Work-family conflict as a mediator between occupational stress and psychological health among mental health nurses in Japan.

BACKGROUND: Occupational stress among mental health nurses may affect their psychological health, resulting in reduced performance. To provide high-quality, sustainable nursing care, it is necessary to identify and control the factors associated with psychological health among mental health nurses. The purpose of this study was to examine the role of work-family conflict (WFC) in the well-known relationship between occupational stress and psychological health among mental health nurses in Japan. METHODS: In this cross-sectional study, data were gathered from 180 mental health nurses who had a coresident child or were married. Data from the Work-Family Conflict Scale, the Generic Job Stress Questionnaire, the Maslach Burnout Inventory-General Survey, and the Center for Epidemiologic Studies for Depression Scale were obtained via self-report questionnaires. The effects of occupational stress and WFC on psychological health were explored by hierarchical linear regression analysis. RESULTS: The relationship between emotional exhaustion and occupational factors, including quantitative workload and the variance in workload, disappeared with the addition of WFC (each work interference with family [WIF] or family interference with work [FIW]). The relationship between emotional exhaustion and mental demands disappeared only with the addition of WIF. The relationship between depressive symptoms and variance in workload disappeared with the addition of WFC (each WIF or FIW). CONCLUSION: Our findings may encourage hospital administrators to consider the risks of medical staff WFC. Furthermore, longitudinal investigations into the factors associated with WFC are required for administrative and psychological interventions.

Relationship between occupational stress and depression among psychiatric nurses in Japan.

Psychiatric nursing is a stressful area of nursing practice. The purpose of this study was to examine occupational stress among psychiatric nurses in Japan. In this cross-sectional study, 238 psychiatric nurses were recruited from 7 hospitals. Data regarding the Generic Job Stress Questionnaire (GJSQ), the Center for Epidemiologic Studies for Depression Scale (CES-D), and the Health Practice Index (HPI) were obtained via self-report questionnaires. After adjusting for all the variables, CES-D scores were associated with job stress, but social support reduced the effect of stress on depression among psychiatric nurses. However, the interpretation of these results was hampered by the lack of data concerning important occupational factors, such as working position, personal income, and working hours. Further longitudinal investigation into the factors associated with depression may yield useful information for administrative and psychological interventions.

Epithelial cell ADAM17 activation by Helicobacter pylori: role of ADAM17 C-terminus and Threonine-735 phosphorylation.

Helicobacter pylori transactivates the epidermal growth factor receptor (EGFR) on gastric epithelial cells via a signalling cascade involving a disintegrin and metalloprotease 17 (ADAM17) cleavage of membrane bound heparin binding-epidermal growth factor (HB-EGF). The effects of H. pylori on ADAM17 C-terminus in epithelial cells have been examined. Total cellular ADAM17 and surface expression of ADAM17 were significantly increased by H. pylori in AGS gastric epithelial cells. These changes were associated with ADAM17 C-terminal phosphorylation at T375 and S791. AGS cells lacking the ADAM17 C-terminal domain induced significantly attenuated cleavage of HB-EGF and were also unable to upregulate HB-EGF and EGFR transcripts to the same extent as cells expressing full length ADAM17. In mitotic unstimulated AGS and ADAM17 over-expressing AGS cells, ADAM17 was highly T735 phosphorylated indicating ADAM17 T735 phosphorylation is modified during the cell cycle. In conclusion, H. pylori induced ADAM17 C-terminal T735 and/or S791 phosphorylation in gastric epithelial cells are likely to be an important trigger inducing ADAM17 activation and shedding of HB-EGF leading to EGFR transactivation. ADAM17 over-expression in gastric cancer represents a potential target for therapeutic intervention.

Gender differences in factors associated with suicidal ideation and depressive symptoms among middle-aged workers in Japan.

