Reproductive decision-making following the diagnosis of an inherited metabolic disorder via newborn screening in Japan: a qualitative study

Introduction

The aim of the study was to describe the factors influencing the reproductive decision-making of carrier parents after the diagnosis of an inherited metabolic disorder in newborn screening in Japan.

Methods

We conducted a semi-structured interview with 12 parents and analyzed data based on content analysis methodology.

Results

We identified 11 factors, including personal evaluation of recurrence risk, understanding of hereditary phenomena, concerns and desires for future planned children, concerns for older siblings, perceptions of diseases, degree of acceptance and denial of diseases, the opinions of others on having another child, optimism/faith in positive outcomes, self-evaluation of parental capability, factors unrelated to the disease, and the "right" time to expand the family.

Discussion

Perceptions and acceptance of disease are both important factors in reproductive decision-making, though these factors fluctuate continuously during the childbearing period. Therefore, effective reproductive genetic counseling will be considerate of the parents' fluctuating perceptions on reproduction. To ensure that the decision-making process is for the benefit of the parents and future children, long-term involvement of health care professionals is needed to assess the client's acceptance of the disease and their understanding of genetic phenomena and recurrence rates.

Implementation of Molecular Autopsy for Sudden Cardiac Death in Japan - Focus Group Study of Stakeholders

BACKGROUND

We assessed the awareness of multidisciplinary healthcare professionals of the challenges related to implementation of molecular autopsy (MA) for sudden cardiac death (SCD) among children and young adults.Methods and Results: We conducted 11 focus groups with 31 multidisciplinary healthcare professionals, and categorized them into 2 themes: values, and challenges of MA implementation. The participants recognized 2 different values of MA: discovering the unknown cause of SCD, and SCD prevention among family members of victims. The coexistence of these values makes the MA process and role of professionals more complex. Participants were concerned about the psychological burden for bereaved family members and mentioned challenges in each process of the MA delivery system: obtaining consent, cause of death investigation, disclosing results, and preventive intervention.

CONCLUSIONS

MA is a valuable procedure both in terms of forensic and preventive medicine. However, the dual meanings and complex characteristics of genetic information is a potential source of concern and confusion among healthcare professionals as well as bereaved family members. Increasing awareness among healthcare professionals of the MA process is essential for connecting all related areas of expertise.

The Fragility of Statistically Significant Results in Randomized Clinical Trials for COVID-19

IMPORTANCE

Interpreting results from randomized clinical trials (RCTs) for COVID-19, which have been published rapidly and in vast numbers, is challenging during a pandemic.

OBJECTIVE

To evaluate the robustness of statistically significant findings from RCTs for COVID-19 using the fragility index.

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional study included COVID-19 trial articles that randomly assigned patients 1:1 into 2 parallel groups and reported at least 1 binary outcome as significant in the abstract. A systematic search was conducted using PubMed to identify RCTs on COVID-19 published until August 7, 2021.

EXPOSURES

Trial characteristics, such as type of intervention (treatment drug, vaccine, or others), number of outcome events, and sample size.

MAIN OUTCOMES AND MEASURES

Fragility index.

RESULTS

Of the 47 RCTs for COVID-19 included, 36 (77%) were studies of the effects of treatment drugs, 5 (11%) were studies of vaccines, and 6 (13%) were of other interventions. A total of 138 235 participants were included in these trials. The median (IQR) fragility index of the included trials was 4 (1-11). The medians (IQRs) of the fragility indexes of RCTs of treatment drugs, vaccines, and other interventions were 2.5 (1-6), 119 (61-139), and 4.5 (1-18), respectively. The fragility index among more than half of the studies was less than 1% of each sample size, although the fragility index as a proportion of events needing to change would be much higher.

CONCLUSIONS AND RELEVANCE

This cross-sectional study found a relatively small number of events (a median of 4) would be required to change the results of COVID-19 RCTs from statistically significant to not significant. These findings suggest that health care professionals and policy makers should not rely heavily on individual results of RCTs for COVID-19.

Confirmatory germline testing for presumed germline pathogenic variants using tumor-only testing

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Background: Presumed germline pathogenic variants (PGPVs) can be detected in tumor tissues using comprehensive genomic profiling. Clinicians and patients can decide whether to conduct confirmatory germline testing or not. However, the promoting and obstructive factors for confirmatory germline testing are unclear. Methods: This single institutional retrospective study aimed to identify factors related to confirmatory germline testing in patients with PGPVs. Between April 2015 and April 2019, 270 consecutive patients with cancers of unknown primary site, rare tumors, or solid tumors refractory to standard chemotherapy, who underwent tumor-only comprehensive genomic profiling were reviewed. PGPVs were proposed to be disclosed as variants to the patients by our institutional molecular tumor board. Univariate logistic regression analysis was conducted to investigate the relationship between each patient’s characteristics and confirmatory germline testing. Factors showing a statistical relationship (p < 0.10 in univariate analyses) were included in multivariate logistic regression analysis with a backward selection of variables. Statistical significance was set at p < 0.05. Results: Of the 270 patients who underwent tumor-only comprehensive genomic profiling, 77 possessed PGPVs. The most common PGPVs were TP53 (n = 56), APC (n = 9), PTEN (n = 7), RB1 (n = 6), and BRCA2 (n = 6). Among the 77 patients, only 11 (14.3%) chose to undergo confirmatory germline testing. Multivariate logistic regression analysis revealed that the person disclosing the results (experienced oncologists with knowledge of cancer genome medicine vs. others, odds ratio [OR]: 27.7, 95% confidence interval [CI]: 4.60–167) and study period (OR: 0.110, 95% CI: 0.015–0.787) were independently and significantly associated with confirmatory germline testing. Conclusions: These findings indicate that fostering genomic competency in oncologists and collaborating with genetic experts would facilitate cancer patients and their families to receive genetic medical services in the process of cancer genomic profiling.

Longest survival by the combination of radiation-therapy and resection in patient with metastatic spinal paragangliomas from primary-neck lesion with succinate dehydrogenase subunit B (SDHB) mutation

Metastatic paraganglioma (MPG) of the spine is a rare condition, with no established management. Herein, we report the longest survival case of a primary neck tumor that caused spinal MPG with a succinate dehydrogenase subunit B (SDHB) mutation (c.470delT, p.L157X) which could have promoted its malignancy. This male patient initially presented with a left neck PG which was diagnosed by a biopsy when he was 54 years-old. Simultaneously performed additional examinations revealed the spinal metastatic tumors on the T5-7 vertebrae and L3 vertebra-sacrum. These primary neck and metastatic spinal tumors' growths were once suppressed under the radiation therapy. Nineteen years later, he developed acute progressive paraparesis due to a mass located at the T2-3 level, tightly compressing the spinal cord, and protruding into the left thoracic cavity. We resected the maximum possible area of tumor in the spinal canal, confirmed MPG by histological examination, and then, we administered radiation therapy of 40 Gy in 20 fractions. Eventually, the patient was able to walk unaided with no evidential tumor recurrence for 3 years after treatment. Generally, clinical feature of MPG with SDHB mutation from abdominal lesion is thought to be poor prognosis. However, our case suggests the possibility of long-term control of spinal MPG with the adequate combination of radiation therapy and resection if metastatic lesions from primary-neck lesion with an SDHB mutation are remained to spine.

Comprehensive genomic profiling for patients with chemotherapy-naïve advanced cancer

Comprehensive genomic profiling (CGP) testing by next‐generation sequencing has been introduced into clinical practice as part of precision cancer medicine to select effective targeted therapies. However, whether CGP testing at the time of first‐line chemotherapy could be clinically useful is not clear. We conducted this single‐center, prospective, observational study to investigate the feasibility of CGP testing for chemotherapy‐naïve patients with stage III/IV gastrointestinal cancer, rare cancer, and cancer of unknown primary, using the FoundationOne^® companion diagnostic (F1CDx) assay. The primary outcome was the detection rate of at least one actionable/druggable cancer genomic alteration. Actionable/druggable cancer genomic alterations were determined by the F1CDx report. An institutional molecular tumor board determined the molecular‐based recommended therapies. A total of 197 patients were enrolled from October 2018 to June 2019. CGP success rate was 76.6% (151 of 197 patients), and median turnaround time was 19 days (range: 10‐329 days). Actionable and druggable cancer genomic alterations were reported in 145 (73.6%) and 124 (62.9%) patients, respectively. The highest detection rate of druggable genomic alterations in gastrointestinal cancers was 80% in colorectal cancer (48 of 60 patients). Molecular‐based recommended therapies were determined in 46 patients (23.4%). CGP testing would be a useful tool for the identification of a potentially effective first‐line chemotherapy.

