Factors responsible for elevated plasma B-type natriuretic peptide levels in severe aortic stenosis: Comparison between elderly and younger patients

AbstractBackgroundElevated plasma B-type natriuretic peptide (BNP) is a predictor of outcome and helpful for risk stratification in aortic stenosis (AS). However, left ventricular (LV) diastolic dysfunction progresses with aging and may also influence plasma BNP levels in elderly patients. We hypothesized that plasma BNP levels may be influenced by age in severe AS, and that factors that affect the elevation of plasma BNP levels may be different between elderly and younger patients with AS.MethodsWe performed echocardiography in 341 patients with severe AS [aortic valve area (AVA)<1.0cm2] and classified them into two groups by age (elderly ≥75 years old, n=201; younger patients <75 years old, n=140). We used multivariate linear regression analysis to assess the factors that determine plasma BNP levels in both groups.ResultsAge was found to be one of the independent determinants of plasma BNP levels in all patients (β=0.135, p=0.005). Although AVA was similar in the two groups, plasma BNP levels and E/e′ were significantly higher in elderly than younger patients [133.0 (IQR, 73.3–329.7)pg/dl vs 92.8 (IQR, 40.6–171.8)pg/dl, p<0.01; 20±8 vs 16±6, p<0.01, respectively). In multivariate stepwise linear regression analysis, AVA index, LV ejection fraction, mass index, E/e′, estimated systolic pulmonary artery pressure (eSPAS), and the presence of atrial fibrillation were independent determinants of plasma BNP levels in younger patients. In contrast, the independent determinants of plasma BNP levels in elderly patients were LV ejection fraction, mass index, E/e′, eSPAS, the presence of atrial fibrillation, age, and hemoglobin levels, but not AVA index.ConclusionsThere may be differences in the factors that influence plasma BNP levels between elderly and younger patients with severe AS. In elderly patients, plasma BNP levels may be influenced more by these factors than AS severity compared with younger patients

実習指導者-教員の協働状況とユニフィケーション活動との関係

本研究の目的は、実習における実習指導者?教員の協働に関わる現状を把握し、指導体制およびユニフィケーション活動が実習指導者?教員の協働的な活動に及ぼす影響を明らかにすることである。A大学看護教員と実習先の2施設の実習指導者（以下、指導者）に無記名自記式質問紙調査を実施した。51の有効回答を分析した結果、意思決定、協調性、情報共有において、教員が指導者よりも協働の認識は高く、協調性、情報共有に有意差が見られた。実習指導者?教員の協働に、ユニフィケーション活動の企画・実施した者が3因子とも高く、協調性に有意差があった。ユニフィケーション活動の場や機会が両者のコミュニケーションを促進し、実習指導の協働に影響を与えることが示唆された

Additional file 1 of Inadequate care and excessive overprotection during childhood are associated with the presence of diabetes mellitus in adulthood in a general Japanese population: a cross-sectional analysis from the Hisayama Study

Additional file 1: Supplemental Table S1. Parental care and overprotection scores for all participants according to age group. Supplemental Table S2. Combination of paternal and maternal parenting styles. Supplemental Table S3. Association of the score of parental care and overprotection with the presence of diabetes after including the participants with a single parent. Supplemental Table S4. Characteristics of included and excluded subjects