Megumi Haruna

The University of Tokyo, Tōkyō, Japan

Are you Megumi Haruna?

Claim your profile

Publications (38)55.04 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: The association between depression and omega-3 polyunsaturated fatty acids, including eicosapentaenoic and docosahexaenoic acid, continues to gain focus. In this study, we examined whether dietary intakes and plasma concentrations of eicosapentaenoic and docosahexaenoic acid were associated with depressive symptoms during pregnancy. Healthy Japanese women with singleton pregnancies were recruited at a university hospital in Tokyo between 2010 and 2012. The depressive-symptom group included participants with Edinburgh Postnatal Depression Scale scores greater than eight. Of the 329 participants, 19 (5.8%) had depressive symptoms. Lower plasma docosahexaenoic acid concentration was significantly associated with prenatal depressive symptoms. Women with depressive symptoms had a higher rate of pregnancy-associated nausea than those with non-depressive symptoms (52.6% vs 28.7%, respectively). Although we adjusted for the presence of pregnancy-associated nausea, dietary fatty acid intake was not associated with depressive symptoms in the multiple logistic regression analyses. Further large studies would be required to examine any preventive effect of dietary fatty acid intake on depressive symptoms among pregnant women.
    Nursing and Health Sciences 01/2015; · 0.85 Impact Factor
  • Cochrane database of systematic reviews (Online) 10/2014; · 5.70 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Diaper dermatitis, a common skin problem in newborn infants, is characterized by poor functioning of the skin barrier. This study aimed to elucidate the relationship between skin barrier function in 4-day-old infants and the occurrence of diaper dermatitis during the first month of life. We recruited healthy Japanese infants born at 35 weeks of gestation or more. We measured indicators of skin barrier function, namely skin pH and transepidermal water loss, in 4-day-old infants on four places on the body. Individual characteristics were recorded from the infants' medical charts. The presence of diaper dermatitis was judged using the diaper rash and erythema scoring scale, which was based on daily recording of the infants' skin condition by their parents. The parents also filled out a questionnaire 1 month after birth regarding stool frequency and certain external factors. The association between diaper dermatitis and skin barrier function was assessed using multiple logistic regression analysis. The analysis included 88 infants. The incidence of diaper dermatitis was 25.0%. After adjusting for stool frequency for 1 month we noted that high pH on the inner arm skin in 4-day-old infants increased the risk of diaper dermatitis during the first month of life (adjusted odds ratio 3.35 [95% confidence interval = 1.12, 10.04]). Early neonatal skin pH may predict the risk of diaper dermatitis during the first month of life. Our results may be useful in devising strategies to prevent diaper dermatitis.
    Pediatric Dermatology 09/2014; · 1.52 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: While antenatal fear of childbirth (FOC) has been associated with many psychosocial variables, few studies have focused on individual stress resiliency. Sense of coherence (SOC) is one of the essential components of individual stress resiliency. This study investigates the relationship between antenatal FOC and SOC in Japanese healthy pregnant women. Self-reported questionnaires were distributed to 240 women at 37 gestational weeks at an obstetric clinic in Tokyo, Japan. Structural regression modeling was conducted to identify the causal relationships between FOC and SOC. The non-recursive model showed significant acceptance of fit (chi-square value/degree of freedom = 1.72, comparative fit index = 0.97, and root mean square error of approximation = 0.05). The model identified SOC as a direct cause of FOC (β = -0.89, p < 0.001), not a reflection of FOC. We found that SOC was negatively linked with antenatal fear of childbirth. High SOC works as a resiliency factor that helps pregnant women cope with the stress of their upcoming childbirth and reduces FOC.
