JMA journal最新文献

Advancements in artificial intelligence and sensor-based systems are transforming personalized preventive medicine. This "suggestion review" explores an artificial intelligence (AI)-driven healthcare ecosystem that integrates and analyzes personal health data to ensure transparency and tailored guidance for optimal well-being. AI enables real-time health monitoring, proactive interventions, and emergency response systems, addressing current healthcare limitations. By employing advanced machine learning techniques, AI improves decision-making, stress management, and personalized health recommendations. Additionally, this review explores the economic benefits of AI-driven preventive healthcare, emphasizing cost-effectiveness and improved outcomes. Ethical considerations, data security, and user autonomy are also discussed to ensure the responsible deployment of AI in healthcare.

Introduction: Biological agents have been approved and are now widely used in the treatment of Crohn's disease (CD), fundamentally changing therapeutic strategies. However, evidence regarding long-term outcomes and treatment approaches-particularly in elderly onset (ED) and pediatric onset (PO) CD-remains limited. This study aimed to clarify the long-term prognosis and therapeutic patterns of patients newly diagnosed with CD using a nationwide real-world claims database in Japan.

Methods: A retrospective cohort study was conducted using the DeSC Healthcare Inc. database, identifying 1,345 patients newly diagnosed with CD from 2014 to 2023. Patients were categorized by age at onset as pediatric (<16 years), elderly (≥65 years), and non-elderly/non-pediatric. Treatment strategies were classified as step-up or top-down based on the initial therapy. Kaplan-Meier analysis and log-rank tests were used to evaluate the cumulative rates of advanced therapy-free survival, steroid-free survival, and biological retention.

Results: Of the 1,345 patients, 56 had PO and 472 had EO disease. Top-down therapy was used in 52.2% of cases. The 5-year advanced therapy-free and steroid-free rates were 57.2% and 44.2%, respectively. EO patients showed the highest advanced therapy-free rate (76.2%) and the lowest use of top-down therapy. PO patients had the lowest steroid-free rate and the highest top-down therapy (80%).

Conclusions: Age at CD onset influences treatment strategies in Japan. Early biologic therapy is common in younger patients, whereas conservative approaches are preferred in older adults. Real-world data provide important insights for optimizing individualized CD management in the biological era.

Introduction: The atopic march describes the progression from early eczema to food allergies and asthma. In Japan, early-onset atopic dermatitis (AD) is linked to allergic diseases, but the role of peanut sensitization-a known asthma risk factor in Western populations-remains uncertain because of its lower prevalence. This study aimed to evaluate whether peanut sensitization predicts asthma development in Japanese children with AD and to compare its predictive value with other common allergens.

Methods: We conducted a retrospective cohort study of 203 children under age two with physician-diagnosed AD who underwent simultaneous measurement of specific immunoglobulin E to egg white, peanut, and house dust mite at a tertiary Allergy Center in Tokyo. Participants were followed until age six. Sensitization was categorized as none, mono (one allergen), or oligo (≥2 allergens). Associations with asthma development were evaluated using multivariate logistic regression and decision tree analysis.

Results: Asthma developed in 32.0% of participants. Peanut sensitization was significantly more common in the asthma group (53.8% vs. 29.7%, p = 0.001), as were oligo-sensitization and allergic rhinitis. Decision tree analysis identified peanut sensitization as the most influential predictor, with an 83% asthma incidence among children with both peanut sensitization and rhinitis. Logistic regression confirmed peanut sensitization as an independent risk factor (adjusted odds ratio: 2.74, 95% confidence interval: 1.44-5.24).

Conclusions: Peanut sensitization in infancy strongly predicts asthma in Japanese children with AD. Early allergen-specific sensitization profiling may help identify high-risk children and support targeted asthma prevention strategies.

Introduction: There is no standard geriatric assessment (GA) for patients aged ≥65 years with lung cancer (hereafter referred to as patients). This retrospective study evaluated whether GA could be achieved by combining Geriatric-8 (G8) score (G8s), body weight loss (BWL) of more than 5% (5%BWL), and bioelectrical impedance analysis (BIA).

