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The cause of spontaneous abortion of normal conceptuses remains unknown in most cases. The study was aimed to reveal the latent abnormalities by using a large collection of embryo images from a magnetic resonance imaging (MRI) database and novel phase-contrast radiographic computed tomography (PXCT). MRI from 1,156 embryos between Carnegie stage (CS) 14 and CS23 from the Kyoto Collection were screened by using the volume of the liver as the target organ. Embryos with liver volumes ≥2 SD above or below the mean for the stage of development were screened and examined precisely on MRI. Embryos with potentially abnormal livers were further analyzed by using PXCT. Liver abnormality was detected in all 7 embryos in the extra-small liver group and in 2 of 8 embryos in the extra-large liver group. The abnormalities in the extra-small liver group consisted of hepatic agenesis (2 embryos), hepatic hypogenesis (4), and liver lobe defect (1). Among the 7 extra-small liver group, 2 had only liver abnormalities and 5 exhibited complications in other organs. Of the 2 embryos in the extra-large liver group, one had only a single liver abnormality and the other had a morphologically abnormal liver with complications in other organs. Most of such liver abnormality cases are not survive, as liver function becomes essential. The prevalence of liver malformations in CS18 and CS21 in the intrauterine population of externally normal embryos is approximately 1.7%. The present study is the first step toward the elucidation of the latent abnormalities resulting in spontaneous abortion in externally normal embryos.

Depression in older adults erodes their health, quality of life and the economy. Existing interventions are not feasible for broad application at the community. Postcard intervention only requires a few resources, and previous studies have shown its effectiveness for patients following drug overdose, self-harm and hospitalisation for major depression. The purpose of the present study is to evaluate the effectiveness of a postcard intervention. Participants were community-dwelling individuals, aged 65 or older, who eat meals alone and with the score of 4 or higher on the 15-item Geriatric Depression Scale (GDS-15). We enrolled 184 eligible participants, with 93 in the intervention and 91 in the control arm. Postcards were sent to participants once a month for eight months. Primary outcome was the GDS-15 score at post-intervention. Secondary outcomes were quality of life and activities of daily living. There was no significant difference in primary and secondary outcomes between completers of the intervention and the control arm. However, most of the participants who received intervention thought the intervention was effective. The postcard intervention for depression in community-dwelling elderly people in Japan is neither feasible nor effective. However, the descriptive results suggest that the intervention may be effective given different parameters.

Background Missing data are inevitable in almost all medical studies. Imputation methods using the probabilistic model are common, but they cannot impute individual data and require special software. In contrast, the ipsative imputation method, which substitutes the missing items by the mean of the remaining items within the individual, is easy and does not need any special software, but it can provide individual scores. The aim of the present study was to evaluate the validity of the ipsative imputation method using data involving the 15-item Geriatric Depression Scale. Methods Participants were community-dwelling elderly individuals (n = 1178). A structural equation model was constructed. The model fit indexes were calculated to assess the validity of the imputation method when it is used for individuals who were missing 20% of data or less and 40% of data or less, depending on whether we assumed that their correlation coefficients were the same as the dataset with no missing items. Finally, we compared path coefficients of the dataset imputed by ipsative imputation with those by multiple imputation. Results When compared with the assumption that the datasets differed, all of the model fit indexes were better under the assumption that the dataset without missing data is the same as that that was missing 20% of data or less. However, by the same assumption, the model fit indexes were worse in the dataset that was missing 40% of data or less. The path coefficients of the dataset imputed by ipsative imputation and by multiple imputation were compatible with each other if the proportion of missing items was 20% or less. Conclusion Ipsative imputation appears to be a valid imputation method and can be used to impute data in studies using the 15-item Geriatric Depression Scale, if the percentage of its missing items is 20% or less.

Risk perception is one of the core factors in theories of health behavior promotion. However, the association between knowledge, risk perception, and depressed mood in depression is unknown. The aim of this study was to clarify the relationships between subjective knowledge, risk perception, and objective scores of depression in community-dwelling elderly people in Japan. A total of 747 elderly participants (mean age: 76.1, female: 59.8%) who completed the 15-item Geriatric Depression Scale (GDS-15) along with items assessing subjective knowledge and risk perception were included in the analysis. We assessed the correlation between subjective knowledge and risk perception, and then compare GDS-15 scores by level of subjective knowledge and risk perception. Subjective knowledge was weakly associated with risk perception and related to lower GDS-15 scores in a dose–response pattern, which did not change after adjusting for age, gender, basic activities of daily living (ADL), instrumental ADL, years of education and history of depression. There was no significant association between risk perception and GDS-15 scores. The relationship between knowledge, risk perception, and depressed mood in younger generations is unclear, but warrants examination.

