村山 陵子

はじめに:輸液療法は効果や安全を優先して実施される一方、患者はさまざまな我慢を強いられる。今回、輸液中の患者の療養生活行動がどのように妨げられているのかを明らかにした。方法:2013年7〜8月に一大学病院に勤務する看護師14名を対象に、輸液療法による患者の離床の妨げとその要因、離床促進の工夫についてフォーカス・グループ・インタビューを行い、語りをグラウンデッド・セオリー法を援用し、継続比較分析を行った。結果:対象者の語りから6個の【カテゴリ】が生成され、療養生活行動の妨げにいたるつぎのプロセスが明らかとなった。1)【輸液の投与条件】や【輸液投与デバイス】は、特定の【患者の状況】や【療養環境】下で、【療養生活行動への諦め】を引き起こす。2)【療養生活行動の妨げ】は【療養生活行動への諦め】を引き起こし、【療養生活行動への諦め】は【療養生活行動の妨げ】を引き起こす、双方向の関係があった。結論:療養生活行動の妨げを予防するためには、輸液療法中の環境や患者の状態だけでなく、療養生活行動への諦めに対するアプローチが必要である。(著者抄録)

This prospective observational study was designed to clarify the rate of peripheral intravenous catheter, especially short peripheral catheter, failures among adult patients in medical and surgical wards. The study was conducted during a 2-month period at a university hospital in Tokyo, Japan. A total of 5316 catheters from 2442 patients were studied. The rate of catheter removal as a result of catheter failure was 18.8%. The reasons for removal in catheter failures were infiltration (41.3%) and pain (19.3%). Pain was a major reason for catheter failure and removal. For this reason, observing changes under the skin before signs and symptoms appear might help prevent catheter failures.

© 2017 Infusion Nurses Society. Short peripheral catheter (SPC) failure is an important clinical problem. The purpose of this study was to clarify the relationship between SPC failure and etiologies such as thrombus, subcutaneous edema, and catheter dislodgment using ultrasonography and to explore the risk factors associated with the etiologies. Two hundred catheters that were in use for infusion, excluding chemotherapy, were observed. Risk factors were examined by logistic regression analysis. Sixty catheters were removed as the result of SPC failure. Frequency of thrombus with subcutaneous edema in SPC failure cases was significantly greater than in those cases where therapy was completed without complications (P <.01). Multivariate analysis demonstrated that 2 or more insertion attempts were significantly associated with thrombus with subcutaneous edema. Results suggest that subsurface skin assessment for catheterization could prevent SPC failure.

Introduction: Peripheral intravenous catheters (PIVCs) are frequently removed due to phlebitis. We hypothesized that catheters made of polyurethane, which is more flexible than Teflon, would decrease phlebitis, and that flexibility could be estimated by measuring the catheter-tip angle. Ultrasonography in two groups of patients with different catheter types was then used to compare catheter-tip angles and phlebitis. Methods: Observational studies were carried out at a medical ward in a university hospital. Infusion therapy was administered to one group of patients in 2014 using Teflon catheters (control group, n = 200), and to another group of patients in 2015 using polyurethane catheters (investigational group, n = 207). The symptoms were assessed according to a scale developed by the Infusion Nurses Society. Long-axis ultrasonography images taken immediately before catheter removal were used to measure the angle between the central line of the catheter within 2 mm from the distal point and a tangent to the vessel wall. Results: There were no significant differences between the two groups with respect to sex, age, and medical diagnosis. In the control and investigational groups, the rates of phlebitis were 37% (73/200) and 17% (36/207), respectively (p< 0.001). The median angles of the catheter tip were 7.8 degrees and 4.1 degrees, respectively (p< 0.001). Phlebitis occurred more frequently when the catheter-tip was placed at angle >5.8 degrees. Discussion: The frequency of phlebitis was lower in the polyurethane, in which the catheter was placed at lower angle, almost parallel to the vessel. Our results will aid in developing new catheters and in improving PIVC-securement techniques.

Background Our aim in this study was to determine the ability of ultrasonography (US) to assess and classify the degree of subcutaneous edema caused by infusion via peripheral intravenous catheter, compared to assessment by the Infusion Nurses Society infiltration scale. Methods This prospective study included 64 adult patients who underwent infusion via peripheral intravenous catheter. All patients underwent US imaging of the subcutaneous tissue just after the insertion of indwelling catheters and just before catheter removal. The grade of swelling was then assessed using the infiltration scale. Subcutaneous edema and edema thickness were analyzed on transverse US images, and the edema was classified as normal, mild, or severe. The relationship between US-determined subcutaneous edema and that determined by using the infiltration scale was evaluated. Results Among the 64 patients, US images of the subcutaneous edema were classified into three groups: normal in 15 patients, mild subcutaneous edema in 41 patients, and severe subcutaneous edema in eight patients. Thus, US classification of subcutaneous edema could provide more detailed information than the infiltration scale. Conclusion The results of the present study suggest that US imaging of subcutaneous tissue could help classify the degree of subcutaneous edema.

