Bacterial invasion into the epidermis of rats with sodium lauryl sulphate-irritated skin increases damage and induces incontinence-associated dermatitis.

Incontinence-associated dermatitis (IAD) is caused by prolonged exposure to urine/liquid stool. It is a common and often painful skin condition in older incontinent adults because of poor prevention. Patients with urinary infections are at risk of developing IAD, and to guide the development of novel prevention strategies, we aimed to develop an animal model of IAD by urine and bacteria. First, contralateral sites on the dorsal skin of Sprague-Dawley rats were compromised by sodium lauryl sulphate (SLS), simulating frequent cleansing with soap/water. Filter discs were then placed inside ring-shaped chambers on foam dressings, inoculated with or without Pseudomonas aeruginosa, covered with agarose gels immersed in cultured filtrated urine, and secured in place with an occlusive dressing for 3 days. Untreated and SLS-compromised sites served as controls. The IAD was developed at bacteria-inoculated sites, characterised by severe IAD-like redness that persisted for up to 3 days post-exposure and higher disruption of the skin barrier function compared with non-inoculated sites. Pathological changes included epidermal thickening, partial skin loss, inflammatory cell infiltration, accumulation of red blood cells, and invasion of bacteria into the epidermis. This novel, clinically relevant IAD rat model can serve for future prevention developments.

Development of a method to identify persistent and blanchable redness by skin blotting in mice.

Persistent and blanchable redness (PBR) is not currently included in category I pressure injury (PI), which is defined as non-blanchable redness (NBR). However, PBR progresses to PI in a clinical setting. Therefore, it should be clinically managed as category I PI, and a method to distinctly identify PBR is needed. This study aimed to examine whether PI-related biomarkers can distinguish PRB from transient redness (TR) and NBR using skin blotting. TR, PBR, and NBR models were established by the different conditions of dorsal skin compression. Redness observation and skin blotting were performed, and the skin tissue samples were subjected to histological and molecular biological analyses. The vascular endothelial growth factor (Vegf) b, heat shock protein (Hsp) 90aa1, tumour necrosis factor, interleukin (Il) 1b, and Il6 messenger ribonucleic acid levels were significantly different between the three models. The VEGF-A, VEGF-B, IL-1ß, and IL-6 protein levels were different between the three models. Although the results of skin blot examinations were inconsistent with those of the expression analysis of tissue, HSP90α and IL-1ß are suggested to be potential markers to distinguish PBR from TR and NBR.

The Efficacy of a Resilience-Enhancement Program for Mothers Based on Emotion Regulation: A Randomized Controlled Trial in Japan.

This study evaluated the efficacy of a brief (four 2-h sessions) group-based resilience-enhancement program focused on emotion regulation in Japan. Mothers (n = 123) of children aged 3-6 years were recruited in two prefectures and allocated with stratified randomization by the prefecture to either a bi-weekly intervention or treatment as usual. Mothers self-reported online at pre/post-intervention and at 2-month follow-up. Analysis of covariance was used to compare groups. At post-intervention and 2-month follow-up, the intervention group mothers showed significant improvements compared to the control group in resilience (p < 0.001/p = 0.001), self-esteem (p = 0.008/p = 0.001), anger control toward the child (p < 0.001/p = 0.012), and positive attribution toward the child's misbehavior (p < 0.001/p = 0.003). The partners of mothers in both groups answered the same questionnaire at the same timepoints without participating in either program; no differences between groups were found. This study was the first randomized controlled trial investigating how a resilience-enhancement program improves maternal resilience, emotion regulation, and cognition toward children and themselves. This preliminary study provides evidence that improving resilience may reduce the risk of child maltreatment. Further research regarding implementing this intervention in the community is warranted.

The association between self-compassion in the postnatal period and difficult experiences with COVID-19 pandemic-related changes during pregnancy: An observational study for women at 1-month postnatal in Japan.

