Work engagement influencing factors of Japanese midwives working in prenatal medical centers.

INTRODUCTION: There have been significant changes in the work environment of midwives, such as the establishment of prenatal medical centers and shared wards for obstetrics and other departments. These changes in the work environment pose a psychological burden on midwives. Under these circumstances, the concept of work engagement is essential for overcoming the ensuing difficulties. However, no studies have yet investigated midwives working in prenatal medical centers in Japan. This study examined the factors affecting work engagement among midwives working in prenatal medical centers in Japan. METHODS: A cross-sectional survey of 498 midwives working at prenatal medical centers nationwide was conducted. Data were analyzed using the Mann-Whitney U test or Kruskal-Wallis test, correlation analysis using Spearman's rank correlation coefficient, and multiple regression analysis as linear regression. RESULTS: The median of work engagement score was 3.00 (IQR: 2.40-3.60). The multiple linear regression analysis showed that professional identity (ß=0.494, p<0.001), resilience (ß=0.243, p<0.001), presence of in-hospital midwifery in the facility (ß=0.138, p<0.011), and age (ß=0.085, p=0.021) were significant. The adjusted R2 value was 0.490 (p<0.001). CONCLUSIONS: These results offer management insights into improving work engagement among midwives working in prenatal medical centers in Japan. The proposed measures include hospital/ward administrators establishing the professional identity of midwives and providing them with opportunities to demonstrate their expertise, for instance, within in-hospital midwifery systems at perinatal medical centers.

Preterm toddlers have low nighttime sleep quality and high daytime activity.

A number of studies have been made on the sleep characteristics of children born preterm in an attempt to develop methods to address the sleep problems commonly observed among such children. However, the reported sleep characteristics from these studies vary depending on the observation methods used, i.e., actigraphy, polysomnography and questionnaire. In the current study, to obtain reliable data on the sleep characteristics of preterm-born children, we investigated the difference in sleep properties between 97 preterm and 97 term toddlers of approximately 1.5 years of age using actigraphy. Actigraphy units were attached to the toddlers' waists with an adjustable elastic belt for 7 consecutive days, and a child sleep diary was completed by their parents. In the study, we found that preterm toddlers had more nocturnal awakenings and more daytime activity, suggesting that preterm-born children may have a different process of sleep development in their early development.

Patient-centered outcomes at hospital discharge in mechanically ventilated COVID-19 patients in Kobe, Japan: A single-center retrospective cohort study.

BACKGROUND: Apart from saving the lives of coronavirus disease (COVID-19) patients on mechanical ventilation (MV), recovery from the sequelae of prolonged MV (PMV) is an emerging issue.c METHODS: We conducted a retrospective study among consecutive adult COVID-19 patients admitted to an intensive care unit (ICU) in Kobe, Japan, between March 3, 2020, and January 31, 2021, and received invasive MV. Clinical outcomes included in-hospital mortality and recovery from COVID-19 in survivors regarding organ dysfunction, respiratory symptoms, and functional status at discharge. We compared survivors' outcomes with MV durations of >14 days and ≤14 days. RESULTS: We included 85 patients with a median age of 69 years (interquartile range, 64-75 years); 76 (89%) patients had at least 1 comorbidity, 72 (85%) were non-frail, and 79 (93%) were functionally independent before COVID-19 infection. Eighteen patients (21%) died during hospitalization. At discharge, 59/67 survivors (88%) no longer required respiratory support, 50 (75%) complained of dyspnea, and 40 (60%) were functionally independent. Of the survivors, 23 patients receiving MV for >14 days had a worse recovery from COVID-19 at discharge compared with those on MV for ≤14 days, as observed using the Barthel index (median: 35 [5-65] vs. 100 [85-100]), ICU mobility scale (8 [5-9] vs. 10 [10-10]), and functional oral intake scale (3 [1-7] vs. 7 [7-7]) (P < 0.0001). CONCLUSION: Although four-fifths of the patients survived and >50% of survivors demonstrated clinically important recovery in organ function and functional status during hospitalization, PMV was related to poor recovery from COVID-19 at discharge.

An Evaluation of the Signs of Nipple Trauma Associated With Breastfeeding: A Delphi Study.

