Published papers

Objective: The objective of this paper is to provide a practical illustration of methods useful for translating and testing questionnaire instruments for nursing and healthcare to ensure reliability, validity, and appropriateness for the target culture. Methods: We present the process used to create the Japanese version of a well-established quality of life (QOL) instrument, originally developed in American English. The Ferrans and Powers Quality of Life Index (QLI)-Cancer Version III was translated into Japanese by a team of bilingual translators and tested using an iterative process involving cognitive interviewing with monolingual Japanese cancer patients. Results: Discussions among the translation team made it possible to find and resolve linguistic, cultural, and practical issues regarding the translation. Problems stemming from question interpretation and information retrieval were resolved through the cognitive interviewing process. One problem related to response editing could not be remedied with altered phrasing, namely a question referring to the respondents' sex lives. This item was retained in the Japanese version of the QLI as an indispensable component of QOL, particularly in a healthcare context. Conclusions: The final Japanese version captured the intended meaning of the original, and also was culturally appropriate and clearly understood by Japanese cancer patients.

The objective of this study was to translate the Ferrans and Powers Quality of Life Index (QLI) into the Indonesian language, considering its cultural and functional appropriateness, and to evaluate its psychometric properties by testing the reliability and validity. A committee approach was conducted to create the Indonesian version of the QLI (QLI-Id) and cognitive interviewing with 15 patients with cancer was conducted to identify potential problems or errors in answering the QLI-Id. A cross-sectional descriptive study was carried out using 236 responses to the QLI-Id questionnaire from patients with cancer; 62 of whom completed the same questionnaire twice within a 3-week interval to verify stability reliability. Confirmatory factor analysis results supported construct validity with model fit statistics for the original single-factor and four-factor structure of the QLI (corresponding to the QLI's total score and four subscale scores, respectively) with some rearrangement of the items within each subscale. Reliability for the total QLI-Id scale was supported by McDonald's Omega of 0.92 and the intraclass/intrasubject correlation coefficient at two time points of 0.86. The strong correlation between the QLI-Id total and the Satisfaction with Life Scale scores and the overall health/QOL domain of the EORTC QLQ-C30 (both r = 0.73) supported its construct validity. This study provides evidence for the reliability and validity of the QLI-Id as an instrument to measure the impact of cancer on the overall QOL of Indonesian patients.

In the current study, we investigated the motivational status and underlying factors of the motivational changes among Japanese medical science students brought by the COVID-19 pandemic. Two groups of second-year undergraduate medical science students (training to become medical technologists and/or medical science researchers) participated in this study in the summers of 2020 and 2021 by writing essays describing how the pandemic had affected their motivation to study. A content analysis of the motivation status and underlying factors (both motivating and demotivating factors) was conducted before statistical analysis was used to investigate possible differences between the sexes and the two groups. In total, 73 essays were included in the analysis. The students had increased motivation to study in both groups (89% and 62%, respectively); however, in Group 2021, 19% of the students (all women) had decreased motivation. Among the underlying reasons behind the increased motivation, students showed a desire to help/save others, contribute to the development of medical science, increase knowledge, and disseminate correct information. The demotivating factors were largely linked to online learning and the negative emotions associated with lockdown. Our findings suggest that, for Japanese medical science students, the COVID-19 pandemic has been an overall motivating experience for our students. However, the prolonged pandemic and lockdown measures could attenuate this and be particularly disruptive for women.

The purpose of this study was to examine, using a sequential model, factors associated with volunteer participation and sleep efficiency in Japanese older adults receiving treatment for hypertensive disease. A questionnaire survey was conducted to collect data on participant demographics, lifestyle, health status, and depression, and sleep activity monitors were used to objectively measure sleep status and sleep efficacy. Of the 167 respondents, the 59 being treated for hypertension were divided into two groups based on their participation in volunteering. Comparison between the groups showed significant differences in nocturnal awakening, sleep efficiency, and nap frequency. Volunteers had less nocturnal awakening, increased sleep efficiency, fewer naps, and decreased depression. Covariance structure analysis of the survey data and sleep measurements for hypertensive older adults in the volunteer group was performed by modeling the relationships between variables with a path diagram. Our model showed strong goodness of fit (χ2 test = 15.636, p = 0.111, GFI = 0.925, AGFI = 0.842, CFI = 0.925, RMSEA = 0.099). The findings of this study suggest that older adults with hypertension who participate in volunteer activities have less nocturnal awakening, improved sleep quality, and reduced risk of depression, and provides evidence to promote social participation in volunteering among older adults with hypertension.

