Return to daily life Early mobilization program Comprehensive CR (disease management program) Discharge from hospital, Return to home Maintain comfortable life, Prevention of recurrence Returning to society-workforce, Establish new healthy lifestyle Inpatient rehabilitation program (CCU/ICU/ward) *Notation of corporation is omitted.

Volatile anaesthetics inhibit endothelium-dependent relaxation, but the underlying mechanism(s) have not been clarified. In an attempt to elucidate the mechanism(s), we determined the effects of halothane, isoflurane and sevoflurane on relaxation induced by acetylcholine and sodium nitroprusside (SNP) and the cGMP formation elicited by exogenous nitric oxide (NO) and SNP in rat aortas. Acetylcholine (10(-7)-10(-5) M)-induced relaxation was attenuated by halothane (2%), isoflurane (2%) and sevoflurane (4%). SNP (10(-8) M)-induced relaxation was reduced by halothane (2%), but not by isoflurane (2%) or sevoflurane (4%). The cGMP level of NO-stimulated aorta was reduced by halothane (2%) and sevoflurane (4%), but not by isoflurane (2%). The cGMP level of SNP (10(-7) M)-stimulated aorta was reduced by halothane (2%), but not by isoflurane (2%) and sevoflurane (4%). We conclude that the mechanisms responsible for the inhibition of endothelium-dependent relaxation differ among anaesthetics. Isoflurane inhibits the relaxation mainly by inhibiting the formation of NO in the endothelium. In contrast, the effect of halothane on endothelium-dependent relaxation may be largely due to the inhibition of action of NO in the vascular smooth muscle and the effect of sevoflurane may be to inactivate NO or to inhibit the action of NO.

OBJECTIVE -The aim of this study was to assess the reliability and validity of an evaluation scale for self-management behavior related to physical activity of type 2 diabetic patients (ES-SMBPA-2D).RESEARCH DESIGN AND METHODS -Outpatients with type 2 diabetes (n ϭ 146) completed a self-administered questionnaire supported by a semistructured interview based on a literature review. The content, factor, and concurrent validity and internal consistency and reproducibility of the scale were analyzed. Pearson's correlation coefficients for the ES-SMBPA-2D and International Physical Activity Questionnaire (IPAQ) subscale scores were calculated to evaluate the concurrent validity.RESULTS -The ES-SMBPA-2D was divided into two parts, the first dealing with selfmanagement behavior to enhance physical activity in daily life and the second with behavior to maintain the level of physical activity. Factor analysis showed that the first part comprised four factors and the second five. The ES-SMBPA-2D correlated with the IPAQ subscales. Cronbach's ␣ coefficient was between 0.56 and 0.90, and the intraclass test-retest correlation coefficient of the subscales was between 0.60 and 0.88.CONCLUSIONS -The ES-SMBPA-2D is reasonably reliable and valid and is expected to prove useful for the assessment of patients' self-management behavior and for individualized instruction. Diabetes Care 30:2843-2848, 2007R egular physical activity is recommended for type 2 diabetic patients, as it is commonly known to improve metabolic disorders and prevent complications such as cardiovascular disease (1). Even moderately intense physical activity through daily activities is beneficial for management of this condition (2,3). However, many patients fail to achieve the recommended level of physical activity (4) because of barriers such as the commonly given reason of "perceived difficulty in exercising" (5). The aim of self-management education is to enable patients to acquire knowledge and skills to improve their diabetic state, identify barriers that hinder improvement, and attain problem-solving and coping skills to achieve effective self-care behavior (6). Thus, medical personnel need to provide patients with strategies to enhance and maintain the required level of physical activity.Self-management education also involves individualized instruction, based on assessment of patients' psychosocial factors and self-management skills and behaviors (7) and strategies to enhance and maintain the required level of physical activity. Most scales designed for this purpose evaluate environmental and psychosocial factors (8 -11), the frequency of diabetes self-care behaviors (12), and perceived adherence to patients' self-care recommendations (13). No tools exist, however, to evaluate self-management behavior related to patients' physical activity. Therefore, the aim of this study was to develop an evaluation scale for selfmanagement behavior related to physical activity of type 2 diabetic patients (ES-SMBPA-2D). RESEARCH DESIGN AND METHODS -The EthicsCommitt...

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