[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.

The effect of gait training with low-intensity neuromuscular electrical stimulation of hip abductor muscles in two patients following surgery for hip fracture: Two case reports.

BACKGROUND: The rate of force development (RFD) is an indicator of muscle strength. A previous study reported that the RFD of hip abductor muscles was increased by neuromuscular electrical stimulation (NMES) to gluteus medius (GM) during gait in healthy adults. However, the effects for patients following femoral head replacement for hip fracture are unclear. PURPOSE: The aim of this case report was to investigate the effects of gait training with sub-motor threshold NMES on RFD of hip abductor muscles in two patients following femoral head replacement for hip fracture compared to gait training without NMES. CASE DESCRIPTION: Two elderly patients following femoral head replacement for hip fracture received both interventions of gait training with sub-motor threshold NMES to GM and without NMES. Intervention phases involved 14 sessions each, for 28 sessions total. OUTCOMES: The RFD of hip abductor muscles, maximum walking speed, six-minute walk distance (6MWD), Berg Balance Scale, one-leg standing time (OLST), functional independence measure, and Numeric Pain Rating Scale (NPRS) were used as outcome measures. In both patients, RFD, 6MWD, OLST, and NPRS were improved by gait training with NMES compared to without NMES. CONCLUSION: Our results suggest the potential of NMES as a treatment methodology for these two patients undergoing femoral head replacement for hip fracture.

Effect of Lee Silverman Voice Treatment (LSVT)® BIG on motor symptoms in a patient with severe Parkinson's disease: a case report.

INTRODUCTION: Lee Silverman Voice Treatment® BIG (LSVT® BIG) is widely used to improve motor symptoms in patients with mild-to-moderate Parkinson's disease (PD). OBJECTIVE: To describe the effect of LSVT® BIG on the motor symptoms of a patient with severe PD. CASE DESCRIPTION: A 77-year-old woman who was diagnosed with PD received a 4-week LSVT® BIG program under the supervision of certified LSVT® BIG physical therapists. Her disease severity was classified as Hoehn and Yahr stage 4. The unified Parkinson's disease rating scale (UPDRS) part 3, 10-m walk test (10MWT), timed up-and-go test (TUG), Berg balance scale (BBS), and 30-s chair stand test (30-s CST) were used for assessment before and after intervention. OUTCOMES: The UPDRS part 3, 10MWT, TUG, BBS, and 30-s CST improved after intervention (33 to 26, 0.51 to 0.69 m/s, 38.1 to 23.2 seconds, 11 to 34, and 3 to 9 times, respectively). All improvements exceeded the Minimal Clinically Important Difference or Minimal Detectable Change values (2.5, 0.16 m/s, 3.5 seconds, 5, and 3 times, respectively). CONCLUSIONS: These results indicated that LSVT® BIG appears to have improved motor symptoms in a patient with severe PD. Further studies, ideally randomized controlled trials, are needed to confirm these findings.

[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.

Learning experiences and identity development of Japanese nursing students through study abroad: a qualitative analysis.

OBJECTIVES: This study aimed to qualitatively analyze the experiences and perceptions of students at a nursing college in Japan who studied abroad in Asia and North America, thereby identifying the full range of benefits of study abroad programs for Japanese nursing students. METHODS: We conducted a qualitative analysis of the reflection papers and free-response questionnaire items completed by 50 Japanese undergraduate nursing students who participated in 9 study abroad programs in Asia and North America. Content analysis of the data proceeded from typological and deductive to data-driven and inductive, recursively and collaboratively. RESULTS: The results reveal perceived benefits in the areas of English language proficiency and motivation; knowledge of nursing practices, healthcare systems, and global health; cultural awareness and sensitivity; and various types of identity development (second-language motivation and identity, national/ethnic identity, professional identity, identity as a global citizen, and personal growth). It was also shown that students' perceptions of what they learned or gained varied according to the specific characteristics of each study abroad program. CONCLUSIONS: Study abroad experiences are often critical turning points that enhance nursing students' identity formation in the context of multiple and overlapping communities of practice. They also enhance core elements of the educational mission of a nursing college, particularly relating to liberal arts and internationalization. These findings can inform the development of assessment tools to be used in conjunction with study abroad programs at nursing colleges.

