Background Satisfaction with medical decisions among patients with cancer is associated not only with the results of decisions they make but also with how they make those decisions. To elucidate the decision-making process among Japanese women with breast cancer, we explored the correlates of regret with patients’ treatment decision-making. Methods An Internet-based cross-sectional survey was utilized. Japanese women ( N = 467) who self-reported that they had been diagnosed with stage 0­II breast cancer participated. Data regarding their decisional role (active, collaborative, or passive) in treatment decision-making, their most regrettable experience regarding their decision-making, the importance of various factors related to decision-making at the time, and clinical and sociodemographic factors were obtained. A forced-entry logistic regression analysis was performed on the likelihood that patients would have some regrets regarding the decision-making process. Results About half the women expressed some regret (51.4%). Women who had a mastectomy were significantly more likely to have regret than women who had breast conserving surgery. Correlates of regret differed by surgical type. For women who had a mastectomy, those who were aged ≥50 years when diagnosed, or who made their decisions collaboratively with their doctors were significantly less likely to have regret with the decision-making. For women who had breast conserving surgery, those who worked on a contract or part-time basis or whose decision-making roles matched their preferred role were significantly less likely to have regret. Among women who reported some regret, 23.8% expressed that their most regrettable experience concerned gathering information, while 21.3% regretted not consulting with others. For women who were diagnosed at a younger age, the influence on their sex life and pregnancy and childbirth was more important when making their treatment decisions than for women diagnosed an older age. Conclusions Approximately half of the Japanese women with breast cancer in this study reported some regret in the treatment decision-making process. Effective participation in decision-making differed by surgical types. Additionally, women who are diagnosed with breast cancer at a relatively younger age, as compared to those who are older, may need additional information and support regarding their sex life and fertility after cancer treatment. Electronic supplementary material The online version of this article (10.1186/s12905-019-0783-5) contains supplementary material, which is available to authorized users.

ObjectivesAir pollution is a growing concern in Korea because of transboundary air pollution from mainland China. A panel study was conducted to clarify the effects of air pollution on respiratory symptoms and health-related quality of life (HR-QoL) in outpatients with and without chronic obstructive pulmonary disease (COPD) in Korea.MethodsPatients filled out a questionnaire including self-reported HR-QoL in February and were followed up in May and July. The study was conducted from 2013 to 2015, with different participants each year. Air quality parameters were applied in a generalized estimating equation as independent variables to predict factors affecting HR-QoL.ResultsLower physical fitness scores were associated with Asian sand dust events. Daily activity scores were worse when there were high concentrations of particulate matter (PM) less than 10 μm in diameter (PM10). Lower social functioning scores were associated with high PM less than 2.5 μm in diameter and nitrogen dioxide (NO2) concentrations. High NO2 concentrations also showed a significant association with mental health scores. Weather-related cough was prevalent when PM10, NO2, or ozone (O3) concentrations were high, regardless of COPD severity. High PM10 concentrations were associated with worsened wheezing, particularly in COPD patients.ConclusionsThe results suggest that PM, NO2, and O3 cause respiratory symptoms leading to HR-QoL deterioration. While some adverse effects of air pollution appeared to occur regardless of COPD, others occurred more often and more intensely in COPD patients. The public sector, therefore, needs to consider tailoring air pollution countermeasures to people with different conditions to minimize adverse health effects.

BackgroundWe previously found that the empowerment of patients with type 2 diabetes mellitus can be strongly affected by gender and age in addition to self-managed diet and exercise behaviors and treatment. This study was to examine the effects of gender, age, family support, and treatment on the perceived stress and coping of patients with type 2 diabetes mellitus living with family.MethodsA survey was conducted of 140 adults with type 2 diabetes mellitus who were living with family. There was no significant difference in hemoglobin A1c (HbA1c) between male and female. Perceived stress and coping were measured with the Japanese version of the Appraisal of Diabetes Scale and the Lazarus Type Stress Coping Inventory. Stepwise regression analysis and path analysis were performed to identify factors that affect the perceived stress and coping of patients.Results(1) Perceived stress and coping were strongly affected by gender. (2) Perceived stress and coping were affected by age for males, but perceived stress was not affected by age for females. However, females showed a greater “psychological impact of diabetes” than did males. Females aged between 50 and 69 years engaged in active problem solving, but awareness of diabetes was low. (3) Treatment regimens had an effect on HbA1c for both sexes, and diet therapy affected the awareness of diabetes of males and coping of females. (4) For females, “sense of self-control” was strongly associated with coping, and those who were living with non-spouse family members had a greater psychological impact of diabetes than those living with only their spouse. (5) For males, coping was strongly affected by living with their spouse.ConclusionsThe results suggest that perceived stress, coping, and diet regimen are deeply associated with gender and age and that a male with type 2 diabetes mellitus living with his spouse is strongly dependent on support from the spouse. It is important to take into account gender, age, and family environment to provide patients with an individualized approach to addressing perceived stress and to provide education program for coping that can maximize treatment and maintain better, continuous glycemic control.