The identification of appropriate skin tear prevention guidelines for the elderly requires clinicians to focus on local risk factors such as structural alterations of the epidermis and dermis related to skin tears. The aim of this cross-sectional study is to explore the prevalence of skin tears and to explore skin properties related to skin tears in elderly Japanese patients at a long-term medical facility. After doing the prevalence study, 18 participants with skin tears and 18 without were recruited and an evaluation of their skin properties using 20-MHz ultrasonography, skin blotting and also Corneometer CM-825, Skin-pH-meterPH905, VapoMeter, Moisture Meter-D and CutometerMPA580 was undertaken. A total of 410 patients were examined, the median age was 87 years and 73·2% were women. The prevalence of skin tears was 3·9%, and 50% of skin tears occurred on the dorsal forearm. The changes in skin properties associated with skin tears included increased low-echogenic pixels (LEP) by 20-MHz ultrasonography, decreased type IV collagen and matrix metalloproteinase-2, and increased tumour necrosis factor-α by skin blotting. In conclusion, this study suggests that increased dermal LEP, including solar elastosis, may represent a risk factor for skin tears; this indicates that skin tear risk factors might not only represent chronological ageing but also photoageing.

Small veins are a risk factor for infiltration. However, there are no data regarding the ideal vein diameter for preventing infiltration. Using ultrasound, vessel diameter and calculated ratios of the vessel diameter to the catheter gauge were measured. The relationship between the ratio and infiltration was assessed to establish a cutoff point. The mean ratio of the infiltration group was significantly smaller than that of the no-infiltration group (P &lt .01), and the ratio was an independent risk factor according to the multivariable analysis. The ratio of 3.3 was determined to be the cutoff point that enables health care professionals to identify veins appropriately.

Infiltration is a frequent complication of infusion therapy. We previously demonstrated the usefulness of infrared thermography as an objective method of detecting infiltration in healthy people. However, whether thermography can detect infiltration in clinical settings remains unknown. Therefore, we report two cases where thermography was useful in detecting infiltration at puncture sites. In both cases, tissue changes were verified ultrasonographically. The patients were a 56-year-old male with cholangitis and a 76-year-old female with hepatoma. In both cases, infiltration symptoms such as swelling and erythema occurred one day after the insertion of a peripheral intravenous catheter. Thermographic images from both patients revealed low-temperature areas spreading from the puncture sites however, these changes were not observed in other patients. The temperature difference between the low-temperature areas and their surrounding skin surface exceeded 1.0°C. Concurrently, ultrasound images revealed that tissues surrounding the vein had a cobblestone appearance, indicating edema. In both patients, subcutaneous tissue changes suggested infiltration and both had low-temperature areas spreading from the puncture sites. Thus, subcutaneous edema may indicate infusion leakage, resulting in a decrease in the temperature of the associated skin surface. These cases suggest that infrared thermography is an effective method of objectively and noninvasively detecting infiltration. © 2016, International Research and Cooperation Association for Bio &amp Socio-Sciences Advancement. All rights reserved.

Maternal vitamin D status is important for fetal development and the prevention of pregnancy complications. Mothers require both sufficient intakes and skin production of this vitamin. We investigated the validity and test-retest reliability of a self-administered diet history questionnaire (DHQ) to establish a method of assessing vitamin D intakes of Japanese pregnant women, using a serum marker. A total of 245 healthy pregnant women in the second trimester, who were not taking vitamin D supplements, were recruited at a university hospital in Tokyo between June 2010 and July 2011. Serum 25-hydroxyvitamin D [25(OH)D] concentrations were measured as an indicator of vitamin D status. To assess the test-retest reliability of the DHQ, 58 pregnant women completed it twice within a 4-5-week interval. Significant positive correlations between intakes and serum concentrations of vitamin D were found (r=0.266 for daily intakes and r=0.249 for energy-adjusted intakes). In the winter investigation in which the serum 25(OH)D concentrations were less likely to be affected by sunlight exposure, the correlation coefficients were 0.304 for both daily and energy-adjusted intakes. After excluding participants with pregnancy-associated nausea, the coefficients increased. The intraclass correlation coefficient between vitamin D intakes estimated from the two-time DHQ was 0.638. The DHQ provides an acceptable validity and reliability of the vitamin D intake of Japanese pregnant women. However, the data of women with nausea should be interpreted with caution. We believe that the DHQ is a useful questionnaire to grasp and improve vitamin D intakes during pregnancy.

Objectives: Maternal docosahexaenoic acid (DHA) intakes is important for brain development in fetuses. Accurate assessment of EPA and DHA intakes is required in clinical settings to identify women with deficiency of these nutrients and provide an appropriate intervention for them. We examined the validity and reproducibility of a brief-type self-administered diet history questionnaire (BDHQ) for evaluating EPA and DHA intakes of pregnant Japanese women, to establish an easily administered dietary assessment tool. Methods: A total of 105 women in the second trimester and 102 women in the third trimester were studied at a university hospital in Tokyo, between November 2010 and February 2012. The reference values for the validation study were plasma concentrations of EPA and DHA. For the reproducibility study, 54 women completed the BDHQ twice, within a 4-week period in the second trimester. Results: Energy-adjusted intakes of EPA, DHA, and EPA+DHA were significantly associated with the corresponding plasma concentrations (r(s)=0.354, r(s)=0.305, and r(s)=3.327 in the second trimester; r(s)=0.391, r(s)=0.316, and r(s)=0.358 in the third trimester, respectively). Intraclass correlation coefficients for the two-time BDHQ were 0.543 (EPA), 0.611 (DHA), and 0.581 (EPA+DHA). In the Bland-Altman plots, the intakes of EPA, DHA, and EPA+DHA in the two-time BDHQ showed that the values for most participants were in the accepted range of agreement. Conclusions: BDHQ has an acceptable validity level for assessing EPA and DHA intakes among Japanese women in the second and third trimesters.

