Keiko Kazuma

Validity and reliability of the Physical Activity Scale for the Elderly (PASE) in Japanese elderly people.

Aim:  In Japan, there are no valid and reliable physical activity questionnaires for elderly people. In this study, we translated the Physical Activity Scale for the Elderly (PASE) into Japanese and assessed its validity and reliability.

Difficulties encountered by nurses in the care of terminally ill cancer patients in general hospitals in Japan

The aim of this study was to investigate the difficulties encountered by nurses who have cared for terminally ill cancer patients at general hospitals. To collect data, a survey by questionnaire was self-administered. The respondents were 375 nurses and the response rate was 70.2%. Factor analysis was conducted on 80 items related to the difficulties encountered by nurses who have cared for terminally ill cancer patients to allow reasonable item reduction and to explore better domains. Two items were excluded and the results revealed eight underlying domains: Communication with patients and families, Knowledge and skill of nurses, Treatment and informed consent (IC), Personal issues, Collaboration as a team including patients and families, Environment and system, Collaboration among nurses, and Near-death issues. Cronbachs alpha coefficients for each domain ranged from 0.77 to 0.93. The results showed that nurses working at general hospitals have experienced a high degree of difficulty overall while caring for the dying, particularly with communication with patients and families. It was concluded that this study was useful in determining the specific areas where nursing education and research should be focused.

Adherence to self-care behavior and factors related to this behavior among patients with heart failure in Japan

BACKGROUND Adherence to self-care behavior is important for patients with heart failure (HF) to prevent exacerbation of HF. The aim of this study was to evaluate adherence, identify associated factors, and clarify the impact of previous HF hospitalizations on adherence in outpatients with HF. METHODS A total of 116 outpatients completed a questionnaire, including the Japanese version of the European Heart Failure Self-Care Behavior Scale, to assess adherence. RESULTS Regardless of previous hospitalizations, adherence to seek help if HF worsened was poor. Multivariate analysis adjusted for age and brain natriuretic peptide showed that diabetes mellitus and being employed were independent predictors of poorer adherence to self-care behavior (P = .03, P = .02, respectively), but the experience of previous HF hospitalizations was not a predictor. CONCLUSIONS Self-care strategies for HF should target patients with diabetes mellitus and employed patients. Further study is necessary to develop effective programs for such patients.

Relationship of Depressive Symptoms With Hospitalization and Death in Japanese Patients With Heart Failure

BACKGROUND Depressive symptoms are risk factors for poor outcomes and are positively associated with disease severity in patients with heart failure (HF). However, little is known about this association in the Japanese population. Therefore, we evaluated the prevalence of depressive symptoms and whether depressive symptoms predicted hospitalization for HF and death independent of disease severity and other factors in HF patients. METHODS AND RESULTS A 2-year prospective cohort study was conducted on 115 outpatients with HF (73.9% males; mean age 64.7 years) in Tokyo. Of these, 27 patients (23.5%) were classified as having depressive symptoms (Center for Epidemiologic Studies Depression Scale score >or=16). Patients with depressive symptoms had higher rates of 2-year cardiac death or HF hospitalization (34.0% vs. 10.3%; P < .01), HF hospitalization (27.4% vs. 9.2%; P = .01), and all-cause death (27.4% vs. 7.2%; P < .01). Multivariate Cox regression analyses indicated that depressive symptoms were predictors of cardiac death or HF hospitalization (hazard ratio [HR], 3.29; P = .02), HF hospitalization (HR, 3.36; P = .04), and all-cause death (HR, 5.52; P = .01), independent of age and brain natriuretic peptide. CONCLUSIONS Depressive symptoms were common and independent predictors of poor outcomes in Japanese patients with HF.

Validity and Reliability of the Japanese Version of the European Heart Failure Self-Care Behavior Scale

Background: It is important to assess the self-care behavior of patients with heart failure. However, in Japan, there is no valid and reliable scale for this purpose. The European Heart Failure Self-Care Behavior Scale (EHFScBS) is used to measure the self-care behavior of heart failure patients. The purpose of this study was to translate the EHFScBS into Japanese and evaluate its validity and reliability. Methods and results: A convenience sample of 116 outpatients with heart failure completed the Japanese version of the EHFScBS. Confirmatory factor analysis demonstrated the one-dimensionality of the scale. The Japanese version of the EHFScBS was significantly correlated with another scale, which was considered to evaluate the concept linked with the self-care behavior theoretically. These confirm its construct validity. Cronbachs alpha was 0.71, suggesting that internal consistency was satisfactory. Test–retest reliability was evaluated. The intraclass correlation coefficient of the scale was 0.69 and weighted kappa for individual items was 0.33–0.87, suggesting that test–retest reliability is adequate. Conclusions: The Japanese version of the EHFScBS was showed acceptable validity and reliability. It can be used to evaluate self-care behavior of Japanese patients with heart failure.

Mental adjustment to first recurrence and correlated factors in patients with breast cancer.

Previous reports have demonstrated that breast cancer patients felt that news of their recurrence was more upsetting than their initial diagnosis. However, no studies have examined the factors that are correlated with mental adjustment in breast cancer patients who experienced recurrence. The authors investigated factors that are correlated with mental adjustment styles of fighting spirit or helplessness/hopelessness in women with breast cancer with a first recurrence. Fifty-five participants were interviewed and completed the Mental Adjustment to Cancer scale. Factors that correlated significantly with fighting spirit were performance status and history of major depression, while factors that correlated significantly with helplessness/hopelessness were age, pain, and history of major depression. These findings suggest that it is necessary to provide intervention for first recurrent breast cancer patients who have such biomedical factors, as young age, poor performance status, pain, and history of major depression to help them better cope with cancer.