Greenspace and depression in Japanese Older Adults considering physical activities: JAGES study

Introduction

Older adult's depression is a public health problem. In recent years, exposure to local greenspace is beneficial to mental health via increased physical activity in people. However, few studies approach the relationship between greenspace and depression while simultaneously considering the frequency, time, and the number of types of physical activity, and large-scale surveys targeting the older adults.

Methods

Cross-sectional data conducted in 2016 by the Japan Gerontological Evaluation Study was used. The analysis included older adults aged 65 and over who did not require care or assistance, and a total of 126,878 people in 881 School districts. The explanatory variable is the percentage of the greenspace of the area, and the greenspace data used is data created from satellite photographs acquired by observation satellites of the Japan Aerospace Exploration Agency. The objective variable was depression (Geriatric Depression Scale 5 points or more). The analysis method was a multi-level logistic regression analysis. Physical activity was the number of sports-related hobbies, the frequency of participation in sports meetings, and walking time in daily life. Other factors such as personal attributes, population density of residential areas, and local climate were also considered.

Results

Depression in the survey was 20.4%. The abundance of greenspace was still associated with depression, considering all physical activity. The odds ratio of depression in areas with more greenspace was 0.92 (95% CI 0.87 - 0.98) compared to areas with less greenspace.

Conclusions

It became clear that areas with many greenspace were still associated with low depression, even considering the frequency, time and number of physical activities. It is conceivable that the healing effect of seeing greenspace, the reduction of air pollution and noise, etc. are related to the lack of depression without going through physical activity.

Key messages

In Japan, older adults are less depressed when there are many local greenspace. It became clear that areas with many greenspace were still associated with low depression, even considering physical activities.

Evaluation of radiological recurrence patterns following gamma knife radiosurgery for solitary meningioma previously treated via cranial surgery

The use of gamma knife radiosurgery (GKS) for meningiomas after cranial surgery has been extensively evaluated; however, studies on tumor progression, including recurrence out of the margin dose line, are scarce. Hence, we aimed to evaluate the meningioma recurrence after GKS within and out of the margin dose. We included 37 consecutive patients with World Health Organization (WHO) grade 1 meningiomas who were treated with GKS following cranial surgery. Radiologically indicated recurrences were classified into three patterns by their relationship to the margin dose and tumor. The median follow-up was 58.9 months; 2 (5.4%) patients died. Only 2 (5.4%) patients did not keep active daily lives because of tumor progression. Cumulative local control at 5 years was 85.2%. Local recurrence and recurrence out of the margin dose occurred in 5 (13.5%) and 13 (35.1%) patients, respectively. A larger preoperative maximum diameter was a risk factor for local recurrence (hazard ratio [HR]: 2.118; P = 0.033), adjacent progression (HR: 1.633; P = 0.015), and remote progression (HR: 2.016; P = 0.003). Symptomatic adverse radiation effects occurred in 1 patient. Salvage GKS and cranial surgery were performed in 9 (24.3%) and 8 (21.6%) patients, respectively. Progression to WHO grade 2-3 occurred in 5 (13.5%) patients. A larger preoperative maximum diameter was a risk factor for progression of WHO grade (HR: 2.016, P = 0.033). Progression out of the margin dose was associated with a larger preoperative tumor size.

Abstract TP159: Unilateral Spatial Neglect as an Independent Prognostic Factor for Poor Fim Efficiency in Patients With Mild to Moderate Ischemic Stroke

Background and Purpose: Unilateral spatial neglect (USN) is often observed in ischemic stroke patients suffered their right parietal lobe. USN is an obstacle to undergo rehabilitation smoothly, then might influence the recovery of activities of daily living (ADL) after stroke. We aimed to clarify the association between the presence of USN after ischemic stroke and the ADL improvement.

Methods: Consecutive patients with first-ever ischemic stroke and left limb paralysis who admitted to within 7 days from onset during February 2011 and March 2019 were included. Patients met the following criteria were excluded: mRS ≥3 before onset, NIHSS >15 on admission, without left limb paralysis, and missing NIHSS or functional independence measure (FIM) score on admission. Multiple regression analysis was performed to investigate the association between FIM efficiency score of acute phase and following factors: age, sex, acute reperfusion therapy (using an intravenous infusion of recombinant tissue plasminogen activator and/or endovascular therapy), FIM score on admission, and other clinical characteristics. All data were collected retrospectively using our electrical health record.

Results: 721 ischemic stroke patients with left limb paralysis (320 women, median age 76) were included. Median FIM efficiency score was significantly lower in patients with USN than without USN (n=240, 481; 0.83 vs 1.63, respectively). Multiple regression analysis showed that USN, age, and acute reperfusion therapy were significant prognostic factors of FIM efficiency (coefficient and 95% confidence interval [CI]: -0.135 [-0.771 to -0.153], -0.106 [-0.022 to -0.002], and 0.224 [0.136 to 0.305], respectively).

Conclusions: USN significantly influence the recovery of ADL after ischemic stroke. Clinicians should adequately evaluate USN after stroke and undergo USN-specific rehabilitation for them to optimize the effect of post-stroke rehabilitation. USN-specific rehabilitation might lead to better FIM efficiency.

Salvage gamma knife radiosurgery for active brain metastases from small-cell lung cancer after whole-brain radiation therapy: a retrospective multi-institutional study (JLGK1701)

PURPOSE

To evaluate the efficacy of gamma knife radiosurgery (GKS) for brain metastases (BMs) from small-cell lung cancer after whole-brain radiotherapy (WBRT).

METHODS

We retrospectively analyzed the usefulness and safety of GKS in 163 patients from 15 institutions with 1-10 active BMs after WBRT. The usefulness and safety of GKS were evaluated using statistical methods.

RESULTS

The median age was 66 years, and 79.1% of patients were men. The median number and largest diameter of BM were 2.0 and 1.4 cm, respectively. WBRT was administered prophylactically in 46.6% of patients. The median overall survival (OS) was 9.3 months, and the neurologic mortality was 20.0%. Crude incidences of local control failure and new lesion appearance were 36.6% and 64.9%, respectively. A BM diameter ≥ 1.0 cm was a significant risk factor for local progression (hazard ratio [HR] 2.556, P = 0.039) and neurologic death (HR 4.940, P = 0.031). Leukoencephalopathy at the final follow-up was more prevalent in the therapeutic WBRT group than in the prophylactic group (P = 0.019). The symptom improvement rate was 61.3%, and neurological function was preserved for a median of 7.6 months. Therapeutic WBRT was not a significant risk factor for OS, neurological death, local control, or functional deterioration (P = 0.273, 0.490, 0.779, and 0.560, respectively). Symptomatic radiation-related adverse effects occurred in 7.4% of patients.

CONCLUSIONS

GKS can safely preserve neurological function and prevent neurologic death in patients with 1-10 small, active BMs after prophylactic and therapeutic WBRT.

Clinical significance of TP53 variants as possible secondary findings in tumor-only next-generation sequencing

In tumor-only next-generation sequencing (NGS), identified variants have the potential to be secondary findings (SFs), but they require verification through additional germline testing. In the present study, 194 patients with advanced cancer who underwent tumor-only NGS between April 2015 and March 2018 were enrolled, and the incidences of possible and true SFs were evaluated. Among them, 120 patients (61.9%) harbored at least one possible SF. TP53 was the most frequent gene in which 97 variants were found in 91 patients (49.5%). Nine patients provided informed consent to undergo additional germline testing, and a total of 14 variants (BRCA1, n = 1; BRCA2, n = 2; PTEN, n = 2; RB1, n = 1; SMAD4, n = 1; STK11, n = 1; TP53, n = 6) were analyzed. Three variants (BRCA1, n = 1; BRCA2, n = 2) were confirmed to be SFs, whereas TP53 variants were confirmed to be somatic variants. To confirm the low prevalence of SFs in TP53, we analyzed 24 patients with TP53 variants who underwent a paired tumor–normal NGS assay. As expected, all TP53 variants were confirmed to be somatic variants. A total of 30 patients were tested for germline variants in TP53, but none of them resulted in true SFs, suggesting the low prevalence of SFs in this gene. Therefore, the significance of additional germline testing for TP53 variants appears to be relatively low in daily clinical practice using a tumor-only NGS assay, unless patients have any relevant medical or family history.