The association between depression and omega-3 polyunsaturated fatty acids, including eicosapentaenoic and docosahexaenoic acid, continues to gain focus. In this study, we examined whether dietary intakes and plasma concentrations of eicosapentaenoic and docosahexaenoic acid were associated with depressive symptoms during pregnancy. Healthy Japanese women with singleton pregnancies were recruited at a university hospital in Tokyo between 2010 and 2012. The depressive-symptom group included participants with Edinburgh Postnatal Depression Scale scores greater than eight. Of the 329 participants, 19 (5.8%) had depressive symptoms. Lower plasma docosahexaenoic acid concentration was significantly associated with prenatal depressive symptoms. Women with depressive symptoms had a higher rate of pregnancy-associated nausea than those with non-depressive symptoms (52.6% vs 28.7%, respectively). Although we adjusted for the presence of pregnancy-associated nausea, dietary fatty acid intake was not associated with depressive symptoms in the multiple logistic regression analyses. Further large studies would be required to examine any preventive effect of dietary fatty acid intake on depressive symptoms among pregnant women.

抗がん剤投与過程の中でも、看護師がかかわる輸液ルートの抜去や接続場面に焦点を当てて抗がん剤の曝露や周囲への飛散を検討した報告はない。そこで、我々は、抗がん剤の曝露や飛散の予防を目的に、これらの場面に着目して曝露防止ルートの効果を検討したので報告する。蛍光剤を用いた定性評価では看護師1人の飛散数を調査し、定量評価では看護師4人のシクロフォスファミドの飛散量を測定した。いずれもベッドサイドでの輸液交換を想定し、ボトルの抜き差しを行い、従来法と曝露防止ルートを用いた方法で比較した。従来法では定性、定量評価とも数ヶ所に抗がん剤が飛散したが、曝露防止ルート法では定量法で手袋への飛散が1人のみに認められた。看護師経験年数による違いはなかった。看護師自身が抗がん剤の曝露や飛散の実際を自覚することは予防策を実施する上で重要で、今回用いた評価法は動機づけと看護技術の向上に有用である可能性がある。(著者抄録)

There have been no reports about the incidence and etiologies of foot ulcers in Japanese patients with diabetes, and the best method to prevent foot ulcers remains unclear. We investigated the incidence and etiologies of foot ulcers in patients with diabetes at a university hospital in Tokyo over a 5-year period. Neuropathy, angiopathy, foot deformity, and history of foot ulcers were investigated in 578 diabetic patients from September 2007 to March 2008. Information on the development of foot ulcers between the day of the first survey and 1st October 2012 was obtained from medical records, and the incidence was calculated using Kaplan–Meier survival analysis. The mean age of the subjects was 65.4 ± 10.8 years and the mean duration of diabetes was 13.8 ± 9.3 years. During the study period, 153 subjects dropped out. Among the 6 subjects who developed foot ulcers, 4 were in category 0 in the Risk Categorization System of the International Consensus on the Diabetic Foot, 1 was in category 1, and 1 was in category 2. Three ulcers were due to burns, 3 ulcers were secondary to trauma, and 1 was due to deterioration of callus. The incidence of foot ulcers over a period of 60 months was 1.2 %. The incidence of foot ulcers in Japanese patients with diabetes was low. Of note, both high-risk and no-risk patients developed foot ulcers. Most cases were caused by burns or trauma. Education will be needed for all diabetic patients to prevent burns and trauma in Japan.

The present observational study aimed to clarify the relationship between the tip position of an indwelling venous catheter and the subcutaneous edema using ultrasonography images. Data were obtained before catheter removal in a medical ward of a university hospital in Tokyo, Japan. Two hundred peripheral intravenous catheters (PIVCs) from 154 patients were observed just before removal. We analyzed data for 194 PIVCs from 150 patients. Subcutaneous edema was observed in 43.8% of ultrasonography images. According to the univariate analysis, insertion site, PIVC tip contact with the vessel wall, and irritant drug's presence were selected as independent variables for logistic regression analysis. Both irritant drug and PIVC tip contact were associated with the presence of subcutaneous edema [adjusted odds ratio (OR) = 2.68, 95% confidence interval (CI) = 1.14-6.33 and OR = 2.01, 95% CI = 1.04-3.88, respectively]. To the best of our knowledge, this is the first study to use ultrasonography to simultaneously observe PIVC tip position and subcutaneous edema. Using ultrasonography to observe PIVC may be a useful method to understand these mechanisms. Medical staff should select an appropriate vein and indwelling catheter to avoid contact of PIVC tip with the vessel wall. Further studies exploring the causality of the relationship between subcutaneous edema, catheter placement, and thrombus formation is required. In addition, further development of nursing skills and medical devices to reduce mechanical stress is required.

