Japanese Nursing Staff's Knowledge and Attitude toward Bereavement Care for Couples with Miscarriage/Stillbirth and Its Associated Factors

Bereavement care is conducted to meet the emotional needs of grieving couples who are devastated by the experience of a miscarriage or stillbirth. From January to April 2022, we distributed a questionnaire that assessed the knowledge and attitudes of Japanese nursing staff (nurses and midwives) in Japan's Chugoku-Shikoku region toward bereavement care for couples with miscarriage/stillbirth. The 370 survey respondents' answers revealed that the nursing staff's knowledge regarding recurrent pregnancy loss and subsequent bereavement care was insufficient. About 41.1% and 64.1% of the respondents had received school and on-the-job education in bereavement care, respectively, and 79.2% expressed willingness to provide such care. Our analyses revealed that the following factors were associated with the nursing staff's knowledge level: parent status, age, reproductive history, midwifery license, work experience and environment, and on-the-job education. The following were correlated with the staff's willingness to provide bereavement care: work environment, midwifery license, bereavement care knowledge, and on-the-job education. Together our findings indicate that education plays a significant role in equipping caregivers to provide effective bereavement care for couples who have experienced a miscarriage or stillbirth.

Rapid thawing of frozen bull spermatozoa by transient exposure to 70 °C improves the viability, motility and mitochondrial health

Up to now, the definitive conclusion of the positive effects of rapid transient thawing at higher temperatures for shorter durations has not been obtained yet and is still under discussion due to some contradictory findings and limited assessment of post-thawed parameters. The purpose of the current study was to evaluate the effectiveness of rapid thawing in water at 70 °C by using various post-thawed parameters of frozen bull spermatozoa. Experiment 1, monitoring the change of temperature inside frozen bull straw thawed in water at different temperatures. Experiment 2, evaluation of various post-thawed characteristics of frozen bull spermatozoa thawed in water at different temperatures by using a computer-assisted sperm analysis, flow cytometry and immunocytochemistry. The time it took for the temperature inside the straw to warm up to 15 °C was nearly twice as faster when the straw was thawed in 70 °C water compared with 39 °C. Although there were differences among bulls, viability, motility, and mitochondrial membrane potential of spermatozoa thawed at 70 °C for 8 seconds and stabilized at 39 °C for 52 seconds were significantly higher than those of controls (thawed at 39 °C for 60 seconds) at 0 and 3 h after thawing. Just after thawing, however, there were no differences in acrosome integrity and distribution of phospholipase C zeta1, whereas mitochondrial reactive oxygen species production was significantly lower in spermatozoa thawed at 70 °C. From these results, we conclude that rapid thawing at 70 °C and then stabilization at 39 °C significantly improves viability, motility and mitochondrial health of bull spermatozoa rather than conventional thawing at 39 °C. The beneficial effect of rapid transient thawing could be due to shorter exposure to temperatures outside the physiological range, consequently maintaining mitochondrial health.

Collaborative support for child abuse prevention: Perspectives of public health nurses and midwives regarding pregnant and postpartum women of concern

Child abuse is a globally prevalent problem, and its numbers have continuously increased in Japan over the past 30 years. Prevention of child abuse depends on the support available to pregnant and postpartum women from the time of pregnancy. Public health nurses and midwives are expected to provide preventive support in cooperation, as they can support pregnant and postpartum women from close proximity and recognize their health problems and potential signs of child abuse. This study aimed to deduce the characteristics of pregnant and postpartum women of concern, as observed by public health nurses and midwives, from the perspective of child abuse prevention. The participants comprised ten public health nurses and ten midwives with five or more years of experience working at the Okayama Prefecture municipal health centers and obstetric medical institutions. Data were collected through a semi-structured interview survey and analyzed qualitatively and descriptively using an inductive approach. The characteristics of pregnant and postpartum women, as confirmed by public health nurses, included four main categories: having "difficulties in daily life;" "a sense of discomfort of not feeling like a normal pregnant woman;" "difficulty in child-rearing behavior;" and "multiple risk factors checked by objective indicators using an assessment tool." The characteristics observed by midwives were grouped into four main categories: "mental and physical safety of the mother is in jeopardy;" have "difficulty in child-rearing behavior;" "difficulties in maintaining relationships with the surrounding people;" and "multiple risk factors recognized by an assessment tool." Public health nurses evaluated pregnant and postpartum women's daily life factors, while midwives evaluated the mothers' health conditions, their feelings toward the fetus, and stable child-rearing skills. To prevent child abuse, they utilized their respective specialties to observe those pregnant and postpartum women of concern with multiple risk factors.