    Archives of Women s Mental Health 02/2014; 17(5). · 2.01 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To assess the psychometric properties of the Pregnancy Physical Activity Questionnaire (PPAQ) for women who read and speak Japanese. This longitudinal study used a self-report questionnaire and quantitative biometric and instrumental measurements (actigraph) to assess the reliability and criterion validity. A university hospital in Tokyo, Japan. Sixty-nine pregnant women living in Tokyo and its suburbs were recruited. The test-retest reliability of the Japanese version of the Pregnancy Physical Activity Questionnaire (PPAQ-J) was evaluated through intraclass correlation coefficients (ICCs) between PPAQ-J results administered three times (at recruitment, 7 and 14 days later). Criterion validity was assessed by comparing results to actigraph measures using Spearman's correlation coefficients. Participants wore the actigraph over the 2-week research period. Data from 58 participants were analyzed for test-retest reliability. The data of 54 participants were used to analyze criterion validity. The ICCs for the first and second and for the first and third PPAQ-J questionnaires were ≥0.56 for total activity and activities broken down by intensity and type (in metabolic equivalents [METs] × hours/day). To evaluate criterion validity, Spearman's correlation coefficients were calculated between the first measurement of the PPAQ-J and three published cut-points used to classify actigraph data (minutes/day); correlations ranged from .02 to .35 for total activity, -.21 to -.25 for vigorous activity, -.09 to .38 for moderate activity, and .01 to .28 for light activity. The PPAQ-J is a psychometrically sound and comprehensive measure of physical activity in pregnant Japanese women.
    Journal of Obstetric Gynecologic & Neonatal Nursing 01/2014; 43(1):107-16. · 1.03 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Oxidative stress plays a major pathological role in pregnancy-related complications. Although oxidative stress is induced by exogenous toxins in association with a poor lifestyle in normal subjects, there is little information on the factors altering oxidative stress and antioxidant levels during pregnancy. The purpose of this study was to determine the relationship between lifestyle factors and oxidative stress/antioxidant levels during each trimester and 1-month postpartum. This prospective cohort study followed 54 healthy women through pregnancy; first, second, and third trimester and 1-month postpartum. Participants were administered a questionnaire on characteristics and lifestyle factors. Morning blood and urine samples were obtained to measure urinary biopyrrins and serum coenzyme Q10 (CoQ10) levels. The levels of urinary biopyrrins and serum CoQ10 increased significantly throughout pregnancy, with peak values registered during the third trimester. Higher biopyrrin levels were significantly associated with non-consumption of morning meal during the first trimester, smoking during the third trimester and 1-month postpartum, alcohol consumption during the third trimester, high food-based polyunsaturated fatty acid intake during the third trimester, and poor mental health scores during the first and third trimesters. Higher CoQ10 levels were significantly associated with no smoking during pregnancy and at 1-month postpartum, and with a high frequency of exercise during the third trimester and 1-month postpartum. Thus, pregnancy represents a state of oxidative stress, which can be counterbalanced by increased levels of antioxidants, such as CoQ10. We speculate that certain lifestyle choices such as avoiding smoking can reduce oxidative stress and increase antioxidant levels during pregnancy.
    Bioscience trends 01/2014; 8(3):176-84. · 1.21 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Maternal vitamin D status is important for fetal development and the prevention of pregnancy complications. Mothers require both sufficient intakes and skin production of this vitamin. We investigated the validity and test-retest reliability of a self-administered diet history questionnaire (DHQ) to establish a method of assessing vitamin D intakes of Japanese pregnant women, using a serum marker. A total of 245 healthy pregnant women in the second trimester, who were not taking vitamin D supplements, were recruited at a university hospital in Tokyo between June 2010 and July 2011. Serum 25-hydroxyvitamin D [25(OH)D] concentrations were measured as an indicator of vitamin D status. To assess the test-retest reliability of the DHQ, 58 pregnant women completed it twice within a 4-5-week interval. Significant positive correlations between intakes and serum concentrations of vitamin D were found (r = 0.266 for daily intakes and r = 0.249 for energy-adjusted intakes). In the winter investigation in which the serum 25(OH)D concentrations were less likely to be affected by sunlight exposure, the correlation coefficients were 0.304 for both daily and energy-adjusted intakes. After excluding participants with pregnancy-associated nausea, the coefficients increased. The intraclass correlation coefficient between vitamin D intakes estimated from the two-time DHQ was 0.638. The DHQ provides an acceptable validity and reliability of the vitamin D intake of Japanese pregnant women. However, the data of women with nausea should be interpreted with caution. We believe that the DHQ is a useful questionnaire to grasp and improve vitamin D intakes during pregnancy.
