The increase in the elderly population in need of healthcare services has led to a serious shortage in the nursing workforce. To retain a large nursing workforce, a strong work–life balance among nurses is needed along with a healthy work environment. This prospective study investigates the influence of work–life balance and sense of coherence on intention to leave among hospital nurses. A questionnaire survey was conducted with 2239 nurses as a baseline. The explanatory variables included striving for work–life balance behavior, a sense of coherence in terms of personal resources, and work-, organizational-, and individual-related factors. Using a cohort of 1368 valid responses, we measured intention to leave among 975 nurses with whom we were able to follow up 6 months after the baseline survey. We then performed multiple regression analysis. The behavior striving for work–life balance was shown to influence nurses’ intention to leave. Nurses who exhibited less striving for work–life balance behavior showed higher intentions to leave. The sense of coherence was not identified as a factor affecting intention to leave. Securing a comfortable work–life balance would reduce the nurses’ desire to quit the hospital. To reduce nurse turnover, nurse managers should develop support programs that can help nurses achieve a better work–life balance.

Many previous studies indicate that heart failure (HF) increases the risk of cognitive dysfunction and stroke, showing the logic that several physiological factors associated with cardiac dysfunctions affect homeostasis in the cerebral circulation. In the chronic process of HF patients, it is suggested that reduced cerebral blood flow (CBF) and abnormal auto-regulation might result in impaired perfusion, metabolic insufficiency, and regional or global structural deteriorations in the brain. However, the mechanism underlying HF-induced brain disease remains unclear. Cardiac dysfunction in patients with HF or HF-induced several physiological abnormalities may cause brain dysfunction. Possible physiological factors should be considered for future studies to prevent brain disease as well as cardiovascular dysfunction in patients with HF.

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Head‐up tilt (HUT)‐induced gravitational stress causes collapse of the internal jugular vein (IJV) by decreasing central blood volume and through mass‐effect from the surrounding tissues. Besides HUT, lower body negative pressure (LBNP) is used to stimulate orthostatic stress as an experimental model. Compared to HUT, LBNP has less of a gravitational effect because of the supine position; therefore, we hypothesized that LBNP causes less of a decrease in the cross‐sectional area of the IJV compared to HUT. We tested the hypothesis by measuring the cross‐sectional area of the IJV using B‐mode ultrasonography while inducing orthostatic stress at levels of −40 mmHg LBNP and 60° HUT. The cross‐sectional area of IJV decreased from the resting baseline during both LBNP and HUT trials, but the LBNP‐induced decrease in the cross‐sectional area of IJV was smaller than that of HUT (right, −45% ± 49% vs. −78% ± 27%, p = 0.008; left, −49% ± 27% vs. −78% ± 20%, p = 0.004). Since changes in venous outflow may affect cerebral arterial circulation, the findings of the present study suggest that orthostatic stress induced by different techniques modulates cerebral blood flow regulation through its effect on venous outflow.

METHODS: Shear-mediated dilation was measured using the TR and SS tests in 12 healthy men (25±3 years, mean±SD) on separate days. In each test, subjects breathed under three conditions: spontaneous breathing (SB), hypocapnic hyperventilation (HV), and isocapnic hyperventilation (IHV) with a tidal volume of 1.5 times SB. Shear-mediated dilation was induced by an increase in P ET CO 2 (10 mmHg above the baseline value) for 30 sec and 3 min in the TR and SS tests, respectively, and was calculated as percent rise in peak diameter relative to the baseline diameter. SR area under the curve (SR AUC ) was calculated as SR from P ET CO 2 elevation to the peak dilation. RESULTS: Baseline hypocapnia attenuated baseline SR, and SR AUC was lower during HV than during SB in both tests (both P<0.05). Shear-mediated dilation corrected by baseline diameter and SR AUC was not altered by an increase in ventilatory drive in the TR test (SB: 3.3%±2.1%, HV: 4.5%±2.3%, and IHV: 4.0%±1.9%; P>0.05 for all). In contrast, corrected shear-mediated dilation in the SS test was lower during HV (3.6%±1.8%) than during SB (5.3%±1.7%, P<0.05), but not during IHV (4.7%±1.7%, P>0.05). Shear-mediated dilation was positively correlated with SR AUC during SB in both TR and SS tests (r=0.80, P<0.01 and r=0.68, P=0.02, respectively), but not during IHV (r=0.36, P=0.55, respectively). During HV, there was a positive relationship between shear-mediated dilation and SR AUC in the TR test (r=0.69, P=0.02), but not in the SS test (r=−0.41, P=0.21). CONCLUSIONS: Baseline hypocapnia, but not increased ventilation, blunts shear-mediated dilation of the ICA in the SS test, but not in the TR test. Supported by JSPS KAKENHI Grants (21J22042 and 20K11186).