Maternal vitamin D deficiency causes pregnancy complications and delayed skeletal development in offspring. This study aimed at identifying demographic and lifestyle factors associated with vitamin D status in pregnant Japanese women. A total of 284 healthy pregnant women in the second trimester were recruited at a university hospital in Tokyo, between June 2010 and July 2011. Serum 25-hydroxyvitamin D (25(OH)D) concentrations were measured using chemiluminescent immunoassay. We assessed vitamin D intake using a self-administered diet history questionnaire and asked participants about lifestyle variables, including daily duration of sunlight exposure and supplement use. The mean (SD) serum 25(OH)D concentration was 9.8 (4.7) ng/mL. Almost 60% of the participants had severe vitamin D deficiency (measured as 25(OH)D<10 ng/mL). Multiple regression analysis showed that multigravidity, pre-pregnancy non-underweight status, higher energy-adjusted vitamin D intake, and use of vitamin D supplements were correlated with higher serum 25(OH)D concentrations (beta=0.245, beta=-0.119, beta=0.226, and beta=0.197, respectively). In the summer investigation, women with longer durations of sunlight exposure had significantly higher serum 25(OH)D concentrations (beta=0.201) that were unrelated to the factors outlined previously. In the winter investigation, women with a high education level had higher serum 25(OH)D concentrations than others (beta=0.330). Our results would be useful for identifying pregnant women at a high risk of low vitamin D status, such as primigravidae and those with pre-pregnancy underweight status, low education level, low vitamin D intake, and short durations of sunlight exposure.

A high total homocysteine (tHcy) level during pregnancy is a risk factor for adverse perinatal outcomes, such as fetal growth restriction and preeclampsia. Caffeine is assumed to increase tHcy levels by acting as a vitamin B6 antagonist. The objective of this study was to examine a relationship between circulating tHcy levels and dietary caffeine and vitamin B6 intakes in pregnant Japanese women. A total of 321 healthy women with singleton pregnancies were recruited in metropolitan Tokyo, from June to December 2008, resulting in the final number included in the study as 254. Dietary caffeine intakes did not correlate with plasma tHcy levels. When we analyzed the data according to caffeinated beverages, caffeinated tea consumption was positively associated with plasma tHcy levels only among the women with a high intake of vitamin B6, after controlling for confounding factors (P = 0.029). No correlation between coffee consumption and plasma tHcy levels was found. Pregnant Japanese women might need to cut down the consumption of caffeinated tea as well as take sufficient vitamin B6 in order to prevent the tHcy levels from increasing.

点滴静脈内注射の血管外漏出の早期発見のための客観的評価指標の開発を目的に、サーモグラフィーを用いた鑑別方法を開発し、その効果を、健常者6名を対象に、漏出モデルとして、前腕の皮下組織に留置針を刺入して生理食塩水を1.7ml/分で滴下し、対照群として、反対側の前腕の静脈内に留置針を刺入し、同様に滴下し、それぞれ滴下後10秒ごとにサーモグラフィーにより針先周囲を確認した。その結果、漏出モデルでは6名全員に滴下開始2分以内に針先を中心に広がる円形の低温域が出現し、サーモグラフィーにより非接触かつ迅速に点滴静脈内注射の血管外漏出が鑑別できる可能性が示唆された。

ObjectiveTo assess the psychometric properties of the Pregnancy Physical Activity Questionnaire (PPAQ) for women who read and speak Japanese. DesignThis longitudinal study used a self-report questionnaire and quantitative biometric and instrumental measurements (actigraph) to assess the reliability and criterion validity. SettingA university hospital in Tokyo, Japan. ParticipantsSixty-nine pregnant women living in Tokyo and its suburbs were recruited. MethodsThe test-retest reliability of the Japanese version of the Pregnancy Physical Activity Questionnaire (PPAQ-J) was evaluated through intraclass correlation coefficients (ICCs) between PPAQ-J results administered three times (at recruitment, 7 and 14days later). Criterion validity was assessed by comparing results to actigraph measures using Spearman's correlation coefficients. Participants wore the actigraph over the 2-week research period. Data from 58 participants were analyzed for test-retest reliability. The data of 54 participants were used to analyze criterion validity. ResultsThe ICCs for the first and second and for the first and third PPAQ-J questionnaires were 0.56 for total activity and activities broken down by intensity and type (in metabolic equivalents [METs]xhours/day). To evaluate criterion validity, Spearman's correlation coefficients were calculated between the first measurement of the PPAQ-J and three published cut-points used to classify actigraph data (minutes/day); correlations ranged from .02 to .35 for total activity, -.21 to -.25 for vigorous activity, -.09 to .38 for moderate activity, and .01 to .28 for light activity. ConclusionThe PPAQ-J is a psychometrically sound and comprehensive measure of physical activity in pregnant Japanese women.