BACKGROUND: No consensus on the definitions of nipple trauma has been reported. Thus, different individuals assess identical events inconsistently. RESEARCH AIMS: To establish clear definitions for the seven signs of nipple trauma related to breastfeeding-erythema, swelling, scabbing, blistering, fissure, purpura, and peeling-and to reach consensus among multiple specialists. METHODS: We implemented a longitudinal, prospective survey design using a 3-step Delphi method. In the first survey we targeted specialists in breastfeeding, dermatology, and cosmetics, and we presented images as representative cases during a set of semi-structured interviews. In the second and third surveys, we questioned midwives who were certified as "advanced midwives" through mail, using a questionnaire prepared based on the results of the first survey. The agreement criteria of this study were as follows: (1) a median of 2.0 or below; (2) an interquartile range of 1.0 or below; and (3) at least 51% showing responses of either "strongly agree" or "agree." RESULTS: Based on the responses of the 42 experts, we reached a consensus on 48 items: eight related to erythema, 10 to swelling, nine to scabbing, seven to blistering, seven to fissure, four to purpura, and three to peeling. We then classified these items based on the condition or possible mechanism of the wound. Finally, we developed an observation tool: "seven signs of nipple trauma associated with breastfeeding," along with images. CONCLUSIONS: Application of this tool for breastfeeding support could improve objectivity in observing and evaluating nipple trauma.

Sleep maturation influences cognitive development of preterm toddlers.

Our recent study on full-term toddlers demonstrated that daytime nap properties affect the distribution ratio between nap and nighttime sleep duration in total sleep time but does not affect the overall total amount of daily sleep time. However, there is still no clear scientific consensus as to whether the ratio between naps and nighttime sleep or just daily total sleep duration itself is more important for healthy child development. In the current study, to gain an answer to this question, we examined the relationship between the sleep properties and the cognitive development of toddlers born prematurely using actigraphy and the Kyoto scale of psychological development (KSPD) test. 101 premature toddlers of approximately 1.5 years of age were recruited for the study. Actigraphy units were attached to their waist with an adjustable elastic belt for 7 consecutive days and a child sleep diary was completed by their parents. In the study, we found no significant correlation between either nap or nighttime sleep duration and cognitive development of the preterm toddlers. In contrast, we found that stable daily wake time was significantly associated with better cognitive development, suggesting that sleep regulation may contribute to the brain maturation of preterm toddlers.

Daytime nap and nighttime breastfeeding are associated with toddlers' nighttime sleep.

The purpose of the present study is to examine the association between toddlers' sleep arrangements and their nighttime sleep duration and other sleep variables. For this investigation, we performed a study in which child activity and sleep levels were recorded using actigraphy. The parents of 1.5-year-old toddlers (n = 106) were asked to attach an actigraphy unit to their child's waist with an adjustable elastic belt and complete a sleep diary for 7 consecutive days. Questionnaires were used to assess the sleep arrangements of the toddlers. There was a significant negative correlation between nap duration and nighttime sleep duration, suggesting that longer nap sleep induces shorter nighttime sleep duration. Among the sleep arrangements, such as nighttime breastfeeding or co-sleeping, only nighttime breastfeeding predicted shorter nighttime sleep duration. Our findings indicate that shorter naps induce a longer nighttime sleep in 1.5-year-old toddlers while nighttime breastfeeding decreases their nighttime sleep duration.

Clinical characteristics and outcomes of critically ill patients with COVID-19 in Kobe, Japan: a single-center, retrospective, observational study.

PURPOSE: Coronavirus disease 2019 (COVID-19) has placed a great burden on critical care services worldwide. Data regarding critically ill COVID-19 patients and their demand of critical care services outside of initial COVID-19 epicenters are lacking. This study described clinical characteristics and outcomes of critically ill COVID-19 patients and the capacity of a COVID-19-dedicated intensive care unit (ICU) in Kobe, Japan. METHODS: This retrospective observational study included critically ill COVID-19 patients admitted to a 14-bed COVID-19-dedicated ICU in Kobe between March 3, 2020 and June 21, 2020. Clinical and daily ICU occupancy data were obtained from electrical medical records. The last follow-up day was June 28, 2020. RESULTS: Of 32 patients included, the median hospital follow-up period was 27 (interquartile range 19-50) days. The median age was 68 (57-76) years; 23 (72%) were men and 25 (78%) had at least one comorbidity. Nineteen (59%) patients received invasive mechanical ventilation for a median duration of 14 (8-27) days. Until all patients were discharged from the ICU on June 5, 2020, the median daily ICU occupancy was 50% (36-71%). As of June 28, 2020, six (19%) died during hospitalization. Of 26 (81%) survivors, 23 (72%) were discharged from the hospital and three (9%) remained in the hospital. CONCLUSION: During the first months of the outbreak in Kobe, most critically ill patients were men aged ≥ 60 years with at least one comorbidity and on mechanical ventilation; the ICU capacity was not strained, and the case-fatality rate was 19%.