AIM: This observational study aimed to describe the rate and degree of difficult experiences with COVID-19 pandemic-related changes (DE) during pregnancy, clarify the relationship between DE and self-compassion of women postnatally, and investigate the influence of compassion from a partner (CP) and compassion from the woman's mother (CM) on this relationship. METHODS: Data from 46 1-month postnatal women in Japan were collected through a self-report questionnaire from October to December 2020. Self-compassion was measured using the Japanese version of the Self-Compassion Scale; DE, CP, and CM were measured using original questions based on prior studies. RESULTS: Almost all participants (97.8%) experienced more than one DE during pregnancy. Data analyses revealed that DE in maternity hospitals (d = 0.76), DE in social support (d = 0.53), and CM (d = 0.64) were associated with self-compassion. A two-way analysis of variance suggested that CM moderated the relationship between self-compassion and DE in preparation for the baby (η2  = 0.11) and the birth plan (η2  = 0.11), whereas CP moderated the relationship between self-compassion and DE in social support (η2  = 0.07). CONCLUSIONS: Our findings suggest that self-compassion negatively correlates with DE in maternity hospitals and social support. Additionally, CM may buffer the influence of DE in preparation for the baby and the birth plan on self-compassion; moreover, CP may buffer the influence of DE in social support on self-compassion. This study highlights the importance of supporting perinatal women to adapt to COVID-19-related changes through cooperation with their families, which may increase self-compassion.

Safety verification of a new peripheral intravenous catheter placed in the upper arm vein for administration of drugs with high irritant potential.

Despite the widespread use of peripheral intravenous catheters, unscheduled catheter failure before completion of treatment occurs frequently. If a large vein is selected, catheter failures may be prevented despite administering a highly irritant drug. In this study, we attempted to use a catheter that can be placed in a large upper arm vein. The new catheter was 88 mm long but had no guidewire to reduce contamination risk. This study aimed to evaluate the safety of the first-in-human trial for the new catheter with the administration of highly irritant drugs. This study was conducted at a university hospital in Tokyo, Japan. Eight Japanese adults were hospitalized adults with planned administration of non-cancer drugs with high irritant potential using a peripheral catheter. A trained nurse catheterized with the new catheter in the upper arm using ultrasonography. The catheterization site was monitored by staff and a research nurse once every 24 hours for up to 7 days. No adverse events or catheter failure occurred and the catheter placement success rate was 100%. In two patients, a temporary occlusion alarm of the infusion pump occurred, possibly due to the flexion of the catheter base. The new peripheral intravenous catheter did not interrupt medical treatments as is common after placement, but safety administered the irritant drugs. However, because this catheter may be easily affected by the contraction of the muscle at the fixation position, the position and method of catheter fixation in the upper arm need to be carefully considered.

Which objective itch-assessment tools are applicable to patients with advanced cognitive impairments? A scoping review.

BACKGROUND: Itching is an irritating and uncomfortable sensation that has a profound effect on patients' physical and mental health. It is a major under-recognised problem in older patients who cannot express their pain due to advanced cognitive impairment. Therefore, objective itch-assessment tools that do not rely on patients' reports of itching may be of value for this patient group. OBJECTIVE: To summarise the characteristics of validated objective itch-assessment tools for patients with advanced cognitive impairment. METHODS: This scoping review was conducted according to the PRISMA extension for scoping reviews checklist. The PubMed, CINAHL and Cochrane Library databases were searched, via database-specific search strategies, for articles published in English between January 1, 1990 and March 11, 2020. Based on the eligibility criteria, two authors independently screened the articles for inclusion. Thereafter, the lead author performed data extraction and analysis. RESULTS: Three validated scratch-monitoring using accelerometers and a sound sensor and one validated scratch-mark assessment have been reported. The Actiwatch Plus, ActiTrac® , body-conducted sound sensor and Scoring Atopic Dermatitis index for scratching (SCORAD-scratch) had positive criterion validity outcomes. The Actiwatch Plus, ActiTrac® and body-conducted sound sensor were significantly correlated with scratch behaviour (r = 0.91, p < 0.001; r = 0.71, p = 0.042; r = 0.99, and p-value not shown, respectively). The SCORAD-scratch was significantly correlated with subjective itch-assessment scores (r = 0.78-0.80, p = <0.0001-0.010). CONCLUSIONS: This scoping review summarises the characteristics of validated objective itch-assessment tools to investigate which of these are applicable to older patients with advanced cognitive impairments. Although there are limitations and further verification is required, the ActiTrac® , Actiwatch Plus and body-conducted sound sensor may be useful for measuring scratch movements and itching. IMPLICATIONS FOR PRACTICE: Nurses and patients' families may better understand the characteristics and validity of each objective itch-assessment tool and select the optimal tool for patients with advanced cognitive impairment who cannot express their discomfort caused due to itching.

