Mixed-methods research of motivational processes in workers' adoption of healthy behavior

BACKGROUND

In occupational health, the maintenance and promotion of workers' health, especially lifestyle motivation-based interventions, have gained considerable attention and are actively implemented. Motivational theories include self-determination theory, and some studies focus on healthy lifestyles. However, the effectiveness of health promotion interventions varies depending on the health awareness and motivation of the participants. Therefore, this study aimed to clarify the processes by which workers are motivated to improve their health and to identify the need for and type of support according to their motivation.

METHODS

Using a mixed-research design, an initial questionnaire survey of 94 employees (mean age = 40.97 ± 9.65) at a multicenter company in Japan, followed by semi-structured interviews with 16 employees (mean age = 40.13 ± 9.45) from the high- and low-motivation groups, were conducted. Multiple regression analysis followed by modified grounded theory-based analysis of the results of the first stage was used and the quantitative and qualitative results were integrated.

RESULTS

In the first stage, autonomous motivation scores were predicted by the behavioral change stage and relatedness satisfaction/frustration. The second stage revealed that "the process of reflecting and managing one's own health while receiving support and feedback for maintaining and improving health" was the motivational process of workers. Result integration revealed that motivation increased through repeatedly escaping and adjusting to real problems and situational coping until the behavioral change. Despite interruptions during behavioral change, receiving feedback from others could increase motivation and continued behavioral change.

CONCLUSION

Regardless of their level of motivation for health behaviors, workers indicated that support from others was essential. The nature of this support was found to range from providing information to offering feedback. Interventions individualized by the identified process could enable customized motivation-driven health guidance.

Reliability and validity of the Japanese treatment self-regulation questionnaire for Japanese workers

Background

Motivational interventions are used as preventive measures in occupational health. However, existing studies primarily focus on motivation methods and not the stage of motivation—the process from extrinsic to intrinsic motivation. The treatment self-regulation questionnaire (TSRQ) can predict workers’ health at each motivational stage. Accordingly, this study examined the reliability and validity of the Japanese version of the TSRQ (Diet and Exercise) in occupational health settings.

Methods

Responses of 912 workers were analyzed. In this study, the Cronbach’s alphas were 0.85 for Diet and 0.84 for Exercise after excluding items with low Item-Total correlations. Regarding convergent validity, there was a weak correlation between behavior modification stages and the TSRQ. Regarding structural validity, confirmatory factor analysis was performed assuming a four-factor structure.

Results

The goodness-of-fit indices were: Comparative Fit Index (CFI) = 0.94, Tucker Lewis Index (TLI) = 0.92, and Root Mean Square Error of Approximation (RMSEA) = 0.07 for Diet and CFI = 0.92, TLI = 0.91, and RMSEA = 0.08 for Exercise.

Conclusion

The Japanese version of the TSRQ has a certain degree of reliability and validity. It can measure motivation for Diet and health-related behaviors in occupational health settings. The findings of this study may serve as a basis for promoting primary and secondary prevention.

Factors that facilitate multigenerational exchanges in regional locations: a cross-sectional study in Niigata City, Japan

Background

In the process of community building, it is important to create a place for multigenerational exchanges. To promote multigenerational exchanges in regional locations, it is essential to clarify whether such exchanges are related to government infrastructure, regional characteristics, and social capital, and how these exchanges contribute to community building.

Methods

A cross-sectional questionnaire study was conducted with representatives from 455 Chiiki no Cha-no-Ma (literal translation “community living room,” and hereafter “Cha-no-Ma”) in Niigata City, Japan. Responses were received from 405 representatives (response rate: 89.0 %), and 401 agreed to participate (4 declined). The survey details included basic information (e.g., date each location was established, frequency of meetings, number of caretakers and participants, qualifications of the representative), activities reflecting local culture, a social capital scale, the effects of the Cha-no-Ma implemented by the representative (12 items), challenges for management (16 items), and the implementation of multigenerational exchanges.

