Registered nurses and licensed practical nurses have been educated as professional nurses. Professional nurses can concentrate on their jobs requiring a high degree of expertise with help they get from nursing assistants.If professional nurses have improper attitudes toward nursing assistants, it is most likely that the nursing assistants will not help them to the best of their ability. We investigated nursing assistants’ impressions regarding professional nurses’ attitudes, and what effects nursing assistants’ impressions have on their “desire to be helpful to professional nurses.” The study design was a cross sectional study. Twenty-five small- to medium-sized hospitals with 55 to 458 beds were included in this study. The analyzed subjects were 642 nursing assistants (96 males, 546 females). Factor analyses were conducted to extract the factors of nursing assistants’ impressions regarding professional nurses’ attitudes. Multiple linear regression analysis was conducted to investigate the predictors of “desire to be helpful to professional nurses.” We discovered 5 factors: 1. professional nurses’ model behavior, 2. manner dealing with nursing assistants, 3. respect for nursing assistants’ passion for their work, 4. respect for nursing assistants’ work, and 5. enhancing the ability of nursing assistants to do their work. The “desire to be helpful to professional nurses” was significantly associated with “professional nurses’ model behavior,” “manner dealing with nursing assistants” and “respect for nursing assistants’ passion for their work.” Factors 1 to 3 are fundamental principles when people establish appropriate relationships. Professional nurses must consider these fundamentals in their daily work in order to get complete cooperation from nursing assistants.
After the introduction of prostate-specific antigen (PSA) screening, prostate cancer diagnosis has shifted to early and curative stages, although 10-20% of patients still present with metastatic and incurable cancer. Prostate cancer is androgen-dependent, and most patients with prostate cancer initially respond to androgen deprivation therapy (ADT). After 1-2 years of the treatment, advanced prostate cancer eventually progresses to castration resistant prostate cancer (CRPC). A variety of mechanisms of progression from androgen-dependent prostate cancer to CRPC under ADT have been postulated, and the key pathway is re-activation of the androgen-androgen receptor (AR) axis, for example, caused by AR mutation/overexpression/splice variants, altered expression of AR cofactors, and increased production of androgens. Recently approved new agents, such as the hormonal agents abiraterone and enzalutamide and the chemotherapeutic agent cabazitaxel, have demonstrated survival benefit in men with CRPC. However, the prolongation of survival times provided with these agents is limited because of the treatment resistance. Androgen-AR axis still plays a pivotal role in the resistance to the new agents for CRPC. To improve the prognosis of patients with CRPC, intensive research to identify effective agents, treatment strategies, and useful predictive biomarkers to select the patients who can benefit from such treatments are required. Additional clinical data, with a better understanding of the biology of CRPC, may provide better CRPC treatment outcomes. This article reviews the underlying mechanisms of treatment resistance and future direction of CRPC treatments.
Neurodegenerative diseases (NDDs) are a group of intractable diseases that significantly affect human health. To date, the pathogenesis of NDDs is still poorly understood and effective disease-modifying therapies for NDDs have not been established. NDDs share the common morphological characteristic of the deposition of abnormal proteins in the nervous system, including neurons. Autophagy is one of the major processes by which damaged organelles and abnormal proteins are removed from cells. Impairment of autophagy has been found to be involved in the pathogenesis of NDDs, and the regulation of autophagy may become a therapeutic strategy for NDDs. In recent years, some active compounds from plants have been found to regulate autophagy and exert neuroprotection against NDDs, including Alzheimer’s disease, Parkinson’s disease, Huntington’s disease, spinal and bulbar muscular atrophy, spinocerebellar ataxia 3, and amyotrophic lateral sclerosis, via activating autophagy. In this paper, we review recent advances in the use of active ingredients from plants for the regulation of autophagy and treatment of NDDs.
Dapagliflozin, a selective inhibitor of sodium glucose co-transporter 2 (SGLT2), is a novel glucose-lowering agent that has pleiotropic actions on blood pressure and lipids. Its glucose-lowering effect is not mediated by insulin. We report a type 2 diabetic patient whose blood pressure pattern improved from non-dipper to dipper after treatment with dapagliflozin. The 60-year-old man was treated with 5 mg/day dapagliflozin, and the effect of treatment on his blood pressure (BP) was evaluated by ambulatory blood pressure monitoring (ABPM) before and at 8 and 14 days after the start of treatment. The 24-h systolic blood pressure/diastolic blood pressure decreased from 131/87 to 127/83 mmHg at day 14, with a particular decrease in nocturnal blood pressure from 123/84 to 116/75 mmHg (nocturnal blood pressure dip increased from 9.6% to 12.8%), changing from a non-dipper to a dipper blood pressure pattern. Dapagliflozin might potentially improve not only the average blood pressure, but also nighttime blood pressure from non-dipper to dipper in type 2 diabetic patients.