BackgroundPatient empowerment has recently been proposed as an important concept in self-management for effective glycemic control. A concise self-completed questionnaire for patients with type 2 diabetes mellitus was created to comprehensively evaluate their empowerment on the basis of self-managed dietary/exercise behaviors, psychological impact, and family support. The reliability and validity of this short questionnaire were tested and factors relating to patient empowerment were analyzed.MethodsThe self-completed empowerment questionnaire was based on questionnaires for self-managed dietary and exercise behaviors, the Appraisal of Diabetes Scale, and the Diabetes Family Behavior Checklist. The questionnaire was trialed on 338 male and female patients with type 2 diabetes mellitus who lived with family. The validity and reliability of the questionnaire were investigated and stepwise multiple linear regression analysis was used to identify factors that affect patient empowerment.ResultsThe self-completed patient empowerment questionnaire included 13 questions on background data (e.g., age, gender, and HbA1c) and 18 questions within five scales to assess self-managed dietary behaviors, self-managed exercise behaviors, and psychological impact of diabetes, as well as positive and negative feedback in patient-family communication. The questionnaire showed sufficient internal consistency, construct validity, reproducibility, factorial construct validity, and concurrent validity. The results were generally satisfactory, and the questionnaire reflected the particular characteristics of treatment methods. Multiple linear regression analysis showed that patient empowerment was strongly affected by the number of disease-related symptoms, age, and gender.ConclusionsThe results suggest that the concise self-completed empowerment questionnaire developed here is useful for measuring the empowerment of individual patients and evaluating the impact of symptoms and therapies on empowerment.

BackgroundUlaanbaatar, Mongolia, is known as severely air-polluted city in the world due to increased coal consumption in the cold season. The health effects of air pollution in Mongolia such as mortality, morbidity and symptoms have been previously reported. However, the concept of health-related quality of life (HR-QoL), which refers to the individual’s perception of well-being, should also be included as an adverse health outcome of air pollution.MethodsSurveys on the Mongolian people living in Ulaanbaatar were performed in the warm and cold seasons. Self-completed questionnaires on the subjects’ HR-QoL, data from health checkups and pulmonary function tests by respiratory specialists were collected for Mongolian adults aged 40–79 years (n = 666). Ambient PM2.5 and PM10 were concurrently sampled and the components were analyzed to estimate the source of air pollution.ResultsIn logistic regression analyses, respiratory symptoms and smoke-rich fuels were associated with reduced HR-QoL (> 50th percentile vs. ≤ 50th percentile). PM 2.5 levels were much higher in the cold season (median 86.4 μg/m3 (IQR: 58.7–121.0)) than in the warm season (12.2 μg/m3 (8.9–21.2). The receptor model revealed that the high PM2.5 concentration in the cold season could be attributed to solid fuel combustion. The difference in HR-QoL between subjects with and without ventilatory impairment was assessed after the stratification of the subjects by season and household fuel type. There were no significant differences in HR-QoL between subjects with and without ventilatory impairment regardless of household fuel type in the warm season. In contrast, subjects with ventilatory impairment who used smoke-rich fuel in the cold season had a significantly lower HR-QoL.ConclusionsOur study showed that air pollution in Ulaanbaatar worsened in the cold season and was estimated to be contributed by solid fuel combustion. Various aspects of HR-QoL in subjects with ventilatory impairment using smoke-rich fuels deteriorated only in the cold season while those with normal lung function did not. These results suggest that countermeasures or interventions by the policymakers to reduce coal usage would improve HR-QoL of the residents of Ulaanbaatar, especially for those with ventilatory impairment in the winter months.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-017-4507-1) contains supplementary material, which is available to authorized users.