The purpose of this study was to assess middle-aged Japanese workers for possible gender differences in the risk factors associated with depressive symptoms and suicidal ideation. 5,878 workers (40-60 yr of age) (3,631 males and 2,247 females) were recruited from randomly selected companies in northern Japan. Demographic and lifestyle factors, suicidal ideation rate, and the data for the Brief Job Stress Questionnaire (BJSQ) and the Center for Epidemiologic Studies for Depression scale (CES-D) were obtained from the self-report questionnaires. After adjusting for possible confounding variables, marital status, absent of stress reduction technique and low job compatibility were significant independent risk factors for suicidal ideation among males. In females, marital status, feeling of insufficient sleep and absence of stress reduction techniques were significant independent risk factors after adjusting for all variables. Under the same adjustments, temporary employment also showed a protective effect against female suicidal ideation. In conclusion, our results suggest that factors related to suicidal ideation differed by gender. Different approaches for each gender might be useful in the development of suicide prevention programs. However, interpretation of work-related effects, such as temporary employment, interpersonal conflict and transportation industry, was hampered by lack of data concerning personal income, working hours and organizational commitment. Additional studies are needed to examine the longitudinal relationships between the risk factors associated with suicidal ideation and depressive symptoms.

Effects of EGFR Inhibitor on Helicobacter pylori Induced Gastric Epithelial Pathology in Vivo.

Helicobacter pylori transactivates the Epidermal Growth Factor Receptor (EGFR) and predisposes to gastric cancer development in humans and animal models. To examine the importance of EGFR signalling to gastric pathology, this study investigated whether treatment of Mongolian gerbils with a selective EGFR tyrosine kinase inhibitor, EKB-569, altered gastric pathology in chronic H. pylori infection. Gerbils were infected with H. pylori and six weeks later received either EKB-569-supplemented, or control diet, for 32 weeks prior to sacrifice. EKB-569-treated H. pylori-infected gerbils had no difference in H. pylori colonisation or inflammation scores compared to infected animals on control diet, but showed significantly less corpus atrophy, mucous metaplasia and submucosal glandular herniations along with markedly reduced antral and corpus epithelial proliferation to apoptosis ratios. EKB-569-treated infected gerbils had significantly decreased abundance of Cox-2, Adam17 and Egfr gastric transcripts relative to infected animals on control diet. EGFR inhibition by EKB-569 therefore reduced the severity of pre-neoplastic gastric pathology in chronically H. pylori-infected gerbils. EKB-569 increased gastric epithelial apoptosis in H. pylori-infected gerbils which counteracted some of the consequences of increased gastric epithelial cell proliferation. Similar chemopreventative strategies may be useful in humans who are at high risk of developing H.pylori-induced gastric adenocarcinoma.

Factor structure of the Liebowitz Social Anxiety Scale in community-dwelling subjects in Japan.

This study examined the internal consistency and structural/construct validity of the Liebowitz Social Anxiety Scale (LSAS) for community-dwelling subjects in Japan. A cross-sectional study that included 929 participants was conducted. Structural/construct validity was assessed on confirmatory factor analysis. The internal consistency reliability was good for the overall LSAS scale (α = 0.97) and for its original four factors (α = 0.92-0.89). The original four-factor model fit the observed data relatively better than alternative models. These findings indicate that the LSAS is a valid and reliable measure of anxiety symptoms for this community-dwelling population in Japan.

Effect of age and disease on bone mass in Japanese patients with schizophrenia.

BACKGROUND: There have been a limited number of studies comparing bone mass between patients with schizophrenia and the general population. The aim of this study was to compare the bone mass of schizophrenia patients with that of healthy subjects in Japan. METHODS: We recruited patients (n = 362), aged 48.8 ± 15.4 (mean ± SD) years who were diagnosed with schizophrenia or schizoaffective disorder based on the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV). Bone mass was measured using quantitative ultrasound densitometry of the calcaneus. The osteosono-assessment index (OSI) was calculated as a function of the speed of sound and the transmission index. For comparative analysis, OSI data from 832 adults who participated in the Iwaki Health Promotion Project 2009 was used as representative of the general community. RESULTS: Mean OSI values among male schizophrenic patients were lower than those in the general population in the case of individuals aged 40 and older. In females, mean OSI values among schizophrenic patients were lower than those in the general community in those aged 60 and older. In an analysis using the general linear model, a significant interaction was observed between subject groups and age in males. CONCLUSIONS: Older schizophrenic patients exhibit lower bone mass than that observed in the general population. Our data also demonstrate gender and group differences among schizophrenic patients and controls with regard to changes in bone mass associated with aging. These results indicate that intervention programs designed to delay or prevent decreased bone mass in schizophrenic patients might be tailored according to gender.

