Toyoko Yoshizawa

Reflex control of autonomic function induced by posture change during the menstrual cycle

This study was designed to determine whether autonomic regulation induced by posture changes varies during the menstrual cycle. Heart rate variability (HRV) was analyzed in women with normal menstrual cycles (n = 10, age range 20-37 years) during 3 min periods of controlled frequency breathing (15 breaths/min) in supine followed by sitting positions. In a supine or sitting position, high frequency (HF) components of HRV, which reflects only parasympathetic activity, were significantly high in the follicular phase compared with those in the menstrual phase, suggesting that parasympathetic nerve activity increases in this phase. Following the change of position to sitting from supine, the HF component decreased significantly in the menstrual, ovulatory and luteal phases, but not the follicular or premenstrual phase. After changing the position to sitting, the low to high frequency component ratio, which reflects the balance of autonomic nerve activities, was increased significantly in the menstrual, luteal and premenstrual phases, indicating that sympathetic nerve activities in these phases became predominant by the sitting position. These results suggest that parasympathetic nerve activity is predominant in the follicular phase, resulting in an impairment of baroreflex caused by posture changes. Moreover, baroreflex control of the sympathetic component, not the parasympathetic component, increases in the premenstrual phase, while the reflex response of the sympathetic component is less in the ovulatory phase compared with the menstrual or luteal phase. We concluded that baroreflex regulation of autonomic functions induced by changing positions is modified during the menstrual cycle. A difference of a balance of ovarian hormones may be responsible for these changes of autonomic functions during the menstrual cycle.

Cross-cultural comparisons of health-related quality of life in Australian and Japanese midlife women : the Australian and Japanese midlife women's health study

Objective:The purpose of this study was to address (1) the existence of an association between menopausal status and the health-related quality of life (HRQOL) in Australian and Japanese women and (2) the relative contributions of menopausal status, modifiable lifestyle risk factors, health, and sociodemographic factors on HRQOL. Design:The Australian and Japanese Midlife Womens Health Study (AJMWHS) was a multisite, population-based study conducted in 2001 to 2002. Measures were conducted on data collected from a survey questionnaire used for a sample of women from Australia and Japan. HRQOL was assessed with seven subscales from the Short Form-36. Results:The differences seen in physical functioning, general health, and vitality are significant. The results support an effect of country of residence on physical functioning and general health. The impact of menopausal status on HRQOL was significantly associated with bodily pain and role-emotional. The country of residence did have a modifying effect on the relationship between menopausal status and physical functioning. After control for confounders, there was a significant difference between Australian and Japanese women for HRQOL. Menopausal status was not associated with HRQOL in the areas of general health and physical functioning. Modifiable lifestyle risk factors contributed more highly to HRQOL for the Australian women than for the Japanese women. If the women had a lowered body mass index, undertook physical activity, consumed dietary phytoestrogens, and used alcohol, their physical functioning seemed to be better. Differences were seen in the contributions to HRQOL in these areas, with lower body mass index in the Australian women and physical activity in the Japanese women being the highest predictors. Somatic and psychological symptoms seem to negatively affect both Japanese and Australian womens physical functioning, contributing more than sociodemographic factors, menopausal status, and behavioral determinants combined to general health and physical functioning. Conclusions:It is important that that consideration be given to incorporating the same tool within the cross-cultural design of studies so that comparisons between cultures and patterns of healthy aging can be made. The research suggests that there seems to be variations across Australian and Japanese midlife women in some areas of HRQOL and some factors that contribute to these areas.

The InterLACE study: Design, data harmonization and characteristics across 20 studies on women's health.

