JMA journal最新文献

Introduction: This study examined the test-retest reliability of the Kids Brain Balancer, a tablet-based cognitive assessment app, among children in the special education system and gathered preliminary validity evidence by evaluating score agreement with the Wechsler Intelligence Scale for Children, Fourth Edition (WISC-IV).

Methods: A total of 36 children undergoing special education (aged 7-11 years) completed the Balancer tasks more than three times for over 1 month. Intraclass correlation coefficients (ICCs) facilitated the analysis of score reliability across sessions. Score agreement with Wechsler indices were evaluated for each task.

Results: Of the nine tasks, six demonstrated moderate-to-good reliability for raw or age-adjusted scores. The Full-Scale Intelligence Quotient (FSIQ), composite scores on the WISC-IV, and Balancer index scores on several tasks exhibited moderate-to-strong correlations over three repeated test administrations. Agreement with the FSIQ varied; however, most visuospatial/executive tasks initially correlated better, whereas verbal/working memory tasks converged by the third session. Those with lower baseline scores exhibited improvement in agreement over repeat testing.

Conclusions: This study provides initial evidence supporting the validity and test-retest reliability of the Kids Brain Balancer in evaluating intellectual/cognitive functioning among children undergoing special education. Enhancement and wider testing could establish this convenient tool to support evaluation of diverse developmental needs.

Introduction: Long hospital stay is associated with high costs and poor quality of life in elderly patients with heart failure (HF). This study aimed to investigate the association of early administration of tolvaptan with length of hospital stay among elderly patients with HF.

Methods: The cohort included elderly patients (age ≥ 75 years) admitted to Shinonoi General Hospital between July 2016 and December 2018 with a primary diagnosis of acute decompensated HF treated with tolvaptan. Patients who died during hospitalization, patients who had acute coronary syndrome, patients who required treatment in the intensive care unit, and patients who had already taken tolvaptan before admission were excluded. Patients were divided into two groups according to the median duration of admission to tolvaptan administration: those who received tolvaptan within 1 day (24 h) after admission (early treatment group) and those for whom tolvaptan was prescribed after 1 day (24 h) or more from hospitalization (add-on group). We compared the length of hospital stay between the two groups and investigated the relationship between early tolvaptan administration and length of hospital stay.

Results: Of 110 enrolled patients (median age 85 years), 56 (51%) received tolvaptan within 1 day (24 h) after admission. The median length of hospital stay was 22 [14-35] days. The length of hospital stay was significantly shorter in the early treatment group (16 [11-22] days vs. 30 [21-46] days, p < 0.001). On multivariable regression analysis, early tolvaptan was associated with shorter hospital stay after adjusting for age, sex, serum creatinine, B-type natriuretic peptide, continuous dobutamine, and whether they live alone (partial regression coefficient -16.213, p < 0.001). Linear regression analysis showed a positive relationship between time of tolvaptan administration and length of hospital stay (R² = 0.564, p < 0.001).

Conclusions: Early tolvaptan administration was associated with reduced length of hospital stay in elderly HF.

Introduction: This study investigated the relationships between changes in renal prognosis-related factors after initiating tofogliflozin and the corresponding baseline values in clinical practice in Japanese patients with type 2 diabetes.

Methods: We investigated the relationships between changes in hematocrit, hemoglobin, systolic blood pressure (sBP), urinary protein excretion (uPE), serum uric acid (sUA), and estimated glomerular filtration rate (eGFR) 12 months after initiating tofogliflozin (20 mg) and their corresponding baseline values in 130 patients with type 2 diabetes. The subjects were divided into two groups: normal (≥60 mL/min/1.73 m², n = 87) and low (<60 mL/min/1.73 m², n = 43) eGFR.

Results: Although the change in eGFR was negatively correlated with the baseline value in the normal-eGFR group, no significant correlation was found between the change in eGFR and baseline value in the low-eGFR group. Although changes in hematocrit (r = -0.39, P = 0.01) and hemoglobin (r = -0.36, P = 0.02) levels were significantly negatively correlated with corresponding baseline values in the low-eGFR group, no significant correlations were observed in the normal-eGFR group. Changes in sBP, uPE, and sUA were significantly negatively correlated with the corresponding baseline values in both the normal- and low-eGFR groups. None of the correlation coefficients between the normal- and low-eGFR groups showed a significant difference.

Conclusions: Favorable changes in renal prognosis-related factors after tofogliflozin therapy may contribute to renoprotection in patients with type 2 diabetes and poor corresponding baseline values, despite the presence of renal impairment.

Introduction: Dyslipidemia increases the risk of cardiovascular and cerebrovascular diseases. Visiting a physician for follow-up is essential when dyslipidemia is detected during health checkups. We investigated factors associated with non-attendance at a follow-up visit for dyslipidemia.

Methods: We conducted a retrospective cohort study using linked health checkups and medical claims data from individuals covered by National Health Insurance in Ibaraki Prefecture, Japan. Participants were 40-74 years old, underwent health checkups between April 2018 and March 2019, and had cholesterol levels exceeding the recommended levels to visit a physician. We excluded individuals who had visited physicians for dyslipidemia in the past year. We calculated the proportion of patients who had a follow-up visit with a physician within 180 days after their health checkup. Then, we investigated the demographic and clinical characteristics associated with non-attendance using a multivariable logistic regression model.

Results: Among 33,503 individuals (median age, 66 years [interquartile range, 59-69 years]; females, 58.8%) with dyslipidemia at the health checkup, 18.1% attended follow-up visits. Younger age, male sex, drinking habits, and lack of symptoms were associated with higher odds of non-attendance. Participants who underwent health checkups at public facilities, lacked other abnormal results at health checkups, and had not visited physicians for other diseases were less likely to attend a follow-up visit. Among those with elevated low-density lipoprotein cholesterol (LDL-C) levels, those with relatively lower LDL-C levels were less likely to attend.

Conclusions: Systems that inform high-risk populations of non-attendance and encourage follow-up visits are warranted.

In October 2023, Herat Province in Afghanistan was devastated by three earthquakes, resulting in 1,480 fatalities and 1,950 injuries, affecting approximately 154,000 people. The destruction included over 21,300 buildings, including 40 healthcare facilities, intensifying an existing humanitarian crisis under Taliban rule since August 2021. A comprehensive and coordinated response is vital for sustainable recovery and resilience, transcending political barriers to address the immediate and long-term needs of the Afghan population.