Human neutrophils show decreased survival upon long-term exposure to clozapine.

OBJECTIVE: Clozapine is an atypical antipsychotic prescribed for treatment-resistant schizophrenic patients, but treatment with clozapine is strictly limited because it can induce lethal-hematologic side effects. We investigated the effects of short- and long-term exposure of human neutrophils derived from healthy subjects to clozapine and compared them with the effects of reactive metabolite of clozapine, olanzapine, and doxorubicin. METHODS: Neutrophils were exposed to clozapine and olanzapine (1, 10, 50, or 100 µM), reactive metabolite of clozapine (50 or 100 µM), or doxorubicin (0.2 µM) and cultured for a short (2 hr) or long (24 or 48 hr) duration, and then the survival rate of neutrophils was calculated. RESULTS: Decreased human neutrophil survival was observed in short-term exposure to clozapine (100 µM) and long-term exposure to clozapine even at a lower concentration (50 µM). A similar phenomenon was observed in reactive metabolite of clozapine and long-term exposure to doxorubicin (0.2 µM), but not to olanzapine (1-100 µM). CONCLUSIONS: The effect of long-term exposure to clozapine on neutrophil survival is plausibly associated with delayed onset of agranulocytosis after initial exposure. Our results suggest that human neutrophils are vulnerable to clozapine and its reactive metabolite in a concentration- and time-dependent manner.

Interactive effects of 5-HTTLPR genotype and rearing environment on affective attitude towards own infant in Japanese mothers.

Maternal positive attitude towards one's own infant is the cornerstone of effective parenting. Previous research has revealed an influence of both genetic and environmental factors on maternal parenting behavior, but little is known of the potential gene-environment interaction in shaping a mother's affective attitude. To address this gap, we investigated the effect of a mother's childhood rearing environment and a serotonin transporter gene polymorphism (5-HTTLPR) on affective attitude towards her infant. Our analyses found an interactive effect between rearing environment and 5-HTTLPR genotype on maternal attitude. Specifically, a poor rearing environment (characterized by low maternal care and high paternal overprotection) decreased positive attitude towards one's own infant in mothers with homozygous short allele genotype. In contrast, this detrimental effect was almost eliminated in long allele carriers. Altogether, our results indicate that the 5-HTTLPR gene moderates the influence of experienced rearing environment on maternal parental behavior in a manner consistent with the notion that the short 5-HTTLPR allele amplifies environmental influence.

Involvement of the histamine H4 receptor in clozapine-induced hematopoietic toxicity: Vulnerability under granulocytic differentiation of HL-60 cells.

Clozapine is an effective antipsychotic for treatment-resistant schizophrenia, but can cause fatal hematopoietic toxicity as agranulocytosis. To elucidate the mechanism of hematopoietic toxicity induced by clozapine, we developed an in vitro assay system using HL-60 cells, and investigated the effect on hematopoiesis. HL-60 cells were differentiated by all-trans retinoic acid (ATRA) into three states according to the following hematopoietic process: undifferentiated HL-60 cells, those undergoing granulocytic ATRA-differentiation, and ATRA-differentiated granulocytic cells. Hematopoietic toxicity was evaluated by analyzing cell survival, cell proliferation, granulocytic differentiation, apoptosis, and necrosis. In undifferentiated HL-60 cells and ATRA-differentiated granulocytic cells, both clozapine (50 and 100µM) and doxorubicin (0.2µM) decreased the cell survival rate, but olanzapine (1-100µM) did not. Under granulocytic differentiation for 5days, clozapine, even at a concentration of 25µM, decreased survival without affecting granulocytic differentiation, increased caspase activity, and caused apoptosis rather than necrosis. Histamine H4 receptor mRNA was expressed in HL-60 cells, whereas the expression decreased under granulocytic ATRA-differentiation little by little. Both thioperamide, a histamine H4 receptor antagonist, and DEVD-FMK, a caspase-3 inhibitor, exerted protection against clozapine-induced survival rate reduction, but not of live cell counts. 4-Methylhistamine, a histamine H4 receptor agonist, decreased the survival rate and live cell counts, as did clozapine. HL-60 cells under granulocytic differentiation are vulnerable under in vitro assay conditions to hematopoietic toxicity induced by clozapine. Histamine H4 receptor is involved in the development of clozapine-induced hematopoietic toxicity through apoptosis, and may be a potential target for preventing its occurrence through granulocytic differentiation.