OBJECTIVES The International Collaboration for a Life Course Approach to Reproductive Health and Chronic Disease Events (InterLACE) project is a global research collaboration that aims to advance understanding of womens reproductive health in relation to chronic disease risk by pooling individual participant data from several cohort and cross-sectional studies. The aim of this paper is to describe the characteristics of contributing studies and to present the distribution of demographic and reproductive factors and chronic disease outcomes in InterLACE. STUDY DESIGN InterLACE is an individual-level pooled study of 20 observational studies (12 of which are longitudinal) from ten countries. Variables were harmonized across studies to create a new and systematic synthesis of life-course data. MAIN OUTCOME MEASURES Harmonized data were derived in three domains: 1) socio-demographic and lifestyle factors, 2) female reproductive characteristics, and 3) chronic disease outcomes (cardiovascular disease (CVD) and diabetes). RESULTS InterLACE pooled data from 229,054 mid-aged women. Overall, 76% of the women were Caucasian and 22% Japanese; other ethnicities (of 300 or more participants) included Hispanic/Latin American (0.2%), Chinese (0.2%), Middle Eastern (0.3%), African/black (0.5%), and Other (1.0%). The median age at baseline was 47 years (Inter-quartile range (IQR): 41-53), and that at the last follow-up was 56 years (IQR: 48-64). Regarding reproductive characteristics, half of the women (49.8%) had their first menstruation (menarche) at 12-13 years of age. The distribution of menopausal status and the prevalence of chronic disease varied considerably among studies. At baseline, most women (57%) were pre- or peri-menopausal, 20% reported a natural menopause (range 0.8-55.6%) and the remainder had surgery or were taking hormones. By the end of follow-up, the prevalence rates of CVD and diabetes were 7.2% (range 0.9-24.6%) and 5.1% (range 1.3-13.2%), respectively. CONCLUSIONS The scale and heterogeneity of InterLACE data provide an opportunity to strengthen evidence concerning the relationships between reproductive health through life and subsequent risks of chronic disease, including cross-cultural comparisons.

Comfort with Motherhood in Late Pregnancy Facilitates Maternal Role Attainment in Early Postpartum

Quality of life, comfort, and wellbeing during pregnancy are essential for every country in the world. Pregnancy is considered a preparation period for becoming a mother. Maternal role development, including confidence and satisfaction as a mother, is important in the transition to motherhood. Negative psychosocial affect, such as increased anxiety and distress, during pregnancy adversely influences the childbirth experience and childcare, which contributes to postpartum depression. However, the impact of positive feelings on the maternal role development remains unclear. Therefore, the study purpose was to clarify the relationship between comfort in late pregnancy and maternal role attainment and childcare during early postpartum. We designed a descriptive, longitudinal, correlational study by using the Prenatal Comfort Scale, the Postpartum Maternal Role Confidence Scale, and the Postpartum Maternal Satisfaction Scale. Among 339 participants who had received care at a university hospital located in Sendai city in Japan, 215 subjects completed the longitudinal study by answering a questionnaire for the respective Scale late in their pregnancy or during early postpartum. The subjects consisted of 114 primipara (32.0 ± 5.4 years) and 101 multipara (33.4 ± 4.9 years). In primipara, comfort with motherhood was significantly correlated with maternal confidence regarding knowledge and childcare skills and maternal satisfaction. In multipara, comfort in late pregnancy was related to maternal confidence and satisfaction. Positive affect was related to maternal confidence and maternal satisfaction in early postpartum. Therefore, a prenatal nursing intervention helps women become more comfortable with impending motherhood, thereby promoting maternal role attainment after delivery.

Remote community-based public health nursing during a disaster: An ethnographic case study in Japan

BACKGROUND The Great East Japan Earthquake that occurred on March 11, 2011 generated a tsunami that directly struck Japan. Public health nurses (PHNs) played important roles in this disaster response and community recovery. This research identified a PHNs experience in an affected area. METHODS An ethnographic case study approach was used to obtain in-depth information regarding the experiences of one PHN, using semi-structured interviews, participant observation, and statistical documents. RESULTS Six themes were identified and explored, including that the PHN undertook overwhelming responsibilities to protect the local residents, made several autonomous decisions, and had a strong sense of mission. These were based on the relationship-building that occurred with the local residents due to the geographical characteristics and her own preparations. CONCLUSIONS The findings encourage PHNs to participate in simulations of disasters in preparation for major catastrophes and establish good collaborative efforts with residents by being a part of the community.

Immediate Needs and Concerns among Pregnant Women During and after Typhoon Haiyan (Yolanda).