Oxidative stress plays a major pathological role in pregnancy-related complications. Although oxidative stress is induced by exogenous toxins in association with a poor lifestyle in normal subjects, there is little information on the factors altering oxidative stress and antioxidant levels during pregnancy. The purpose of this study was to determine the relationship between lifestyle factors and oxidative stress/antioxidant levels during each trimester and 1-month postpartum. This prospective cohort study followed 54 healthy women through pregnancy first, second, and third trimester and 1-month postpartum. Participants were administered a questionnaire on characteristics and lifestyle factors. Morning blood and urine samples were obtained to measure urinary biopyrrins and serum coenzyme Q10 (CoQ10) levels. The levels of urinary biopyrrins and serum CoQ10 increased significantly throughout pregnancy, with peak values registered during the third trimester. Higher biopyrrin levels were significantly associated with non-consumption of morning meal during the first trimester, smoking during the third trimester and 1-month postpartum, alcohol consumption during the third trimester, high food-based polyunsaturated fatty acid intake during the third trimester, and poor mental health scores during the first and third trimesters. Higher CoQ10 levels were significantly associated with no smoking during pregnancy and at 1-month postpartum, and with a high frequency of exercise during the third trimester and 1-month postpartum. Thus, pregnancy represents a state of oxidative stress, which can be counterbalanced by increased levels of antioxidants, such as CoQ10. We speculate that certain lifestyle choices such as avoiding smoking can reduce oxidative stress and increase antioxidant levels during pregnancy.

We investigated the validity and reproducibility of a self-administered diet history questionnaire (DHQ) that estimates the intakes of β-carotene, vitamin C and α-tocopherol. Ninety-five healthy women with singleton pregnancies in the second trimester were examined at a university hospital in Tokyo. The intakes of β-carotene, vitamin C and α-tocopherol assessed by the DHQ were compared to the corresponding serum concentrations. To assess the reproducibility, 58 pregnant women completed it in two sessions within a 4-5 week interval. We found significantly positive correlations between the energy-adjusted intakes and serum concentrations of β-carotene and vitamin C (r = 0.254 and r = 0.323, respectively). However, α-tocopherol intake was not associated with the corresponding serum concentration. The intraclass correlation coefficients of the two-time DHQ were 0.743 (β-carotene), 0.665 (vitamin C) and 0.718 (α-tocopherol). DHQ has acceptable validity and reproducibility for β-carotene and vitamin C intakes in Japanese pregnant women. © 2013 Informa UK Ltd.

Severe antenatal fear of childbirth causes adverse effects on emotional well-being during the postpartum period. The Wijma Delivery Expectancy/Experience Questionnaire is widely used to measure fear of childbirth among women before (version A) and after (version B) delivery. In this study, the original Swedish version was translated into Japanese, and its validity and reliability were examined among healthy, pregnant Japanese women. The Japanese-translated version presented a multidimensional structure with four factors: fear, lack of positive anticipation, isolation, and riskiness. Exhibiting concurrent/convergent validity, the Japanese version correlated with other psychological measures at expected levels. The Cronbach's α (0.90) and the intraclass correlation coefficient (0.86, P&lt 0.001) were high. In conclusion, the results provide support for the Japanese version to be considered a valid and reliable measure of prenatal fear of childbirth among pregnant Japanese women. © 2013 Wiley Publishing Asia Pty Ltd.

Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) intakes during pregnancy affect fetal development and maternal mental health therefore, an accurate assessment of EPA and DHA intakes is required. We hypothesized that a self-administered diet history questionnaire (DHQ) that was developed for non-pregnant adults could be used for estimating EPA and DHA intakes in pregnant Japanese women thus, we evaluated the validity and reproducibility of the DHQ during pregnancy. We recruited 262 healthy participants with singleton pregnancies during their second trimester at a university hospital in Tokyo between June 2010 and July 2011. Plasma concentrations of EPA and DHA were measured as reference values. Fifty-eight women completed the DHQ twice, within a 4- to 5-week period to assess the reproducibility of the results. Among the participants without pregnancy-associated nausea (n = 180), significantly positive correlations were observed between energy-adjusted intakes and plasma concentrations of EPA (rs = 0.388), DHA (rs = 0.264), and EPA + DHA (rs = 0.328). More than 60% of the participants without nausea fell into the same or adjacent quintiles according to energy-adjusted intakes and plasma concentrations of EPA, DHA, and EPA + DHA. Meanwhile, among the participants with nausea, a low correlation for EPA and no correlation for DHA and EPA + DHA were found. Intraclass correlation coefficients for the 2-time DHQ measurements were 0.691 (EPA) and 0.663 (DHA). The results indicate that the DHQ has an acceptable level of validity and reproducibility for assessing EPA, DHA, and EPA + DHA intakes in pregnant Japanese women without nausea. © 2013 Elsevier Inc.