    Maternal and Child Nutrition 10/2013; · 2.97 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: ntroduction. Women attain numerous benefits from physical activity during pregnancy. However, because of physical changes that occur during pregnancy, special precautions are also needed. This review summarizes current guidelines for physical activity among pregnant women worldwide. Methods. We searched PubMed (MedLINE) for country-specific governmental and clinical guidelines on physical activity during pregnancy through the year 2012. We cross-referenced with articles referring to guidelines, with only the most recent included. An abstraction form was used to extract key details and summarize. Results. In total, 11 guidelines were identified from 9 countries (Australia, Canada, Denmark, France, Japan, Norway, Spain, United Kingdom, United States). Most guidelines supported moderate-intensity physical activity during pregnancy (10/11) and indicated specific frequency (9/11) and duration/time (9/11) recommendations. Most guidelines provided advice on initiating an exercise program during pregnancy (10/11). Six guidelines included absolute and relative contraindications to exercise. All guidelines generally ruled-out sports with risks of falls, trauma, or collisions. Six guidelines included indications for stopping exercise during pregnancy. Conclusion. This review contrasted pregnancy-related physical activity guidelines from around the world, and can help inform new guidelines as they are created or updated and facilitate the development of a worldwide guideline.
    American Journal of Lifestyle Medicine 08/2013;
  • [Show abstract] [Hide abstract]
    ABSTRACT: A high total homocysteine (tHcy) level during pregnancy is a risk factor for adverse perinatal outcomes, such as fetal growth restriction and preeclampsia. Caffeine is assumed to increase tHcy levels by acting as a vitamin B6 antagonist. The objective of this study was to examine a relationship between circulating tHcy levels and dietary caffeine and vitamin B6 intakes in pregnant Japanese women. A total of 321 healthy women with singleton pregnancies were recruited in metropolitan Tokyo, from June to December 2008, resulting in the final number included in the study as 254. Dietary caffeine intakes did not correlate with plasma tHcy levels. When we analyzed the data according to caffeinated beverages, caffeinated tea consumption was positively associated with plasma tHcy levels only among the women with a high intake of vitamin B6 , after controlling for confounding factors (P = 0.029). No correlation between coffee consumption and plasma tHcy levels was found. Pregnant Japanese women might need to cut down the consumption of caffeinated tea as well as take sufficient vitamin B6 in order to prevent the tHcy levels from increasing.
    Nursing and Health Sciences 07/2013; · 0.85 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) intakes during pregnancy affect fetal development and maternal mental health; therefore, an accurate assessment of EPA and DHA intakes is required. We hypothesized that a self-administered diet history questionnaire (DHQ) that was developed for non-pregnant adults could be used for estimating EPA and DHA intakes in pregnant Japanese women; thus, we evaluated the validity and reproducibility of the DHQ during pregnancy. We recruited 262 healthy participants with singleton pregnancies during their second trimester at a university hospital in Tokyo between June 2010 and July 2011. Plasma concentrations of EPA and DHA were measured as reference values. Fifty-eight women completed the DHQ twice, within a 4- to 5-week period to assess the reproducibility of the results. Among the participants without pregnancy-associated nausea (n = 180), significantly positive correlations were observed between energy-adjusted intakes and plasma concentrations of EPA (rs = 0.388), DHA (rs = 0.264), and EPA + DHA (rs = 0.328). More than 60% of the participants without nausea fell into the same or adjacent quintiles according to energy-adjusted intakes and plasma concentrations of EPA, DHA, and EPA + DHA. Meanwhile, among the participants with nausea, a low correlation for EPA and no correlation for DHA and EPA + DHA were found. Intraclass correlation coefficients for the 2-time DHQ measurements were 0.691 (EPA) and 0.663 (DHA). The results indicate that the DHQ has an acceptable level of validity and reproducibility for assessing EPA, DHA, and EPA + DHA intakes in pregnant Japanese women without nausea.