Self-management behavior concerning physical activity of Japanese type 2 diabetes patients, characterized by sex, daily energy intake and body mass index

Objectives

We assess differences in physical activity self-management behavior in association with dietary intake and BMI between the sexes in patients with type 2 diabetes.

Methods

Patients with type 2 diabetes (n = 145) completed a self-administrated questionnaire. Patients were classified into four groups by BMI and dietary intake: non-obesity and non-overeating (NO/NOE); non-obesity and overeating (NO/OE); obesity and non-overeating (O/NOE); obesity and overeating (O/OE). Differences in physical activity self-management behavior between the four groups were determined by the analysis of variance using a Tukey-Kramer post hoc test.

Results

Male O/OE group showed higher HbA1c (p = 0.001) than the other groups. Male NO/OE group had higher steps/day than O/NOE (p = 0.036) and score of "Exercising to stimulate the enjoyment of eating" was higher than O/OE (p = 0.031). Female NO/OE group showed higher HbA1c (p = 0.001) than NO/NOE and O/NOE.

Conclusions

BMI and dietary intake were associated with frequencies of physical activity self-management strategies in men. Self-management behavior peculiar to male NO/OE group is "Exercising to stimulate the enjoyment of eating". Health professionals should assess sex, BMI, and dietary intake of patients and endeavor to improve individuals' ability to regulate their caloric balance based on physical activity level.

Abstract TP147: Factors Influencing Home Discharge Preference of Inpatients With Acute Cerebral Infarction: A Retrospective Cohort Study

Background and Purpose: Many previous studies explained clinical predictors of discharge planning for inpatients with acute cerebral infarction, while the factors that influence inpatients and their family’s preference for discharge destination are not often investigated. The purpose of this study was to clarify the relationship between home discharge preference of inpatients with acute cerebral infarction and socio-demographic factors or clinical characteristics.

Methods: We surveyed the electronic medical records of 2,495 (mean age 73.5+ years, 62% were male) acute cerebral infarction patients who were admitted to a stroke center in Japan between January 1, 2011 and December 31, 2015. The main outcome variable was the home discharge preference within 5 days after hospitalization. The explanatory variables were socio-demographic and clinical factors. Multiple logistic regression analysis with backward variable selection was performed to investigate relationships between home discharge preference and these factors.

Results: In all, 1,056 (42%) patients showed their preference for discharge to their homes. Multiple logistic regression analysis identified relationships between discharge preference to home and five variables. Patients exhibiting the following characteristics tend to show the preference for discharge to their home: higher age, paresis, cancer, cohabitating, and higher functional independence measure motor (FIM-M) score on admission (13-91 points). The odds ratio of these factors for home discharge preference were 1.02 per a year (95% confidence interval[95%CI] 1.00-1.03), 3.68 (vs. without paresis, 95%CI 1.83-7.38), 2.35 (vs without cancer, 95%CI 1.11-4.94), 3.04 (vs. living alone, 95%CI 2.03-4.56), 1.06 (vs lower FIM-M score, 95% 1.05-1.07), respectively. The model showed an area under the curve equal to 0.83 (95%CI 0.80-0.86).

Conclusion: Patients’ preference for home discharge is influenced largely by physical impairments and support availability. Additionally, patients with comorbidity such as cancer tend to choose facility care rather than home care. These results showed that development of a family support system for elder patients in multimorbid situations facilitated their decision for home discharge.

Abstract TP19: Impact of Revascularization Therapy on Patient Outcome by the Severity of Acute Ischemic Stroke

Background and Purpose: It has not fully investigated whether the benefit from revascularization therapy for patients with mild acute ischemic stroke (AIS) can overweigh the risk. The aim of this study was to investigate the impact of revascularization therapy on patient outcome as related to the severity of the stroke.

Methods: From our hospital’s stroke database from January 2006 to March 2017, we extracted data for patients with AIS. Eligible criteria for the patients were: modified Rankin Scale (mRS) of 0 or 1 before onset, admitted less than 24 hours after onset, and followed up for at least 3 months. Revascularization therapy included intravenous tissue plasminogen activator; endovascular therapy (intra-arterial urokinase infusion, percutaneous transluminal angioplasty, emergent carotid artery stenting, and thrombectomy); and carotid endarterectomy performed within 14 days from onset.

Patients were divided into 4 groups based on the severity using the National Institutes of Health Stroke Scale (NIHSS) on admission : Group 1 = 0-4, Group 2 = 5-9, Group 3 = 10-19, and Group 4=20-. We defined a good outcome as mRS score of 0-1 at 3 months after onset. The odds ratio of a good outcome was computed among 4 groups, adjusting for age and sex.

Results: We extracted data for 3275 patients with AIS (71.3 years, 65.1% men). Of these, 17.9% received revascularization therapy of any type. This was distributed across the 4 NIHSS groups as follows: 6.1% of Group 1 (n=2193), 27.1% of Group 2 (n=527), 56.4% of Group 3 (n=298), and 55.6% of Group 4 (n=257). The odds ratios (95% confidence interval) of treatment for good outcome in group 1 to 4 were 0.42 (0.29-0.62), 1.15 (0.78-1.72), 2.80 (1.60-4.90), and 4.40 (1.79-10.82), respectively. Group 1 was further divided into 5 subgroups by each NIHSS scores of 0-4. The odds ratios for each subgroup (NIHSS scores 0, 1, 2, 3, and 4) were 0.20 (0.07-0.61), 0.28 (0.11-0.69), 0.27 (0.11-0.69), 0.93 (0.43-2.03), and 0.88 (0.42-1.85), respectively.

Conclusions: Approximately half of the patients with NIHSS score of ≥10 received revascularization therapy and had significant benefit. However, revascularization therapy for patients with mild AIS (specifically NIHSS scores of 0, 1, or 2) could be rather harmful.

Serum 1,5-Anhydroglucitol: Risk Factor of Acute Ischemic Stroke and Transient Ischemic Attack in Well-Controlled Diabetes

BACKGROUND

Serum 1,5-anhydroglucitol (1,5-AG) levels are a measure that provides information on daily glycemic variations. We evaluated whether 1,5-AG could be a possible marker of acute ischemic stroke (AIS) or transient ischemic attacks (TIA) in patients with diabetes mellitus (DM).

METHODS

We retrospectively reviewed electronic medical records of 5,294 AIS/TIA patients. Of the 5,294, 1,898 had diabetes and in 1,246, serum 1,5-AG levels were measured (group S). Group S was divided into 2 subgroups: hemoglobin A1c (HbA1c) <7% (S-low) and >7% (S-high). As controls, 394 outpatients with diabetes (group C) without AIS/TIA were likewise divided into subgroups, C-low and C-high according to HbA1c level. In each HbA1c subgroup, the association between serum 1,5-AG (≥14 vs. <14 µg/mL) and stroke was examined using multivariable logistic regression (MLR) with stepwise variable selection. In model 1, the OR and 95% CI was examined adjusted for age and gender. Known risk factors for stroke; hypertension, dyslipidemia, alcohol consumption, smoking, and estimated glomerular filtration rate were included in model 2.

RESULTS

Overall, serum 1,5-AG levels were lower in group S than in group C. Serum 1,5-AG levels were low in subgroups S-high and C-high, showing no differences in mean values. However, mean serum 1,5-AG levels in S-low was statistically lower than that in C-low. MLR analysis showed that the OR for low (<14 µg/mL) 1,5-AG for stroke was statistically significant only in well-controlled diabetes (OR [95% CI] 2.19 [1.54-3.10]) in model 1 and (2.26 [1.56-3.28]) model 2.