Impact of intimate partner violence and childhood maltreatment on maternal-infant maltreatment: A longitudinal study.

AIM: This study identifies the impact of intimate partner violence (IPV) during pregnancy, and childhood maltreatment on mothers' perpetration of child maltreatment on 1-month postnatal infants. METHODS: A longitudinal study was conducted on women in the third trimester of pregnancy in two obstetric hospitals in Tokyo, Japan, from June 2016 to September 2017. Participants were asked to complete online self-reported questionnaires during their pregnancy period and at 1 month postnatal. The relationship between suffering from IPV during pregnancy, experiencing childhood maltreatment before the age of 18 years, and perpetration of child maltreatment toward infants was measured among mothers using the Violence Against Women Screen and a survey of four and 14 ad hoc questions. To identify the impact of poly-victimizations of IPV and childhood maltreatment on maternal-infant maltreatment, the study implemented logistic regression models. RESULTS: The data from 533 respondents to the first and second surveys were analyzed. Maternal-infant maltreatment at 1 month postnatal was strongly associated with poly-victimizations of IPV during pregnancy and childhood maltreatment (adjusted odds ratio [AOR] = 5.17; p < .001; 95% CI = 2.39-11.20), single victimization of IPV (AOR = 3.43, p < .001, 95% CI = 1.76-6.72), and single victimization of childhood maltreatment (AOR = 1.75, p = .03, 95% CI = 1.04-2.93; neither = reference). CONCLUSION: The results emphasize the importance of individuating pregnant women with poly-victimizations of IPV during pregnancy and childhood maltreatment and providing intensive and continuous support for such women to prevent maternal-infant maltreatment after childbirth.

A Follow-Up Study on the Continuity and Spillover Effects of Intimate Partner Violence During Pregnancy on Postnatal Child Abuse.

Previous studies have not focused on how intimate partner violence (IPV) during pregnancy predicts early postnatal child abuse. This study identifies the continuity and spillover effects of IPV during pregnancy on IPV and child abuse and neglect (CAN) at 1-month and 3-month postnatal periods. A total of 822 pregnant women were recruited at the third trimester of pregnancy at two obstetric hospitals in Tokyo, Japan, from June 2016 to September 2017. IPV during pregnancy and IPV and CAN at 1 month and 3 months postnatal were obtained through self-reported questionnaires. Results show that the rate of IPV was highest during pregnancy (16.4%), and there was significant continuance (69.4%) of this occurrence of IPV after childbirth (1 month: 13.9%; 3 months: 13.7%). In addition, the rate of CAN was 20.0% at 1 month postnatal and slightly increased at 3 months postnatal (21.8%). Furthermore, this study indicates that IPV during pregnancy was significantly associated with CAN at 1 month and 3 months postnatal (ß = .16 and ß = .14) and with IPV at 1 month (ß = .68), and subsequently, IPV at 1 month was significantly associated with IPV at 3 months postnatal (ß = .56). This study suggests the importance of conducting screenings for IPV during the perinatal period and providing intensive health interventions for abused women to support their parenting from pregnancy to 3 months postnatal to prevent or reduce CAN at 1 month and 3 months postnatal.

Mediating effect of resilience during pregnancy on the association between maternal trait anger and postnatal depression.

OBJECTIVE: The association between anger and postnatal depression has been reported in previous studies. However, whether this association is mediated by resilience is unknown. Resilience is a dynamic process of individuals' positive adaptation to stress and adversity. This study investigated the mediating effect of resilience during pregnancy on the association between trait anger during pregnancy and postnatal depression at one-month. METHODS: A longitudinal study from the third trimester to one-month postnatal using online self-report questionnaires was conducted in two maternity clinics in Tokyo. Trait anger and resilience during pregnancy and postnatal depression at one-month were measured by the State-Trait Anger Expression Inventory, resilience test, and the Edinburgh Postnatal Depression Scale. To test the hypothesis, Structural Equation Modeling was used. RESULTS: Data of 531 participants were analyzed. The final Structural Equation Modeling model demonstrated that resilience during pregnancy had a partial mediating effect on the association between trait anger during pregnancy and postnatal depression at one-month. Trait anger was significantly associated with resilience during pregnancy (ß = -0.28) and postnatal depression (ß = 0.24). Resilience during pregnancy was significantly associated with postnatal depression (ß = -0.20). CONCLUSIONS: This study demonstrated that resilience during pregnancy had a partial mediating effect on the association between trait anger during pregnancy and postnatal depression at one-month. The findings highlight the importance of identifying pregnant women with high trait anger and providing interventions to enhance their resilience to decrease the risk of postnatal depression.