Introduction and hypothesis: The aim of this study was to translate the Pelvic Floor Distress Inventory-Short Form 20 (PFDI-20) into Japanese and test its reliability and validity among Japanese women. Methods: Fifty-nine women with and without pelvic floor disorders (age 55.8 ± 16.8 years, mean ± SD) completed the Japanese PFDI-20 (J-PFDI-20) questionnaire at baseline and 2 weeks later. Intraclass correlation coefficients (ICC) and the Bland and Altman method for test-retest reliability and Cronbach's alpha for internal consistency of the J-PFDI-20 were used. Scores of total and subscales were compared between women with and without pelvic floor disorders for known-groups validity. Spearman's correlation coefficients between the J-PFDI-20 and the severity of pelvic floor disorders and Urinary Incontinence Quality of Life Scale (I-QOL) were used for construct validity. Results: The PFDI-20 was successfully translated from English into Japanese with face validity through rigorous cross-cultural validation. Test-retest reliability of the J-PFDI-20 and three subscales was good to excellent (ICC = 0.77-0.90). The Bland and Altman analysis showed that differences between the first and second scores of total J-PFDI-20 and its subscales were not significantly different from 0 and largely fell within the range of 0 ± 1.96 SD. Cronbach's alpha values were 0.52-0.83. Analysis of known-groups validity showed differences in scores of the J-PFDI-20 between women with and without pelvic floor disorders. Acceptable construct validity was found in J-PFDI-20 total and subscale scores with positive correlations to severity of pelvic floor disorders (ρ &gt 0.35) and negative correlations to I-QOL (ρ &lt -0.39). Conclusions: The results suggest that the J-PFDI-20 is a reliable and valid condition-specific quality of life instrument for women with pelvic floor disorders. © 2012 The International Urogynecological Association.

Purpose: To compare the pelvic floor function between women with and without stress urinary incontinence after vaginal delivery. Methods: Seventeen women (age 35.5 ± 3.5) were prospectively studied at about 6 weeks, 3 months, and 6 months after vaginal delivery. Urinary incontinence was assessed by the International Consultation on Incontinence Questionnaire - Short Form. Pelvic floor function was assessed by antero-posterior diameter of the levator hiatus using transperineal ultrasound. Results: Five of 17 women experienced postpartum stress urinary incontinence. The antero-posterior diameter of the levator hiatus at rest was significantly longer in stress urinary incontinent women than in continent women until 3 months after delivery (p &lt 0.01), though shortening of the antero-posterior diameter of the levator hiatus was not significantly different between continent women and stress urinary incontinent women. Regardless of urinary incontinence, the antero-posterior diameter of the levator hiatus at rest shortened at 6 months postpartum, compared to 6 weeks postpartum (p &lt 0.001). The antero-posterior diameter of the levator hiatus during contraction had shortened only in continent women by 6 months postpartum (p = 0.02). Conclusion: The extended pelvic floor may be a cause of stress urinary incontinence in the postpartum period. Therefore, treatment to improve the extended pelvic floor should be developed for the prevention of stress urinary incontinence. © 2012 The Japan Society of Ultrasonics in Medicine.

High levels of oxidized low-density lipoprotein (ox-LDL) during pregnancy are a risk factor for preeclampsia. Ox-LDL levels might be affected by folate and total homocysteine (tHcy) levels because of their effects on oxygen free radicals. The relationships between ox-LDL and folate and tHcy during pregnancy, however, remain unclear. The present study investigated whether serum folate levels and plasma tHcy levels were associated with plasma ox-LDL levels in pregnant women. A sample of 137 healthy subjects with singleton pregnancies (age 30.3 ± 4.5 years) was recruited from a prenatal clinic in metropolitan Tokyo between June and October 2008. Their levels of plasma ox-LDL, plasma tHcy, and serum folate were measured, and lifestyle variables were obtained using a questionnaire. Dietary intake was assessed by means of a validated self-administered diet history questionnaire. A negative correlation between plasma ox-LDL levels and serum folate levels was found (rs = -.218, p =.011). However, there was no association between plasma ox-LDL levels and plasma tHcy levels (rs =.055, p =.525). The mean of the logarithmic ox-LDL levels was significantly lower among the participants taking folic acid-containing supplements regularly than among those who were not, after adjusting for confounding factors (p =.024). Serum folate levels and folic acid supplementation might be associated with plasma ox-LDL levels, independent of tHcy levels. The association observed between ox-LDL and folate can be used as evidence for dietary instruction by prenatal care providers. © The Author(s) 2011.

尿失禁は高齢者の健康問題の1つである。尿失禁を有する高齢者は失禁用品を日常的に使用する。特に紙オムツと尿とりパッドの併用は臨床現場で多く、体圧の上昇や蒸れの問題が懸念されている。近年ネットパンツがアウターとして使用されるようになってきた。しかしネットパンツの有用性については十分明らかではないため、幅広い使用にいたっていない。われわれはネットパンツの有用性を明らかにするため、客観的な皮膚温湿度、ならびに主観的な快適性を紙オムツと比較することにより評価した。研究デザインはクロスオーバー試験であり、ネットパンツと紙オムツを交互に着用した。6名の健常人の仰臥位時の臀部皮膚温湿度を経時的に測定するとともに、快適性に関するVASの評価も行った。皮膚温湿度は基準値に対する相対値で比較し、ウィルコクソンの符号付順位和検定を用いて解析した。その結果、60分後の左脇骨部皮膚湿度の相対値は、紙オムツ群よりネットパンツ群で低い傾向にあった(P=0.063)。一方で尿とりパッドに覆われていた仙骨部と恥骨上部は皮膚温湿度ともに両群で差はなかった。VASの評価では、「フィット感のなさ」、「違和感」、「動きにくさ」の項目でネットパンツ群が有意に低値であり、快適に感じていた。本研究より失禁用品は尿とりパッドの選択が重要であり、さらにアウターとしてのネットパンツは主観的にも客観的にも快適であるため、患者のQOL向上に役立つ可能性が示唆された。(著者抄録)

