Multiple-Community-Based Epidemiological Study of Stuttering among 3-Year-Old Children in Japan.

INTRODUCTION: Many epidemiological studies of the disorder of stuttering have been conducted during the 20th century, continuing during the current one. Unfortunately, only a few were carried out in Japan. This study aimed at assessing (1) the incidence and prevalence of stuttering in 3-year-old children in multiple Japanese communities and (2) factors associated with the onset of stuttering among these children. METHODS: A questionnaire aimed at screening for the presence of stuttering was employed for 2,055 children aged 3 years, who underwent a standard nationwide health checkup. Positive responses were confirmed in several ways: (1) direct interviews and assessment of the child's speech, (2) confirmatory questionnaire, or (3) telephone interviews by licensed Speech Language Hearing Therapists. RESULTS: Approximately 6.5% of the children were found to exhibit stuttering at the time of their health checkup. This figure rose to 8.9% after including individuals who previously, but not currently, were reported to have exhibited stuttering. Among the putative risk factors, higher stuttering odds (odds ratio, OR = 3.27) were detected in those with a family history of stuttering, those whose guardians had concerns about their child's development (OR = 1.75), and those with diagnosed diseases or disabilities (OR = 2.13). DISCUSSION/CONCLUSIONS: It was concluded that, in Japan, both the risk of stuttering incidence (8.9%) in children up to, and including, the age of 3 years, as well as its prevalence (6.5%) in this population, was similar to those reported by recent studies in other countries. Additionally, our findings also confirmed that an increased risk for stuttering at age 3 is associated with a family history of stuttering.

Biological variation of 16 biochemical analytes estimated from a large clinicopathologic database of dogs and cats.

BACKGROUND: Biochemical measurements are commonly evaluated using population-based reference intervals; however, there is a growing trend toward reassessing results with within-subject variation (CVI). OBJECTIVES: We aimed to estimate the CVI of 16 biochemical analytes using a large database of dogs and cats, which refers to the results of routine health checkups. METHODS: Pairs of sequential results for 16 analytes were extracted from a database of adult patients. The second result was divided by the first result to produce the ratio of sequential results (rr), and the frequency distribution of rr was plotted. From the plots, the coefficient of variation (CVrr) was calculated. Analytical variation (CVA) was calculated using quality control data, and CVI was estimated as follows: CV I = CV rr / 2 1 / 2 2 - CV A 2 1 / 2 . Estimated CVI was compared with previously reported CVI using the Bland-Altman plot analysis. RESULTS: From the database, 9078 data points from 3610 dogs and 3743 data points from 1473 cats were extracted, with 5468 data pairs for dogs and 2270 for cats. Sampling intervals ranged from 10 to 1970 days (median 366) for dogs and 23 to 1862 days (median 365) for cats. Bland-Altman analysis showed most CVI plots fell within the limits of agreement; however, positive fixed biases were observed in both dogs and cats. CONCLUSIONS: Our study introduces a novel approach of estimating CVI using routine health checkup data in dogs and cats. Despite biases, our method holds promise for clinical application in assessing the significance of measurement result differences.

Influence of history of falls and physical function on obstacle-straddling behavior.

[Purpose] This study aimed to clarify the relationship between falls and lower leg motion during obstacle crossing, in which stumbling or tripping is the most common cause of falls in the elderly population. [Participants and Methods] This study included 32 older adults who performed the obstacle crossing motion. The heights of the obstacles were 20, 40, and 60 mm. To analyze the leg motion, a video analysis system was used. The hip, knee, and ankle joint angles during the crossing motion were calculated by the video analysis software, Kinovea. To evaluate the risk of falls, one leg stance time and timed up and go test were measured, and data on fall history were collected using a questionnaire. Participants were divided into two groups: high-risk and low-risk groups, according to the degree of fall risk. [Results] The high-risk group showed greater changes in hip flexion angle in the forelimb. The hip flexion angle in the hindlimb and the angle change of lower extremities among the high-risk group became larger. [Conclusion] Participants in the high-risk group should lift their legs high when performing the crossing motion to ensure foot clearance and avoid stumbling over the obstacle.

Effects of lower leg muscle quality on gait variability in community-dwelling older and healthy young adults.