Difference in distribution profiles between CD163+ tumor-associated macrophages and S100+ dendritic cells in thymic epithelial tumors.

BACKGROUND: In a number of human malignancies, tumor-associated macrophages (TAMs) are closely involved in tumor progression. On the other hand, dendritic cells (DCs) that infiltrate tumor tissues are involved in tumor suppression. However, there have been very few reports on the distribution profiles of TAMs and DCs in thymic epithelial tumors. We examined the difference in the distribution profiles between TAMs and DCs in thymoma and thymic carcinoma. METHODS: We examined 69 samples of surgically resected thymic epithelial tumors, namely, 16 thymic carcinomas and 53 thymomas, in which we immunohistochemically evaluated the presence of TAMs using CD68 and CD163 as markers and DCs using S100 as the marker in tumor tissue samples in comparison with normal thymic tissues. RESULTS: The percentage of samples with a large number of CD68+ TAMs was not significantly different between thymic carcinoma and thymoma (7/16 versus 16/53, p = 0.904). However, the percentage of sample with a large number of CD163+ TAMs was significantly higher in thymic carcinoma than in thymoma (15/16 versus 34/53, p = 0.024). In contrast, the percentage of samples with a large number of S100+ DCs was significantly lower in thymic carcinoma than in thymoma (2/16 versus 23/53, p = 0.021). CONCLUSIONS: To the best of our knowledge, we are the first to show a high percentage of CD163+ TAMs and a low percentage of S100+ DCs in thymic carcinoma samples, and our findings may provide an idea for future targeted therapeutic strategies for thymic carcinoma using antibodies that inhibit monocyte differentiation to TAMs, thereby skewing TAMs differentiation toward DCs. VIRTUAL SLIDES: The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/13000_2014_215.

Cyclin-dependent kinase inhibitors, p16 and p27, demonstrate different expression patterns in thymoma and thymic carcinoma.

OBJECTIVES: The role of cell cycle inhibitors in tumorigenesis has been proven in various neoplasms; however, their roles in thymic tumors are still unclear. We examined the expression of cell cycle inhibitors such as those of the Cip/Kip family (p21, p27, and p57) and the INK-4/ARF family (p16 and p14) in thymoma and thymic carcinoma. METHODS: Samples from 41 thymoma and 14 thymic carcinoma patients, and 34 normal thymic tissue samples were prepared for the study. Immunohistochemical analysis using antibodies to p21, p27, p57, p16, and p14 was carried out, and the positivity for these inhibitors in each group was estimated in terms of their subcellular location and percentage of cells showing positive staining. RESULTS: Nuclear p27 showed a stepwise decrease (p < 0.0001), and the cytoplasmic p27 showed a stepwise increase (p < 0.0001) in expression level with the increase in malignancy. p16 in both the nucleus and cytoplasm showed a stepwise increase (p < 0.0001) in expression level with the increase in malignancy. However, as for p21, p57, and p14, there was almost no nuclear or cytoplasmic expression in each group. CONCLUSIONS: Our findings suggest that low nuclear and high cytoplasmic p27 expression levels, and high nuclear and cytoplasmic p16 expression levels may correlate with the increase in thymic malignancy.

Detection of RBM15-MKL1 fusion was useful for diagnosis and monitoring of minimal residual disease in infant acute megakaryoblastic leukemia.