CONCLUSIONS

Low serum 1,5-AG levels could be a possible marker for AIS/TIA risk in patients with well-controlled DM.

Reliability and validity of revised and short form versions of diabetes diet-related quality of life scale

OBJECTIVE

To develop both a revised version of the Diabetes Diet-Related Quality of Life (DDRQOL-R) scale that can be applied to patients with nephropathy and a short form of the DDRQOL-R.

METHOD

A total of 184 outpatients with type 2 diabetes were asked to complete the self-administered DDRQOL-R scale to confirm its psychometric properties. A short-form version was developed, based on two methods: the result of the developed DDRQOL-R scale and consensus using the Delphi method among medical experts.

RESULTS

Correlations were generally strong between the DDRQOL-R factors extracted by factor analysis and each SF-36 subscale. Cronbach's α coefficients were at least 0.7, and intraclass correlation coefficients were between 0.59 and 0.78. The nine items that showed high factor loadings were also assessed as important by the medical experts and were selected for the short form of the scale. The reliability and validity of the short form were found to be similar to those of the DDRQOL-R scale.

DISCUSSION

Our findings indicate that the DDRQOL-R scale and its short form have acceptable reliability and validity. The revised version is highly versatile, and the short form can be conveniently administered.

Abstract WP367: Volume of Intracerebral Hemorrhage Varies According to the Kind of Anticoagulant: Direct Oral Anticoagulants vs Warfarin

Background and Hypothesis: The effectiveness and safety of anticoagulants, which are widely used for preventing stroke recurrence, in stroke prevention is well established, they rarely cause severe adverse events, such as intracerebral hemorrhage (ICH). Direct oral anticoagulants (DOACs) have recently become an option for anticoagulation therapy. The incidence of hemorrhagic events in patients under DOAC therapy has been investigated in several studies, but it is unclear whether the severity of a hemorrhagic event is influenced by the use of DOACs. We hypothesized that the severity of ICH is different in patients under warfarin versus those under DOAC therapy.

Method: We retrospectively reviewed medical records and computed tomography images of patients with ICH who were treated at our hospital during April 2011-May 2016. Patients’ clinical characteristics and ICH volume and location were compared between warfarin- and DOAC-treated patients.

Result: Of the 1147 patients with ICH, 114 patients were taking anticoagulants on admission. Eighty-nine patients (78.1%) received warfarin, whereas 25 (21.9%) received DOACs. The following DOACs were used: dabigatran (two patients), rivaroxaban (10 patients), apixaban (12 patients), and edoxaban (one patients). Median ICH volume was significantly lesser in DOAC-treated patients than in warfarin-treated patients [8.1 (range, 0.05-160) ml vs 15.9 (range, 0.1-119) ml, respectively; p = 0.048). A significant correlation between ICH volume and HAS-BLED score was found only in the DOACs group (ρ= 0.560 p = 0.004) but not in the warfarin group (ρ= 0.025 p = 0.822). We found two patients with an ICH volume of >150 mL in the DOACs group. Their HAS-BLED score was 3, and they had experienced multiple stroke events (three or six times).

Conclusion: ICH volume was lesser in DOAC-treated patients than in warfarin-treated patients. We also found that HAS-BLED can be a predictor of ICH volume in DOAC-treated patients.

Abstract WP370: Cerebral Microbleeds Play an Important Role in Turning Recurrent Stroke Towards Intracranial Hemorrhage in Patients With First-ever Ischemic Stroke/Transient Ischemic Attack

Background and Purpose: After ischemic stroke (IS) or transient ischemic attack (TIA), use of an antithrombotic agent to prevent recurrence is mandatory. However, antithrombotic agents rarely cause intracranial hemorrhage (ICH), frequently resulting in worse outcomes than recurrent IS. Cerebral microbleeds (CMBs) have been reported as a useful marker for finding ICH-prone patients. This retrospective study aimed to investigate the significance of CMB in the development of ICH in first-ever IS/TIA patients.

Methods: The data source was our consecutive patient registry between 2005 and 2015. Patients with stroke/TIA admitted to our hospital more than twice (first as first-ever IS/TIA and second or later as recurrent IS/TIA or ICH) and underwent head MRI including T2*-weighted imaging on the first admission were extracted. Clinical characteristics including use of antithrombotic therapy and distribution of CMB on the first and second admissions were compared between recurrent IS/TIA and ICH groups. Distribution of CMB was divided into deep, lobar, or both.

Results: In total, 708 IS/TIA patients (second stroke: 640 IS/TIA; 68 ICH) were extracted. The ICH group showed a longer period until second stroke (1,062 days vs. 817 days, p=0.022) and higher mean NIHSS score (14.8 vs. 6.1, p<0.001) on second admission than the IS/TIA group. On first admission, the ICH group had a higher frequency of CMB (72.1% vs. 49.5%, p<0.001) and lower frequency of cardioembolism (14.7% vs. 25.8%, p=0.044) than the IS/TIA group. About half of hemorrhages occurred in similar locations of the CMB depicted on first admission. A higher frequency of ICH was observed in patients with deep CMB (11.3% vs. 5.6%, p=0.022) or both deep and lobar CMBs (17.4% vs. 5.6%, p<0.001) than in those without CMB. Use of anticoagulants was a significant risk factor for transition from first IS/TIA to second ICH (odds ratio [95% confidence interval]: 3.75 [1.30-10.8], adjusted by sex, age, type of first stroke, and CMB location).

Conclusions: This study found IS/TIA patients with CMB are at high risk of ICH compared to patients without CMB. Preventive antithrombotic treatment particularly use of anticoagulants for CI/TIA patients with CMB should be provided under careful monitoring for the risk of hemorrhage.

A culturally tailored Internet cancer support group for Asian American breast cancer survivors: A randomized controlled pilot intervention study

Introduction The necessity of culturally competent Internet Cancer Support Groups (ICSGs) for ethnic minorities has recently been highlighted in order to increase its attractiveness and usage. The purpose of this study was to determine the preliminary efficacy of a culturally tailored registered-nurse-moderated ICSG for Asian American breast cancer survivors in enhancing the women's breast cancer survivorship experience. Methods The study included two phases: (a) a usability test and an expert review; and (b) a randomized controlled pilot intervention study. The usability test was conducted among five Asian American breast cancer survivors using a one-month online forum, and the expert review was conducted among five experts using the Cognitive Walkthrough method. The randomized controlled pilot intervention study (a pre-test and post-test design) was conducted among 65 Asian American breast cancer survivors. The data were analysed using content analysis and descriptive and inferential statistics including the repeated ANOVA. Results All users and experts positively evaluated the program and provided their suggestions for the display, educational contents, and user-friendly structure. There were significant positive changes in the support care needs and physical and psychological symptoms ( p < 0.05) of the control group. There were significant negative changes in the uncertainty level of the intervention group ( p < 0.10). Controlling for background and disease factors, the intervention group showed significantly greater improvements than the control group in physical and psychological symptoms and quality of life ( p < 0.10). Discussion The findings supported the positive effects of ICSGs on support care needs, psychological and physical symptoms, and quality of life.

Abstract TP62: The Incidence of Post-treatment Cerebral Microbleeds After Combined Therapy of Endovascular Thrombectomy and tPA

Introduction: Cerebral microbleeds (CMBs) are considered as a risk factor for stroke. The incidence of post-tPA microbleeds have been reported in recent studies, however, it is not clear that whether hybrid procedure (the combination of tPA and endovascular thrombectomy) for ischemic stroke would increase risk of post-treatment CMBs more than treatment with tPA or endovascular thrombectomy alone. Objective of this study is to compare the incidence of post-treatment CMBs and symptomatic exraischemic hemorrhage by treatments: hybrid procedure, tPA alone, and endovascular thrombectomy alone.

Hypothesis: Combined therapy of endovascular thrombectomy and tPA for ischemic stroke have higher incidence of post-treatment CMBs than tPA or endovascular thrombectomy alone.

Methods: We retrospectively reviewed pre- and post-T2*-weighted MRI of ischemic stroke patients who received above treatments in our hospital during 2010 to 2014. The presence and number of CMBs were assessed according to the Brain Observer Microbleeds Scale. We compared the number of pre-treatment CMBs, incidence of newly-occurred post-treatment CMBs and symptomatic extraischemic hemorrhage within a year after treatments among hybrid procedure, tPA alone, and endovascular thrombectomy alone.