A 78-year-old Japanese man with fatigue, appetite loss, skin hyperpigmentation, hypotension and hypoglycemia, visited our hospital to evaluate an abnormal chest X-ray and adrenal gland swelling in echography in February 2015. Chest computed tomography showed a mass lesion in the right lower lobe and bilateral adrenal swellings, and small cell lung cancer (SCLC) with bilateral adrenal metastasis was diagnosed after bronchoscopy. According to low levels of serum cortisol, elevated adrenocorticotropic hormone (ACTH) and rapid ACTH test, the diagnosis of adrenal insufficiency associated with SCLC was made. Treatment with hydrocortisone (20 mg/day) was started in addition to systemic chemotherapy with carboplatin and etoposide. The patientʼs symptoms were slightly improved, however, systemic chemotherapy was discontinued according to the patientʼs request after 1 course of chemotherapy. Thereafter, he received only supportive care, and his general condition gradually worsened and he ultimately died in August 2015. Adrenal insufficiency associated with SCLC, which is caused by tissue destruction more than 90% of the adrenal glands, is rare although adrenal metastasis is not rare in patients with lung cancer. The findings such as general fatigue, appetite loss, hypotension, and hyponatremia are often got follow up as findings of advanced cancer, but appropriate therapy for adrenal insufficiency, supplement of the adrenal corticosteroid hormone, may lead to a significant improvement in the symptoms and quality of life in clinical practice of lung cancer. Therefore, physicians must consider potential adrenal insufficiency in lung cancer patients with bilateral adrenal metastasis.
Labor and Social Security Attorneys (LSSAs) advise their clients about occupational mental health, but the competencies necessary in this field are not clear to them. We standardized the necessary competencies as a counseling guide for LSSAs, and we also designed a related discussion training program. These competencies were summarized in a brainstorming session at a research conference comprised of physicians, an occupational health nurse, LSSAs, an instructional design expert, and a management consultant, and then a training program (lasting 9 hours 30 minutes) was developed. Nineteen trainees who were introduced by members of the research conference collectively completed a seven-question written test, both before and after the training, in order to assess its effectiveness. Sixteen trainees who completed the training were surveyed, with a recovery rate of 100%. The necessary competencies that they identified were: information about circular notices from the Ministry of Health, Labor and Welfare; behavior such as the gathering of information; and dealing with the reinstatement of employees. The scores were subjected to the Wilcoxon signed-rank test in order to evaluate the training, and the answers from the pre-training were compared with those from the post-training. A significant difference (P < 0.05) was seen for each question. These results show the effectiveness of the developed training program for the learning of the competencies necessary for LSSAs.
We studied the carcinogenic effects caused by repetitive irradiation at a low dose, which has received attention in recent years, and examined the experimental methods used to evaluate radiation-induced carcinogenesis. For this experiment, we selected a mouse with as few autochthonous cancers as possible. Skin cancer was selected as the target for analysis, because it is a rare cancer in mice. Beta-rays were selected as the radiation source. The advantage of using beta-rays is weaker penetration power into tissues, thus protecting organs, such as the digestive and hematogenous organs. The benefit of our experimental method is that only skin cancer requires monitoring, and it is possible to perform long-term experiments. The back skin of mice was exposed repetitively to beta-rays three times a week until the occurrence of cancer or death, and the dose per exposure ranged from 0.5 to 11.8 Gy. With the high-dose range (2.5-11.8 Gy), the latency period and carcinogenic rate were almost the same in each experimental group. When the dose was reduced to 1-1.5 Gy, the latency period increased, but the carcinogenic rate remained. When the dose was further reduced to 0.5 Gy, skin cancer never happened, even though we continued irradiation until death of the last mouse in this group. The lifespan of 0.5 Gy group mice was the same as that of the controls. We showed that the 0.5 Gy dose did not cause cancer, even in mice exposed repetitively throughout their life span, and thus refer to 0.5 Gy as the threshold-like dose.
In this study we discuss the measures of providing care to young workers with mental health disturbance by analyzing the cases of workers who had taken sick leave due to mental health disturbance. We analyzed 36 cases, collected from 11 occupational physicians, of workers who had taken sick leave due to mental health disturbance, and discuss measures for providing care to such young workers. We organized and classified data containing the details of the care provided to the workers and analyzed the main aspects and problems in providing it.We compared two age groups of workers: a below age 30 group, and an age 30 and above group. We observed that occupational nurses were more frequently the primary persons who dealt with workplace consultations in the below age 30 group (before sick leave: 38.9%; during sick leave: 38.9%) compared to the age 30 and above group (before sick leave: 16.7%, during sick leave: 11.1%). Most of the case providers expressed the opinion that a support system is necessary to help the workers return to work and it is an important factor in providing care to workers who have taken sick leave due to mental health disturbance. Coordination with the families of the workers was also important in the below age 30 group. It might be difficult to assign young workers to suitable workplaces or duties because of their inadequate job skills, lack of sufficient experience, and influence of personal factors on mental health. Our results suggest that it is important to provide appropriate care for young workers with mental health disturbance, such as support by occupational nurses, and to strengthen the collaboration between their families and the workplace staff.