Results

Most of the age groups that participated in the Cha-no-Ma were elderly, and multigenerational exchanges took place in 125 locations (31.5 %). Items that had a significant connection to the implementation of multigenerational exchanges were “Frequency of meetings” (p < 0.001) and “Activities reflecting local culture” (p = 0.026). Binomial logistic regression analysis indicated that a high frequency of meetings was associated with the implementation of multigenerational exchanges (Odds ratio = 3.839).

There was a significantly higher ratio of implementation of multigenerational exchanges when the effects were a “connection with the region” (p = 0.006) and “conversations with different generations” (p = 0.004), and when the challenge was “no support from residents” (p = 0.002).

Conclusions

Cha-no-Ma participation is low among young people. The following ideas can be considered in order to increase multigenerational exchanges in regional locations. These exchanges may be promoted by increasing the frequency of meetings with qualified personnel and by adding activities that reflect local culture, such as festivals and making local foods. This community-based study clearly indicates that implementing multigenerational exchanges is an important activity for community building because it is related to connection within the community.

[Nasopharyngeal Hib Carriage Among Healthy Children Attending Daycare Centers in Yokohama After One Year of a Publicly Funded Vaccine Program]

Yokohama city started a regular, free vaccine program for Haemophilus influenzae type b (Hib) from February of 2011. This study was completed to verify the effectiveness of the vaccine on the nasopharyngeal Hib carriage among healthy children attending daycare centers in the Isogo area. The research was conducted during the late spring (Jun--Jul) and fall (Oct-Nov) of 2012. There was a significant decrease in the Hib carriage rate (spring 8.8%, fall 1.6%). During this period there was no increase in the Hib vaccine coverage. The Hib carriage rate of each daycare center was 0-18.4% in spring and 0-4.9% in fall. There was no significant relationship between the rate of non immunized children and that of Hib carriage. This improvement in nasopharyngeal Hib carriage shows the impact of community immunity.

Long-term follow-up of busulfan, etoposide, and nimustine hydrochloride (ACNU) or melphalan as conditioning regimens for childhood acute leukemia and lymphoma

We retrospectively evaluated early and long-term complications of an intensified conditioning regimen consisting of busulfan and etoposide in combination with either nimustine hydrochloride (ACNU) (BVA regimen, n = 18) or melphalan (BVL regimen, n = 34) in 52 children with acute leukemia or non-Hodgkin's lymphoma. With a median follow-up of 13.2 years after the BVA regimen and 8.1 years after the BVL regimen, 61% and 76% of patients, respectively, are in continuous complete remission. Transplantation-related mortality was 17% and 6% after the BVA and BVL regimens, respectively, and the corresponding relapse rates were 17% and 15%. The most common and severe toxicity was pulmonary complication in the BVA regimen, which was seen in 67% of patients and was life-threatening in 20%. Thirty-three percent of patients after the BVA regimen and 24% after BVL died of relapse or disease progression (n = 9), interstitial pneumonia (n = 2), fungal pneumonia (n = 1), or chronic graft-versus-host disease (n = 2). One of the long-term survivors developed secondary leukemia. A significant decrease in the height standard deviation score of more than 2 SD from diagnosis to the last follow-up was seen in 17% of the patients, with hypothyroidism in 15%, and alopecia in 42%. Because our experience is limited to a small heterogeneous population of patients who mainly underwent transplantation in the first remission, we cannot draw conclusions on the treatment's effectiveness. The BVL regimen is tolerable, however, because no regimen-related death was observed, whereas the BVA regimen is not recommended because of the high incidence of pulmonary complications. The effectiveness of the BVL regimen requires further study.

Loss of heterozygosity of NF1 gene in juvenile chronic myelogenous leukemia with neurofibromatosis type 1

To investigate a genetic relation between juvenile chronic myelogenous leukemia (JCML) and neurofibromatosis type 1 (NF-1), we analyzed the NF1 gene in the leukemic cells of a JCML patient with NF-1. We found a point mutation in exon 29 of one allele and a deletion of the other normal allele in the leukemic cells. The point mutation is considered a germline mutation because it was also detected in fibroblasts obtained from the bone marrow of the patient and the peripheral blood mononuclear cells from a sibling. A loss of heterozygosity of NF1 gene may contribute to the progression of leukemia in NF-1 patients.