Results: A total of 147 (hybrid procedure n=17, tPA alone n=90, endovascular thrombectomy alone n=40) patients’ pre- and post-treatment MRIs were reviewed. The average number of pre- treatment CMBs was 1.4±4.0 and there was no difference among treatments. The incidence of post-treatment CMBs was significantly higher in hybrid procedure (n=5, 29.4%) and tPA alone (n=18, 20.0%) than endovascular thrombectomy (n=1, 2.5%). However, there was no difference between hybrid procedure and tPA alone. Symptomatic extraischemic hemorrhage was found only one patient who received endovascular thrombectomy alone.

Conclusion: The incidence of CMBs after treatments was increased in treatments using tPA. However, there was no difference in post-treatment incidence between hybrid procedure and tPA alone. This result suggests that additional thrombectomy after tPA would not increase the risk of CMBs.

Abstract TP208: 1,5-anhydro-d-glucitol as a Predictor of Cerebral Infarction in Patients With Glycated Hemoglobin A1c-based Good Diabetes Control

Introduction: Current guidelines set the goal of diabetes control to a glycated hemoglobin A1c (HbA1c) level of <7% in order to prevent macrovascular events. However, we often experience diabetes patients with cerebral infarction (CI), even though their HbA1c level is well-controlled. A reason for this disparity between the diabetes control status and CI onset may be the limitation of HbA1c as a diabetes control indicator. HbA1c reflects the mean blood glucose level over the past 2-3 months. Therefore, with HbA1c, we cannot evaluate short-term blood glucose control and glycemic variability, which are reported as risk factors for CI. Measurement of 1,5-anhydro-D-glucitol (1,5AG) allows the evaluation of these factors.

Hypothesis: 1,5AG can be used to evaluate the risk of CI in patients with well-controlled diabetes.

Methods: We retrospectively reviewed the medical records of 1169 patients with diabetes who received treatment for CI at our hospital between 2009 and 2014. These patients were divided into the following two groups according to their HbA1c-based diabetes control status: a CI-low group (HbA1c <7%, n=549) and a CI-high group (HbA1c ≧7%, n=620). We also included a non-CI group of 394 diabetes patients without CI (control group), and these patients were further divided into the following two groups in the same manner: a nonCI-low group (n=199) and a nonCI-high group (n=195). The 1,5AG levels were compared between the CI-low and nonCI-low groups, and the CI-high and nonCI-high groups.

Results: There was no difference in the 1,5AG level between the CI-high and nonCI-high groups (8.8±7.3% vs. 8.9±7.1%, p=0.83). However, the 1,5AG level was significantly lower in the CI-low group than in the nonCI-low group (12.5±8.1% vs. 15.2±8.8%, p<0.001). This difference remained significant after adjusting for age and sex.

Conclusion: The results of this study show that short-term glycemic control and glycemic variability have a significant relationship with existing CI especially in patients with good diabetes control. The 1,5AG level may be a surrogate measure of the risk of CI in patients with HbA1c levels that indicate good diabetes control.

Relationship between Cnm-positive Streptococcus mutans and cerebral microbleeds in humans

OBJECTIVE

Cerebral hemorrhage has been shown to occur in animals experimentally infected with Streptococcus mutans carrying the collagen-binding Cnm gene. However, the relationship between cerebral microbleeds and oral hygiene, with a focus on Cnm gene-positive S. mutans infection, remains unclear.

MATERIAL AND METHODS

One hundred and thirty-nine subjects participated. The presence or absence of Cnm-positive S. mutans and its collagen-binding activity were investigated using saliva samples, and relationship with cerebral microbleeds detected on MRI investigated, including clinical information and oral parameters.

RESULTS

Fifty-one subjects were identified as Cnm-positive S. mutans carriers (36.7%), with cerebral microbleeds being detected in 43 (30.9%). A significantly larger number of subjects carried Cnm-positive S. mutans in the cerebral microbleeds (+) group. S. mutans with Cnm collagen-binding ability was detected in 39 (28.1%) of all subjects, and the adjusted odds ratio for cerebral microbleeds in the Cnm-positive group was 14.4. Regarding the presence of cerebral microbleeds, no significant differences were noted in the number of remaining teeth, dental caries, or in classic arteriosclerosis risk factors.

CONCLUSIONS

The occurrence of cerebral microbleeds was higher in subjects carrying Cnm-positive S. mutans, indicating that the presence of Cnm-positive S. mutans increases cerebral microbleeds, and is an independent risk for the development of cerebrovascular disorders.

Practical issues in multi-lingual research

BACKGROUND

With an increasing number of ethnic minority populations, the use of multiple languages in one research study has increased in recent years. The use of multiple languages helps increase comprehensiveness of educational materials and/or survey questionnaires, and promote ethnic minorities' participation in research. However, little has been clearly known about practical issues in using multiple languages in one research study.

OBJECTIVES

The purpose of this paper is to explore practical issues in using multiple languages in a study among diverse sub-ethnic groups of Asian American breast cancer survivors in order to propose future directions for the use of multiple languages in research projects.

METHODS

Throughout the research process, research team made written records of practical issues and possible reasons for the issues as they arose. Weekly group discussions among research team members were administered, and the written records of these discussions were reviewed and analyzed using the content analysis. The unit of analysis was individual words. The words in the data (memos and written records) were classified into idea categories that emerged from the coding process.

RESULTS

The idea categories included issues in: (a) collaborators from various sub-ethnic groups; (b) IRB protocol submissions; (c) consistencies in translation process, (d) conceptual equivalence; (e) cultural differences; (f) existing translated versions; and (g) authorship issues. Based on the issues, we made the following suggestions for multi-lingual research: (a) networking and setting multiple communication channels with potential collaborators; (b) checking the institution's IRB policies related to the use of multiple languages; (c) setting the rules and procedures for translation process; (d) checking existing different language versions of instruments; and (e) setting the rules for authorship in advance.

CONCLUSIONS

The suggestions made in this study would help the researchers be prepared in advance to deal with the challenges.

Abstract W MP53: The Prevalence and Characteristics of Attention Disorders in The Patients with First-onset Mild Hemorrhagic Stroke

Objectives: Recent study revealed that over 50 % of stroke patients had some form of attention deficits. However, few reports focused on acute phase and mild stroke patients. This study aimed to investigate the prevalence of attention disorders and the change of their symptoms during the hospitalization in the patients with first-onset mild hemorrhagic stroke.

Methods: Study subjects were 231 consecutive patients diagnosed as hemorrhage stroke and treated at our hospital from 2011 to 2012. Patients with severe hemorrhage (i.e., amount of bleeding >5cc), with previous history of cerebrovascular diseases or dementia, with decreased level of consciousness or with impaired activity of daily living were not eligible to this study. Neuropsychological assessments were conducted by speech therapists at 1 and 2 week after stroke onset using Clinical Assessment for Attention (CAT) and examined how they changed. CAT was a test battery developed by the Japan Society for Higher Brain Dysfunction to evaluate deficit of attention disorders.

Results: Among the study subjects, 46 patients met the selection criteria and 16 patients (34.8%, 6 men, mean age was 66) were identified as having attention disorders. Bleeding lesions were left putamen (n=3), right putamen (n=9) and right thalamus (n=4). Significant improvements were observed in two types of focused attention and auditory selective attention measures: percentage of correct answers of Visual Cancellation Task (VCT, p=0.027) and Auditory Detection Task (ADT, p = 0.01). Additionally, working hours in VCT was significantly shortened, and the false-negative rate was also significantly decreased (p= 0.028). In ADT, the false-positive rate was significantly decreased (p= 0.012). No significant changes were observed in other type of tasks.

Discussion: More than one-third of patients showed attention deficits even though they had mild stroke. Only focused and selective attentions were improved in acute phase of mild stroke. These results suggested that improvement in focused and selective attention precede improvement in other attentional functions.