Acute megakaryocytic leukemia (AMKL) with t(1;22)(p13;q13) is a distinct category of myeloid leukemia by WHO classification and mainly reported in infants and young children. Accurate diagnosis of this type of AMKL can be difficult, because a subset of patients have a bone marrow (BM) blast percentage of less than 20% due to BM fibrosis. Therefore, it is possible that past studies have underestimated this type of AMKL. We present here the case of a 4-month-old female AMKL patient who was diagnosed by presence of the RBM15-MKL1 (OTT-MAL) fusion transcript by RT-PCR. In addition, we monitored RBM15-MKL1 fusion at several time points as a marker of minimal residual disease (MRD), and found that it was continuously negative after the first induction chemotherapy even by nested RT-PCR. Detection of the RBM15-MKL1 fusion transcript thus seems to be useful for accurate diagnosis of AMKL with t(1;22)(p13;q13). We recommend that the RBM15-MKL1 fusion transcript be analyzed for all suspected AMKL in infants and young children. Furthermore, monitoring of MRD using this fusion transcript would be useful in treatment of AMKL with t(1;22)(p13;q13).

Successful use of eculizumab in an 86-year-old patient with paroxysmal nocturnal hemoglobinuria in Japan.

Eculizumab was used to treat an 86-year-old male patient with paroxysmal nocturnal hemoglobinuria, the oldest reported case in Japan. As observed in younger patients, this drug rapidly suppressed hemolysis in the present patient, which allowed weaning from blood transfusion. Eculizumab treatment has been continued for 2 years and resulted in the alleviation of renal dysfunction. Despite the patient's advanced age, the inhibition of complement activity caused by this drug did not result in infection, indicating that it is safe to use in elderly patients.

Richter syndrome with follicular colonization of chronic lymphocytic leukemia/small lymphocytic lymphoma cells mimicking follicular lymphoma.

Follicular colonization is occasionally observed in marginal zone lymphoma. In rare cases, it has also been associated with mantle cell lymphoma. Chronic lymphocytic leukemia typically involves nodal or extranodal tissues as diffuse proliferation by complete effacement of the normal architecture. The involvement of chronic lymphocytic leukemia may be less frequently limited to the interfollicular areas. Here, we report a case of Richter syndrome of the small intestine that was initially diagnosed as follicular lymphoma of the gastrointestinal tract because of a partial follicular growth pattern in addition to a mainly diffuse proliferation pattern. The follicular pattern mimicking follicular lymphoma was shown to be composed of reactive follicles with follicular colonization of the original chronic lymphocytic leukemia cells. As the prognoses of Richter syndrome and follicular lymphoma of gastrointestinal tract are quite different, clinicians must carefully diagnose these conditions to avoid a misdiagnosis.

Comparison of the effect of ranibizumab and verteporfin for polypoidal choroidal vasculopathy: 12-month LAPTOP study results.

PURPOSE: To compare the effect of photodynamic therapy (PDT) and intravitreal ranibizumab in patients with polypoidal choroidal vasculopathy (PCV). DESIGN: Randomized clinical trial. SETTING: Multicenter. STUDY POPULATION: Total of 93 patients with treatment-naïve PCV. INTERVENTION: Patients were randomized to 2 arms. Patients in the PDT arm underwent a single session of PDT with verteporfin, and patients in the ranibizumab arm received 3 monthly ranibizumab injections at baseline. Additional treatment was performed as needed in each arm. MAIN OUTCOME MEASURES: Primary outcome measurement was the proportion of patients gaining or losing more than 0.2 logarithm of minimal angle of resolution (logMAR) units from baseline. Mean change of logMAR and central retinal thickness (CRT) were also evaluated. RESULTS: In the PDT arm (n = 47), 17.0% achieved visual acuity gain, 55.3% had no change, and 27.7% experienced visual acuity loss. The results were 30.4%, 60.9%, and 8.7%, respectively, in the ranibizumab arm (n = 46), significantly better than the PDT arm (P = .039). In the PDT arm, mean CRT improved (366.8 ± 113.6 µm to 289.1 ± 202.3 µm, P < .001), but logMAR was unchanged (0.57 ± 0.31 to 0.62 ± 0.40). The ranibizumab arm demonstrated improvement in both CRT (418.9 ± 168.6 µm to 311.2 ± 146.9 µm, P < .001) and logMAR (0.48 ± 0.27 to 0.39 ± 0.26, P = .003). Mean change of logMAR was also greater in the ranibizumab arm (P = .011). CONCLUSION: Intravitreal injection of ranibizumab is more effective than PDT for treatment-naïve PCV.