Methods: This study included patients who underwent G8 screening, BIA (measuring skeletal muscle mass index [SMI] and extracellular water-to-total body water ratio [ECW/TBW]), and physical function tests before treatment at our hospital between March 1, 2023, and December 31, 2024. Patient clinical records were reviewed to collect baseline data. Statistical analyses were conducted using R (version 4.1.1).

Results: A total of 120 patients were analyzed. We found the following significant associations: G8s ≤14.0 and 5%BWL were associated with advanced-stage disease; G8s >14.0 and SMI ≥cut-off value (CV) with higher body mass index; ECW/TBW ≥0.4 (0.4 ECW/TBW) with aging and poor performance status; 5%BWL with lower maximum lower leg calf circumference (MLLCC); SMI ≥CV with higher maximum handgrip strength (MHGS) and MLLCC; 0.4 ECW/TBW with lower MHGS, gait speed, and five-time sit-to-stand performance. The multivariate analysis confirmed significant associations: G8s ≤14.0 was associated with cancer cachexia; SMI < CV and 0.4 ECW/TBW were associated with sarcopenia, and 0.4 ECW/TBW was associated with physical function decrease, as indicated by a Short Physical Performance Battery score of ≤9. Patients with G8s ≤14.0, 5%BWL, or 0.4 ECW/TBW had shorter survival durations than their respective counterparts. Patients were classified into three frailty categories (none, mild combined with moderate, severe) based on a combination of four factors (G8, BWL, SMI, and ECW/TBW) and had distinct survival curves.

Conclusions: The combination of these four factors offers a simple and objective approach for GA in patients.

Introduction: Japan's aging population and declining birthrate have intensified the need for foreign workers, with Vietnamese workers now forming the largest group among over 2 million foreign laborers. While statistical studies on their work situations and mental health are increasing, they offer limited direct insight into these workers' lived experiences. This study aimed to capture their firsthand voices, focusing on differences by residency status.

Methods: Open-ended responses from 100 Vietnamese workers in Japan, collected through a 2022 survey, were analyzed. Content analysis was used to categorize experiences into positive and negative aspects.

Results: Positive experiences included job satisfaction, adequate salaries, safe environments, supportive colleagues, and personal growth, with workers particularly valuing learning opportunities and workplace relationships that fostered development. Negative experiences, which were more prevalent, encompassed demanding workloads, unfair treatment, inadequate pay, long hours, and insufficient rest. Cultural and language barriers also hindered workplace relationships. Technical Intern Trainees (TIT) more frequently reported dissatisfaction with wages and conditions, while Engineer/Specialist in Humanities/International Services (ESI) workers more often cited interpersonal challenges linked to cultural adaptation.

Conclusions: Vietnamese workers gain certain benefits from employment in Japan but frequently report dissatisfaction. TIT workers tend to face systemic issues, whereas ESI workers more often experience interpersonal challenges rooted in cultural differences. Addressing both types of challenges with consideration for the distinct situations of foreign workers may improve their mental health and well-being.

Introduction: Chlorhexidine mouthwash is one of the most widely used anti-microbial agents, reducing oral cavity bacterial load. However, the effects of mouthwash on systemic conditions in patients with chronic kidney disease (CKD) remain unknown. We examined the relationship between Streptococcus mutans abundance in the oral cavity and proteinuria in patients with CKD.

Methods: Patients with CKD (n = 57) gargled with mouthwash containing chlorhexidine gluconate three times daily for 1 year. We prospectively investigated the relationship between changes in the number of S. mutans and proteinuria.

Results: The number of S. mutans colony-forming units (CFU) ≥10³/mL saliva at month 0 was significantly associated with higher urinary proteinuria and S. mutans CFU/mL over time. The mean number of S. mutans in all patients decreased significantly after 12 months. Proteinuria also decreased significantly after 12 months compared with after 6 months. The rate of proteinuria <0.3 g/g creatinine after 12 months was significantly higher in the group that had <10³ CFU/mL S. mutans after 12 months than in other groups.

Conclusions: In this pilot study, a potential association was observed between oral S. mutans counts and proteinuria in patients with CKD. Larger studies are needed to clarify this relationship.