The purpose of this study was to examine the association between sleep quality, frailty, and human relationships in Japanese older adults (aged 65 years and above, excluding those certified as requiring long-term care). This cross-sectional study used a questionnaire survey to gather demographic information, data on frequency of conversation and conversation partners, and employed the following validated instruments: Kihon Checklist (KCL), a Japanese instrument used to determine the care needs and frailty of older adults; the Dysphagia Risk Assessment for Community-Dwelling Elderly (DRACE) scale; Japanese versions of Pittsburgh Sleep Quality Index (PSQI-J); the Geriatric Depression Scale-15 (GDS-15-J); and the University of California Los Angeles Scale (UCLA-J), an instrument to assess loneliness in older adults. The 500 respondents were divided into two groups based on sleep quality (PSQI-J): low sleep quality group (n = 167, 33.4%) and high sleep quality group (n = 333, 66.6%). Our analyses showed that the low sleep quality group had a KCL score of 5.55 ± 2.47, which indicated frailty. Binomial logistic regression analysis identified age, number of diseases under treatment, DRACE, GDS-15-J, and conversation frequency and discussion partner for important matters as factors (p < 0.05) associated with poor sleep quality. These factors could help enhance the detection of frailty and predictability of caregiving needs.

In white-collar workplaces, individuals with autism spectrum disorder (ASD) traits may experience psychological strain and reduced productivity. This study examined structural relationships among ASD traits, social camouflaging, psychological distress, and work functioning impairment, with a focus on gender differences using a secondary analysis of data from an online survey of 543 Japanese white-collar workers (284 men, 259 women). Validated instruments were used to assess ASD traits, camouflaging, psychological distress, and work functioning impairment. Multi-group structural equation modeling by gender was applied using a NIOSH-inspired model. Men scored higher on the Imagination subscale of ASD traits, whereas women scored higher on Attention Switching and Assimilation. ASD traits were indirectly associated with work impairment through psychological distress, while the direct path between ASD traits and work impairment became negative when distress was controlled, indicating a statistical suppression pattern that was more pronounced among women. Assimilation was significantly associated with psychological distress in women but not in men, although the gender difference was at the trend level. The findings indicate a cross-sectional, context-dependent association between ASD traits and work functioning and highlight the importance of considering both gender and workplace context in non-clinical working populations.

Purpose: The aim of this study was to examine the cross-sectional relationship between cancer survivors’ return-to-work (RTW) status and health-related quality of life (HR-QOL) following cancer diagnosis and treatment. Methods: A questionnaire survey, which included three standardized HR-QOL instruments, was carried out among Japanese cancer survivors at their first follow-up appointment following hospital discharge. Participants were recruited by nurse investigators from 2016 to 2017 at their respective inpatient units. Statistical analyses were performed on the gathered data. Results: Analysis of 94 returned questionnaires showed that symptom-related interference, physical function, mental function, and health and functioning, which were indicators of HR-QOL, and the factor “work category” were significantly associated with RTW status although symptoms, subjective well-being, and the other social background factors showed no statistically significant relationship with RTW status. Multinomial logistic regression analysis revealed that only the factor “work category,” which consisted of “physical” and “mental” work, had a significant effect on RTW status. Conclusions: RTW status was associated with work category, symptom-related interference, physical function, mental function, and health and functioning; however, only the factor “work category” had significant influence. This study suggests that helping cancer survivors return to work considering the work category they are engaging is important. At that time interventions that are focused on the individual health functioning including physical and mental functions in preference to social background factors may get to be valuable.

The decline in mental health among workers in Japan has become a serious concern. Autism spectrum disorder (ASD) traits are increasingly recognized as a potential risk factor for mental health issues, yet few individuals receive a formal ASD diagnosis. This study aims to examine whether undiagnosed but working individuals with strong ASD characteristics differ in factors related to presenteeism (low productivity) compared to their counterparts with fewer ASD traits. In particular, we investigated the impact of social camouflaging—the behavioral adaptation used to mask ASD traits—especially on workers with strong ASD characteristics. An online survey was conducted among white-collar workers aged 20 to 60. The survey included items collecting demographic information (gender, age, marital status, highest level of education completed, employment status, job title, length of employment, and working hours) and included the Japanese versions of four validated instruments to measure aspects of autism traits, social camouflaging, work functioning, and occupational stress. Of the 543 respondents, 139 (25.6%) exhibited strong ASD characteristics. These individuals reported lower productivity than their counterparts. While social camouflaging was observed across all ASD trait levels, it was specifically linked to poorer mental health and reduced productivity among workers with strong ASD characteristics. To support workplace well-being and productivity, it is crucial to increase awareness and understanding of ASD traits in professional settings and create an environment that accommodates diverse work styles.