The efficacy of a resilience-enhancement program for mothers in Japan based on emotion regulation: study protocol for a randomized controlled trial.

BACKGROUND: The demands of daily life often cause mothers high levels of distress and other negative emotions. Anger, including harsh verbal discipline, has been linked to child maltreatment, with long-term adverse effects on a child's well-being. It is critically important to teach mothers stress management and emotion regulation in addition to parenting skills, but this is yet to be conducted in a formalized manner. Strengthening the multiple protective factors that constitute resilience helps reduce distress. The aim of this study is to evaluate the efficacy of a resilience-enhancement program for mothers. METHODS: We designed a two-arm, parallel, randomized trial with an active control. Mothers and their partners with children between three and six years old will be recruited. Following an online baseline survey, 140 mothers will be randomly allocated to either an intervention or control group. Self-report assessment will be conducted online post-intervention and at a two-month follow-up. The control group will participate in a serious of group discussions. The intervention group will participate in four bi-weekly 120-min sessions of a Cognitive Behavior Therapy-based program designed to enhance resilience, focusing on emotion regulation through cognitive reappraisal. Participants will be encouraged to apply and share the skills they acquire with their partner and children at home. Partners will also be assessed to explore their indirect influence from the mothers. Intention-to-treat analysis will be conducted and the two groups will be compared, applying covariate analysis. The primary outcome of the intervention is improved resilience. Secondary outcomes include improved anger control, self-esteem, cognition of children's misbehavior, and reduced parental stress. DISCUSSION: To the best of our knowledge, this study will evaluate the first resilience-enhancement program focused on emotion regulation for mothers in Japan. It will contribute to the existing body of knowledge on building emotional resilience. If the program is found to be effective, it will provide an alternative means to enhance mothers' resilience against stress and improve their ability to regulate emotion. In so doing, it will offer a way to prevent child maltreatment and protect the mental health of children and families. TRIAL REGISTRATION: UMIN000027232 , May 3, 2017.

Intimate Partner Violence, Negative Attitudes Toward Pregnancy, and Mother-to-Fetus Bonding Failure Among Japanese Pregnant Women.

We examined the associations between intimate partner violence (IPV) before and during pregnancy, negative attitudes toward pregnancy, and mother-to-fetus bonding. Participants were 636 pregnant women in the third trimester, who completed the Mother-to-Infant Bonding Scale, Violence Against Women Screen, and ad hoc questions (for IPV before pregnancy, negative attitudes, and demographics). We found association between IPV during pregnancy and mother-to-fetus bonding failure was mediated by negative attitudes toward pregnancy in the third trimester. IPV before pregnancy was associated with negative attitudes at the beginning of pregnancy, which predicted negative attitudes in the third trimester and mother-to-fetus bonding failure. Careful assessments and psychological interventions are needed to reduce negative attitudes toward pregnancy among abused women in antenatal health settings to prevent mother-to-fetus bonding failure.

Postpartum depressive symptoms and their association with social support among foreign mothers in Japan at 3 to 4 months postpartum.

BACKGROUNDS: With Japan's globalization, maternal-child health care for foreign mothers is highly necessary. We examined postpartum depressive symptoms in foreign mothers in Japan and the factors associated with such symptoms, particularly social support. METHOD: A cross-sectional study was conducted for Japanese and foreign mothers at 3 to 4 months postpartum. The Edinburgh Postnatal Depression Scale was used to evaluate postpartum depression symptom, and social support was evaluated by support type and provider. Multiple regression analyses was used. RESULTS: Data from 97 Japanese mothers and 68 foreign mothers were analyzed. The average score of Edinburgh Postnatal Depression Scale for foreign mothers was 7.5, significantly higher than that for Japanese mothers (4.2). Financial circumstances, spouse-partners' emotional support, and families' informational support were significantly related to foreign mothers' postpartum depressive symptoms. CONCLUSION: Postpartum depression symptoms were more common among foreign mothers than among Japanese mothers. Medical personnel should encourage such mothers to obtain more social support from their spouse-partners and family.