A screening instrument to identify ulcerative colitis patients with the high possibility of current non-adherence to aminosalicylate medication based on the Health Belief Model: a cross-sectional study

BACKGROUND

Non-adherence to aminosalicylates is observed among 30% to 45% of patients with ulcerative colitis and increases the risk of relapse. The Health Belief Model is a theoretical model that could offer a broader perspective to improve patients' self-medication adherence. This study aimed to develop a screening instrument based on the Health Belief Model to screen patients with ulcerative colitis who had a high possibility of current non-adherence to aminosalicylates. The study was also designed to allow examination of factors of non-adherence.

METHODS

A multicenter, cross-sectional study was conducted in outpatients diagnosed with ulcerative colitis and prescribed aminosalicylates. Non-adherence was defined as taking less than 80% of the prescribed dose. We hypothesized that there was a significant relationship between current aminosalicylate non-adherence and five components of the HBM: beliefs about taking aminosalicylates, disease characteristics, medication characteristics, abdominal symptoms, and sociodemographic characteristics. A logistic regression model was applied and the coefficients converted to a numeric scores in order to develop a screening instrument which could reliably discriminate non-adherent and adherent subjects.

RESULTS

Non-adherence was observed in 127 (29.6%) of the 429 enrolled subjects. Lower perceptions of belief in taking aminosalicylates, absence of visible bleeding, eight daily tablets or less taken, and no concomitant use of thiopurines were related to non-adherence. We then developed a screening instrument comprising 22 items. When the cut-off point was set at 60, the instrument showed 85.0% sensitivity and 69.2% specificity with an area under the curve of 0.84 (95% confidence interval = 0.79-0.91).

CONCLUSIONS

The instrument appeared to be reliable for identifying patients with a high possibility of current non-adherence to aminosalicylates. Further, the instrument may provide useful information for detecting patients with a high possibility of current non-adherence and for assessing factors of non-adherence. On the other hand, we need to evaluate disease activity more strictly and examine whether it is included in the screening instrument in the future.

Computer-supported indirect-form lifestyle-modification support program using Lifestyle Intervention Support Software for Diabetes Prevention (LISS-DP) for people with a family history of type 2 diabetes in a medical checkup setting: a randomized controlled trial

AIMS

To investigate the effect of a computer-supported indirect-form lifestyle-modification program using Lifestyle Intervention Support Software for Diabetes Prevention (LISS-DP), as a clinically feasible strategy for primary prevention, on diet and physical activity habits in adults with a family history of type 2 diabetes.

METHODS

This was a two-arm, randomized controlled trial: (1) lifestyle intervention (LI) group (n=70); (2) control (n=71). Healthy adults aged 30-60 years with a history of type 2 diabetes among their first-degree relatives were recruited. LI group received three times of lifestyle intervention using LISS-DP during six-month intervention period via mail.

RESULTS

Lifestyle intervention group showed significantly greater decrease in energy intake six months after baseline, compared to control (-118.31 and -24.79 kcal/day, respectively, p=0.0099, Cohen's d=0.22), though the difference disappeared 1 year after from baseline. No difference was found in physical activity energy expenditure.

CONCLUSIONS

A computer-based, non-face-to-face lifestyle intervention was effective on dietary habits, only during the intervention period. Further examination of the long-term effects of such intervention and physical activity is required.

Relationship between non-adherence to aminosalicylate medication and the risk of clinical relapse among Japanese patients with ulcerative colitis in clinical remission: a prospective cohort study

BACKGROUND

Thirty to forty-five percent of ulcerative colitis (UC) patients show non-adherence to aminosalicylates, and non-adherence has been reported to increase the risk of clinical relapse. Because Japan differs from Western countries in terms of health care and drugs administered, adherence to aminosalicylates in Japan may differ from that elsewhere. Therefore, we examined aminosalicylate adherence and its relationship to the risk of clinical relapse of UC in Japan.

METHODS

A 1-year, prospective cohort study was conducted in 104 outpatients with UC in remission who had taken aminosalicylates >6 months. Aminosalicylate adherence was evaluated using data from a self-administered questionnaire and medical records. Non-adherence was defined as taking <80 % of the prescribed dose of aminosalicylates. The primary outcome was the record of clinical relapse in medical charts.

RESULTS

Twenty-nine patients (27.9 %) were evaluated as showing non-adherence. Among all subjects, 24 patients (23.1 %) relapsed. The non-adherence group had a higher rate of 1-year relapse than did the adherence group (41.3 vs. 16.0 %). Multiple Cox regression analysis showed that non-adherence increased the risk of clinical relapse 2.3-fold (hazard ratio 2.3, 95 % confidence interval 1.004-5.24, p = 0.04).

CONCLUSIONS

Although the adherence rate in this study was slightly higher than that in previous studies, Japanese patients with UC who were not adherent to their medications had a twofold greater risk of relapse than those who were. These results indicate the importance of early identification of patients with non-adherence. A program to support medication taking behavior is needed to prevent UC relapse.

Care managers' confidence in managing home-based end-of-life care: a cross-sectional study

Background

There are increasing occasions for care managers (CMs) to manage end-of-life (EOL) situations for older persons at home, in Japan. However, many CMs report anxiety, difficulties and low confidence in managing such care, although confidence is considered a significant determinant of professional performance. This study examined the confidence of CMs at managing home-based EOL situations and its factors.

Methods

Participants of this cross-sectional study were CMs from 1,200 homecare agencies in Japan, which were systematically sampled from a national database. Participants were asked about their overall confidence in managing home-based EOL situations, as well as their demographic, professional and agency characteristics. Multiple logistic regression analysis was conducted to examine the factors associated with CM confidence levels.

Results

Valid responses were obtained from 458 participants (response rate, 39.4%). Among the respondents, 81.0% (n = 371) were female; mean age 49.2 years old (standard deviation = 8.8). Their professional backgrounds included nurses (28.2%), care workers (49.8%), social workers (10.9%), and home attendants (6.1%). Approximately 70% of CMs expressed some level of confidence in managing home-based EOL situations. Multiple logistic regression analysis showed that being confident was significantly associated with having a nursing license (OR: 2.71, 95% CI: 1.26–6.19) and having an additional work responsibility other than being a CM, such as working as a homecare nurse or a home attendant (OR: 2.78, 95% CI: 1.06–4.74). Higher confidence levels were more frequently reported among those who had multiple experiences with EOL situations, compared with those who had none, or only one experience: OR=2.60 (95% CI 1.26–5.50) for those with 2-3 cases; OR=7.12 (3.21–16.56) for those with 4-10 cases; OR = 33.67 (8.14–235.19) for those with 11 cases and over.

Conclusions

These results suggest that CMs with direct, hands-on experience with EOL care, or who have managed multiple EOL cases, tended to be confident at managing home-based EOL situations. Given that the number of nurses working as CMs is decreasing, further research is needed to explore what support CMs need to increase their confidence, especially when the CMs do not have nursing licenses and/or experience with EOL situations.

Abstract TP369: Blood Pressure Dynamics During Long Sitting Position In Acute Ischemic Stroke Patients: Prevalence Of Orthostatic Hypotension

Background and Purpose: Long sitting positioning (LSP) using head of bed elevation is an important part of early rehabilitation and mobilization for patients with acute ischemic stroke. However, little is known about orthostatic hypotension (OH) during LSP, which is potential risk factor for ischemic stroke recurrence. This study aimed to investigate the prevalence of OH during LSP and its related factors.

Methods: Patients with acute ischemic stroke were enrolled in this study (n=246, male: 68.1%, mean age 74.7y). Ten-minutes LSP by 70-degree head of bead elevation with successive blood pressure (BP) measurement was conducted a week after their stroke. BP was measured for three times on un-affected arm: pre-measurement in supine position, 1 and 10 minutes after beginning of LSP. OH was defined as ≥20 mmHg fall in systolic BP (SBP) and/ or ≥10 mmHg fall in diastolic BP (DBP) from pre-measurement in supine position. Potential related factors such as demographics, comorbidities, stroke severity, baseline BP were investigated by multivariate logistic analysis.