Aim: The purpose of the present study was to collate examples of end-of-life care guidelines from various counties, examine their contents, and gain an overall picture of how end-of-life care guidance is offered to physicians and care providers internationally. Methods: In this study, eight researchers worked independently to source and examine national-level end-of-life care guidelines from different countries and regions. Data collected by each researcher were gathered into a unified table. The items in the table included basic information (publisher, year, URL etc.) and more specific items, such as the presence/absence of legal information and family's role in decision-making. These data were then used to identify trends, and examine the mechanics and delivery of guidance on this topic. Results: A total of 54 guidelines were included in the study. All the guidelines were published between 2000 and 2016, and 60% (n = 33) were published after 2012. The length of the guidelines varied from two to 487 pages (median 38 pages), and had different target audiences – both lay and professional. A total of 38 (70%) of the guidelines included information about the relevant laws and legal issues, 47 (87%) offered advice on withholding and withdrawing treatment, 46 (85%) discussed the family's role in decision-making and 46 (85%) emphasized the teamwork aspect of care. Conclusions: The present findings show that end-of-life care guidelines are generally made reactively in response to the trend toward patient-centered care, and that to create effective guidelines and implement them requires multilevel cooperation between governmental bodies, healthcare teams, and patients and their families. Geriatr Gerontol Int 2019; 19: 847–853.

For non-English-speaking nations such as Japan, proficiency in English has emerged as an indispensable skill, particularly in scientific fields like medicine. This research paper extends prior investigations into the motivations of Japanese medical students for learning English and delves into their willingness to communicate (WTC) in English. Importantly, it explores the impact of the COVID-19 pandemic on these motivations and communication behaviors. This study reveals that Japanese medical students are strongly instrumentally and vocationally motivated, viewing English as a practical asset for their future medical careers. They also exhibit a strong international posture, demonstrating an eagerness to engage with global cultures through English. Notably, the students’ motivation to study English remains resilient despite the pandemic’s challenges, such as the shift to remote learning and travel restrictions. However, their WTC in English exhibits nuanced changes. While overall WTC remains stable, students’ inclination to give presentations in English decreases significantly, possibly due to reduced face-to-face interactions in virtual learning environments. Additionally, their interest in participating in international events and activities wanes, possibly influenced by pandemic-related travel anxiety. These findings underscore the importance of offering specialized English classes and study abroad/international exchange experiences to sustain students’ motivation to learn English.

Background/Objectives: Loneliness is a critical public health concern associated with adverse mental and physical health outcomes in later life. However, few large-scale studies have examined loneliness in relation to depression, aspiration risk, frailty, and social participation among Japanese older adults. This study examined associations between loneliness and psychosocial and health-related factors among older adults. Methods: This cross-sectional study involved a secondary analysis of data obtained from online surveys conducted in 2018 and 2021 among 1000 community-dwelling Japanese adults (≥65 years). Loneliness was assessed using the UCLA Loneliness Scale Version 3 and dichotomized at the median to define a high-loneliness group. Depressive symptoms, aspiration risk, frailty, conversation frequency, and volunteering participation were assessed using validated scales. Multivariable logistic regression was used to identify factors associated with loneliness and interaction terms were examined to assess effect modification. Results: High loneliness was observed in 52.2% of participants. Greater loneliness was significantly associated with depressive symptoms (GDS ≥ 5; OR = 4.69, 95% CI: 2.84–7.76), higher dysphagia risk (DRACE score; OR = 1.08, 95% CI: 1.00–1.16), and lower daily conversation frequency (OR = 0.76, 95% CI: 0.67–0.86); however, volunteering (OR = 0.475, 95% CI: 0.23–0.87) was a protective factor. Conclusions: Loneliness among Japanese older adults is closely linked to depressive symptoms and aspiration risk, while frequent conversations and volunteer participation appear to be protective. Community-based interventions promoting social engagement and oral health may mitigate loneliness and its health consequences and improve quality of life for older adults. Given the cross-sectional design, the observed associations should not be interpreted as causal.