The clinical course of acquired aplastic anemia in childhood; a retrospective study

We reviewed the clinical courses of 38 children with acquired aplastic anemia (AA). The patients were classified according to the severity criteria by the Japanese Ministry of Health and Welfare (JMHW) Study Group (22 severe, 15 moderate, 1 mild). Early death was observed only in severe cases. Eight of the non-severe cases progressed to severe in 0.5-125 months, and the long-term survival rate of non-severe AA did not differ from that of severe AA. The frequency of lymphocytes in the bone marrow was significantly higher, and the peripheral blood neutrophil count was lower in patients who died within a year, and these patients should be treated as very severe. These findings suggest that the JMHW Study Group criteria are useful for identifying AA patients with a poor prognosis, but even non-severe cases should be repeatedly evaluated. Sixteen of the 33 patients treated with corticosteroids and/or anabolic steroids (AS) showed hematological recovery. Bolus methylprednisolone (mPSL) therapy was effective in one of the 8 patients. Allogenic marrow transplant (BMT) was performed on 3 patients. One died from sepsis and engraftment was not achieved in the other two. Trilineage recovery was obtained in 3 of 6 patients treated with rhG-CSF and rhEPO with or without AS, and hemopoiesis has been maintained 6-12 months after discontinuation in 2 cases. In the other 3 patients, the neutrophil count showed transient increase. Therefore, the treatment for severe AA patients, who have no sibling donor for BMT, should be started with the combination therapy including these cytokines.

Acute simultaneous bilateral vestibulocochlear impairment in neuro-Behçet's disease: a case report

The central nervous system (CNS) is often a preferential target of Behçet's disease and diverse neurological manifestations have been described. Isolated hearing impairment or disequilibrium is also known to occur, but the simultaneous bilateral impairment of both vestibular and cochlear functions has been only rarely documented in Behçet's disease. A 52-year-old Japanese woman with neuro-Behçet's disease had meningoencephalitis, a profound thrombocytopenia, and bilateral vestibulocochlear impairment during the acute exacerbation. Although the CNS involvement was apparent, the clinical history and neuro-otological findings pointed to bilateral inner ear involvement rather than the brainstem or the 8th nerve lesions. She has made an excellent clinical response to pulse-dose methylprednisolone therapy with improvement in her neurological symptoms and in arresting the acute deterioration of hearing loss, but repeated audiograms failed to maintain the improvement with a modest dose of oral prednisolone. Since the bilateral vestibulocochleopathy can be as incapacitating as oculopathy in Behçet's disease, an early detection and prompt instillation of adequate corticosteroid therapy may be mandatory, although not curative.

[Imaged thoracoscopic surgery for bronchogenic cyst in posterior mediastinum--a case report]

A 44-year-old female with bronchogenic cyst in the posterior mediastinum was treated successfully by employing imaged thoracoscopic surgical methods in the same way as laparoscopic cholecystectomy. The patient was placed in the left lateral decubitus position. A first 3.5 cm skin incision was made in the seventh intercostal space on the mid-axillary line. A 10 mm, 0-degree Olympus wide angle telescope was inserted for observation into the thoracic cavity. And three more small skin incisions were done. A grasping forceps, a padron retractor and an electrode with J-hook tip were introduced through each incision. The cyst was completely dissected almost with the J-hook electrode. She was discharged on the 10th-postoperative day without complication and with minimal pain. We suggest that an indication of the imaged endoscopic surgery could be established for some benign mediastinal tumors.