Results: The overall prevalence of OH were 15.0% (n=37) at 1 minute and 20.3% (n=50) at 10 minutes after beginning of LSP. Patients with OH at 1 minute were more likely to have higher supine DBP (p=0.034), and patients with OH at 10 minutes were more likely to have higher supine SBP (p=0.004) and DBP (p<0.001). In multivariate logistic analysis showed that older age (OR [95%CI], 1.05[1.01-1.09]), male gender (3.15[1.19-8.33]) and higher supine DBP (1.03[1.00-1.06]) were independently associated with the OH at 1 minute after LSP. Similarly, older age (1.05[1.01-1.08]) and higher supine DBP (1.05[1.03-1.08]) were independently associated with OH at 10minutes after LSP.

Conclusions: The OH prevalence at 1 minute after beginning of LSP was similar to previous studies which defined OH as hypotension in upright position. However, the prevalence rose remarkably at 10 minutes after LSP, while temporary hemodynamic instability would recover within one minute in healthy adults. These results implicated that impaired activity of the autonomic nervous system in acute ischemic stroke patients was associated with defect in hemodynamics regulation, especially in the patients with older age and/or higher supine BP.

Development of a support skill scale in insulin therapy: a nationwide study in Japan

The aim of this cross-sectional, nationwide study in Japan was to develop a support skill scale for insulin therapy (IT-SSS) and to evaluate its validity and reliability. The sample consisted of 1604 nurses at 123 hospitals throughout the country. The factor validity, known-group validity, convergent validity, discriminant validity and internal consistency of IT-SSS were assessed. IT-SSS consisted of 26 minimum and 25 standard support skills. They included 4 subscales for minimum skills: management strategy for hypoglycemia, education about insulin injection technique, individual assessment and support about insulin rejection, and collaboration with medical professionals and patient/family. Three subscales for standard skills: apprehensions concerning the will and emotion of the patient, management for blood glucose control, and coordination in insulin management. Cronbach's alpha coefficient was between 0.75 and 0.90, suggesting strong internal consistency. Multitrait analysis showed that convergent validity was complete, and discriminant validity was found to be almost complete in both minimum and standard skill scales (scaling success rates of 97.6% and 98.7% across all subgroups, respectively). Known group analysis clearly showed that specialist nurses have significantly higher skills than general nurses. These findings indicate that IT-SSS has a reasonable factor validity, convergent validity, discriminant validity, known group validity, and internal consistency.

Influence of dietary therapy appraisal on future perceived control of type 2 diabetes

We sought to elucidate the causal effect of patients’ self-appraisal of their dietary regimen on their control beliefs among adults with type 2 diabetes. Data from 176 outpatients were assessed using a two-wave cross-lagged panel model. We found that a cross-lagged path connecting dietary appraisal at baseline to perceived control at one year (β = .30, p = .003) was larger than a path connecting perceived control at baseline to dietary appraisal at one year (β = —.16, p = .07). We conclude that dietary appraisal has a feedback effect on the future perceived control of type 2 diabetes.

Impact of a Booklet about Diabetes Genetic Susceptibility and Its Prevention on Attitudes towards Prevention and Perceived Behavioral Change in Patients with Type 2 Diabetes and Their Offspring

Background. Offspring of type 2 diabetic patients are at a high risk of type 2 diabetes. Information on diabetes genetic susceptibility and prevention should be supplied to the offspring. Methods. A six-page booklet on diabetes genetic susceptibility and prevention was distributed to 173 patients who ere ordered to hand it to their offspring. The patients answered a self-administered questionnaire on booklet delivery and attitudinal and behavioral changes toward diabetes and its prevention in themselves and their offspring. Results. Valid responses were obtained from 130 patients. Forty-nine patients had actually handed the booklet. Booklet induces more relief than anxiety. From the patient's view, favorable attitudinal and/or behavioral changes occurred in more than half of the offspring who were delivered the booklet. Conclusion. The booklet worked effectively on attitudes and behaviors toward diabetes and its prevention both in patients and their offspring. However, the effectiveness of patients as information deliverers was limited.

Feasibility and efficiency of indirect lifestyle interventions in offspring of type 2 diabetic patients

INTRODUCTION

Individuals genetically predisposed to type 2 diabetes represent an important target for preventive strategies. Genetic screening, based on information about individual genetic variants, will be possible technically, but translational research in this field is still insufficient. Family history thus represents a useful tool for detecting genetically high-risk populations in this post-genomic era.

OBJECTIVES

The purpose of this pilot study was to investigate the feasibility and efficiency of indirect lifestyle interventions in offspring of type 2 diabetic patients.

METHODS

Offspring were recruited from 74 diabetic (Group 1) and 39 non-diabetic (Group 2, control group) patients. A lifestyle intervention was conducted by mail, a total of 3 times, every 3 months. Lifestyle related to diet and physical activity was assessed using a self-administered questionnaire.

RESULTS

Ten offspring of type 2 diabetic and 6 of non-diabetic patients participated in this study. Total energy intake decreased after 3 interventions in both of the groups (Group 1: 305 ± 228.8 kcal/day, p = 0.004; Group 2: 82 ± 65.6 kcal/day, p = 0.04); however, the effect of intervention was significantly greater in Group 1 compared to Group 2 (p = 0.021). Physical activity and other physical outcomes were stable in normal levels during the study period in both of the groups.

CONCLUSIONS

The intervention program helped to reduce total energy intake in offspring of type 2 diabetic patients more than in the control group, but the acceptance rate of the intervention program was disappointingly low. Further consideration is required to access and motivate offspring to develop precautionary lifestyle principles.

Preventive advice given by patients with type 2 diabetes to their offspring

BACKGROUND

Patients' advice-giving behaviour could be a useful preventive strategy for type 2 diabetes.

AIM

To investigate the conditions under which patients offer advice to their offspring and to assess the factors that facilitate advice giving.

DESIGN OF STUDY

Cross-sectional observational study.

SETTING

A general hospital with a diabetes clinic in a metropolitan suburb in Japan.

METHOD

Parents with type 2 diabetes (n = 221) who had offspring aged 20-49 years inclusive without diabetes completed a self-administered questionnaire containing items relating to advice-giving behaviour, demographic characteristics, risk perception, and their disease status.

RESULTS

A total of 184 (83.3%) patients responded that parental advice-giving behaviour is needed for their offspring, while 138 (62.4%) actually advised their offspring. Multiple logistic regression analysis showed that patients who were female (odds ratio [OR] = 1.94, 95% confidence interval [CI] = 1.03 to 3.65, P = 0.041), living with their offspring (OR =1.92, 95% CI = 1.04 to 3.57, P = 0.038), had complications (OR = 2.74, 95% CI = 1.25 to 6.00, P = 0.029), or perceived that their offspring had a high risk of developing diabetes (OR =1.45, 95% CI = 1.09 to 1.93, P = 0.011) were most likely to advise their offspring.

CONCLUSION

Patients with type 2 diabetes recognised the need to give advice about preventive behaviour to their offspring but were not necessarily engaging in advice-giving behaviour. Advice-giving behaviour was affected by the parents' own disease status, their perception of their offspring's risk of developing diabetes, and the relationship between the patients and their offspring.

Preventive behaviour in adult offspring of Type 2 diabetic patients and its relationship to parental advice

AIMS

This study was conducted to investigate preventive behaviour of offspring at risk of Type 2 diabetes, particularly focusing on the relationship between patients' behaviour of giving advice as parents.

METHODS

This cross-sectional study was based on a self-reported questionnaire survey and was conducted at the diabetes clinic of one general hospital. Subjects were 164 pairs, comprising Type 2 diabetic patients ranging in age from 50 to 75 years and non-diabetic offspring ranging in age from 20 to 50 years.

RESULTS

Approximately half of patients' offspring were engaged in preventive behaviour; 51.2% to prevent weight gain and 50.6% to have a healthy diet. The proportion of offspring taking regular exercise was significantly less (40.2%) than those attempting weight control and eating a healthy diet (P = 0.0039, P = 0.0035, respectively). One hundred and six (64.6%) patients advised their offspring to change their lifestyle habits, such as with diet or exercise, for diabetes prevention. However, preventive behaviours in offspring, including preventing weight gain, having a healthy diet and taking regular exercise, were not facilitated by parental advice (P = 0.27, 0.92, 0.61, respectively). The offspring regarded medical professionals or mass media as reliable information sources, but not the family. However, they received information about diabetes most frequently from their family.

