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Patients with nonalcoholic fatty liver disease (NAFLD) have illness uncertainty. The purpose of this longitudinal study was to investigate the effect of the degree of illness uncertainty in patients with NAFLD on liver function values. We conducted a questionnaire survey and collected blood samples from outpatients with NAFLD. The items in the questionnaire were measured for illness uncertainty using the Japanese version of the Mishel Uncertainty in Illness Scale-Community (MUIS-C). Blood samples were collected at baseline and after 1 year. We divided the patients into two groups: one with high illness uncertainty and the other with low illness uncertainty. We then compared changes in alanine transaminase (ALT) and aspartate aminotransferase (AST) levels over time from baseline using multiple regression analysis. This study analyzed 148 patients with NAFLD; 75 were male and 73 were female, with a mean age of 58.4 ± 12.3 years. The group with higher illness uncertainty had significantly higher ALT and AST levels at 1 year (β = .185 and .183, respectively) than the group with lower illness uncertainty. High illness uncertainty in patients with NAFLD can lead to higher ALT and AST levels. Healthcare providers must focus on reducing illness uncertainty in patients with NAFLD.

Supplemental Material, sj-pdf-2-ajh-10.1177_10499091211061713 for Association Among End-Of-Life Discussions, Cancer Patients’ Quality of Life at End of Life, and Bereaved Families’ Mental Health by Yoko Hayashi, Kazuki Sato, Masahiro Ogawa, Yoshiro Taguchi, Hisashi Wakayama, Aya Nishioka, Chikako Nakamura, Kaoru Murota, Ayumi Sugimura, and Shoko Ando in American Journal of Hospice and Palliative Medicine®

Supplemental Material, sj-pdf-1-ajh-10.1177_10499091211061713 for Association Among End-Of-Life Discussions, Cancer Patients’ Quality of Life at End of Life, and Bereaved Families’ Mental Health by Yoko Hayashi, Kazuki Sato, Masahiro Ogawa, Yoshiro Taguchi, Hisashi Wakayama, Aya Nishioka, Chikako Nakamura, Kaoru Murota, Ayumi Sugimura, and Shoko Ando in American Journal of Hospice and Palliative Medicine®

A new near-infrared spectroscopy was applied to measure the changes in oxidation and hemodynamics in the left trapezius muscle region during experimental manual tasks. Subjects were comprised of male researchers and students with shoulder stiffness, those without symptoms, and nursery school workers with shoulder pain. They were asked to hold the left arm vertically with 180 degrees flexion of the shoulder joint for 90 seconds (task1). Those without shoulder pain had an additional task with holding the left arm horizontally in the sagittal plane with 90 degrees flexion of the shoulder joint for 90 seconds (task2). Using the spectroscopy, we measured relative changes in concentrations of oxyhemoglobin (Δ oxyHb), deoxyhemoglobin ( Δ deoxyHb), and total hemoglobin (Δ totalHb) as well as estimated oxygen saturation (St02) in the region to a depth of 30mm from the skin surface. The totalHb and Δ oxyHb decreased during the task1 but increased during task2, which implied that the physiological measurement of muscle circulation revealed a different aspect from biomechanical evaluation in studying work stress of manual tasks. Subjects with shoulder pain had lower Δ oxyHb, Δ deoxyHb, and Δ totalHb than those without pain. This finding would support the hypothesis that patients with shoulder myalgia have a reduced muscle blood flow when compared with healthy people because of disrupted control mechanisms responsible for regulating circulation in muscles. Some limitations of the methodology and reservations in interpreting the results were also discussed.