Tension pneumoperitoneum caused by intestinal perforation from underlying colon cancer: a case report.

BACKGROUND: Tension pneumoperitoneum, a form of abdominal compartment syndrome, is an important clinical condition. Increased pressure in the intraperitoneal cavity leads to respiratory and circulatory instability. Most of the reported cases include complications due to active air infusion into the peritoneal cavity or trauma; however, few reports are available on tension pneumoperitoneum caused by perforation from colon cancer. We present a case of a patient with tension pneumoperitoneum caused by gastrointestinal perforation owing to colon cancer. CASE PRESENTATION: A 63-year-old Japanese man with altered mental state was brought to our emergency department. He was in shock, and an abdominal radiograph suggested gastrointestinal perforation. Despite rapid fluid infusion and inotropic support, his condition deteriorated. His abdomen was tensely distended; abdominal computed tomography showed significant intra-abdominal gas. Following immediate needle decompression, his circulatory status improved. Emergent laparotomy revealed an approximately 10-cm tumor (adenocarcinoma) in the colon, which caused the perforation. CONCLUSIONS: A perforated wall or the surrounding omental fat that acts as a one-way valve could lead to tension pneumoperitoneum without active air infusion. Although tension pneumoperitoneum is a life-threatening condition, it is reversible if prompt diagnosis and immediate decompression are performed. Physicians should always consider this condition as one of the causes of shock or cardiopulmonary arrest, even without an apparent medical history of active air infusion or trauma.

Nipple Skin Trauma in Breastfeeding Women During Postpartum Week One.

OBJECTIVE: To objectively describe changes to nipple skin and classify signs of nipple trauma in breastfeeding women during postpartum week 1. METHODS: This study was conducted in two phases. Phase 1 was an observational prospective study of breastfeeding mothers in which data were obtained from photographs and digital images of nipple skin and analyzed to anatomically classify signs of nipple trauma. In Phase 2, the reliability of signs identified in Phase 1 was verified with the cooperation of eight clinical midwives. RESULTS: A total of 776 images of 50 breastfeeding mothers were obtained daily. The signs of nipple trauma included erythema, swelling, blistering, fissure, and scabbing. Purpura and peeling were identified only with photographic image analysis. Scabbing and blistering were classified as damage to the dermis, and erythema and swelling as damage to the epidermis, based on anatomical evidence and the mothers' subjective experiences of pain intensity. Erythema and swelling were observed from day 0, with erythema most frequently observed. For inter-rater reliability of the five signs of nipple trauma, Kendall's coefficient of concordance ranged from 0.46 (moderate) to 0.85 (almost perfect). Reliability was high for fissure, substantial for blistering and scabbing, and moderate for erythema and swelling. CONCLUSIONS: Image analysis revealed five signs of nipple trauma. Erythema and swelling were the most frequently observed signs during postpartum week 1. However, the agreement rate was lower than that for other signs, suggesting the possibility of conflicting interpretations in clinical evaluation.

Daytime nap controls toddlers' nighttime sleep.

Previous studies have demonstrated that afternoon naps can have a negative effect on subsequent nighttime sleep in children. These studies have mainly been based on sleep questionnaires completed by parents. To investigate the effect of napping on such aspects of sleep quality, we performed a study in which child activity and sleep levels were recorded using actigraphy. The parents were asked to attach actigraphy units to their child's waist by an adjustable elastic belt and complete a sleep diary for 7 consecutive days. 50 healthy young toddlers of approximately 1.5 years of age were recruited. There was a significant negative correlation between nap duration and both nighttime sleep duration and sleep onset time, suggesting that long nap sleep induces short nighttime sleep duration and late sleep onset time. We also found a significant negative correlation between nap timing and nighttime sleep duration and also a significant positive correlation between nap timing and sleep onset time, suggesting that naps in the late afternoon also lead to short nighttime sleep duration and late sleep onset. Our findings suggest that duration-controlled naps starting early in the afternoon can induce a longer nighttime sleep in full-term infants of approximately 1.5 years of age.

Relation between sleep status of preterm infants aged 1-2 years and mothers' parenting stress.

