Family Members' Experience of Discussions on End-of-Life Care in Nursing Homes in Japan: A Qualitative Descriptive Study of Family Members' Narratives.

In nursing homes, discussions between family members and staff regarding the end of life for residents with cognitive impairment are crucial to the choice of treatment and care consistent with residents' wishes. However, family members experience burden in such discussions, and communication with staff remains inadequate. The purpose of this qualitative descriptive study was to elucidate the meaning of continuous end-of-life discussion for family members. Data were collected using semistructured individual interviews. Thirteen family members of residents from 3 nursing homes in Kyoto, Japan, participated in the study. Data were analyzed using thematic analysis, which focused on both explicit and implicit meanings. Four themes emerged regarding the experience of end-of-life discussion: "the end of life soaking in, " "hardship of making the decision to end my family member's life, " "wavering thoughts about decisions made and actions taken, " and "feeling a sense of participation about the care." Family members had come to accept the deaths of residents through continuous discussion and experienced strong conflict in facing the death of their family members. Moreover, staff members should understand family members' beliefs and the burden they experience in facing residents' death

Breaking Japanese Diplomatic Codes: David Sissons and D Special Section during the Second World War

During the Second World War, Australia maintained a super-secret organisation, the Diplomatic (or `D’) Special Section, dedicated to breaking Japanese diplomatic codes. The Section has remained officially secret as successive Australian Governments have consistently refused to admit that Australia ever intercepted diplomatic communications, even in war-time. This book recounts the history of the Special Section and describes its code-breaking activities. It was a small but very select organisation, whose `technical

シンガポール現代史のなかの日本人--在シンガポール日本人への聞き取り調査から

シンガポールに長期滞在する日本人のライフヒストリーを聞き取り、分析することで、流動の激しいシンガポールに留まり続けた当事者の「個人的な理由」は、その当時の社会情勢や両国関係とどのように連関しているのか、シンガポール人やシンガポール社会との接触・交流にはどのような工夫や苦労があったのか、シンガポール人は日本人をどう見ていたのか、を理解し、それを「人々の社会史」「人々の交流史」として両国関係史の再構築を行った

Mental and physical effects of the 2011 Great East Japan Earthquake on School Children, and Health Support initiatives by YogoTeachers: Findings from a survey of high school yogo teachers 5 years after the disaster

Objective: To clarify the current mental and physical state of students 5 years after experiencing the Great East Japan earthquake, tsunami, and nuclear accident, and to shed light on the practical initiatives and issues faced by yogo teachers in supporting students’ health. Method: In May 2016, we conducted a mail-based questionnaire of yogo teachers at 15 prefectural high schools in Soma District and Futaba District (collectively, “Soso”) in Fukushima Prefecture, one of the areas most heavily affected by the Fukushima Daiichi Nuclear Power Plant accident.　The questionnaire focused on (1) health and school life of students; and (2) current initiatives and issues faced by yogo teachers in supporting student health. Results: We received responses from 8 of the 15 high school yogo teachers surveyed (response rate: 53.3％).Six yogo teachers (75％) responded that the “students are calm.” However, 6 yogo teachers (75％) recognized a tendency among students towards weight gain and obesity, as well as reduced physical stamina and sporting ability, while 4 yogo teachers (50％) indicated that some students were anxious about their future and career path, and were receiving personal support from the school counselor.　The yogo teachers provided support to students while attempting to ascertain their mental and physical well-being through greater health monitoring and questionnaires, and while coordinating with the school physician and counselor. Conclusion: Five years after the earthquake, high school students in the Soso district are now leading a more relaxed school life, but still feel anxious about their future health and career path due to lingering concerns about radiation, highlighting the need for long-term support by yogo teachers

Health Support Provided by Yogo Teachers for Adolescent Female Students with a Thin Body Type