Relationships between suicidal ideation and the dimensions of depressive symptoms among middle-aged population in Japan.

BACKGROUND: The rate of suicides markedly increased in 1998 and leveled off at approximately 30,000 per year thereafter. The aim of the current study was to evaluate the link between the different dimensions of depressive symptoms and suicidal ideation among the middle-aged population in Japan. METHOD: A sample of 6848 middle-aged (40-60years of age) working individuals completed the Center for Epidemiological Studies Depression Scale (CES-D) and a questionnaire measuring suicidal ideation. The responses on the four dimensions of depressive symptoms on the CES-D (depressed affect, lack of positive affect, somatic symptoms, and interpersonal problems) were entered into regression analyses that predicted the presence of suicidal ideation among the participants with probable depression (n=1704). RESULTS: The factor score of depressed affect was significantly higher in females than in males, whereas that of interpersonal problems was significantly higher in males than in females. Among both males and females, depressed affect was a significant predictor of suicidal ideation. Among males, interpersonal problems also significantly predicted suicidal ideation. Contrary to the results of a previous study among adolescents, we did not find a relationship between lack of positive affect and suicidal ideation. CONCLUSIONS: These findings indicate that the dimensions of depressive symptoms measured with the CES-D make different contributions to suicidal ideation. Although our results could not be generalizable to a clinical setting due to lacking clinical samples, the depressed affect dimension of CES-D might be useful for screening of suicide risk among community population. Furthermore, gender differences in the relationships between the dimensions of depressive symptoms in a middle-aged population were identified. Additional studies are needed to examine gender-specific relationships between the dimensions of depressive symptoms and suicidal ideation.

Medical problems and risk factors of metabolic syndrome among radiographic knee osteoarthritis patients in the Japanese general population.

BACKGROUND: The objectives of this study were to investigate the prevalence rate of metabolic syndrome (MetS) among knee osteoarthritis (OA) patients in the Japanese general population, and to analyze the relationship between MetS and knee OA. METHODS: A total of 795 volunteers participated in this study. Based on the Kellgren-Lawrence (K-L) grade, participants were classified into two groups: the non-knee OA (non-KOA) group (K-L grade 0 or 1) or knee OA (KOA) group (grade 2-4). MetS was defined according to the Japanese Committee for the Diagnostic Criteria of MetS with a slight modification. The presence of hyperlipidemia, hypertension, diabetes mellitus and MetS were compared between the non-KOA and KOA groups. Furthermore, risk factors for MetS were analyzed by logistic regression analysis. RESULTS: The prevalence rate of hypertension in the KOA group was significantly higher than in the non-KOA group (P = 0.025) in males. Those of hypertension (P < 0.001), hyperlipidemia (P < 0.001) and diabetes mellitus (P = 0.019) in the KOA group were significantly higher than in the non-KOA group in females. Aging was significantly associated with MetS in males; the odds ratio (OR) for age was 1.033 (P = 0.020), suggesting that a 1-year increase in age raised the risk of MetS. In females, the presence of KOA was significantly associated with MetS; the risk of MetS in the KOA group was 2.196 (P = 0.034) fold the risk in the non-KOA group. CONCLUSION: The prevalence rates of MetS and knee OA tended to increase with age in males; however, there was no association between MetS and knee OA. On the other hand, knee OA was significantly associated with MetS in females. Knee OA patients must be provided the best treatment approach because of their high risk for MetS, which promotes cardiovascular diseases.

The relationship between serum selenium concentration and neutrophil function in peripheral blood.