[Purpose] We aimed to determine whether lower leg muscle echo intensity, an indicator of muscle quality, is a useful predictor of gait variability after examining the relationship between physical activity and gait variability in community-dwelling older and healthy young adults. [Participants and Methods] This study comprised two tasks. In the first task, 18 older and 25 young adults were included as participants. We examined the relationship between the amount of physical activity and gait variability in both groups. In the second task, muscle echo intensity related to gait variability in each group was measured using ultrasound echoes after identifying common factors related to gait variability in 19 older and 19 younger adults, and trends were compared. [Results] In the first task, gait variability was significantly higher in the younger group than in the older group. A significant negative correlation was found between the amount of physical activity and gait variability in both groups. In the second task, multiple regression analysis was performed for gait variability, and lower leg muscle echo intensity was identified as a significant factor. There was no difference in the correlation coefficient between gait variability and lower leg muscle echo intensity between the two groups. [Conclusion] Lower leg muscle quality was one of the causes of gait variability, suggesting that it is a useful predictor of gait sway status.

Age-Related Changes in Accuracy and Speed of Lateral Crossing Motion: Focus on Stepping from Leaning Position.

Fall incidents are increasing every year and prevention is necessary. Preventing falls can increase the quality of life of the elderly and decrease medical costs. Stumbling and tripping are the main causes of falls and falls in the lateral direction, causing the hip fracture. This study aimed to analyze the accuracy and speed of lateral obstacle crossing in the elderly, especially from leaning posture. Twenty healthy older adults (6 men and 14 women, aged 71.7 ± 1.5 years) and 20 healthy young adults (5 men and 15 women, aged 21.4 ± 1.2 years) participated in this study. We set four conditions (normal, fast, leaning, and leaning fast), and participants crossed the obstacle laterally ten times under each condition. The crossing motion was captured using a three-dimensional analysis system. The trajectory of the foot, landed position, step time, center of gravity of the body, and moment of the lower extremity during the swing phase were calculated and compared between older and younger adults. In the leaning condition, the step time and knee moment of the elderly were significantly longer and larger than those of young adults. From the results of the trajectory of the foot and landed position in the leaning condition, motion inconsistency of the foot was found in the elderly. We believe that it is difficult for the elderly to perform the intended crossing motion and swing quickly because of aging. This inconsistency in motion is a serious cause of falls in the elderly.

Different Effects of 12-Week Speed or Accuracy Training on Obstacle-Crossing Foot Motion in Healthy Elderly.

Preventing falls is important in the elderly. One reason for falling is tripping or stumbling; hence, it is important to improve the crossing motion. This study aimed to compare speed- and accuracy-oriented crossing training and establish a useful training method. To investigate the effects of crossing motion training, we conducted a randomized controlled trial. Twenty healthy elderly individuals (aged 71.7 ± 1.5 years) were randomly assigned to two groups: speed training and accuracy training groups. They practiced initiating their crossing motion faster or more accurately for 12 weeks. Using a three-dimensional motion analysis system, the data on the crossing motion was captured before and after the training period. We set four conditions (normal speed, fast, leaning stance, and leaning stance and fast) and two directions (anterior and lateral) to analyze the crossing motion. The crossing motion of the speed training group became significantly faster compared to baseline (p < 0.05); however, the accuracy of the crossing motion of the accuracy training group was not statistically significant. Speed training in this study had clear effects on crossing motion. It is surprising that crossing motion training from a normal upright stance can also improve swing speed from the leaning stance. We believe that this training is easy and useful in the elderly population.

Kinematic effects of different gait speeds during gait initiation movement.