Purpose: To clarify the realities and challenges involved in health support provided by yogo teachers to adolescent girls who have a thin body type. Methods: A semi-structured interview survey was conducted with yogo teachers at a Japanese high school with experience of providing health support to thin adolescent female students and the results of the survey were subjected to qualitative analysis. Results: With regard to health support provided by yogo teachers, the results of analysis found that the actual situation consisted of the five categories of 【sharing information throughout the school organization to investigate methods of support】,【 realizing studentsʼ situations through the provision of individual support】, 【referring students and parents to specialist agencies】,【investigating collaborations with parents with students ʼ consent】, and 【carrying out prevention and awareness-raising activities about thin physiques】.　 However, the analysis also found that the practical challenges for providing such health support consisted of the six categories of 【working with parents to liaise with medical institutions】,【continuous support in collaboration with specialist agencies】,【 educational health support that enables all students to manage their own health】,【 yogo teachersʼ professional knowledge and assessment of eating disorders】,【 support methods that students can engage with on their own initiative, according to their situation】, and 【creating a counseling- friendly environment to facilitate early detection】.Discussion: While yogo teachers had an overall grasp of studentsʼ situations through their organizational engagements in cooperation with faculty and school physicians, as well as individual support activities, it was clear that they faced difficulties and challenges in relation to working together with parents and specialist agencies.　In the future, improving collaboration with parents will require that they, too, be encouraged to recognize that being excessively thin represents a health problem for adolescent female students.　In addition, it will also be necessary to work towards building daily collaboration systems, such as by having yogo teachers keep track of potential partner medical institutions as a matter of routine.　It was further suggested that yogo teachers will need to provide educational and preventive health support oriented toward helping female students acquire the ability to manage their own health

Comparison between early and late carotid endarterectomy for symptomatic carotid stenosis in relation to oxidized low-density lipoprotein and plaque vulnerability

ObjectiveAlthough carotid endarterectomy (CEA), the gold standard in stroke prevention, has been performed in the late stage after the insult, its optimal timing remains unclear. Using biomarkers in plaque and plasma, we evaluated oxidative stress and plaque vulnerability between early and late CEA in symptomatic patients.MethodsWe compared symptomatic stroke patients who underwent early CEA within 4 weeks of the last insult (group A; n = 15) with those who received CEA in the late stage beyond 4 weeks from the last symptom (group B; n = 57). They were divided into vulnerable (group Av, n = 13; group Bv, n = 33) and stable (group As, n = 2; group Bs, n = 24) subgroups according to the pathologic findings on their plaques. We studied the relationships among their primary symptoms, clinical findings, oxidized low-density lipoprotein levels, and gelatinase A (matrix metalloproteinase [MMP]-9) activity in their plaques and plasma.ResultsGroup A had a variety of symptoms; there was no difference in the outcome of CEA between groups A and B. The plaque and plasma oxidized low-density lipoprotein levels were higher in group A than in group B (P < .05). The incidence of pathologically vulnerable plaque was higher in group A than in group B. Plaque oxidized low-density lipoprotein levels and MMP-9 activity were similar in group Av and group Bv and were higher in those groups than in group As and Bs.ConclusionsWe first demonstrated that vulnerable plaques in patients subjected to early CEA manifested a remarkable increase in oxidized low-density lipoprotein and MMP-9 activation. Our findings suggest that early CEA may be beneficial in the aspect of oxidative stress

Anatomical characteristics of the rectus abdominis and transversus abdominis muscles related to ultrasound-guided rectus sheath block for analgesia around the umbilicus in healthy adult Japanese volunteers

Background: The rectus abdominis muscle partially overlaps with the transversus abdominis muscle belly when following cephalad. This study aimed to evaluate the overlapping properties between the rectus abdominis muscle and the transversus abdominis muscle belly in relation to the performance of ultrasound-guided rectus sheath block for analgesia around the umbilicus.Methods: After obtaining institutional approval and written informed consent, ultrasound examinations of bilateral abdominal walls were performed in healthy adult Japanese volunteers. The craniocaudal distance from the level of the umbilicus to the point where the rectus abdominis muscle and the transversus abdominis muscle belly begin to overlap on the ultrasound image was measured.Results: Sixty hemi-abdominal walls were examined in 30 volunteers (15 males, 32±6 years old, and 15 females, 31±5 years old). The craniocaudal distance from the level of the umbilicus to the point where the rectus abdominis muscle and the transversus abdominis muscle belly begin to overlap on the ultrasound image (left side/right side) was 17.4±11.8/18.8±13.3 mm in male subjects and 19.5±11.5/21.2±12.4 mm in female subjects, respectively. At the level of the umbilicus, overlapping of the two muscles was observed only in 2 of 60 subjects. At 45 mm cephalad from the level of the umbilicus, the two muscles began to overlap in 58 of 60 subjects (96.7%).Conclusions: The position where the rectus abdominis muscle and transversus abdominis muscle belly begin to overlap as detected by ultrasound imaging is approximately 20 mm cephalad to the umbilicus