Purpose To assess the utility of transperineal threedimensional (3D) ultrasound for diagnosing anal sphincter defects and evaluating the function of the anal canal in women with anal incontinence. Methods The study subjects were 13 women with anal incontinence. Symptoms of fecal incontinence were assessed by Wexner score. The anal canal of each woman was examined ultrasonically with both a convex transperineal 3D scanner and a radial transanal scanner to compare the accuracy of the two approaches for diagnosis of anal sphincter defects. The anorectal angle and the length of the anal canal were also measured by utilizing the functionality of the transperineal 3D ultrasound. Results The mean age was 58.9 ± 14.9 years (±SD), and the mean Wexner score was 8.4 ± 5.6. In terms of ultrasound diagnosis of anal sphincter defects, the two methods showed consistent results in each woman. The length of the portion where both the internal and external anal sphincters were intact was significantly correlated with the Wexner score, whereas the total length of the anal canal was not. Conclusions Less invasive transperineal 3D ultrasound provides accurate evaluation of the internal and external anal sphincters in women with anal incontinence, and the method is potentially useful for detection of anal sphincter abnormalities. © The Japan Society of Ultrasonics in Medicine 2012.

Background: No validated dietary questionnaire for assessing folate and vitamin B-12 intakes during pregnancy is available in Japan. We evaluated the validity and reproducibility of intakes of folate and vitamin B-12 estimated from a self-administered diet history questionnaire (DHQ) in Japanese pregnant women. Methods: A sample of 167 healthy subjects with singleton pregnancies in the second trimester was recruited at a private obstetric hospital in metropolitan Tokyo from June to October 2008 (n = 76), and at a university hospital in Tokyo from June 2010 to June 2011 (n = 91). The dietary intakes of folate and vitamin B-12 were assessed using the DHQ. The serum concentrations of folate and vitamin B-12 were measured as reference values in the validation study. To assess the reproducibility of the results, 58 pregnant women completed the DHQ twice within 4-5 week interval. Results: Significantly positive correlations were found between energy-adjusted intakes and serum concentrations of folate and vitamin B-12 (r = 0.286, p < 0.001 and r = 0.222, p = 0.004, respectively). After excluding the participants with nausea (n = 121), the correlation coefficient for vitamin B-12 increased to 0.313 (p = 0.001). When participants were classified into quintiles based on intakes and serum concentrations of folate and vitamin B-12, approximately 60% were classified in the same or adjacent quintile. The intraclass correlation coefficients of the two-time DHQ were 0.725 for folate and 0.512 for vitamin B-12. Conclusion: The present study indicated that the DHQ had acceptable validity and reproducibility for assessing folate and vitamin B-12 intakes in Japanese pregnant women.

Aim: To determine the relationship between the working situation (full-time housewife, stopped working during pregnancy, or currently employed) and the lifestyle factors, reasons for stopping work during pregnancy, and effects of working conditions in order to identify the factors that are related to the continuation of employment among pregnant Japanese women. Methods: In a cross-sectional study, a questionnaire was administered to pregnant women who visited an obstetrics clinic in a Tokyo suburb for an outpatient medical check-up during July and August 2004. Results: The data of 530 healthy pregnant women were analyzed. The pregnant women who stopped working during their pregnancy had lower mental health scores than the full-time housewives and employed pregnant women. In each trimester, the employed pregnant women reported a shorter daytime sleep duration than the pregnant women who stopped working during their pregnancy and the full-time housewives. The reasons for stopping work during pregnancy were categorized as somatic symptoms due to pregnancy, working conditions, and a sense of values or social reasons. The employed women in the third trimester more often reported the availability of, and access to, a rest area in their company, compared to those in the first and second trimesters. Conclusion: The lifestyle factors of the pregnant women were different, based on their work situation. In particular, the employed pregnant women had a shorter daytime sleep duration. The pregnant women who stopped working during their pregnancy could have benefited from mental health support. In addition, the reasons for stopping work during pregnancy were different in the three trimesters. A flexible system is needed for working women that adapts to the physical changes that occur during pregnancy. © 2011 The Authors. Japan Journal of Nursing Science © 2011 Japan Academy of Nursing Science.