This study explores the impact of the COVID-19 pandemic on the motivation of medical students using a mixed-method, user-led approach with students as both participants and researchers. Data were collected in 2021 through essays describing students’ motivation during the pandemic. The essays were coded, categorized, quantified, and statistically analyzed for gender-based differences. Results showed that while 71% of students reported increased motivation, female students more often experienced fluctuating motivation levels. Key motivational factors included career aspirations and educational purpose, whereas demotivational factors involved disruptions to college life and mental health struggles. Notably, female students disproportionately expressed doubts about the medical profession. The study also utilized a collaborative autoethnographic method to explore the researchers’ own pandemic experiences, revealing long-term positive effects and resonating with initial findings. This research contributes to understanding the pandemic’s long-term impact on medical students and offers insights into nurturing resilient future doctors capable of handling healthcare crises.

Background/Objectives: Supporting the mental well-being of students through their educational journey is of vital importance. The objective of this study was to investigate the relationship between metacognition, personality traits, and various factors affecting mental health in a cohort of physical therapy (PT) and occupational therapy (OT) students. Methods: This cross-sectional observational study involved a self-administered questionnaire (distributed in October to November 2020) that gathered demographic information and included six scales measuring personality characteristics, health literacy, self-management skills, exercise habits (benefits and barriers), cognitive thinking, and cognitive deliberateness and impulsivity. Results: A cohort of 195 PT and OT students participated in the study. The findings revealed significant associations between metacognition and personality, particularly the association between low cognitive self-confidence and high emotional instability. This link suggests that students who struggle with cognitive self-confidence may also experience greater emotional instability, highlighting a need for targeted mental health support. Additionally, health literacy was negatively correlated with anxiety, while metacognition was positively correlated with perceived exercise benefits. Conclusions: This study highlights the importance of individualized metacognitive approaches to support students’ mental well-being. Interventions should focus on strengthening cognitive self-confidence through methods such as resilience training, cognitive restructuring, and mindfulness practices to help manage emotional instability. Furthermore, promoting physical activity, particularly among female students, and incorporating gender-specific strategies could enhance mental health outcomes.

Background/Objectives: In the context of an aging society, physical disability and its relationship with frailty is of growing concern. The aim of this study was to examine the associations between oral function, social participation, and loneliness among community-dwelling middle-aged and older adult physically disabled individuals. Methods: In this cross-sectional study, the participants were 140 individuals with certified physical disabilities living in the studied area. Demographic characteristics, outing activities, loneliness (Three-Item Loneliness (TIL) Scale), and frailty/ability to live independently (Kihon Checklist (KCL)) were assessed using a questionnaire survey. The participants were divided into two groups based on the presence or absence of oral dysfunction (OD), and statistical analyses were performed to compare the groups. Results: The group with OD had significantly higher TIL and KCL total scores and significantly lower mobility, confinement, cognitive function, greater levels of depression, and fewer outing activities (volunteering, movies, festivals, sports) compared to the group without OD. In a multivariate, age- and sex-adjusted binomial logistic regression analysis, outing activities (OR = 0.011, 95% CI: 0.000–0.529, p = 0.023) and loneliness (OR = 6.174, 95%CI: 1.292-29.502, p = 0.023) were identified as significant factors. Conclusions: An association was found between OD, loneliness, and social activities among middle-aged and older individuals with physical disabilities. The results suggest that future interventions should consider the relationship between oral function and factors such as depression, loneliness, social isolation, and social engagement as a means to mitigate frailty and other health and well-being concerns for physically disabled individuals.

Aim: The purpose of this study was to examine the relationship between health-related quality of life (QOL) and swallowing function among independent community-dwelling older Japanese adults aged 65 years or older. Methods: A total of 500 participants (250 males and 250 females) were surveyed about BMI, dysphagia and eating disorders (Dysphagia Risk Assessment for the Community-dwelling Elderly [DRACE]), quality of life (QOL; SF-8 Physical and Mental Summary Score), sleep (Pittsburgh Sleep Questionnaire Japanese version [PSQI-J]), and depression (Geriatric Depression Scale [GDS]). Results: Participants were divided into two groups based on risk of aspiration and data between the groups were compared. Lo-gistic regression analysis revealed that the SF-8 physical component summary score (PCS) and mental component summary score (MCS) were associated with aspiration risk. In the multiple regression analysis, the SF-8 related to eating and swallowing function and PSQI-J were extracted. Conclusions: The risk of aspiration among the older adults in this study was found to be associated with health-related QOL, sleep quality, revealing a wide-ranging impact on physical, mental, and social functioning. These associated factors may pose a risk for community-dwelling independent older adults, suggesting the need to focus on eating and swallowing function for frailty.