BACKGROUND: The aim of this study was to compare infants' sleep measures through an actigraph and maternal parenting stress among preterm and full-term mothers, and to explore the factors affecting maternal parenting stress in relation to infants' sleep. METHODS: The subjects were 44 pairs of mothers and children. Twenty-one were in the preterm group, and 23 were in the full-term group. Inclusion criteria for preterm infants were born at less than 36 weeks and birthweight of less than 2500 g. The Parenting Stress Index (PSI) Short Form assesses maternal perception of the degree of parenting stress: the children's domain, and the parent's domain. An actigraph was applied to assess the infants' sleep measures. RESULTS: The PSI showed significant differences, with high scores in parenting stress in the preterm group. Also, the number of mothers who complained about their infant's sleep issues was significantly higher in the preterm group. Most of the sleep measures showed improvement by their age in both preterm and full-term infants. Multiple linear regression analysis showed that sleep efficiency, longest sleep duration at nighttime accounted for 71% of stress in the children's domain of the PSI of the preterm group. CONCLUSION: The parenting stress among mothers of preterm infants was significantly higher than that of mothers of full-term infants. The mothers of preterm infants were concerned about their infant's nocturnal sleep quality.

[Development of nocturnal sleep behaviors in very low birth infants].

The objective of this study is to identify the developmental changes in nocturnal sleep behaviors among preterm infants in comparison with full-term infants (control group). The subjects were 18 preterm infants and 23 full-term infants with mean gestational weeks of 26.5 +/- 2.3 and 39.1 +/- 1.3, and average weights of 879 +/- 188 g and 2,940 +/- 352 g, respectively. Sleep measures were obtained through Actigraph (Micro-mini RC, Ambulatory Monitoring Inc., Ardsley, NY) over a week-long period. Results showed that the sleep duration was significantly different depending on the corrected age of months in only the preterm group (Preterm group: 504 +/- 55 min in under 12 months group, 543 +/- 68 min in over 13 months group. Full-term group: 548 +/- 68 min in under 12 months group, 544 +/- 79 min in over 13 months group). ACTX (percentage of minutes with higher than 0 activity score) was significantly higher for the preterm infants at both age groups in months. In conclusion, the nocturnal sleep duration of preterm infants reached the same level as those of full-term infants after the age of 13 corrected months. Also preterm infants were found to have a higher percentage of less restful sleep during nighttime. Further research is needed to understand the developmental course of physical activity during night time of preterm infants.

Comparing sleep measures of infants derived from parental reports in sleep diaries and acceleration sensors.

AIM: Comparing sleep measures of infants derived from two data collection methods, acceleration sensors and sleep diaries, and identify the clinical application for each data collection method. METHODS: The participants were 52 pairs of infants and mothers. Infant sleep measures were obtained through the actigraphs (Micro-mini RC, Ambulatory Monitoring Inc., Ardsley, NY, USA) and sleep diaries for over a period of 7 days. RESULTS: The results showed that the concordance in sleep measures derived from two methods showed decreases in the following order: sleep offset time [r=0.91 (p=0.00)], sleep onset time r=0.89 (p=0.00), nocturnal sleep duration [r=0.75 (p=0.00)], the number of night wakings [r=0.46 (p<0.01)] and WASO [r=0.34 (p<0.05)]. It was revealed that the accuracy of sleep diary records was affected by the sleeping place and varied throughout the study period. CONCLUSION: It was confirmed that the sleep measures indicating sleep schedule reported from the sleep diaries had high concordances compared with the data from the actigraphs. Using the sleep diary was recommended to understand behaviours when focusing on infant's daily rhythms. In terms of accuracy and stability of recording throughout the study period, understanding sleep quality and independence of sleeping places, the choice of actigraph was recommended.

Activity-based assessment of the sleep behaviors of VLBW preterm infants and full-term infants at around 12 months of age.

PURPOSE: The aim of this study is to identify the characteristics of sleep behaviors assessed from activity data among very low-birth weight (VLBW) preterm infants in comparison to full-term infants at the age of around 12 corrected months, due to the possibility that sleep behaviors of preterm infants may be different from those of full-term infants. METHOD: Cross-sectional study. Infant sleep measures were obtained through actigraphs (Micro-mini RC, Ambulatory Monitoring Inc., Ardsley, NY), which were attached to the infants' ankles during a week-long period. The subjects were 14 preterm infants and 14 full-term infants in which the mean ages were 13.3+/-2.1 corrected months and 12.3+/-2.4 month, respectively. RESULTS: Preterm infants showed significantly less sleep duration during nighttime than full-term infants. The mean activity score and ACTX (Activity Index: percentage minutes with more than 0 activity score) of preterm infants during nighttime were significantly higher than those of full-term infants. No significant differences in total sleep duration, daytime sleep duration, the number of night-wakings, and sleep efficiency were found between the two groups. CONCLUSION: Preterm infants slept less and had a larger percentage of less restful sleep during nighttime. The results indicated that prematurity at the time of birth remained throughout the developmental course of sleep behaviors among preterm infants at around the age of 12 corrected months.