The dilemma of nurses in the field of lifesaving：Literature review

The purpose of this study was to clarify the dilemmas that nurses have in the field of lifesaving through a literature review in Japan. As a result of analysis and discussion, it was found that there are four aspects to the dilemma that nurses have: “dilemma of giving priority to lifesaving,” “dilemma of performing the role as a nurse in a team,” “dilemma of the difficulty of practicing nursing under severe conditions,” and “dilemma of confronting oneself. It was inferred that these four aspects were related to each other. In addition, these dilemmas have two characteristics: social conflicts felt in the organization and intra-individual conflicts felt in oneself. Dilemmas are not necessarily harmful, even moderate dilemmas have positive aspects of functioning. By examining and managing dilemmas embraced by nurses, it is suggested that dilemmas can lead to their technical and spiritual growth, their improvement in the quality of nursing, and ultimately their organizational development

COVID-19 vaccine effectiveness against severe COVID-19 requiring oxygen therapy, invasive mechanical ventilation, and death in Japan: A multicenter case-control study (MOTIVATE study).

INTRODUCTION: Since the SARS-CoV-2 Omicron variant became dominant, assessing COVID-19 vaccine effectiveness (VE) against severe disease using hospitalization as an outcome became more challenging due to incidental infections via admission screening and variable admission criteria, resulting in a wide range of estimates. To address this, the World Health Organization (WHO) guidance recommends the use of outcomes that are more specific to severe pneumonia such as oxygen use and mechanical ventilation. METHODS: A case-control study was conducted in 24 hospitals in Japan for the Delta-dominant period (August-November 2021; "Delta") and early Omicron (BA.1/BA.2)-dominant period (January-June 2022; "Omicron"). Detailed chart review/interviews were conducted in January-May 2023. VE was measured using various outcomes including disease requiring oxygen therapy, disease requiring invasive mechanical ventilation (IMV), death, outcome restricting to "true" severe COVID-19 (where oxygen requirement is due to COVID-19 rather than another condition(s)), and progression from oxygen use to IMV or death among COVID-19 patients. RESULTS: The analysis included 2125 individuals with respiratory failure (1608 cases [75.7%]; 99.2% of vaccinees received mRNA vaccines). During Delta, 2 doses provided high protection for up to 6 months (oxygen requirement: 95.2% [95% CI:88.7-98.0%] [restricted to "true" severe COVID-19: 95.5% {89.3-98.1%}]; IMV: 99.6% [97.3-99.9%]; fatal: 98.6% [92.3-99.7%]). During Omicron, 3 doses provided high protection for up to 6 months (oxygen requirement: 85.5% [68.8-93.3%] ["true" severe COVID-19: 88.1% {73.6-94.7%}]; IMV: 97.9% [85.9-99.7%]; fatal: 99.6% [95.2-99.97]). There was a trend towards higher VE for more severe and specific outcomes. CONCLUSION: Multiple outcomes pointed towards high protection of 2 doses during Delta and 3 doses during Omicron. These results demonstrate the importance of using severe and specific outcomes to accurately measure VE against severe COVID-19, as recommended in WHO guidance in settings of intense transmission as seen during Omicron

Rice-Based Diet and Cardiovascular Disease Mortality in Japan: From the Takayama Study

Rice is the staple food in Japan and many other Asian countries, but research on rice-based diets and cardiovascular disease is limited. We aimed to evaluate the association between rice consumption as grain dishes and cardiovascular disease mortality in comparison with bread and noodle consumption. The subjects were 13,355 men and 15,724 women aged ≥35 years who enrolled in the Takayama Study. Diet intake was assessed using a validated food-frequency questionnaire. Causes of death were identified from death certificates. Cardiovascular disease was defined according to the International Classification of Diseases and Health Related Problems, 10th Revision (code I00–I99). Hazard ratios in the second, third, and highest quartiles versus the lowest quartile of rice intake for cardiovascular disease mortality were 0.98, 0.80, and 0.78 for men, respectively (trend p = 0.013), but no significant association was observed among women. Rice intake was positively correlated with the intake of soy products and seaweed, and negatively correlated with the intake of meat and eggs. Neither bread nor noodles were associated with cardiovascular disease mortality. In Japan, choosing rice as a grain dish is likely to be accompanied by healthier foods as side dishes, which may have a potential role in the prevention of cardiovascular disease

Dietary milk sphingomyelin prevents disruption of skin barrier function in hairless mice after UV-B irradiation

Exposure to ultraviolet-B (UV-B) irradiation causes skin barrier defects. Based on earlier findings that milk phospholipids containing high amounts of sphingomyelin (SM) improved the water content of the stratum corneum (SC) in normal mice, here we investigated the effects of dietary milk SM on skin barrier defects induced by a single dose of UV-B irradiation in hairless mice. Nine week old hairless mice were orally administrated SM (146 mg/kg BW/day) for a total of ten days. After seven days of SM administration, the dorsal skin was exposed to a single dose of UV-B (20 mJ/cm2). Administration of SM significantly suppressed an increase in transepidermal water loss and a decrease in SC water content induced by UV-B irradiation. SM supplementation significantly maintained covalently-bound ?-hydroxy ceramide levels and down-regulated mRNA levels of acute inflammation-associated genes, including thymic stromal lymphopoietin, interleukin-1 beta, and interleukin-6. Furthermore, significantly higher levels of loricrin and transglutaminase-3 mRNA were observed in the SM group. Our study shows for the first time that dietary SM modulates epidermal structures, and can help prevent disruption of skin barrier function after UV-B irradiation

Coital Frequency and the Probability of Pregnancy in Couples Trying to Conceive Their First Child: A Prospective Cohort Study in Japan

Background: Low fertility persists but remains unexplained in Japan. We examined whether the probability of pregnancy was influenced by coital frequency, age, reproductive age (assessed by antimüllerian hormone, AMH), and BMI. Methods: We established a two-year prospective study with a sample of hormonally monitored Japanese women aged 23–34 years wanting to conceive their first child. For a maximum of 24 weeks participants recorded menstrual bleeding, sexual intercourse, ovulation, and pregnancy. Additional information on pregnancy and infertility treatment was collected one and two years after intake. Results: The natural conception rate and coital frequency were both low in this sample. Among 80 participants, 44% (35) naturally conceived in 24 weeks. After two years, 74% (59) of women had delivered or were currently pregnant, 50% (40) due to natural and 24% (19) due to assisted conception, and 5% (4) were lost to follow-up. By two years, 56% (45) of women had sought fertility treatment. In 18% (58/319) of the observed ovarian cycles across 24 weeks there was no intercourse in a fertile period. Higher coital frequency at intake was associated with increased probability of conception by 24 weeks of follow-up (OR 1.23, 95%CI 1.02, 1.47). Chronological age, reproductive age, and BMI were not associated with the probability of pregnancy at 24 weeks. Conclusions: Our results suggest that first, natural conception rates could potentially increase with more frequent and well timed intercourse, and second that further work is needed to understand why even in a motivated sample of women monitoring their fertile periods, both the conception and coitus rates were low