Structural equation modeling of factors contributing to quality of life in Japanese patients with multiple sclerosis.

BACKGROUND: To improve quality of life (QOL) in patients with multiple sclerosis (MS), it is important to decrease disability and prevent relapse. The aim of this study was to examine the causal and mutual relationships contributing to QOL in Japanese patients with MS, develop path diagrams, and explore interventions with the potential to improve patient QOL. METHODS: Data of 163 Japanese MS patients were obtained using the Functional Assessment of MS (FAMS) and Nottingham Adjustment Scale-Japanese version (NAS-J) tests, as well as four additional factors that affect QOL (employment status, change of income, availability of disease information, and communication with medical staff). Data were then used in structural equation modeling to develop path diagrams for factors contributing to QOL. RESULTS: The Expanded Disability Status Scale (EDSS) score had a significant effect on the total FAMS score. Although EDSS negatively affected the FAMS symptom score, NAS-J subscale scores of anxiety/depression and acceptance were positively related to the FAMS symptom score. Changes in employment status after MS onset negatively affected all NAS-J scores. Knowledge of disease information improved the total NAS-J score, which in turn improved many FAMS subscale scores. Communication with doctors and nurses directly and positively affected some FAMS subscale scores. CONCLUSIONS: Disability and change in employment status decrease patient QOL. However, the present findings suggest that other factors, such as acquiring information on MS and communicating with medical staff, can compensate for the worsening of QOL.

Activation of the anterior prefrontal cortex and serotonergic system is associated with improvements in mood and EEG changes induced by Zen meditation practice in novices.

To gain insight into the neurophysiological mechanisms involved in Zen meditation, we evaluated the effects of focused attention (FA) on breathing movements in the lower abdomen (Tanden) in novices. We investigated hemodynamic changes in the prefrontal cortex (PFC), an attention-related brain region, using 24-channel near-infrared spectroscopy during a 20-minute session of FA on Tanden breathing in 15 healthy volunteers. We found that the level of oxygenated hemoglobin in the anterior PFC was significantly increased during FA on Tanden breathing, accompanied by a reduction in feelings of negative mood compared to before the meditation session. Electroencephalography (EEG) revealed increased alpha band activity and decreased theta band activity during and after FA on Tanden breathing. EEG changes were correlated with a significant increase in whole blood serotonin (5-HT) levels. These results suggest that activation of the anterior PFC and 5-HT system may be responsible for the improvement of negative mood and EEG signal changes observed during FA on Tanden breathing.

Impact and characteristics of quality of life in Japanese patients with multiple sclerosis.

PURPOSE: To evaluate health-related quality of life (HRQOL) in Japanese patients with multiple sclerosis (MS) and investigate associations between the results of these QOL assessments and disease severity. METHODS: One-hundred sixty-three Japanese MS patients completed a questionnaire battery comprising the Functional Assessment of MS (FAMS), the Nottingham Adjustment Scale-Japanese version (NAS-J), and the European QOL scale (EQ-5D). Additional five factors affecting QOL as identified by MS patients in a focus group interview were also investigated: employment status, change of income, availability of disease information, communication with medical staff, and care received. Disease severity was determined using the Expanded Disability Status Scale (EDSS). RESULTS: There was a strong negative correlation of the subscale scores for mobility, symptoms, emotional well-being, thinking and fatigue, and additional concerns on the FAMS with EDSS score. For the NAS-J, only acceptance of the condition was correlated with disease severity. Among the five additional aspects of the condition identified by patients, employment status, income, and disease information were shown to be important for maintaining QOL in patients with MS. CONCLUSIONS: Support for finding employment and having increased or maintained household income and readily available information about the disease contribute to improving QOL in Japanese MS patients.

Prolonged gum chewing evokes activation of the ventral part of prefrontal cortex and suppression of nociceptive responses: involvement of the serotonergic system.

We have proposed a concept that prolonged rhythmic gum chewing causes a suppressed nociceptive flexion reflex via the serotonergic (5-HT) descending inhibitory pathway. However, the mechanism of activation of the 5-HT system by gum chewing remains undetermined. Several human and animal studies have reported that a direct connection exists between the prefrontal cortex (PFC) and 5-HT neurons in the dorsal raphe nucleus; therefore, we hypothesized that activation of the PFC region might be responsible for augmented 5-HT activity. To evaluate this hypothesis, oxygenated hemoglobin (oxyHb) and deoxygenated hemoglobin concentrations in the PFC were measured in the PFC during a 20-min time period of gum chewing using 24-channel near-infrared spectroscopy. A significant increase in oxyHb level was observed in the ventral part of PFC compared with the dorsal part of PFC. We confirmed the previous results in that the nociceptive flexion reflex was significantly suppressed and the 5-HT level in blood was significantly increased following prolonged gum chewing. These results support the hypothesis that activation of the ventral part of PFC during gum chewing evokes augmented activity of 5-HT neurons in the dorsal raphe nucleus, which in turn suppress nociceptive responses.