    Nutrition research 06/2013; 33(6):473-8. · 2.59 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Abstract We investigated the validity and reproducibility of a self-administered diet history questionnaire (DHQ) that estimates the intakes of β-carotene, vitamin C and α-tocopherol. Ninety-five healthy women with singleton pregnancies in the second trimester were examined at a university hospital in Tokyo. The intakes of β-carotene, vitamin C and α-tocopherol assessed by the DHQ were compared to the corresponding serum concentrations. To assess the reproducibility, 58 pregnant women completed it in two sessions within a 4-5 week interval. We found significantly positive correlations between the energy-adjusted intakes and serum concentrations of β-carotene and vitamin C (r = 0.254 and r = 0.323, respectively). However, α-tocopherol intake was not associated with the corresponding serum concentration. The intraclass correlation coefficients of the two-time DHQ were 0.743 (β-carotene), 0.665 (vitamin C) and 0.718 (α-tocopherol). DHQ has acceptable validity and reproducibility for β-carotene and vitamin C intakes in Japanese pregnant women.
    International Journal of Food Sciences and Nutrition 03/2013; · 1.20 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background and Objective: There is controversy on the psychological effects of postpartum exer-cise. The study aimed to evaluate the effective-ness of a postpartum exercise program on health-related quality of life and psychological well-being. Methods: We conducted a randomized controlled trial in Tokyo, Japan. The intervention groups participated in ball-exercise classes (week-ly exercise of 90 minutes for four weeks) at three months postpartum. The exercise class included the following: 1) greeting and warm-up; 2) aero-bic exercise involving bouncing on an exercise ball 55 or 65 cm in diameter; 3) rest and self-introduction; 4) stretching and cooling down. The primary outcome measure was health-relat-ed Quality of Life (QOL) assessed using the MOS Short-Form 36-Item Health Survey (SF-36v2). The secondary outcome measures were Rosen-berg Self-Esteem Scale (RSES) and Edinburgh Postnatal Depression Scale (EPDS) scores. The intervention group was compared to the control group at four months postpartum. Results: Of the 120 women screened, 110 women met the study criteria. Nine could not be included and the remaining 101 were allocated randomly into intervention and control groups (50 and 51 par-ticipants respectively). Analysis of covariance adjusting for baseline values indicated that the SF36 subscales of physical functioning (p = 0.018) and vitality (p = 0.016) significantly im-proved in the intervention group compared to the control group, although there were no signi-ficant differences between the groups in the SF36 Physical Component Summary (PCS) and Mental Component Summary (MCS) scores. The RSES increased in the intervention group (p = 0.020) compared to the control group. No signi-ficant group differences were observed in EPDS scores. Conclusions: The postpartum exercise class program provided to healthy postpartum women appears to have contributed to promo-ting health-related QOL and self-esteem.
    Health 03/2013; 5:432-43953058. · 2.10 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Severe antenatal fear of childbirth causes adverse effects on emotional well-being during the postpartum period. The Wijma Delivery Expectancy/Experience Questionnaire is widely used to measure fear of childbirth among women before (version A) and after (version B) delivery. In this study, the original Swedish version was translated into Japanese, and its validity and reliability were examined among healthy, pregnant Japanese women. The Japanese-translated version presented a multidimensional structure with four factors: fear, lack of positive anticipation, isolation, and riskiness. Exhibiting concurrent/convergent validity, the Japanese version correlated with other psychological measures at expected levels. The Cronbach's α (0.90) and the intraclass correlation coefficient (0.86, P < 0.001) were high. In conclusion, the results provide support for the Japanese version to be considered a valid and reliable measure of prenatal fear of childbirth among pregnant Japanese women.