Depressive symptoms are common and associated with adverse clinical outcomes in heart failure with reduced and preserved ejection fraction

BACKGROUND Little is known about depressive symptoms in heart failure with preserved ejection fraction (HFpEF, EF ≥50%). We aimed to assess the prevalence of depression, to clarify the impact of depressive symptoms upon clinical outcomes, and to identify factors associated with these symptoms in HF with reduced EF (HFrEF, EF <50%) and HFpEF. METHODS AND RESULTS A total of 106 HF outpatients were enrolled. Of them, 61 (58%) had HFpEF. Most patients were male (HFrEF 80%, HFpEF 70%) and the mean of plasma B-type natriuretic peptide (BNP) level in the HFrEF group was similar to that in the HFpEF group (164.8 ± 232.8 vs. 98.7 ± 94.8 pg/mL). HFrEF patients were treated more frequently with beta-blockers compared with HFpEF patients (71% vs. 43%, p=0.004). Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D). The prevalence of depression (CES-D score ≥16), and CES-D score did not significantly differ between HFrEF and HFpEF (24% vs. 25%, 14.1 ± 8.3 vs. 12.1 ± 8.3, respectively). During the 2-year follow-up, depressed patients had more cardiac death or HF hospitalization in HFrEF (55% vs. 12%, p=0.002) and HFpEF (35% vs. 11%, p=0.031). Cox proportional hazard analysis revealed that a higher CES-D score, indicating increased depressive symptoms, predicted cardiac events independent of BNP in HFrEF [hazard ratio (HR) 1.07, 95% confidence interval (CI) 1.01-1.13] and HFpEF (HR 1.09, 95% CI 1.04-1.15). Multiple regression analyses adjusted for BNP showed that independent predictors of depressive symptoms were non-usage of beta-blockers and being widowed or divorced in HFrEF. On the other hand, usage of warfarin was the only independent risk factor for depressive symptoms in HFpEF (all, p<0.05). CONCLUSIONS Depressive symptoms are common and independently predict adverse events in HFrEF/HFpEF patients. This study suggests that beta-blockers reduce depressive symptoms in HFrEF. In contrast, treatment for depression remains to be elucidated in HFpEF.

Effects of an Off-Site Walking Program on Energy Expenditure, Serum Lipids, and Glucose Metabolism in Middle-Aged Women

The present study aims to identify the effects of systematic walking on exercise energy expenditure (EEE) and blood profiles in middle-aged women. Fifty-two female nurse managers, aged 32 to 57 years (42.0 ± 6.2), were randomly assigned to an intervention group (IG) and a control group (CG) for a 12-week study of the walking program. EEE was measured using a microelectronic device. Blood profiles were assessed before and after the walking program. The mean EEE (kcal/kg/d) in the IG and CG was 4.73 ± 1.02 and 3.88 ± 0.81 (P = 0.01), indicating an increase of 1.17 ± 0.98 and 0.46 ± 0.68 from baseline (P = 0.01), respectively. The mean change in high-density lipoprotein cholesterol in the IG and CG was 1.8 ± 8.3 mg/dL and −2.9 ± 7.0 mg/dL (P = 0.051); that in insulin was −4.5 ± 7.5 μU/dL and −0.6 ± 4.3 μU/dL (P = 0.046), respectively. These results show that systematic walking increases EEE and improves blood profiles.

The Influence of Life Stage on Psychosocial Adjustment in Colorectal Cancer Patients

Abstract The influence of life stage on psychosocial adjustment and on factors related to this adjustment were examined in post-operative colorectal cancer patients without stoma. PAIS-SR (Psychosocial Adjustment to Illness Scale-Self-Report) was used to assess psychosocial adjustment, and patients were divided into two groups; a senior group (age > 65 years, n =34) and a non-senior group (age < 65 years, n =59) based on cultural features in Japan. Results were compared between two groups for each of the following PAIS domains: “vocational environment,” “domestic environment,” “sexual relationship,” “extended family environment,” “social environment,” and “psychological distress.” Psychosocial adjustment was found to differ by life stage only for “psychological distress” (non-senior vs. senior: 48.6 ± 9.4 vs. 44.7 ± 7.7, p < .05). However, analysis of background factors related to psychosocial adjustment revealed distinct patterns in each life stage. This study suggests that life stage should be considered when attempts are made to improve the psychosocial adjustment among cancer patients.

Prospective longitudinal evaluation of quality of life in patients with permanent colostomy after curative resection for rectal cancer: a preliminary study.

PURPOSE: The aim of this study was to evaluate health-related quality of life in patients with a colostomy immediately before and during the first year after surgery. SUBJECTS AND SETTING: Patients (aged ≥20 years) who were diagnosed with rectal cancer and scheduled to undergo curative surgery with a permanent colostomy were recruited for this study. Data were collected at 2 university hospitals in Tokyo. METHODS: Participants were asked to complete a self-administered questionnaire regarding health-related quality of life before surgery and a mailed or hand delivered questionnaire to evaluate quality of life at 2, 6, and 12 months after surgery using the Short Form–36 version 2. For patients who responded at all 4 time points, the scores at each time point were compared using paired t tests to examine longitudinal changes in quality of life after surgery. RESULTS: Mean quality-of-life scores in most domains before surgery and during the first year after surgery were lower than the normal control in the norm-based scoring method. Scores at 2 months after surgery were lower than those before surgery. At 12 months after surgery, however, quality-of-life scores improved almost to the level observed before surgery, with the exception of the score in the social functioning domain. Statistical differences in scores between the time points of the survey were observed in the role-physical, bodily pain, and mental health domains. CONCLUSIONS: These results suggest that patients with permanent colostomy after curative resection for rectal cancer need additional medical support and care before surgery and during the first year after surgery.