Validity and Reliability of the Japanese Version of the 12-item Self-administered World Health Organization Disability Assessment Schedule (WHODAS) 2.0 in Patients with Schizophrenia

It is necessary to assess functional impairment when treating schizophrenia. The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) has been adopted as a measure of functional disability in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. This study was a secondary analysis from a cross-sectional study of health-related behaviors among patients with schizophrenia. We examined the validity and reliability of the Japanese version of the 12-item WHODAS 2.0 when self-administered by such patients. Participants were 350 outpatients with schizophrenia from a psychiatric hospital. The standard six-factor structure of the WHODAS 2.0 showed a good fit for these participants. The Cronbach’s alpha coefficient was 0.858, showing good internal consistency. The WHODAS 2.0 showed moderate correlations with the modified Global Assessment of Functioning and Kessler 6 scales (r=−0.434 and 0.555, respectively). The results of this study show that the Japanese version of the 12-item self-administered WHODAS 2.0 has good internal consistency and convergent validity among patients with schizophrenia. Further exploration of the usefulness of WHODAS 2.0 in clinical settings is needed

母性看護学実習における看護学生のライフコースに影響を与えた学び

母性看護学実習が青年期にある看護学生のライフコースに影響を与えることは予測されるが、実際に看護学生がライフコースへの影響についてどのように考えているかとの検討はなされていない。そこで、母性看護学実習が自身のライフコースに影響を与えたと答えた看護学生の自由記述の結果を元に、その学びについて検討した。80名の自由記述の分析を行ったところ、【家族の存在を意識したライフコースへの願望】、【出産や育児というライフイベントに対する意識の具現化】、【母親役割、女性役割への気づき】、【職業選択への影響】、【両親への感謝】、【かけがえのない生命についての学び】という6つのカテゴリーが抽出された。看護学生は母性看護学実習を通して、過去から未来へと続く、非常に長いライフコースの軌跡を描くという学びをしていた。Maternal nursing practicums are believed to affect the life courses of nursing students in their adolescence. However, the perceptions of nursing students regarding the actual impact on their life courses have not been considered.Therefore, we investigated their acquired knowledge, based on an open-ended questionnaire survey of 80 nursing students who responded that their own life course was influenced by the maternal nursing practicum. Six categories were extracted: desire for a life course rewarded by the presence of a family, increased awareness of life events (childbirth and childcare), awareness of maternal and female roles, effects on career choices, gratitude for their own parents, and leaning about the irreplaceability of life. Nursing students gain knowledge from a very long life course trajectory from the past to the future through the maternal nursing practicum

Is Estrogen Effective for Full-Thickness Cutaneous Wound Healing in Young Male Mice ?

The aim of this study is to show the effects of estrogen upon its topical application on the wound healing process in young male mice. Fifty-six male mice aged 7 weeks old were divided into 4 groups: sham operation, castration, estrogen treatment after sham operation, and estrogen treatment after castration. Wound healing was observed daily until day 14 after wounding. Specimens were harvested on days 3, 7, 10, and 14, and stained to evaluate reepithelialization, inflammation, contraction, and collagen accumulation. Wound healing periods of all groups were almost the same, although the concentration of serum estrogen in the estrogen-applied mice was very high, and that in the nonapplied groups was low. The numbers of macrophages in the castrated, estrogen-treated after sham operation, and estrogen-treated after castration groups were significantly decreased compared with that in the sham group in the inflammatory phase; however, the ratio of wound area in these groups did not decrease, and other histological data did not reveal any effects of estrogen. These results indicate that estrogen may show limited effectiveness for full-thickness cutaneous wound healing in young male mice, and decreased inflammation may not always be associated with decreased wound area

Use of the index of pulmonary vascular disease for predicting long-term outcome of pulmonary arterial hypertension associated with congenital heart disease

AimsLimited data exist on risk factors for the long-term outcome of pulmonary arterial hypertension (PAH) associated with congenital heart disease (CHD-PAH). We focused on the index of pulmonary vascular disease (IPVD), an assessment system for pulmonary artery pathology specimens. The IPVD classifies pulmonary vascular lesions into four categories based on severity: (1) no intimal thickening, (2) cellular thickening of the intima, (3) fibrous thickening of the intima, and (4) destruction of the tunica media, with the overall grade expressed as an additive mean of these scores. This study aimed to investigate the relationship between IPVD and the long-term outcome of CHD-PAH.MethodsThis retrospective study examined lung pathology images of 764 patients with CHD-PAH aged <20 years whose lung specimens were submitted to the Japanese Research Institute of Pulmonary Vasculature for pulmonary pathological review between 2001 and 2020. Clinical information was collected retrospectively by each attending physician. The primary endpoint was cardiovascular death.ResultsThe 5-year, 10-year, 15-year, and 20-year cardiovascular death-free survival rates for all patients were 92.0%, 90.4%, 87.3%, and 86.1%, respectively. The group with an IPVD of ≥2.0 had significantly poorer survival than the group with an IPVD <2.0 (P = .037). The Cox proportional hazards model adjusted for the presence of congenital anomaly syndromes associated with pulmonary hypertension, and age at lung biopsy showed similar results (hazard ratio 4.46; 95% confidence interval: 1.45–13.73; P = .009).ConclusionsThe IPVD scoring system is useful for predicting the long-term outcome of CHD-PAH. For patients with an IPVD of ≥2.0, treatment strategies, including choosing palliative procedures such as pulmonary artery banding to restrict pulmonary blood flow and postponement of intracardiac repair, should be more carefully considered

Preoperative Screening CT and PET/CT Scanning for Acral Melanoma: Is it Necessary?

The efficacy of preoperative imaging for acral melanoma (AM) has not been fully evaluated. We examined the accuracy of imaging modalities in the detection of nodal and distant metastases in patients with AM. A retrospective review of 109 patients with AM was performed. All patients had no clinical signs suggestive of distant metastases, and underwent preoperative screening computed tomography (CT) and positron emission tomography (PET)/CT scans. Of 100 patients without lymphadenopathy, 17 patients were suspected of having nodal metastasis in CT and PET/CT, but only two of them were confirmed on histopathological analysis. On the other hand, 12 out of 83 negatively imaged patients showed histopathological signs of nodal metastasis; thus, the sensitivity and specificity of nodal detection were 14.3% and 82.6%, respectively. Regard to the detection of distant metastases, four patients were suspected of having metastasis, but this was later ruled out. The remaining 96 negatively imaged patients were confirmed to have no metastasis at the time of CT and PET/CT by the follow-up. In contrast, distant metastases were found by CT and PET/CT in four of nine patients (44.4%) with lymphadenopathy. Routine preoperative CT and PET/CT for AM patients without lymphadenopathy may not be warranted because of low sensitivity and specificity, but it can be considered for those with lymphadenopathy