[Purpose] We investigated the influence of gait speed on the movement strategy during gait initiation. [Participants and Methods] This study included 21 young healthy individuals (11 males and 10 females; mean age, 21.7 ± 0.5 years; mean height, 166.1 ± 9.8 cm; and mean weight, 57.3 ± 11.2 kg). A three-dimensional motion analyzer and strain gauge force platform were used in this study. The measurement task consisted of gait initiation from the quiet stance; the two measurement conditions were normal gait and the highest speed. The analysis interval was from the start of the center of pressure migration to the heel contact at the first step of the swing limb. The center of gravity, center of pressure, joint movements, step length, and step time during the anticipatory postural control (from the start of center of pressure migration to swing leg-heel off) and swing (swing leg-heel off to swing leg-heel contact) phases were analyzed. [Results] Significant differences were observed in the center of gravity, center of pressure, hip flexion, abduction movement, stance-limb ankle dorsiflexion movement during the anticipatory postural control phase, and step time during the anticipatory postural control and swing phases. The stance-limb ankle plantar flexion movement and step length did not differ significantly in the swing phase. [Conclusion] When the gait speed increases, fluctuations in the joint movements increase as the center of pressure displacement increases, thus requiring complex control.

The relationship between changes in deoxy Hb and body composition before and after cycling exercise during unilateral lower extremity occlusion.

[Purpose] To clarify the relationship between changes in deoxygenated hemoglobin level due to cycling exercise and body composition in healthy participants with unilateral lower-limb obstruction. [Participants and Methods] The height, weight, body mass index, and body composition (skeletal muscle mass, body water content, and body fat percentage) of nine healthy males were measured along with the anaerobic threshold. The protocol consisted of 7 minutes of rest followed by 4 minutes of cycling exercise (anaerobic threshold level) with unilateral lower extremity occlusion. After exercise, ischemia was released, and the participants was allowed rest for 5 minutes. Deoxygenated hemoglobin levels before and after the exercise and the relationship between the level of variation and each index were examined. [Results] Body water content and skeletal muscle mass showed a significant negative correlation with changes in deoxygenated hemoglobin level; however, no correlation was found for the other indices. Body water content and skeletal muscle mass were found to be significantly positively correlated. they showed a significant positive correlation with deoxygenated hemoglobin levels. [Conclusion] Our study indicates that body water content and skeletal muscle mass play a significant role in the recovery of blood flow following exercise.

Recurrent Kawasaki disease and cardiac complications: nationwide surveys in Japan.

INTRODUCTION: Based on data obtained before high-dose (2 g/kg) intravenous immunoglobulin (IVIG) therapy prevailed in Japan, children with a history of Kawasaki disease (KD) were highly susceptible to disease recurrence and more likely to develop cardiac sequelae. We aimed to examine the epidemiological features of cardiac complications among patients with recurrent KD following the widespread use of high-dose IVIG therapy. DESIGN: Two cohorts of patients with recurrent KD retrieved from Japanese nationwide surveys (previous cohort: 1989-1994; recent cohort: 2003-2012) were compared. RESULTS: Of 1842 patients with recurrent KD in the recent cohort, 3.5% and 5.2% developed cardiac sequelae at the initial and second episodes, respectively, which were markedly decreased compared with those (>10%, respectively) in the previous cohort. Multivariate analyses showed that the risk factors for cardiac sequelae at the second episode were similar between the cohorts. Patients with recurrent KD in both cohorts were more likely to have coronary aneurysms at the second episode than at the initial episode. However, when patients with coronary aneurysms at the initial episode were excluded from analyses, the difference in the proportions of coronary aneurysms between KD episodes disappeared in the recent cohort. Residual rates of previously formed coronary aneurysms were similar between the cohorts (approximately 50%). CONCLUSION: This study suggests that KD recurrence is no longer a risk factor for developing cardiac complications, unless cardiac sequelae appear at the initial episode. However, residual rates of previously formed coronary aneurysms remain high. Therefore, the importance of carefully managing coronary aneurysms associated with KD remains unchanged.

Recovery of brain abscess-induced stuttering after neurosurgical intervention.

Stuttering occurs in approximately 5% of all children and 1% of adults. One type, neurogenic stuttering, is usually attributable to strokes or other structural damages to the brain areas that are responsible for language fluency. Here, we present the first case of neurogenic stuttering caused by a brain abscess. The patient was a 60-year-old man admitted for a seizure and administered an anticonvulsant, after which he began stuttering. MRI revealed a brain abscess in the left frontal lobe that extended to the dorsolateral prefrontal cortex (BA (Brodmann's area) 9 and 46), frontal eye field (BA 8) and premotor cortex and supplementary motor area (BA 6). After neurosurgical drainage and antibiotic treatment, the symptoms had resolved. This case is unique in that the therapeutic effects and localisation of the cause of stuttering were rapidly identified, allowing for a more accurate description of the neural circuitry related to stuttering.