We evaluated the relationships between neutrophil-related functions and serum selenium (Se) concentration in the general population. We examined 800 subjects who had participated in the Iwaki Health Promotion Project in 2005 to determine the relationships between serum Se concentration and neutrophil-related functions such as the production capability of reactive oxygen species (ROS), phagocytic activity, and serum opsonic activity (SOA). In nonstimulated neutrophils, i.e., in neutrophils at their baseline condition before the application of the phagocytic stimulus, the serum Se concentration tends to be high and the ROS production tends to be low. With regard to SOA, there was a significant negative correlation between lucigenin-dependent chemiluminescence and serum Se concentration in both men and women. Moreover, in women, a significant negative correlation was observed between luminol-dependent chemiluminescence and serum Se concentration. These results suggest that subjects with a lower serum Se concentration may be exposed to a greater chronic oxidative stress due to neutrophil ROS production. In addition, the findings of our study suggest that women rather than men benefit more from Se against oxidative stress.

[Changes in neutrophil immune functions under different exercise stresses].

The aim of this review is to provide a summary of the known effects of exercise on neutrophil immune functions of athletes. We measured three neutrophil immune functions (i.e., phagocytic activity (PA), reactive oxygen species (ROS) production, and serum opsonic activity (SOA)) in various types of exercise. The following is our recent findings. (1) A regular exercise increases ROS production and decreases PA. We call this change a normal pattern, and an abnormal pattern except this change. (2) A prolonged, strenuous activity (e.g., rugby match and marathon) decreases both ROS production and PA. This is one of the abnormal pattern. (3) The exercise loading performed after a camp training decreases ROS production whereas PA does not change. This is another abnormal pattern. (4) When judoists who had stopped judo training for 6 months restarted their training, the exercise loading at the beginning of their training decreases PA whereas ROS production does not change. This is another abnormal pattern. (5) A regular exercise 2 months after the beginning of their training increases ROS production and decreases PA. This change is a normal pattern. SOA showed a similar pattern of changes to ROS under all conditions. The changes in neutrophil immune functions after performing various exercises might result from the balance between external factors (intensity and style of exercise) and internal factors (e.g., fatigue and physical pain). Therefore, the changes in three neutrophil immune functions after exercise might be an index of athletes' condition.

The relationship between exhaled carbon monoxide and human neutrophil function in the Japanese general population.

We have evaluated the relationship between exhaled carbon monoxide (CO) level and neutrophil-related functions such as reactive oxygen species (ROS) production capability, phagocytic activity and serum opsonic activity in the general population. Serum opsonic activity was determined by measuring the effects of serum on neutrophil ROS production capability using lucigenin- and luminol-dependent chemiluminescence (LgCL, LmCL). LgCL is associated with the detection of O(2)(-) , whereas LmCL mainly detects H(2)O(2) and HOCl, which are higher reactive oxygen radicals. In females, exhaled CO level was found to have positive associations with ROS production capability and LgCL. However, the opposite tendency was seen between exhaled CO level and LmCL in both genders. This result suggests that neutrophil ROS production in females may have contributed to oxidative stress, which led to the increases in intrinsic CO and exhaled CO consequently. Such changes then may have inhibited the process of changing reactive oxygen radicals into higher oxidizing potential levels.

Assessment of the Center for Epidemiological Studies Depression Scale factor structure among middle-aged workers in Japan.

Our aim was to assess the internal consistency and structural/construct validity of the Center for Epidemiological Studies Depression Scale among middle-aged employees in Japan. We conducted a cross-sectional study of 7284 workers, aged 49.0 ± 6.3 (mean ± SD) years old. Structural/construct validity was assessed by confirmatory factor analysis. The 4-factor structure reported in the general population was replicated, and a second-order model with an overarching depression factor fitted well. These findings indicate that the Center for Epidemiological Studies Depression Scale is a valid and reliable measure of depressive symptoms for middle-aged workers in Japan.

Smoking habits and health-related quality of life in a rural Japanese population.