Introduction: Pregnant and postpartum women are especially vulnerable to natural disasters. These women suffer from increased risk of physical and mental issues including pregnant related problems. Typhoon Haiyan (Yolanda), which hit the Philippines affected a large number of people and caused devastating damages. During and after the typhoon, pregnant women were forced to live in particularly difficult circumstances. The purpose of this study was to determine concerns and problems regarding public health needs and coping mechanisms among pregnant women during and shortly after the typhoon. Methods: This study employed a cross-sectional design utilizing focus group discussions (FGDs). Participants were 53 women (mean age: 26.6 years old; 42 had children) from four affected communities who were pregnant at the time of the typhoon. FGDs were conducted 4 months after the typhoon, from March 19 to 28, 2014, using semi-structured interviews. Data were analyzed using the qualitative content analysis. Result: Three themes were identified regarding problems and concerns during and after the typhoon: 1) having no ideas what is going to happen during the evacuation, 2) lacking essentials to survive, and 3) being unsure of how to deal with health concerns. Two themes were identified as means of solving issues: 1) finding food for survival and 2) avoiding diseases to save my family. As the pregnant women already had several typhoon experiences without any major problems, they underestimated the catastrophic nature of this typhoon. During the typhoon, the women could not ensure their safety and did not have a strong sense of crisis management. They suffered from hunger, food shortage, and poor sanitation. Moreover, though the women had fear and anxiety regarding their pregnancy, they had no way to resolve these concerns. Pregnant women and their families also suffered from common health problems for which they would usually seek medical services. Under such conditions, the pregnant woman cooperated with others for survival and used their knowledge of disease prevention. Discussion: Pregnant women experienced difficulties with evacuation, a lack of minimum survival needs, and attending to their own health issues. Pregnant women were also concerned about needs and health issues of their families, particular, when they had small children. Collecting accurate information regarding the disaster and conducting self-sustainable preparation prior to the disaster among pregnant women will help them to protect their pregnancy status, thereby improving their families’ chance of survival during and after disasters.

Cross-sectional online survey of research productivity in young Japanese nursing faculty.

AIM To investigate the factors affecting the research productivity of young nursing faculty in Japan. METHODS An online survey targeting young nursing scholars (aged ≤ 39 years) who were members of the Japan Academy of Nursing Science was conducted from October to November 2012. Of 1634 potential respondents, 648 completed the survey (39.7%), and 400 full-time faculty of a baccalaureate degree program were selected for the analysis. The numbers of English-language and Japanese publications in the past 3 years were regressed onto personal characteristics, such as academic degree and type of university. RESULTS The mean numbers of publications in English and Japanese in the past 3 years were 0.41 and 1.63, respectively. Holding a doctoral degree was significantly related to a higher number of publications in English and Japanese (e(β) = 5.78 and e(β) = 1.89, respectively). Working at a national university (e(β) = 2.15), having a research assistant (e(β) = 2.05), and the ability to read research articles in English (e(β) = 2.27) were significantly related to more English-language publications. Having the confidence to conduct quantitative research (e(β) = 1.67) was related to a larger number of Japanese publications. The lack of mentoring (e(β) = 0.97) and university workload (e(β) = 0.96) were associated with a lesser number of Japanese publications. CONCLUSION The research productivity of young nursing faculty appeared to be quite low. Strategies to enhance research productivity in young nursing faculty, such as encouraging the achievement of a doctoral degree or enrichment of research resources, should be undertaken.

Assessment of quality of life in pregnant Japanese women: comparison of hospitalized, outpatient, and non-pregnant women.

This cross-sectional study explored the comfort and quality of life in hospitalized, preterm, pregnant women compared with pregnant outpatients, and identified the relationship between comfort, quality of life, and hospitalization. Two-hundred-and-twenty-one hospitalized pregnant women who met the inclusion criteria were recruited from obstetric units, and 1015 outpatient pregnant women were recruited from obstetric outpatient units in Japan. The women were questioned on six domains of the Japanese Short-Form-36 version 2 (bodily pain, general health, vitality, role emotional, social functioning, and mental health) and on their subjective comfort. A total of 189 hospitalized pregnant women and 503 low-risk pregnant women were analyzed. Subjective comfort and all six domains of health-related quality of life showed significantly lower scores for hospitalized women than outpatient women (P < 0.05-0.001). The mean differences in social functioning and role-emotional domains between the two groups were particularly marked. The result of this study suggests that these patients require positive psychological support to improve their comfort and quality of life.

Committed to Working for the Community: Experiences of a Public Health Nurse in a Remote Area During the Great East Japan Earthquake

We examined the experiences of a public health nurse (PHN) in a rural area affected by the Great East Japan Earthquake. We used an ethnographic method to obtain in-depth information about her experiences, from which six themes were developed. The PHN risked her life to protect members of the community, but she remained anxious to see her own young children as soon as possible. Nevertheless, she was strongly committed to helping community members and continued to work for them. We suggest creating a practical system to allow PHNs to obtain information about the safety of their own families during a disaster.