Large amount of oil cake is generated during biodiesel production from Jatropha seeds. Although Jatropha oil cake is rich in plant nutrients, presence of toxic phorbol esters restricts the usage of oil cake as a fertilizer. The objective of this study is to evaluate the components and tumor promoting activity of phorbol esters in Jatropha oil cake-supplemented soil and plants grown in the treated soil. Contents and their biological activity of Jatropha phorbol esters in soil and plants were sequentially analyzed by high-performance liquid chromatography (HPLC) and in vitro cell transformation assay, respectively. Disappearance of Jatropha phorbol-ester-specific peaks were followed with HPLC during incubation of Jatropha oil cake with soil for five weeks. Along with the degradation of Jatropha phorbol ester in soil, tumor-promoting activity in the sample was also attenuated and ultimately disappeared. Jatropha phorbol esters and tumor promoting activity were not detected from mustard spinach grown in the Jatropha oil cake-supplemented soil. In addition, the esterase KM109 degrades DHPB (see definition below; Jatropha phorbol ester) and reduced its tumor-promoting activity. From these data, we conclude: (1) components and tumor promoting activity of Jatropha phorbol esters in the oil cake disappeared completely by incubation with soil for five-week, (2) Jatropha phorbol esters did not transfer into plants grown in the Jatropha oil cake-supplemented soil, and (3) DHPB can be degraded by esterase from soil bacterium. These observations are useful for utilization of Jatropha oil cake as a fertilizer.

BackgroundUlaanbaatar, Mongolia, is one of the world’s worst air-polluted cities, but effects of this air pollution on the population health status have not yet been evaluated. Therefore, we developed a Mongolian version of the SF-36v2 questionnaire to investigate the health status of Mongolian population.MethodsHealth checkups were conducted in Ulaanbaatar and the health status was measured using a Mongolian translated version of the SF-36v2 questionnaire. The reliability and validity of the Mongolian SF-36v2 questionnaire, and the relationship between health status and respiratory condition were examined.ResultsFactor analysis of the Mongolian SF-36v2 questionnaire showed that the “Role-physical” and “Role-emotional” were classified into a single subscale. The “Mental health” and “Vitality” were each divided into two subscales. Cronbach’s alpha and intraclass correlation coefficient (ICC) for reproducibility were >0.7, except for “General health perceptions” (Cronbach’s alpha and ICC < 0.7), “Social functioning” (Cronbach’s alpha < 0.7), and “Vitality” (ICC < 0.7). The SF-36v2 subscales and the corresponding items of the COOP/WONCA charts were correlated, and subjects with respiratory symptoms showed lower SF-36v2 scores compared to normal subjects, suggesting external validity. Subjects with respiratory symptoms showed significantly lower scores for the majority of the SF-36v2 subscales than those with normal lung function. In subjects with combined ventilatory impairment, “Physical functioning”, “Role-physical”, “Bodily pain”, and “Vitality” scores were significantly lower than those with normal lung function.ConclusionsThe Mongolian version of the SF-36v2 questionnaire provides substantial reliability and validity, and is useful for evaluating the health status of Mongolian adults with ventilatory impairment. Health status measured by SF-36v2 was significantly aggravated by combined ventilatory impairment when compared with normal lung function.Electronic supplementary materialThe online version of this article (doi:10.1186/s40064-016-2204-7) contains supplementary material, which is available to authorized users.

BackgroundThis study was performed to investigate the effects of air pollution and seasonality on the respiratory symptoms and health-related quality of life (HR-QoL) of outpatients with respiratory diseases in Ulaanbaatar, Mongolia. Subjects were outpatients who visited the hospital with chronic obstructive pulmonary diseases (COPD) or bronchial asthma (BA) in March. Their symptoms and HR-QoL were evaluated using a questionnaire including the SF-36v2 and COOP/WONCA charts in March, May and July. PM2.5 was sampled in March and July in Ulaanbaatar, and its composition was analyzed.ResultsPatients with COPD or BA showed higher prevalence of respiratory symptoms than the control subjects in each month. For HR-QoL, all subscales worsened in the patients than in the control group in March. Although the HR-QoL of the COPD and control groups were not significantly changed through the surveys, some subscales of the BA group showed remarkable improvement in July as compared to March. Daily means of PM2.5 in March were significantly higher than those in July. Carbon and ionic component concentrations, except for magnesium and calcium ions, were significantly higher in March than July. Mass concentrations of some metallic components were also significantly higher in March than July. The percentage of nitrate ion in PM2.5 was significantly higher in March when compared to that in July.ConclusionsThese results suggested that the symptoms in the COPD and BA groups were caused by the disease, and the association with air pollution or seasonality remained unclear. However, the effects of air pollution and seasonality on the HR-QoL were significant in the patients with BA.Electronic supplementary materialThe online version of this article (doi:10.1186/s40064-016-3481-x) contains supplementary material, which is available to authorized users.