Age- and Sex-Specific Impact of Health Literacy on Healthy Lifestyle Characteristics among Japanese Residents in a Rural Community

The study aimed to examine age- and sex-specific associations between health literacy (HL) and healthy lifestyle characteristics. The cross-sectional study was conducted to examine a total 1348 Japanese participants (613 male and 735 female) who took the health check-up program in April 2013, at Tsumagoi Village, Japan. Information was collected by self-administered questionnaire on three communicative and two critical HL items, and healthy lifestyle characteristics listed in Bres-low’s seven health practices. In multivariate logistic analysis, high HL (≥18) was significantly asso-ciated with healthy lifestyle characteristics in both non-elderly (<65 years old) and elderly (≥65 years old) [Odds ratio (OR) = 1.40, 95% Confidence interval (CI) = 1.13 - 1.75 for non-elderly, OR = 1.34, 95% CI = 1.02 - 1.76 for elderly], as well as female participants (OR = 1.43, 95% CI = 1.06 - 1.94), while the significance was borderline in male participants (OR = 1.34, 95% CI = 0.96 - 1.88). Among 5 HL items, the ability to extract health-related information was significantly associated with healthy lifestyle characteristics (OR = 1.52, 95% CI = 1.11 - 2.07 for non-elderly, OR = 1.55, 95% CI = 1.04 - 2.30 for elderly, OR = 1.95, 95% CI = 1.28 - 2.97 for female participants. HDL-C concentration in the high HL group was significantly higher than that in the low HL group. Among healthy lifestyle characteristics, proportions of smoking behavior (non-smoker), exercise frequency (twice or more per week), and sleep duration (7 - 8 hours) were significantly higher in the high HL group than in the low HL group. The present study revealed a positive association between HL and healthy lifestyle characteristics, which suggests that people are likely to engage in health-promoting behaviours based on access and ability to understand medical information for both age groups and female participants. Significant findings among female participants may be emphasized since it’s important from the entire family's perspective as women are the caretakers of the family. These findings may indicate the importance of comprehensive assessment, including HL, for health promotion in the community.

Assessment of multi-modality evaluations of obscure gastrointestinal bleeding

AIMTo determine the frequency of bleeding source detection in patients with obscure gastrointestinal bleeding (OGIB) who underwent double balloon enteroscopy (DBE) after pre-procedure imaging [multiphase computed tomography enterography (MPCTE), video capsule endoscopy (VCE), or both] and assess the impact of imaging on DBE diagnostic yield.METHODSRetrospective cohort study using a prospectively maintained database of all adult patients presenting with OGIB who underwent DBE from September 1st, 2002 to June 30th, 2013 at a single tertiary center.RESULTSFour hundred and ninety five patients (52% females; median age 68 years) underwent DBE for OGIB. AVCE and/or MPCTE performed within 1 year prior to DBE (in 441 patients) increased the diagnostic yield of DBE (67.1% with preceding imaging vs 59.5% without). Using DBE as the gold standard, VCE and MPCTE had a diagnostic yield of 72.7% and 32.5% respectively. There were no increased odds of finding a bleeding site at DBE compared to VCE (OR = 1.3, P = 0.150). There were increased odds of finding a bleeding site at DBE compared to MPCTE (OR = 5.9, P < 0.001). In inpatients with overt OGIB, diagnostic yield of DBE was not affected by preceding imaging.CONCLUSIONDBE is a safe and well-tolerated procedure for the diagnosis and treatment of OGIB, with a diagnostic yield that may be increased after obtaining a preceding VCE or MPCTE. However, inpatients with active ongoing bleeding may benefit from proceeding directly to antegrade DBE.

Predictive Models of Clinical Improvement in Rituximab-Treated Myositis Patients Using Clinical Features, Autoantibodies, and Biomarkers

Background: Response to rituximab so far is unpredictable in patients with refractory myositis. Predictive models of clinical improvement are developed using clinical, laboratory, and gene expression/cytokine/chemokine variables in rituximab-treated refractory myositis patients. Methods: We analyzed data for 200 myositis patients (76 with adult polymyositis (PM), 76 with adult dermatomyositis (DM), and 48 with juvenile (DM)) in the rituximab in myositis trial. Clinical improvement is defined as the change from baseline to 24 weeks in Physician Global Visual Analog Scale (VAS). We analyze the association of baseline variables with improvements: demographics, myositis subtype, clinical and laboratory parameters, autoantibody status, and interferon (IFN)- regulated chemokines. Multivariable linear regression models are developed by using stepwise variable selection methods. Results: A “base” multivariable model to predict improvement with clinical and laboratory variablesonly is built with modest predictive ability (adjusted R2 = 0.21). This model includes two significant factors at baseline: Physician Global VAS and Muscle Disease Activity VAS. A “final” multivariable model to predict improvement including non-standard laboratory measures is developed and demonstrated better predictive ability (adjusted R2 = 0.32). This model includes Physician Global VAS, IFN chemokine score and IL-2 levels. The “final” model explained 11% more variability than the “base” model. Conclusions: Changes in disease activity over time following treatment with rituximab in refractory myositis can be predicted. These models can be clinically useful to optimize treatment selection in myositis.