Ventral prefrontal cortex and serotonergic system activation during pedaling exercise induces negative mood improvement and increased alpha band in EEG.

This study evaluates a possible involvement of the prefrontal cortex (PFC) and serotonergic (5-HT) system in psychiatric and electroencephalography (EEG) changes during and after pedaling exercise (PE). The subjects performed PE for 15 min using a cycle ergometer. PE rate was kept at 60 rpm, and the work load (93+/-5.4 W) was decided for each subject before the experiment based on a Rating of Perceived Exertion of 12-13 for self-selected exercise intensity. Cerebral oxygenation in the PFC was assessed by concentration changes in oxygenated hemoglobin (oxyHb) using 24-channel near-infrared spectroscopy. We found that PE evoked a significant increase in oxyHb levels in the ventral PFC during PE as compared with that in the dorsal PFC. Subjects had a feeling of reduced negative mood accompanied by a tendency of increased vigor-activity after PE, as assessed by the Profile of Mood States (POMS) questionnaire. Because the ventral PFC is associated with mood state, we hypothesized that the observed mood changes may have been induced by the activation of the ventral PFC. As for EEG changes during and after PE, we found a significant increase in the relative powers of high-frequency alpha bands (10-13 Hz) during and after PE. A significant increase in whole blood 5-HT level was obtained after PE. Because cortical attenuation would be caused by the 5-HT-induced inhibition of the basal forebrain, we hypothesized that the observed EEG changes are linked with the increased blood 5-HT level or an augmentation of the 5-HT system in the brainstem.

Decreased blood serotonin in the premenstrual phase enhances negative mood in healthy women.

The purpose of this study was to evaluate mechanisms underlying the action of selective serotonin reuptake inhibitors on the improvement of negative mood symptoms in premenstrual syndrome. We assessed relationships between serotonin (5-HT) levels in the brain (estimated from 5-HT concentrations in whole blood) and negative mood states during the premenstrual phase in 13 healthy women. Mood states were evaluated using the Profile of Mood States questionnaire. We also evaluated relationships between 5-HT and ovarian hormones (oestradiol and progesterone). A significant negative correlation was seen between 5-HT concentrations in whole blood and negative mood scores (tension-anxiety and fatigue) observed in the premenstrual phase. A significant positive correlation was observed between 5-HT and oestradiol in the premenstrual phase, but not in the follicular phase. These results suggest that healthy women with lower whole blood 5-HT concentrations in the premenstrual phase exhibit enhanced negative mood due to lower 5-HT concentrations at brain synapses, which may be caused in part by lower oestrogen concentration.

[Effective inpatient ward round by discharge support team - a report of the inpatient ward round at acute hospital specialized in elderly patient].

As an acute hospital specialized in elderly patient, we utilized an integrated function screening sheet in order for doctors and nurses to start early in the discharge support at the inpatient ward. However, due to inadequate assessment, it consumed a lot of time until the request of discharge arrangement was made. Thus, as one of activities of discharge support team within the hospital, we started the inpatient ward round by team members aiming to begin a discharge support from inpatient ward. As a result of the activity, the round seems to be effective in deciding the direction of discharge, creating co-operative framework, etc. However, it revealed several problems as well. We need to study further identifying a better way of the inpatient ward round.

[A survey on constitutive elements of quality of life in patients with multiple sclerosis].

BACKGROUND AND METHODS: We conducted a survey on the constitutive elements of quality of life (QOL) in patients with multiple sclerosis (MS). We recruited 20 MS patients to complete several questionnaires including Functional Assessment of MS (FAMS), Short Form 36 (SF-36), Nottingham Adjustment Scale-Japanese version (NAS-J), Sense of Coherence (SOC), and EuroQoL (EQ-5D). We also determined their Expanded Disability Status Scale (EDSS) scores, and 10 of the 20 patients answered The Schedule of Individual Quality of Life-Direct Weighting (SEIQoL-DW) by semi-structured interviews. RESULTS: 1) We confirmed that internal consistency of FAMS was excellent. 2) Comparison analysis showed associations in most items between FAMS and SF-36. 3) Acceptance of the disorder (i. e., MS), attitude towards MS, and problem-solving ability greatly influenced QOL based on analyses of FAMS, NAS-J, SOC. 4) FAMS total score closely correlated with EQ-5D score. 5) SEIQoL-DW identified personal relations, psychological status, and execution of social roles as important constituents of QOL as well as clinical symptoms and physical status. Each scale used in the present study provided information about various constitutive element of QOL. Taking into consideration the burden placed on patients in such questionnaires as well as the result of present study, a feasible set of scales are FAMS, NAS-J.