The cause of spontaneous abortion of normal conceptuses remains unknown in most cases. The study was aimed to reveal the latent abnormalities by using a large collection of embryo images from a magnetic resonance imaging (MRI) database and novel phase-contrast radiographic computed tomography (PXCT). MRI from 1,156 embryos between Carnegie stage (CS) 14 and CS23 from the Kyoto Collection were screened by using the volume of the liver as the target organ. Embryos with liver volumes ≥2 SD above or below the mean for the stage of development were screened and examined precisely on MRI. Embryos with potentially abnormal livers were further analyzed by using PXCT. Liver abnormality was detected in all 7 embryos in the extra-small liver group and in 2 of 8 embryos in the extra-large liver group. The abnormalities in the extra-small liver group consisted of hepatic agenesis (2 embryos), hepatic hypogenesis (4), and liver lobe defect (1). Among the 7 extra-small liver group, 2 had only liver abnormalities and 5 exhibited complications in other organs. Of the 2 embryos in the extra-large liver group, one had only a single liver abnormality and the other had a morphologically abnormal liver with complications in other organs. Most of such liver abnormality cases are not survive, as liver function becomes essential. The prevalence of liver malformations in CS18 and CS21 in the intrauterine population of externally normal embryos is approximately 1.7%. The present study is the first step toward the elucidation of the latent abnormalities resulting in spontaneous abortion in externally normal embryos.

Missing data are inevitable in almost all medical studies. Imputation methods using the probabilistic model are common, but they cannot impute individual data and require special software. In contrast, the ipsative imputation method, which substitutes the missing items by the mean of the remaining items within the individual, is easy and does not need any special software, but it can provide individual scores. The aim of the present study was to evaluate the validity of the ipsative imputation method using data involving the 15-item Geriatric Depression Scale.Participants were community-dwelling elderly individuals (n = 1178). A structural equation model was constructed. The model fit indexes were calculated to assess the validity of the imputation method when it is used for individuals who were missing 20% of data or less and 40% of data or less, depending on whether we assumed that their correlation coefficients were the same as the dataset with no missing items. Finally, we compared path coefficients of the dataset imputed by ipsative imputation with those by multiple imputation.When compared with the assumption that the datasets differed, all of the model fit indexes were better under the assumption that the dataset without missing data is the same as that that was missing 20% of data or less. However, by the same assumption, the model fit indexes were worse in the dataset that was missing 40% of data or less. The path coefficients of the dataset imputed by ipsative imputation and by multiple imputation were compatible with each other if the proportion of missing items was 20% or less.Ipsative imputation appears to be a valid imputation method and can be used to impute data in studies using the 15-item Geriatric Depression Scale, if the percentage of its missing items is 20% or less.

Background Depression in older adults deteriorates quality of life and increases morbidity, mortality, and medical expenses. Medicine and social policy should work together to decrease this burden. Existing prevention studies are often based on time-consuming psychotherapies, which therefore are not feasible for a wide application at the community level. Postcard interventions have been shown to be effective for patients after hospitalization for major depression, drug overdose, or self-harm. This paper describes the protocol of a pragmatic, randomized controlled trial designed to examine the efficacy of a postcard intervention for depression among community-dwelling individuals aged 65 years or older. Methods/Design This is a pragmatic, non-blinded, parallel comparison, randomized controlled trial using Zelen’s design in a community setting. Participants will include community-dwelling older adults (aged 65 years or older) with limited social support (indicated by eating meals alone) and with symptoms of depression (scoring 4 or higher on the 15-item Geriatric Depression Scale (GDS)). The intervention will consist of sending postcards with handwritten messages and seasonal reports from a historical city to participants once a month for eight consecutive months. Self-addressed, stamped envelopes will be enclosed to facilitate non-obligatory replies. Primary outcomes will be changes in the GDS scores that are administered to all elderly inhabitants of the community every year as part of annual health checks. Secondary outcomes include quality of life as measured by a visual analogue scale, and self-rated basic and advanced activities of daily living. We will also examine the subjective sense of effectiveness of the intervention, recollection of the number of intervention mailings received, and the number of mailed replies as the index of the acceptability of the postcard intervention. The time × group interaction for two consecutive years will be analyzed using a generalized linear mixed model. To detect an effect size of 0.5 at alpha error of 0.05 and statistical power of 0.80, 63 participants per group are required. Based on an estimated consent and dropout rate of 70%, a total of 180 subjects will be recruited. Trial registration UMIN000010529