Relation Between Identity Disclosure to Family Members and Mental Health in Japanese Transgender People

Family members are critical mediators of the experiences of transgender people. We studied whether transgen-der subjects had disclosed their identity to their families and their families' reactions after the disclosure. We also evaluated the subjects' mental state and its association with disclosure status. Transgender people were recruited for this anonymous questionnaire survey in the Okayama University Hospital gender clinic. Subjects disclosed their identity to family members at the following rates: 68.7% to the father, 89.1% to the mother, 59.1% to a brother, 77.8% to a sister, and 47.6% to grandparents. Fathers had the lowest rate (26.7%) of posi-tive reactions, while over 50% of fathers showed an ambiguous response. Approximately 20% of parents showed a negative response. The majority of parents agreed to hormonal treatment and sex-reassignment sur-gery and that the transgender child should live with the gender they wanted to express. However, the rate of subjects with mood and anxiety disorders according to the Kessler 6 scale was significantly higher in those who experienced negative or ambiguous reactions from family members compared to those who experienced posi-tive reactions. Educational and mental health professionals should support the disclosure process of transgen-der people as well as their family members.

Trehalose in glycerol-free freezing extender enhances post-thaw survival of boar spermatozoa

Cryopreservation of boar semen is still considered suboptimal due to lower fertility as compared with fresh samples when glycerol, a permeating cryoprotectant, is used. Trehalose is a non-permeable cryoprotectant and nonreducing disaccharide known to stabilize proteins and biologic membranes. The aim of this study was to evaluate the cryosurvival and in vitro penetrability of boar spermatozoa when glycerol was replaced with trehalose in a freezing extender. Ejaculated Berkshire semen samples were diluted in egg yolk-based freezing extender containing glycerol (100 mM) or trehalose (0, 50, 100, 150, 200 and 250 mM) and cryopreserved using a straw freezing procedure. Thawed samples were analyzed for motility, viability, mitochondrial membrane potential (MMP), and acrosome integrity. In experiment 2, penetrability of spermatozoa cryopreserved with 100 mM glycerol or trehalose was examined. Replacement of cryoprotectant glycerol (100 mM) with trehalose had no effect on sperm viability, but replacing it with 100 mM trehalose improved motility, MMP and acrosome integrity significantly. Sperm motility and MMP were considerably higher in 100 mM trehalose, whereas the acrosome integrity was substantially higher in 100–250 mM trehalose. The in vitro penetration rate was also significantly higher in spermatozoa cryopreserved with trehalose (61.3%) than in those cryopreserved with glycerol (43.6%). In conclusion, 100 mM non-permeable trehalose can be used to replace glycerol, a permeating cryoprotectant, for maintenance of better post-thaw quality of boar spermatozoa.

63 STEPWISE THAWING PRESERVES MITOCHONDRIA MEMBRANE POTENTIAL OF BOAR SPERMATOZOA EXTENDED IN GLYCEROL-FREE MEDIUM CONTAINING TREHALOSE

Motility and penetrability of spermatozoa are significantly affected by the energy produced in mitochondria. The survival of cryopreserved spermatozoa is influenced by the warming rate as well. The objective in the present study was to evaluate the effect of stepwise thawing on post-thaw motility and mitochondria activity of boar spermatozoa. The sperm samples collected from a Berkshire boar with high fertility at an AI centre were diluted in egg yolk-based and glycerol-free freezing extender containing 100 mM trehalose and 0.25% Equex STM™. The samples were cryopreserved using the straw freezing procedure. Best thawing durations in high temperatures were examined in a previous study. Straws were immersed in 80, 70, and 60°C water for 6, 8, and 10 s and continued to thaw in 39°C for 54, 52, and 50 s, respectively. Sperms thawed at 39°C for 60 s were considered as the control. Frozen-thawed spermatozoa were analysed for motility with computer-assisted semen analysis and mitochondrial membrane potential (MMP) with JC-1/PI staining (Table 1). Data were analysed with ANOVA and Pearson correlation. Motility and MMP of frozen-thawed sperm were significantly lower than fresh samples. Motility was fairly high compared with frozen-thawed controls, when thawed rapidly in 2-steps, though the difference was not significant. The MMP was also significantly higher when thawed in 2-steps from 80 or 70°C, then to 39°C, as compared with frozen-thawed controls, and it was positively correlated with the thawing temperature (r = 0.64; P < 0.01). There was a positive trend between thawing temperature and motility, but it was not significant (r = 0.37; P = 0.11). In conclusion, our results suggest that stepwise thawing with a rapid thawing at the beginning preserves post-thaw motility and MMP of boar spermatozoa. Table 1.Effect of thawing temperature on post-thaw motility and mitochondrial membrane potential (MMP)1