Nationwide surveys show that the incidence of recurrent Kawasaki disease in Japan has hardly changed over the last 30 years.

AIM: Since Kawasaki disease (KD) was first reported in 1967, its aetiology has been intensively investigated, but remains unclear. We investigated the incidence of recurrent KD in Japan in 2003-2012, compared with previous data from our team, and assessed the potential risk factors for disease recurrence. METHODS: Data from nationwide KD surveys were retrospectively analysed and 81 310 patients were observed. Incidence rates were compared between different years. RESULTS: The incidence rates for recurrent KD were 3.89 per 1000 person-years (January 2003 to December 2012), 4.95 (July 2003 to December 2010), 6.48 (January 2003 to December 2006) and 6.51 (January 2007 to December 2010). These rates were almost consistent with our previous data, which started in the 1980s. The incidence rate for recurrence was statistically higher among males, patients under the age of three years and those who received intravenous immunoglobulin or steroid therapy at the initial episode. The presence of cardiac sequelae during the initial episode did not affect the recurrence incidence. CONCLUSION: Although the incidence of KD has increased, the incidence of recurrent KD has remained largely unchanged over the past 30 years. Risk factors for recurrence included male sex, young age and initial resistance to immunoglobulin therapy.

Coronary artery lesions of incomplete Kawasaki disease: a nationwide survey in Japan.

UNLABELLED: Incomplete Kawasaki disease (KD) is associated with delayed diagnosis and treatment, which in turn can lead to the development of coronary artery lesions (CALs). The aim of this study was to determine the epidemiological features of incomplete KD compared with complete KD and to identify risk factors for CALs from incomplete KD patients using data from a nationwide survey of 2007-2008 in Japan. A total of 23,263 patients were classified according to the number of principal clinical signs: 80% (n = 18,620) had complete forms of KD, 14.2% had four principal signs, 4.6% had three signs, and 1.2% had only one or two signs. In comparison with complete KD cases, the prevalence of CAL development tended to be larger and the proportion receiving initial intravenous immunoglobulin (IVIG) treatment were significantly smaller in patients with incomplete forms. In addition, hospital attendance after 7 days of illness or later was significantly associated with CAL development in all incomplete groups (OR: 2.52 in total patients with incomplete KD, 3.26 in those with one or two principal signs, 2.94 in those with three signs, 2.35 in those with four signs). CONCLUSION: The higher prevalence of CALs in incomplete KD reflects difficulties in diagnosis and delays in treatment. More timely diagnosis and treatment of incomplete KD patients could further prevent the development of cardiac lesions.

Case-control study of giant coronary aneurysms due to Kawasaki disease: the 19th nationwide survey.

BACKGROUND: The risk factors for recently reported cases of giant coronary aneurysms due to Kawasaki disease have not been elaborated. METHODS: Fifty-three patients with giant coronary aneurysms, diagnosed as Kawasaki disease in 2005 and 2006, were selected from the 19th nationwide survey of the disease in Japan. With all the other patients recorded at the same hospitals as a control group, OR and their 95%CI were calculated to delineate the risk factors. RESULTS: In multivariate analyses, patients aged younger than 1 year (OR compared with 1-2-year-olds = 6.57) and those older than 5 years (OR compared with 1-2-year-olds = 4.24), those who received additional intravenous immunoglobulin (IVIG) without the use of steroid (OR = 8.38) and those who received steroid administration with or without the additional use of IVIG (OR = 220.51 and 83.83, respectively), showed significantly higher OR for giant coronary aneurysms. As for IVIG therapy, the additional use of IVIG (OR = 14.84), total dosage of IVIG exceeding 2500 mg/kg (OR compared with 1500-2499 mg/kg = 12.26) and the duration of IVIG administration for more than 3 days (OR = 30.12), were found to significantly increase the risk of developing giant aneurysms in univariate analyses that were adjusted for sex and age. CONCLUSIONS: The observation of 53 patients with giant coronary aneurysms due to Kawasaki disease among those included in the nationwide survey presented some risk factors, together with considerations about the associated aneurysms.