    Nursing and Health Sciences 02/2013; · 0.85 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Bonding disorders towards their child has been recognized as a serious problem, which might lead to give adverse effects on the relationship with child or maltreatment towards their child. The aim of this study was to identify the factor structure of the Mother-Infant Bonding Scale (MIBS) as well as the determinants of parental bonding disorders in Japan. In this cross-sectional observational study, the MIBS and other psychosocial questionnaires were distributed to 396 fathers and 733 mothers of children aged between 0 and 10, at 20 clinics of Kumamoto prefecture, in Japan. An exploratory factor analysis of the MIBS revealed a two-factor structure: lack of affection (LA) and anger and rejection (AR). A confirmatory factor analysis demonstrated its cross-validity, with no statistical differences between fathers and mothers. A multi-group analysis using structural equation modelling demonstrated that LA and AR were predicted by parental dysphoric mood while only AR was predicted by parental anger. To be concluded, the current study suggests that the MIBS has two subscales that can be predicted by intrapersonal and interpersonal variables, and may provide information applicable to the design of therapeutic or preventive approaches to parents with bonding disorders.
    Journal of Child and Family Studies 01/2013; · 1.42 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background. To examine the effects of temperament and character domains on depression during pregnancy. Methods. We examined 601 pregnant women using a questionnaire that included the Edinburgh Postnatal Depression Scale (EPDS), the Temperament and Character Inventory (TCI), and demographic variables. Results. In a hierarchical regression analysis, severity of depression during pregnancy was predicted by the women's negative response towards the current pregnancy, low self-directedness, and high harm avoidance, persistence, and self-transcendence. Conclusion. Depression during pregnancy is predicted by personality traits as well as women's negative attitudes towards the current pregnancy.
    Depression research and treatment 01/2013; 2013:140169.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Purpose To assess the utility of transperineal three-dimensional (3D) ultrasound for diagnosing anal sphincter defects and evaluating the function of the anal canal in women with anal incontinence. Methods The study subjects were 13 women with anal incontinence. Symptoms of fecal incontinence were assessed by Wexner score. The anal canal of each woman was examined ultrasonically with both a convex transperineal 3D scanner and a radial transanal scanner to compare the accuracy of the two approaches for diagnosis of anal sphincter defects. The anorectal angle and the length of the anal canal were also measured by utilizing the functionality of the transperineal 3D ultrasound. Results The mean age was 58.9 ± 14.9 years (±SD), and the mean Wexner score was 8.4 ± 5.6. In terms of ultrasound diagnosis of anal sphincter defects, the two methods showed consistent results in each woman. The length of the portion where both the internal and external anal sphincters were intact was significantly correlated with the Wexner score, whereas the total length of the anal canal was not. Conclusions Less invasive transperineal 3D ultrasound provides accurate evaluation of the internal and external anal sphincters in women with anal incontinence, and the method is potentially useful for detection of anal sphincter abnormalities.
    Journal of Medical Ultrasonics 10/2012; 39(4):241-247. · 0.74 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Purpose To compare the pelvic floor function between women with and without stress urinary incontinence after vaginal delivery. Methods Seventeen women (age 35.5 ± 3.5) were prospectively studied at about 6 weeks, 3 months, and 6 months after vaginal delivery. Urinary incontinence was assessed by the International Consultation on Incontinence Questionnaire – Short Form. Pelvic floor function was assessed by antero-posterior diameter of the levator hiatus using transperineal ultrasound. Results Five of 17 women experienced postpartum stress urinary incontinence. The antero-posterior diameter of the levator hiatus at rest was significantly longer in stress urinary incontinent women than in continent women until 3 months after delivery (p p p = 0.02). Conclusion The extended pelvic floor may be a cause of stress urinary incontinence in the postpartum period. Therefore, treatment to improve the extended pelvic floor should be developed for the prevention of stress urinary incontinence.