54 EFFECT OF THAWING TEMPERATURE ON POST-THAW SURVIVAL OF BOAR SPERM

The survival of cryopreserved sperm is strongly influenced by the warming rate. Aims of the study were to examine the time taken by the extender inside the straw to reach 39°C and to evaluate the effect of thawing temperature on post-thaw survival of boar sperm. The sperm samples were diluted in egg yolk-based freezing extender containing trehalose (100 mM) and 0.25% Equex STM™. The samples were cryopreserved using the straw-freezing procedure (Buranaamnuay et al. 2009 Reprod. Domest. Anim. 44, 69–73). To examine the change of extender temperature inside the straw, sealed 0.5-mL straws with the extender were immersed in water (40, 60, or 80°C) after freezing and the temperature inside the straw was measured using a 2-channel digital record thermometer (TNA-140, Tasco Japan Co. Ltd., Osaka, Japan). After frozen sperms were thawed at different temperatures for the time taken by the extender inside the straw to reach 39°C, the sperms were analysed for motility, viability, and acrosome integrity. Statistical analysis from 5 replicated trials was performed by ANOVA. Average time taken to reach 39°C in 40, 60, and 80°C water was 36, 13, and 9 s, respectively (n = 8). There were 2 phases of the rates of change of temperature (RCT) inside the straw: rapid at the beginning of the course of thawing (–196 to approximately 0°C) and relatively slower at the liquid phase. The RCT was very rapid during the first 2 s, with a mean rate of 73.3, 81.3, and 86.9°C s–1 in 40, 60, and 80°C water, respectively. The RCT was not significantly different among the 3 groups between 2 and 6 s after the start of warming, whereas the RCT was significantly higher in 80°C water compared with 60 and 40°C from the next second (P < 0.01). Starting from 12th second, RCT was significantly higher in 60°C water compared with 40°C water (P < 0.01). When frozen sperms were thawed at 40, 60, or 80°C for 36, 13, or 9 s, respectively, however, there were no significant differences in post- thaw parameters (motility and viability) of sperms thawed in different temperatures. The motility of sperms thawed at 40, 60, and 80°C water was 41.2, 42.5, and 30.0%, whereas the viability was 42.3, 47.6, and 42.6%, respectively. The percentage of sperms with intact acrosomes was 54.8, 64.2, and 68.0%, respectively. There was a trend of increased acrosome integrity when the sperms were thawed at higher temperature (P = 0.06). In conclusion, this preliminary result suggests that rapid thawing may affect acrosome integrity rather than the motility and viability of cryopreserved sperm. However, additional observations are necessary to reach further conclusions.

57 TREHALOSE SUPPLEMENTED EXTENDER PRESERVE ACROSOMAL INTEGRITY IN POST-THAW BOAR SPERM

Cryopreservation of boar semen is still considered suboptimal due to lower fertility when compared to fresh semen. The use of glycerol for boar semen cryopreservation may be a reason of low fertility results. Trehalose is a nonreducing disaccharide known to stabilize proteins and biologic membranes during processes such as cryopreservation. The aim of this study was to evaluate the effects of trehalose on boar sperm cryosurvival in an egg-yolk-based extender. The semen samples collected from different individual Berkshires were diluted in egg-yolk-based freezing extender containing glycerol (final concentration 68.5 and 274 mM) or trehalose (50 and 100 mM). Then the samples were cryopreserved using the straw freezing procedure. Frozen sperms were thawed at 39°C in water. Post-thawed sperm were analyzed for motility (under microscope by a conventional method), viability, and acrosome integrity (under fluorescence microscope following LIVE/DEAD or CTC staining, respectively). Statistical analyses of results from 5 replicated trials were performed by ANOVA with a Bonferroni/Dunn post hoc test (significance; P < 0.05). The extender supplemented with 100 mM trehalose exhibited significantly higher acrosomal integrity (41.6%) compared with other extenders (P < 0.05, n = 5; Table 1). The trend of motility and viability was higher in 274 mM glycerol (28.0 and 52.9%) and 100 mM trehalose extenders (23.6 and 53.9%), but those were not significant. These results demonstrate that the presence of trehalose at 100 mM during cryopreservation improves the acrosome integrity of boar sperm, without any reduction in viability and motility, after thawing. Table 1.Effect of glycerol and trehalose on post-thaw boar sperm