Despite the fact that more than 90% of mothers in Japan prefer breastfeeding, the breastfeeding rate at 6 months postpartum is as low as approximately 35%. Postpartum depression and bonding disorder are recognized as factors associated with discontinuation of breastfeeding. However, these factors remain controversial. The purpose of the present study was to clarify the effect of postpartum depressive symptoms and bonding on the feeding pattern from 1- to 5-month postpartum. A longitudinal study was conducted at 1- and at 5-month postpartum, in 405 mothers who attended health check at three hospitals in the Tokyo metropolitan area at 1-month postpartum, and completed longitudinal questionnaires. A high proportion of breastfeeding mothers at 1 month postpartum had Edinburgh Postpartum Depression Scale (EPDS) score of ≥ 9 at 5 months postpartum (p = 0.01), and these mothers changed to formula milk-based feeding at 5-month postpartum, when compared with those of the breastfeeding-based group at both 1- and 5-month postpartum,. The appearance of depressive symptoms seems to promote discontinuation of breastfeeding at 5-month postpartum. © 2011 Elsevier B.V. All rights reserved.

<B>目 的</B><br> 本研究の目的は，1）産痛評価に使用される主観的評価尺度の特性，使用方法，妥当性，信頼性を整理し，実際に産婦に使用する際の長所と短所について検討することである。<br><b>方 法</b><br> Pubmed，CINAHL，医学中央雑誌Web版を使用し，2010年5月までの期間，経膣分娩の妊産婦を対象として主観的疼痛評価尺度を使用し産痛測定を行っている計50文献でレビューを行った。<br><b>結 果</b><br> 産痛強度の主観的評価尺度として，Visual analogue scale (VAS), Numerical Rating Scale (NRS), Face rating scale (FRS), Verbal Rating Scale (VRS), Mcgill Pain Questionnaire (MPQ)のPresent Pain Intensity (PPI)が使用されていた。産痛の質・強度両方を測る尺度としてMPQが使用されていた。どの尺度も分娩全時期，産後に使用されていた。<br> VASは痛みを視覚的に連続的なものとして扱う尺度であり，レビュー文献の内最も多く使用され，収束的妥当性，MPQのPPIとの併存的妥当性が確認された。<br> NRS，FRS，VRS，MPQのPPIは数字や痛みの説明による順序尺度である。MPQのPPIはVASとの併存的妥当性，PPIとPRIは弁別的妥当性が確認された。NRS，FRS，VRSは妥当性が確認されなかった。MPQのPRIは産痛測定での因子妥当性が確認された。MPQ日本語版は訳の推敲，カテゴリー化の再考を課題としている。<br> どの主観的評価尺度も産痛測定における信頼性は確認できなかった。<br><b>結 論</b><br> 産痛測定に最も多く使用されるVASは産痛測定において併存妥当性，収束妥当性が検証されており，個人の微細な痛みを表すことが可能であるが，個人間でばらつきが大きいことが欠点である。<br> どの主観的評価尺度も産痛測定における信頼性は確認されなかった。<br> 産痛の質と強度を多面的に捉え得るMPQは，産痛測定において妥当性が示されているがVAS，NRS，FRS，VRSに比べて回答に時間がかかることが欠点である。今後日本語版の改良，簡略版の開発が課題とされる。<br> 産痛を正確に捉えるためには尺度の特性を踏まえ，目的に合った尺度の選定をし，個人間のばらつきや測定値の不安定性を考慮し，尺度の併用や測定時期の統一など使用方法を工夫し，結果の解釈に注意を払う必要性がある。

全国47都道府県から層化無作為抽出法により,大学病院,一般病院,産婦人科診療所,助産院から合計270ヶ所を抽出し,平成9年の分娩数に比例配分して調査対象者数を割付けた.回答した褥婦のうち,早産,児体重2000g未満,多胎,胎児仮死,帝王切開を除く6676名を対象とし,分娩後の初回授乳の時期,入院中の新生児への補充栄養の実態について調査した.その結果,分娩後1時間以内に47%が初回吸啜を行い,入院中から母乳のみは15%で,糖水補充45%,人工乳補充29%,白湯補充5%であった.1ヵ月時の母乳栄養は初産婦42%,経産婦54%,平均48%であった.初回吸啜が早く,入院中母乳以外のものを補充しない母親ほど,1ヵ月時の母乳栄養率が有意に高かった

全国47都道府県から層化無作為抽出法により,種々の医療機関の合計232ヶ所の1ヵ月健診に来所した母親4067名を対象とし,産後1ヵ月間の母親の問題,生後1ヵ月の乳児の問題,育児環境,希望する子育て支援サービス等について調査した.その結果,退院後大多数の母親が家事援助を得ていたにも関わらず,初産婦の73%,経産婦56%が睡眠不足で疲労感があり,20%が乳房トラブル,13%が育児放棄感や,自信喪失感を経験していた.乳児の問題は,初産婦の43%が母乳哺育,38%が皮膚の事,32%が乳児の不眠,22%が育児の仕方に関する心配事を抱え,経産婦の32%が皮膚の事,25%が母乳哺育,14%が睡眠に関することであり,全項目が初産婦に有意に多かった.育児支援として,夜間診療の小児科医の情報54%,保育料軽減など経済支援53%,一時預かり保育39%,24時間電話相談28%,予防接種実施法の弾力化26%,乳児健診や分娩施設での育児相談を20〜24%の母親が望んでいた