[Treatment and prognosis after late relapse in childhood acute lymphoblastic leukemia]

We evaluated the clinical courses and laboratory features in 13 late-relapse cases of 55 children with acute lymphoblastic leukemia who had been in complete remission for longer than their years. In 8 of 13 cases, leukemia relapsed in bone marrow; 2 with testicular, 1 with central nervous system and one with ovarian involvement. Further, extramedullary relapse not involving bone marrow occurred in 5 cases (4 testicular and 1 CNS). Late-relapse was more frequently observed in boys (37.5%) than in girls (4.4%). Initial age and leukocyte counts were of no value in predicting late-relapse. The relapse rate in cases initially treated by the VPL regimen was twice that of those by a multi-drug regimen. A second prolonged remission was achieved in 5 of 10 cases by combinations of intensive chemotherapy (modified HEX) and irradiation to the testes or CNS. On the contrary, all late relapse patients initially treated by the multi-drug chemotherapy had a poor outcome. More intensive chemotherapy, including high-dose chemoradiotherapy and bone marrow transplantation, should be employed in this group of patients.

[High-dose busulfan, VP-16 and ACNU therapy with stem cell transplantation for the treatment of children with acute leukemia]

In order to strengthen the anti-leukemia effect, we developed a new conditioning regimen with high dose busulfan, VP-16 and ACNU (BVA) for cytoreduction before stem cell transplantation. Fourteen patients with refractory acute leukemia received allogeneic bone marrow transplantation (BMT) or peripheral blood stem cell transplantation (PBSCT) after conditioning with the BVA regimen, 7; allogeneic BMT, 1; syngeneic BMT, 6; PBSCT. # Seven patients were transplanted in the first complete remission, and 8 patients were in their second or third remission. Although total body irradiation or cyclophosphamide was not included in this regimen, engraftment was obtained in all cases. Two patients suffered relapse, and one patient died of cytomegalovirus interstitial pneumonitis (IP) 64 days after PBSCT. The other 11 patients are alive and free of disease at a median follow up time of 647 days (98-1235 days). Major regimen-related toxicity was pulmonary complications such as IP (3 cases) and pulmonary edema (2 cases). However, all patients recovered rapidly following steroid therapy. The results indicate that this conditioning regimen is highly effective for the treatment of childhood acute leukemia.

[Two resected cases of malignant fibrous histiocytoma originated from the thoracic soft tissues]

Two resected cases, a 56-year-old man and a 49-year-old man, of malignant fibrous histiocytoma originated from the soft tissues of chest wall were reported. In both cases, MFH was histologically diagnosed prior to our radical operation. One patient received an incisional biopsy and the other was a recurrent case after excisional resection in other hospital. We resected the whole chest wall together with the tumor sufficiently apart from the tumor margin. In one patient the defect of chest wall was reconstructed with the material made of bone cement which sandwiched between 2 sheets of marlex heavy mesh and covered by latissimus dorsi muscle flap on it. The other was reconstructed with single sheet of marlex heavy mesh and covered by rectus abdominis muscle flap. Recurrence was not seen in either of two patients, in spite of the general acknowledgment that MFH recurs frequently and locally. We considered that the extended wide resection including the whole chest wall should be performed, and that marlex heavy mesh and the pedunculated musculo-cutaneous flap was useful for the reconstruction of chest wall defect.

[A case report of solitary bone cyst of rib detected from pathological fracture]

A case of solitary bone cyst of rib was reported. The patient was 28-year-old man who was admitted to our hospital complaining of chest pain caused by pathological fracture of the left 10th rib. Chest x-ray film revealed a solitary cystic lesion of the 10th rib. The tumor was removed by extrapleural rib partial resection and the histological examination confirmed the diagnosis of solitary bone cyst.

Mammary gland growth and response to hormones in mastomys compared with mice

Mammary gland growth with or without hormone manipulation was examined in virgin mastomys (Praomys (mastomys) natalensis) and compared with C3H/He mice having a low mammary tumor incidence. Mammary glands of mastomys consisted mostly of duct systems even at 720 days of age, whereas conspicuous formation of normal end-buds and preneoplastic hyperplastic alveolar nodules were seen in the glands of mice after 180 days of age. Mammary glands of mastomys showed a higher response to estrogen or progesterone rather than prolactin, which is much different from other rodents.