PURPOSE: To investigate the association between smoking and health-related quality of life (HRQOL) in a rural Japanese population. METHODS: A cross-sectional study of data from 823 subjects in Iwaki area of Hirosaki City, Japan. SF-36 scores between non-smokers and smokers were compared. To test the sensitivity of SF-36 scores in detecting health deterioration, effects of having diseases and having deviations from normal thresholds in health check-up were analyzed by adding them into covariates in ANCOVA. RESULTS: There was no significant difference in SF-36 scores between non-smokers and smokers. Presence of diseases significantly decreased the physical components of SF-36 scores while the results of health check-up had no significant influence on SF-36 scores. CONCLUSIONS: The results suggested the possibility that in Japan, where smoking prevalence is still relatively high, smokers may be less sensitive to sub-clinical deterioration in their own health status than smokers in Western countries that already have experienced the major decline in their smoking rate. The importance of having the smoker become more sensitive to the sub-clinical adverse effects of cigarette smoking should be stressed for the success of smoking control programs.

Ankle brachial pressure index as a marker of apathy in a community-dwelling population.

BACKGROUND: Apathy is defined as a lack of interest or emotion. Several studies have shown the relationship between apathy and atherosclerotic change in poststroke patients. Although apathy is confused with depression, it might be a specific neuropsychiatric syndrome separate from depression. OBJECTIVE: To clarify the relationship between atherosclerotic change and apathy in a community-dwelling population, which does not include the psychologic factors associated with stroke events. METHODS: The ankle brachial pressure index (ABI) was measured using a volume-plethymographic apparatus in 860 volunteers (315 males and 545 females) who participated in the Iwaki Health Promotion Project 2008. Starkstein's apathy score and the Center for Epidemiologic Studies Depression Scale (CES-D) were used to assess the psychologic status. The association between the ABI and apathy was assessed by a multiple linear regression analysis. RESULTS: Gender and low-density lipoprotein (LDL)-cholesterol were independently and significantly associated with the CES-D score. We did not find any association between CES-D score and the ABI. In addition, the extent of education and the ABI were independently and significantly associated with the apathy scale (AS). CONCLUSION: In a community-dwelling population, a lower ABI score was an independent risk factor for a higher AS score, but not for a higher CES-D score. Apathy and depression may have different etiologies in vascular factors.

Association between concentration of trace elements in serum and bronchial asthma among Japanese general population.

BACKGROUND AND AIMS: A number of previous studies had revealed the association between trace elements in serum and bronchial asthma. However, only a few researches had focused on serum concentration of trace elements in a general population. In this study, an association between trace elements in serum and bronchial asthma was investigated in a general population. METHODS: Subjects were 1025 volunteers (385 males and 640 females between ages 19 and 82 years old) who had participated in the Iwaki Health Promotion Project 2005. Bronchial asthma was diagnosed based on the European Community Respiratory Health Survey II according to the self-questionnaires on health conditions of subjects. The serum concentrations of certain trace elements (manganese, copper, zinc, selenium and iron) were measured and compared. Also, an association between serum trace elements level and neutrophil-related functions (oxidative burst activity, phagocytic activity, serum opsonic activity) were determined. RESULTS: In males, no significant differences were seen in any serum trace elements concentrations. In females, serum zinc level was significantly higher in bronchial asthma group than in control. A positive correlation was seen between serum concentration of zinc and serum opsonic activity in both genders. CONCLUSIONS: In female asthmatics, increase of oxidative stress was suggested to be caused by superoxide dismutase pathway (elimination system of reactive oxygen species) rather than serum opsonic activity (production system of reactive oxygen species from neutrophils) pathway, as the zinc concentration in bronchial asthma group was higher than that in control.

Comparison of ankle-brachial pressure index and pulse wave velocity as markers of cognitive function in a community-dwelling population.

BACKGROUND: Vascular factors have been implicated in the development of cognitive decline and dementia. The purpose of this study is to determine the association of the Ankle Brachial pressure Index (ABI) and brachial-ankle Pulse Wave Velocity (ba-PWV) to cognitive impairment in a community-dwelling population. METHODS: The ABI and ba-PWV were measured using the volume-plethymographic apparatus in 388 subjects aged 60 years old and over. The Mini-Mental State Examination was also employed to measure global cognitive status. The effectiveness of the ABI and ba-PWV as putative markers of cognitive impairment were determined by using a multiple logistic regression analysis after adjusting for confounding factors. RESULTS: Subjects with poor cognition were significantly older and less well educated than those with normal cognition. According to the multiple logistic regression analysis, the lowest ABI tertile was found to be a significant independent risk factor (OR = 3.19, 95% CI = 1.30 to 7.82) of the cognitive impairment, whereas the highest brachial-ankle PWV tertile was not. CONCLUSIONS: A low ABI was an independent risk factor for cognitive impairment in community-dwelling older populations, whereas a high ba-PWV may not be. Further research will be required to analyze ABI and PWV with greater accuracy.

