soleus (SOL) in highly trained participants because MG and LG include more fast-twitch muscles than SOL. Thus, we compared relative muscle volume among highly trained sprinters, long-distance runners, and untrained participants to examine whether the above hypothesis is correct. Magnetic resonance imaging was used to calculate the muscle volume of MG, LG, and SOL from 126 participants. The total muscle volume of the three muscles and the relative muscle volume of each muscle with respect to the total muscle volume were calculated. The total muscle volume was significantly larger in the sprinters than in the long-distance runners and untrained participants. The relative muscle volume of MG was significantly larger in the sprinters than in the long-distance runners and untrained participants and that of SOL was significantly smaller in the sprinters than in the long-distance runners and untrained participants. These results indicate that the relative muscle volume can vary among participants, possibly due to fiber type-dependent muscle hypertrophy.

Effects of Respiratory Muscle Endurance Training in Hypoxia on Running Performance.

PURPOSE: We hypothesized that respiratory muscle endurance training (RMET) in hypoxia induces greater improvements in respiratory muscle endurance with attenuated respiratory muscle metaboreflex and consequent whole-body performance. We evaluated respiratory muscle endurance and cardiovascular response during hyperpnoea and whole-body running performance before and after RMET in normoxia and hypoxia. METHODS: Twenty-one collegiate endurance runners were assigned to control (n = 7), normoxic (n = 7), and hypoxic (n = 7) groups. Before and after the 6 wk of RMET, incremental respiratory endurance test and constant exercise tests were performed. The constant exercise test was performed on a treadmill at 95% of the individual's peak oxygen uptake (V˙O2peak). The RMET was isocapnic hyperpnoea under normoxic and hypoxic conditions (30 min·d). The initial target of minute ventilation during RMET was set to 50% of the individual maximal voluntary ventilation, and the target increased progressively during the 6 wk. Target arterial oxygen saturation in the hypoxic group was set to 90% in the first 2 wk, and thereafter it was set to 80%. RESULTS: Respiratory muscle endurance was increased after RMET in the normoxic and hypoxic groups. The time to exhaustion at 95% V˙O2peak exercise also increased after RMET in the normoxic (10.2 ± 2.4 to 11.2 ± 2.6 min) and hypoxic (11.5 ± 2.6 to 12.6 ± 3.0 min) groups, but not in the control group (9.6 ± 3.2 to 9.4 ± 4.0 min). The magnitude of these changes did not differ between the normoxic and the hypoxic groups (P = 0.84). CONCLUSION: These results suggest that the improvement of respiratory muscle endurance and blunted respiratory muscle metaboreflex could, in part, contribute to improved endurance performance in endurance-trained athletes. However, it is also suggested that there are no additional effects when the RMET is performed in hypoxia.

The Potential Relationship Between Leg Bone Length and Running Performance in Well-Trained Endurance Runners.

The present study aimed to determine the relationship between leg bone length and running performance in well-trained endurance runners. The lengths of the leg bones in 42 male endurance runners (age: 20.0 ± 1.0 years, body height: 169.6 ± 5.6 cm, body mass: 56.4 ± 5.1 kg, personal best 5000-m race time: 14 min 59 s ± 28 s) were measured using magnetic resonance imaging. The lengths of the femur and tibia were calculated to assess the upper and lower leg lengths, respectively. The total length of the femur + tibia was calculated to assess the overall leg bone length. These lengths of the leg bones were normalized with body height, which was measured using a stadiometer to minimize differences in body size among participants. The relative tibial length was significantly correlated with personal best 5000-m race time (r = -0.328, p = 0.034). Moreover, a trend towards significance was observed in the relative femoral length (r = -0.301, p = 0.053). Furthermore, the relative total lengths of the femur + tibia were significantly correlated with personal best 5000-m race time (r = -0.353, p < 0.05). These findings suggest that although the relationship between the leg bone length and personal best 5000-m race time was relatively minor, the leg bone length, especially of the tibia, may be a potential morphological factor for achieving superior running performance in well-trained endurance runners.

Association between Forefoot Bone Length and Performance in Male Endurance Runners.

Recently, we reported that the forefoot bones were longer in sprinters than in non-sprinters, and that longer forefoot bones correlated with higher sprint performance in sprinters. To further understand the superiority of long forefoot bones in athletic performance, we examined whether forefoot bone length was associated with running performance in endurance runners. The length of the forefoot bones of the big and second toes were measured using magnetic resonance imaging in 45 male well-trained endurance runners and 45 male untrained subjects. After normalization with the foot length, it was found that the forefoot bones of the big and second toes were significantly longer in endurance runners than in untrained subjects (P<0.05 for both). Furthermore, longer forefoot bones of the big toe, but not of the second toe, correlated significantly with better personal best 5000-m race time in endurance runners (r=-0.322, P=0.031). The present findings demonstrated that forefoot bones were longer in endurance runners than in untrained subjects. These findings were similar to our findings for sprinters. In addition, we found that longer forefoot bones may be advantageous for achieving higher running performance in endurance runners.