CONCLUSIONS

Although more offspring practised preventive behaviour than expected, they were less likely to exercise than to change their diet or attempt to control their weight. Parental advice did not facilitate offspring preventive behaviour. Further research is needed to discover how to mediate links between parental advice and offspring preventive behaviour.

2-Arachidonoylglycerol and anandamide oppositely modulate norepinephrine release from the rat heart sympathetic nerves

Anandamide (10(-7) and 10(-6) M) as well as a synthetic cannabinoid HU210 (10(-8) to 10(-6) M) suppressed the norepinephrine release evoked by perivascular nerve stimulation (PNS) of the rat heart Langendorff's preparation. The effects of HU210 and the lower dose of anandamide were completely blocked by the cannabinoid CB1-receptor antagonist AM251, while that of anandamide at 10(-6) M was partly mediated by arachidonate-derived metabolites. 2-Arachidonoylglycerol (2-AG), at 10(-6) M in the presence of DFP and indomethacin, increased PNS-evoked norepinephrine release, which was completely blocked by AM251. The present results suggest that the two endocannabinoids may oppositely participate in the CB1-receptor-mediated modulation of sympathetic norepinephrine release.

Different turnover rate of hepatitis C virus clearance by different treatment regimen using interferon-beta

BACKGROUND/AIM

Since patients with high viral load and HCV subtype 1b are known to respond poorly to interferon (IFN) therapy, the viral dynamics of HCV RNA after initiation of interferon therapy were examined in the present study with respect to two different administration regimens, once vs. twice a day.

METHODS

Twenty-two patients with chronic hepatitis C confirmed by liver biopsy and with >1 Meq/ml of HCV RNA and HCV subtype 1b were randomly assigned to two different IFN administration regimens (6 million units of IFN once a day or 3 million units of IFN twice a day), and the serum HCV RNA level was serially measured.

RESULTS

Graphs of HCV RNA levels vs. treatment time showed an initial rapid fall, followed by a slower clearance phase. Fitting the data to a model for HCV decay proposed by Neumann et al. showed that the treatment efficacy was significantly higher with twice daily administration. Negativity for HCV RNA measured by Amplicor assay in the twice-a-day administration group was 18%, 73% and >89% at 1, 2 and 3 weeks, respectively, in contrast to 0%, 0%, and 18%, respectively, with once-a-day administration. However, a significant reduction of platelet count and albumin level, a marked increase in serum aspartate aminotransferase/alanine aminotransferase, and a high incidence of renal toxicity (proteinuria) were found in patients receiving IFN twice a day in comparison with those receiving it once a day.

CONCLUSION

The twice-a-day administration of IFN accelerated the clearance of HCV RNA from serum, leading to a more efficient virological response for patients with chronic hepatitis C, but with a high rate of renal toxicity.

[Adjuvant chemotherapy with UFT or UFT with OK-432 to patients with gastric and colorectal cancer. Kanto Adjuvant Study Group]

In Japan, long-term oral therapy with tegafur in combination with immunopotentiators is commonly used as adjuvant therapy after curative resection of gastric or colorectal can for gastric and colorectal cancer. When the outcome was analyzed in terms of the relative performance (R.P.) and the individual dose intensity (I.D.I.) of OK-432, gastric cancer patients with a R.P. of 0.5 or higher tended to have a better survival curve. There were no marked differences in lymphocytes subsets, except that the Leu 7 level at 3 months after gastric cancer resection was significantly higher (p < 0.05) in group B than in group A. Thus, no inhibition of the anticancer effect of UFT was noted during long term combination therapy with UFT and an immunopotentiator as postoperative adjuvant therapy for patients who underwent curative resection of gastric or colorectal cancer. The results suggest that UFT combined with long-term OK-432 maintenance therapy may contribute to improve survival rates in gastric cancer patients.

Biological implications of estrogen and androgen effects on androgen receptor and its mRNA levels in human uterine endometrium

It has been shown that some effects of testosterone are different from those of its 5 alpha-reduced metabolite, dihydrotestosterone. Briefly, activities of testosterone might be related to cellular differentiation, whereas dihydrotestosterone acts on cellular proliferation. The number of testosterone binding sites in the uterine endometrium was increased by estradiol dipropionate, and this increase was down-regulated by testosterone cypionate. Dihydrotestosterone-specific binding sites in the endometrium were not modulated by estradiol dipropionate and testosterone cypionate. The dissociation constants of the binding sites for testosterone and dihydrotestosterone were not altered by these steroids. Estradiol dipropionate with or without testosterone cypionate induced androgen receptor mRNA expression in the endometrium. In conclusion, testosterone might predominantly affect cellular differentiation in the endometrium.

Danazol decreases transcription of estrogen receptor gene in human monocytes

1. Administration of danazol for over one month reduced the levels of estrogen receptor (ER) and its mRNA to approximately 50 and 20%, respectively in monocytes. 2. Danazol did not alter the degradation rate of ER mRNA in monocytes. 3. Danazol decreased the transcription rate of ER gene to approximately 50% in monocytes in a run-on assay. 4. Danazol may release estrogen predominance via the reduction of transcription for ER gene, which leads to the reduction of ER mRNA and ER expressions in monocytes.

Effects of Estradiol and Testosterone on the Synthesis, Expression and Degradation of Androgen Receptor in Human Uterine Endometrial Fibroblasts

The mechanism of known receptor-mediated androgen effects on the endometrial stroma was studied in endometrial fibroblasts derived from human uterus. 17beta-Estradiol (E) induced the expressions of androgen receptor (AR) mRNA, and predominantly increased the level of testosterone-binding sites (TBS) in uterine endometrial fibroblasts. The effect on the level of dihydrotestosterone-binding sites (DHTBS) was similar but smaller. This result suggests that the AR mRNA expressed might encode TBS, but probably not DHTBS. The TBS level increased by estrogen was down-regulated by testosterone (T) + E, but the AR mRNA expression increased by E was not down-regulated by E + T in the fibroblasts. Although the synthesis rate of AR was slightly increased (p < 0.05) by E alone or E + T, the degradation rate of AR was significantly accelerated (p < 0.05) by E + T in the fibroblasts. This result suggests that T might stimulate the metabolic rate of TBS, but does not inhibit the synthesis rate of AR mRNA to TBS in endometrial fibroblasts. Copyright 1995 S. Karger AG, Basel

Effects of danazol and medroxyprogesterone acetate on estrogen-(estradiol and estriol) specific binding sites in rabbit uterus

In rabbit uterus, the presence of separate specific binding sites for not only estradiol but also estriol has been proposed. These sites may be correlated with an antiestradiol effect. Therefore, this study was designed to investigate the effect of antiestrogenic agents such as danazol and medroxyprogesterone acetate (MPA), especially on the estriol binding sites. Danazol and MPA in combination with estradiol were administered subcutaneously to immature female rabbits daily for 10 days, and resulted in a significant (p < 0.05) decrease in uterine weight and estradiol binding sites in the uterus. Treatment with MPA significantly (p < 0.05) decreased the level of estriol binding sites, but treatment with danazol resulted in this to a minimal extent in the uterus primed by estradiol. MPA did not bind to estradiol and estriol binding sites, while danazol at a high concentration bound to estriol binding sites with some affinity, but not to estradiol binding sites in the uterine cytosol of estrogen-primed rabbits. These results suggest that within the antiproliferative effect of danazol and MPA (an antiestrogenic action on estrogen-stimulated uterine growth) there are likely to be specific differences between some of the possible mechanisms of danazol and MPA in their action at the estriol binding site.

Expression of progesterone receptor form A and B mRNAs in gynecologic malignant tumors

This study was designed to examine the biological implication of progesterone receptor (PR) forms A and B mRNA expressions in gynecologic cancers. The ratio of PR form A to form B in mRNA expression was approximately 1:1 in all endometria studied. The predominant expressions of form B transcript occurred in 6 out of 7 cases of advanced stages (stages III and IV) in ovarian cancers, in 5 out of 9 cases of cervical cancers, and in 5 out of 11 cases of endometrial cancers. In conclusions, the dominancy of PR form B mRNA expression might be associated with the expression of a malignant phenotype in gynecologic cancers, and advanced clinical stage in ovarian cancers, suggesting a biological marker of malignant phenotype in these three types of cancer cell.