The purpose of this study was to determine the physiological effects of a programmed accommodating circuit exercise (PACE) program consisting of aerobic exercise and hydraulic-resistance exercise (HRE) on fitness in older adults. Thirty-five volunteers were randomly divided into two groups [PACE group (PG) 8 men and 10 women, 68.3 (4.9) years, and non-exercise control group (CG) 7 men and 10 women, 68.0 (3.4) years). The PG participated in a 12-week, 3 days per week supervised program consisting of 10 min warm-up and 30 min of PACE (moderate intensity HRE and aerobic movements at 70% of peak heart rate) followed by 10 min cool-down exercise. PACE increased ( P<0.05) oxygen uptake ( V(.)O(2)) at lactate threshold [PG, pre 0.79 (0.20) l min(-1), post 1.02 (0.22) l min(-1), 29%; CG, pre 0.87 (0.14) l min(-1), post 0.85 (0.15) l min(-1), -2%] and at peak V(.)O(2) [PG, pre 1.36 (0.24) l min(-1), post 1.56 (0.28) l min(-1), 15%; CG, pre 1.32 (0.29) l min(-1), post 1.37 (0.37) l min(-1), 4%] in PG measured using an incremental cycle ergometer. Muscular strength evaluated by a HRE machine increased at low to high resistance dial settings for knee extension (9-52%), knee flexion (14-76%), back extension (18-92%) and flexion (50-70%), chest pull (6-28%) and press (3-17%), shoulder press (18-31%) and pull (26-85%), and leg press (21%). Body fat (sum of three skinfolds) decreased (16%), and high-density lipoprotein cholesterol (HDLC) increased (10.9 mg dl(-1)) for PG. There were no changes in any variables for CG. These results indicate that PACE training incorporating aerobic exercise and HRE elicits significant improvements in cardiorespiratory fitness, muscular strength, body composition, and HDLC for older adults. Therefore, PACE training is an effective well-rounded exercise program that can be utilized as a means to improve health-related components of fitness in older adults.

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The purpose of this study was to obtain baseline data of Japanese nurses' knowledge, skills and attitudes concerning physical assessment. The design of the study was survey research, using a self-administered questionnaire. Nurses with more experience were more knowledgeable about almost all physical assessment skills. Fourteen of the physical assessment skills were used more often by respondents with more experience in nursing practise. Ten of the physical assessment skills were cited as more difficult to carry out by respondents with less experience in nursing. The group with more clinical practise experience had more knowledge of physical assessment skills, used the skills more frequently and had less difficulty in using them. The results of this study indicated that Japanese nurses learn physical assessment skills 'on the job'.

This study aimed to develop a reliable and valid measure of functional health literacy in a Japanese clinical setting. Test development consisted of three phases: generation of an item pool, consultation with experts to assess content validity, and comparison with external criteria (the Japanese Health Knowledge Test) to assess criterion validity. A trial version of the test was administered to 535 Japanese outpatients. Internal consistency reliability, calculated by Cronbach's alpha, was 0.81, and concurrent validity was moderate. Receiver Operating Characteristics and Item Response Theory were used to classify patients as having adequate, marginal, or inadequate functional health literacy. Both inadequate and marginal functional health literacy were associated with older age, lower income, lower educational attainment, and poor health knowledge. The time required to complete the test was 10-15 min. This test should enable health workers to better identify patients with inadequate health literacy.

In Japan, more people require care activities at home. In particular, patients with an invasive mechanical ventilator in the home require extensive care by family caregivers. Collaboration between their nurses and paid caregivers in the provision of care activities, especially tracheal suctioning, is necessary. This three-round Delphi study identifies the essential items required by nurses to instruct the paid caregivers in how to carry out tracheal suctioning on patients with an invasive mechanical ventilator in the home. By the final round, three competencies were found to be important by the home-visit nurses and paid caregivers: the anticipation of risk, the manner of handling an emergency situation, and the observation of a patient's breathing. The Delphi technique was used to obtain consensus between the home-visit nurses and the paid caregivers regarding the essential knowledge, skills, and attitudes required to carry out tracheal suctioning for patients with an invasive mechanical ventilator in the home.