Prenatal exposure to a polychlorinated biphenyl (PCB) congener influences fixation duration on biological motion at 4-months-old: a preliminary study.

Adverse effects of prenatal exposure to polychlorinated biphenyl (PCB) congeners on postnatal brain development have been reported in a number of previous studies. However, few studies have examined the effects of prenatal PCB exposure on early social development. The present study sought to increase understanding of the neurotoxicity of PCBs by examining the relationship between PCB congener concentrations in umbilical cord blood and fixation patterns when observing upright and inverted biological motion (BM) at four-months after birth. The development of the ability to recognize BM stimuli is considered a hallmark of socio-cognitive development. The results revealed a link between dioxin-like PCB #118 concentration and fixation pattern. Specifically, four-month-olds with a low-level of prenatal exposure to PCB #118 exhibited a preference for the upright BM over inverted BM, whereas those with a relatively high-level of exposure did not. This finding supports the proposal that prenatal PCB exposure impairs the development of social functioning, and indicates the importance of congener-specific analysis in the risk analysis of the adverse effects of PCB exposure on the brain development.

Visual outcome of photodynamic therapy for typical neovascular age-related macular degeneration and polypoidal choroidal vasculopathy over 5 years of follow-up.

PURPOSE: To evaluate the long-term effects of photodynamic therapy (PDT) on typical neovascular age-related macular degeneration (tAMD) and polypoidal choroidal vasculopathy (PCV). METHODS: This was a multicenter prospective study of 139 eyes from 136 patients (tAMD: 74 eyes; PCV: 65 eyes) who underwent PDT as the initial treatment. The change in best-corrected visual acuity (BCVA), predictive factors for the BCVA at 60 months, frequency of recurrence, and mean recurrence period were analyzed. RESULTS: The pre-PDT BCVA and greatest linear dimension (GLD) did not differ between the two groups. The mean BCVA (logMAR) was significantly improved at 6 months post-initial PDT (post-PDT) in the PCV group (-0.11, P = 0.0091). However, at 60 months post-PDT, the mean BCVA was significantly worse than baseline in the tAMD (+0.21, P = 0.0035) and PCV (+0.21, P = 0.0076) groups. Pre-PDT BCVA, age, and GLD were the factors significantly associated with the BCVA at 60 months post-PDT. Although the frequency of recurrence did not significantly differ between the two phenotype groups, the mean recurrence period was significantly longer in the PCV group than in the tAMD group (15.7 vs. 8.6 months, P = 0.0020). CONCLUSIONS: PDT may not have benefits for visual acuity in cases of tAMD and PCV over 5 years of follow-up.

Nodal marginal zone B cell lymphoma with prominent follicular colonization with deletion of chromosome 13.

Nodal marginal zone B cell lymphoma is a rare type of malignant lymphoma and appears to be heterogeneous. Here we report a 60-year-old woman with stage I splenic type of nodal marginal zone B cell lymphoma with prominent follicular colonization. She was treated only by radiation therapy, and remained free of disease on examination for 4 years. The lymph node cells showed an abnormal chromosome of deletion 13, although neither bone marrow cells nor peripheral blood cells demonstrated the same abnormal chromosome. This type of chromosomal abnormality has not been previously reported and may be related to good prognosis in the present case.

Low dose cepharanthine ameliorates immune thrombocytopenic purpura associated with multiple myeloma.

Immune thrombocytopenic purpura associated with multiple myeloma is extremely rare. Here, we present the successful management of an elderly Japanese patient with multiple myeloma complicated by immune thrombocytopenia with low dose cepharanthine - a plant derived alkaloid. A 78-year-old male patient with IgGκ multiple myeloma was repetitively treated with melpharan and prednisolone. In each chemotherapy course, we demonstrated a close relationship between platelet recovery and administration of high dose prednisolone. When further chemotherapy was avoided because of the patient's poor general condition, administration of cepharanthine was effective in halting progressive thrombocytopenia due to abnormal immune mechanisms. We propose the usefulness of cepharanthine in management of this rare disease.