This paper intended to describe recent trends and problems to be solved in occupational health for caregiving workers by reviewing papers and original data by the authors. As the number of elderly people is rapidly growing, the demand for care-giving services is markedly increasing in Japan. Especially, the number of home care service (HCS) workers is expected to be 560,000 in 2010, even though it was still around 178,500 in 1999. Home help service is suspected to have physically and mentally stressful tasks, such as client transfer, changing carpets, care of violent clients and management of money. There have been some studies that found increase in risks of musculoskeletal problems and traffic accidents among HCS workers, even though the number of the studies was very limited. We had not found any papers presenting the evidence of mental problems among them. In order to protect caregiver from health problems related to their work, five strategic measures listed in the following were discussed. 1. improvement of working conditions and establishment of administrative systems for occupational health, 2. improvement of caregivers' techniques, 3. utilization and exploitation of assistive devices and equipment, 4. removal of various barriers to clients from houses and public places, and 5. occupational health education for caregivers. As the final remark, we commented that recent restructuring of social welfare systems and relaxation of regulations for protecting workers would undermine care services and working conditions of caregivers, then possibly affect their health.

An experimental study was conducted to evaluate techniques for transferring client from bed to wheelchair. Eight transferring tasks were studied by combining three factors with binary categories comprised of high / low bed height, standard / new make of wheelchair, and with / without belt for transfer. Ten and one female nursing students served as caregivers and a client, respectively. The caregivers rated significantly higher perceived exertion for the left arm in transferring tasks with belt than in the tasks without belt. The patient, however, found the transfer with belt to be more secure than without belt.

This research was designed to investigate the influence of lifting on physiological indexes and to examine relations between the influence and the level of physical strength. Twelve female students lifted a oblong box (L29.2cm X W25.4cm X H21.6cm) weighing 6.9kg at a tempo of 1 lift per 10 seconds for 15 minutes. The box weight was set up on the basis of the limitation of work load derived from the NIOSH formula The average heart rate and intensity of work load during the work were 103.7 bpm and 19.2% of maximal oxygen uptake, respectively. Before and after the work, the average concentration of blood lactate somewhat increased (0.563mmol/L to 0.851mmol/L) but its increment was not statistically significant. On the other hand, the correlation coefficient (r = -0.637) between the increase rate of the blood lactate concentration and the arm strength indicated the significantly negative interrelation. These results suggested that the workers with lower strength should pay attention to their work load, even though the work load was within the standard limit.

To identify the magnitude of musculoskeletal problems in social welfare service workers. prevalence of pains in the neck, shoulder, arm, and low back regions was studied in cross-sectional design. Questionnaires were distributed to workers in several private and public institutions for social welfare services in A-prefecture or N-city. The 12 months prevalence of low back pain mostly exceeded 50% in male groups, and 60% in female groups, while that of neck, shoulders. and arms ranged from 35% to 50% in male groups and from 48% to 75% in female groups. The prevalence of low back pain in the previous month mainly distributed between 20% and 42% in male groups, and between 36% and 60% in female groups. The prevalence of pains in the neck, shoulders, and arms was in the range of 24%-37% for males and 35%-60% for females. Higher prevalence of sick leave from work because of musculoskeletal pains was found in some occupational groups including nursery school cooks and home care service workers. There were associations between age and the prevalence of pains in several occupational groups, which suggested cumulative trauma in musculoskeletal systems or age related reduction in tolerance to work load. It was supposed that the questionnaire made for this study fulfilled the rcquirements for comparing basic information between studies regarding musculoskeletal pains. Some limitations of the study were also discussed with regard to the questionnaire ancl the sample size.

A questionnaire study was carried out in order to find actual conditions of preventive measures against work-related musculoskeletal problems in private nursery schools in Nagoya and its outskirts. Two-thirds of the twenty-four workplaces participating in the study were legally authorized social welfare corporations, and the rest were unauthorized small nursery schools. Many kinds of preventive measures were in place in many workplaces, including the improvement of facilities and equipment, working hours and rest schedules, the number of staffs, work organization, and health administration. However, few workplaces had regular meetings for occupational health issues and some preventive measures were taken only very infrequently. Responders regarded some measures as effective, (e.g., improvement of cooking facilities, rest rooms, air conditioning, number of staffs, and health examinations). Many responders thought that the introduction of some preventive measures from Swedish nursery schools would be difficult in Japanese workplaces with some exceptions, because workspace and finances, were limited and the age of children and the number of handicapped children were different from those in Swedish workplaces.