Cauda equina symptoms are closely related to male lower urinary tract symptoms.

INTRODUCTION: To determine the impact of cauda equina symptoms on male lower urinary tract function, we investigated the related risk factors in healthy Japanese men. METHODS: Subjects included 345 healthy males (average age 56 years; range 26-83) who participated in the Iwaki Health Promotion Project in 2006. They were residents of Iwaki district, Hirosaki City, northern Japan. Using a self-administered, self-reported questionnaire for lumbar spinal stenosis and International Prostate Symptom Score (IPSS), we investigated the prevalence of cauda equina symptoms. We also measured body mass index; blood pressure; and triglyceride, cholesterol, glucohemoglobin, and prostate-specific antigen levels. RESULTS: Nineteen participants (5.5%) were positive for cauda equina symptoms; 270 participants (78.3%) scored 0-7 points on the total IPSS survey, 65 (18.8%) scored 8-19, and 10 (2.9%) scored 20-35. The total IPSS, and storage and voiding symptom scores of participants negative for cauda equina symptoms were significantly lower than those who were positive. Multiple logistic regression analysis revealed that age and cauda equina symptoms were independent significant risk factors for total IPSS and storage symptoms. CONCLUSIONS: Cauda equina symptoms are closely related to lower urinary tract symptoms in healthy Japanese men.

Comparison of a stool antigen test and serology for the diagnosis of Helicobacter pylori infection in mass survey.

BACKGROUND: Serum antibody to Helicobacter pylori is tested in mass screening for gastric cancer along with the level of serum pepsinogens (PG) I and II. Recently, stool antigen tests have been developed as a new non-invasive test. We examined H. pylori infection by both serology and stool antigen test in a mass survey and compared the results to estimate applicability of stool antigen test for mass survey. METHODS: A total of 994 healthy adults who received mass survey in April 2005 were tested. There were 379 men and 615 women, and the mean age was 57.7 years old. Stool samples were used to measure a H. pylori-specific antigen by enzyme immunoassay. Serum samples were tested for the prevalence of IgG antibody to H. pylori, and the level of PGs I and II was also measured to determine the presence of atrophic gastritis. RESULTS: Infection of H. pylori was defined as positive 61.4% and 56.4% by serology and stool antigen test, respectively. The concordance of both tests was not affected by gender and age of the subjects but difference was seen in subjects with atrophic gastritis. In particular, positivity of stool antigen test (81.8%) was significantly lower than that of serology (88.7%, p < .05) in 303 subjects with severe atrophic gastritis. CONCLUSIONS: Stool antigen test, which detects present but not previous infection of H. pylori, would be applicable to diagnose H. pylori infection in mass survey. Usefulness of stool antigen tests for the screening of gastric cancer should be examined.

The recovery rate at the human terminal ileum of an orally administered non-digestive oligosaccharide (raffinose).

We clarified how raffinose, one of the non-digestive oligosaccharides, reaches the large intestine. Seven healthy male volunteers were given a test meal containing 10.0 g raffinose. A double-lumen tube was placed in the terminal ileum, and the ileal contents were aspirated through the tube. The amounts of raffinose were orally administered and collected from the terminal ileum and were compared with each other. The result was that the mean+/-standard error percentage of the amount of ingested raffinose collected in the terminal ileum was 97.1+/-2.4%. Furthermore, the average times taken for 20%, 40%, 60% and 80% of raffinose to reach the terminal ileum were 2.0+/-0.6 h, 2.6+/-0.7 h, 3.6+/-0.7 h and 4.9+/-0.7 h, respectively. In conclusion, approximately 100% of ingested raffinose was recovered in the terminal ileum in the present study. This corresponds with the present generally accepted definition of a dietary fibre.