Potential Relationship between Passive Plantar Flexor Stiffness and Running Performance.

The present study aimed to determine the relationship between passive stiffness of the plantar flexors and running performance in endurance runners. Forty-eight well-trained male endurance runners and 24 untrained male control subjects participated in this study. Plantar flexor stiffness during passive dorsiflexion was calculated from the slope of the linear portion of the torque-angle curve. Of the endurance runners included in the present study, running economy in 28 endurance runners was evaluated by measuring energy cost during three 4-min trials (14, 16, and 18 km/h) of submaximal treadmill running. Passive stiffness of the plantar flexors was significantly higher in endurance runners than in untrained subjects. Moreover, passive plantar flexor stiffness in endurance runners was significantly correlated with a personal best 5000-m race time. Furthermore, passive plantar flexor stiffness in endurance runners was significantly correlated with energy cost during submaximal running at 16 km/h and 18 km/h, and a trend towards such significance was observed at 14 km/h. The present findings suggest that stiffer plantar flexors may help achieve better running performance, with greater running economy, in endurance runners. Therefore, in the clinical setting, passive stiffness of the plantar flexors may be a potential parameter for assessing running performance.

Relationship between Achilles tendon length and running performance in well-trained male endurance runners.

This study aimed to determine the relationship between Achilles tendon (AT) length and running performance, including running economy, in well-trained endurance runners. We also examined the reasonable portion of the AT related to running performance among AT lengths measured in three different portions. The AT lengths at three portions and cross-sectional area (CSA) of 30 endurance runners were measured using magnetic resonance imaging. Each AT length was calculated as the distance from the calcaneal tuberosity to the muscle-tendon junction of the soleus, gastrocnemius medialis (GMAT ), and gastrocnemius lateralis, respectively. These AT lengths were normalized with shank length. The AT CSA was calculated as the average of 10, 20, and 30 mm above the distal insertion of the AT and normalized with body mass. Running economy was evaluated by measuring energy cost during three 4-minutes submaximal treadmill running trials at 14, 16, and 18 km/h, respectively. Among three AT lengths, only a GMAT correlated significantly with personal best 5000-m race time (r=-.376, P=.046). Furthermore, GMAT correlated significantly with energy cost during submaximal treadmill running trials at 14 km/h and 18 km/h (r=-.446 and -.429, respectively, P<.05 for both), and a trend toward such significance was observed at 16 km/h (r=-.360, P=.050). In contrast, there was no correlation between AT CSA and running performance. These findings suggest that longer AT, especially GMAT , may be advantageous to achieve superior running performance, with better running economy, in endurance runners.

Blunted blood pressure response during hyperpnoea in endurance runners.

UNLABELLED: The purpose of this study was to elucidate the cardiovascular response during hyperpnoea in endurance-trained runners compared to sedentary controls. Twelve runners and ten sedentary individuals participated in this study. A maximal respiratory endurance test (MRET) was performed as follows: target minute ventilation was initially set at 30% of maximal voluntary ventilation (MVV12) and was increased by 10% MVV12 every 3min. The test was terminated when the subject could no longer maintain the target ventilation. Heart rate and mean arterial blood pressure (MBP) were continuously measured. Respiratory endurance time during the MRET was longer in the runners than the controls. The change in MBP during the MRET was lower in the runners compared to the sedentary controls (runners: 100.2±2.4mmHg vs. CONTROLS: 109.1±3.0mmHg at 6min of hyperpnoea). Therefore, the blood pressure response during hyperpnoea is blunted in endurance runners, suggesting that whole-body endurance exercise training attenuates the respiratory muscle-induced metaboreflex.

[Factor determining satisfaction with policies regarding disaster wastes: flooded areas of cities].

This study examines the factors that determine satisfaction with the policies regarding disaster wastes, focusing specifically on the case of flood. A survey was conducted of residents in previously flooded areas of Sanjyo, Fukui, and Toyooka. The respondents rated the extent to which the affected administration explained things to them, listened to their opinions, damage from the flood, and problems with disaster wastes. The results showed that the perception of the distance from home to the garbage station determined the satisfaction with the policies regarding disaster wastes among the respondents who had less disaster wastes. On the other hand, the perception of listening to their opinions determined satisfaction with the policies among the respondents who had a lot of waste. The findings suggest that the determinant factors are different depending upon the situational factors.

[Determinant factors of community-based disaster preparedness: a case study of flood prone area].

This study examined the determinants of willingness to participate in a community-based disaster preparedness scheme. The theory of reasoned action (Ajzen & Fishbein, 1977, 1980; Fishbein & Ajzen, 1975) was applied as a basic model and was complemented by the factor of concern about disaster. A structural equation modeling was performed to validate this model. The hypothetical model was supported for the data from the residents (N = 3 036) of an area with a high risk of flood damage. It was clarified that the subjective norm and concern about flood positively contributed to the intention of participating in a community-based disaster preparedness scheme. The perceived cost of preparedness was the inhibitory factor of participating in such a scheme.