This survey study uses the smallest worthwhile difference to assess US and Japanese individuals' willingness to take statins based on expected risk-reduction benefits and burden.
OBJECTIVES:To estimate the effect of initial Elderly Health Check-up (EHC) attendance on the 5-year risk of functional disability or death in community-dwelling older adults in a setting where preventing entry into long-term care (LTC) is a primary health-policy goal. DESIGN:Sequential target trial emulation using a population-based cohort. SETTING AND PARTICIPANTS:Community-dwelling adults aged 75 to 84 years without functional disability and without recent EHC participation, drawn from the Sukagawa Study, a population-based cohort in Sukagawa City, a rural municipality with an aging population in Fukushima Prefecture, Japan, between April 2018 and March 2021. METHODS:We compared initial EHC attendance within a 3-month grace period with nonattendance. The primary outcome was a composite of incident functional disability (LTC certification at care-need level ≥3) or death over 5 years; secondary outcomes were each component, with death treated as dependent censoring for disability. Five-year risks were estimated by inverse probability-weighted pooled logistic regression with 95% CIs. RESULTS:The cohort included 21,484 person-trials from 3096 unique individuals (1001 EHCs, 20,483 non-EHCs). The 5-year composite risk was 20.6% (EHC) vs 26.7% (non-EHC): risk difference, -6.1 percentage points (pp; 95% CI, -11.6 to 0.9); risk ratio, 0.77 (95% CI, 0.57-1.03). Corresponding risk differences were -3.7 pps (95% CI, -10.4 to 3.9) for all-cause mortality and -5.4 pps (95% CI, -12.9 to 0.1) for functional disability alone. CONCLUSIONS AND IMPLICATIONS:The evidence is uncertain about the effect of initial EHC participation on the 5-year risk of functional disability or death; the point estimate is compatible with a modest benefit, but the 95% CI included the null. These findings neither support expansion nor justify discontinuation of the EHC program for preventing entry into LTC, and call for replication in additional cohorts before policy changes are considered.
BACKGROUND:Post-traumatic stress disorder (PTSD) has been reported among both survivors and response workers following large natural disasters. The Japan Disaster Rehabilitation Assistance Team (JRAT) provides rehabilitation-focused support;however, few studies have examined post-traumatic stress symptoms (PTSS) among JRAT members. This study investigated the relationship between PTSS and the physical and mental conditions of JRAT members during support activities. METHODS:A questionnaire on job type, activity location, sleep quality, meal quality, fatigue, physical symptoms, and psychological symptoms was distributed among 23 JRAT members one month after deployment. PTSS were assessed using the Impact of Event Scale-Revised (IES-R), a self-report screening questionnaire. RESULTS:Overall, 27.3% of participants were classified into the probable PTSS group. Compared with the non-probable group, they reported significantly poorer sleep quality, more physical symptoms, and greater fatigue, whereas psychological symptoms were more common in the non-probable group. CONCLUSION:Our findings suggest that limited disaster relief experience, discrepancies between expectations and reality, and stress responses during relief activities may be associated with higher PTSS levels among JRAT members, underscoring the importance of comprehensive management of both physical and mental health across deployment phases.
BACKGROUND:The prognosis of pediatric patients with diffuse intrinsic pontine glioma (DIPG), glioblastoma, or anaplastic astrocytomas (AAs) is dismal. This first-in-child phase 1/2 study examined the safety and efficacy of a Wilms' tumor gene 1 (WT1) peptide vaccine, along with the associations of delayed-type hypersensitivity (DTH) and cytotoxic T lymphocyte (CTL) frequency/count with clinical outcomes. METHODS:Patients (<20 years) were intradermally injected with the vaccine. RESULTS:Among all patients (N = 18; median age: 8.9 years), 11, 5, and 2 had DIPG, glioblastoma, and AAs, respectively. In Phase 1 (n = 4), 3.5 mg was determined for use in Phase 2 (n = 14) because no dose-limiting toxicities occurred. In Phases 1 and 2, injection site reactions (n = 14, 77.8%) were the most common adverse events. All and DIPG patients showed the 9-month overall survival (OS) rates-the primary endpoint-of 44.4% (90% confidence interval (CI) [24.4-65.9]) and 27.3% [7.9-56.4], respectively. The vaccine was not effective statistically because the lower limit of the 90% CI for the primary efficacy endpoint in DIPG patients did not exceed its prespecified threshold-20%. Median OS was 5.4 months for DIPG. Among all patients, median OS was significantly longer (p = 0.024) for WT1-specific immune responders (9.9 months [6.0-33.4]) presenting increased CTL frequency/count and/or being positive for DTH than for nonresponders (4.9 months [2.2-16.5]). CONCLUSIONS:The vaccine was not effective statistically but was well tolerated and appeared to have induced WT1-specific immune responses, suggesting improved survival in WT1-specific immune responders among DIPG patients and warranting its further development. CLINICALTRIALS:gov Identifier: NCT02750891.
Endoscopic bilioduodenal double stenting is sometimes necessary for patients with malignant bilioduodenal obstruction (MBDO). The patency of biliary stents is important for preventing cholangitis and continuing treatment. However, the factors that influence recurrent biliary obstruction (RBO) in patients with MBDO are not well known. This study aimed to identify the factors associated with RBO in patients who underwent endoscopic bilioduodenal double stenting. Patient characteristics, device use, and endoscopic treatment procedures were evaluated as possible risk factors for RBO. Overall, 55 patients with MBDO underwent endoscopic bilioduodenal double stenting (transpapillary drainage, n = 35; endoscopic ultrasound-guided biliary drainage, n = 20). Multivariate analysis using a Fine and Gray competing risk model revealed that biliary stenting on the oral side of the duodenal stricture (HR 2.98; 95