    Journal of Medical Ultrasonics 04/2012; 40(2):125-131. · 0.74 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: No validated dietary questionnaire for assessing folate and vitamin B(12) intakes during pregnancy is available in Japan. We evaluated the validity and reproducibility of intakes of folate and vitamin B(12) estimated from a self-administered diet history questionnaire (DHQ) in Japanese pregnant women. A sample of 167 healthy subjects with singleton pregnancies in the second trimester was recruited at a private obstetric hospital in metropolitan Tokyo from June to October 2008 (n = 76), and at a university hospital in Tokyo from June 2010 to June 2011 (n = 91). The dietary intakes of folate and vitamin B(12) were assessed using the DHQ. The serum concentrations of folate and vitamin B(12) were measured as reference values in the validation study. To assess the reproducibility of the results, 58 pregnant women completed the DHQ twice within 4-5 week interval. Significantly positive correlations were found between energy-adjusted intakes and serum concentrations of folate and vitamin B(12) (r = 0.286, p < 0.001 and r = 0.222, p = 0.004, respectively). After excluding the participants with nausea (n = 121), the correlation coefficient for vitamin B(12) increased to 0.313 (p = 0.001). When participants were classified into quintiles based on intakes and serum concentrations of folate and vitamin B(12), approximately 60% were classified in the same or adjacent quintile. The intraclass correlation coefficients of the two-time DHQ were 0.725 for folate and 0.512 for vitamin B(12). The present study indicated that the DHQ had acceptable validity and reproducibility for assessing folate and vitamin B(12) intakes in Japanese pregnant women.
    Nutrition Journal 03/2012; 11:15. · 2.64 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To illuminate midwives' and public health nurses' perceptions of managing and supporting prenatal and postnatal migrant women in Norway. Migrant women are affected by social inequalities and likely to have had experiences during and after the migration process that could influence their physical, mental and social well-being. Multistage focus group interviews were conducted and data were analysed in accordance to conventional interpretative qualitative content analysis. The overarching theme 'Managing and supporting educational, relational and cultural diversity in maternity care' was characterized by two themes 'Health challenges' and 'Cultural challenges'. Each theme contained several subthemes. The interviews revealed that Norwegian maternity care is not adjusted to migrant women's needs. The management is the same for everybody who avails of the service. The Norwegian model for managing cultural diversity in maternity care needs to be developed. Capacity building and a closer cooperation between maternity care services is necessary. IMPLICATIONS FOR MIDWIVES AND NURSING MANAGEMENT: Maternity care requires reflection at several levels to reduce disparities in individual health. In order to ensure continuity and a trusting relationship, it is necessary to organize leadership and adopt flexible models that support migrant women's health.
    Journal of Nursing Management 03/2012; 20(2):287-95. · 1.14 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: High levels of oxidized low-density lipoprotein (ox-LDL) during pregnancy are a risk factor for preeclampsia. Ox-LDL levels might be affected by folate and total homocysteine (tHcy) levels because of their effects on oxygen free radicals. The relationships between ox-LDL and folate and tHcy during pregnancy, however, remain unclear. The present study investigated whether serum folate levels and plasma tHcy levels were associated with plasma ox-LDL levels in pregnant women. A sample of 137 healthy subjects with singleton pregnancies (age 30.3 ± 4.5 years) was recruited from a prenatal clinic in metropolitan Tokyo between June and October 2008. Their levels of plasma ox-LDL, plasma tHcy, and serum folate were measured, and lifestyle variables were obtained using a questionnaire. Dietary intake was assessed by means of a validated self-administered diet history questionnaire. A negative correlation between plasma ox-LDL levels and serum folate levels was found (r(s) = -.218, p =.011). However, there was no association between plasma ox-LDL levels and plasma tHcy levels (r(s) = .055, p = .525). The mean of the logarithmic ox-LDL levels was significantly lower among the participants taking folic acid-containing supplements regularly than among those who were not, after adjusting for confounding factors (p = .024). Serum folate levels and folic acid supplementation might be associated with plasma ox-LDL levels, independent of tHcy levels. The association observed between ox-LDL and folate can be used as evidence for dietary instruction by prenatal care providers.
    Biological Research for Nursing 12/2011; · 1.34 Impact Factor

Publication Stats

107 Citations
55.04 Total Impact Points


  • 2003–2014
    • The University of Tokyo
      • • Department of Health Science and Nursing
      • • Faculty & Graduate School of Medicine
      Tōkyō, Japan
  • 2012
    • Vestfold University College
      • Faculty of Health Sciences
      Tønsberg, Vestfold county, Norway
  • 2009
    • UERM
      Quezon, Western Visayas, Philippines