Up-Titration Strategy After DPP-4 Inhibitor-Based Oral Therapy for Type 2 Diabetes : A Randomized Controlled Trial Shifting to a Single-Dose GLP-1 Enhancer Versus Adding a Variable Basal Insulin Algorithm

Introduction: It is unclear whether adding basal insulin or enhancing incretin signaling with a glucagon-like peptide-1 receptor agonist (GLP-1RA) is more effective as an up-titration strategy after dipeptidyl peptidase-4 inhibitor (DPP-4i)-based oral antidiabetic drug (OAD) therapy. GLP-1RAs can be injected without dose adjustment, unlike basal insulin. Our objective was to examine the efficacy of changing patients inadequately controlled with oral DPP-4i-based OAD therapy to injectable GLP-1RA and discontinuing the DPP4i versus adding basal insulin glargine (IGlar) with the continuation of the oral DPP4i. Methods: Sixty patients with type 2 diabetes (T2DM) and glycated hemoglobin (HbA1c) between 7.0% and 10.0% on DPP-4i-based OAD therapy were randomized to either adding IGlar and remaining on the DPP-4i or liraglutide and discontinuing the DPP-4i for 24 weeks. Patients in the IGlar group started with 0.1 unit/kg and were titrated according to the algorithm. In the liraglutide group, the DPP-4i was replaced with liraglutide 0.9 mg/day, the maximum dose in Japan. We evaluated HbA1c, glycated albumin (GA), and anthropometrics. Results: HbA1c was significantly lower at week 24 (− 1.0 ± 0.9% in the IGlar group and − 0.6 ± 0.8% in the liraglutide group), but the difference between groups was not significant. Changes in GA were similar (− 2.9 ± 3.2% vs. − 2.6 ± 3.2%) in both groups. Body weight (BW) was significantly lower only in the liraglutide group (+ 0.5 ± 2.6 kg vs. − 2.2 ± 2.0 kg). The rate of minor hypoglycemic episodes was similar for both groups. Conclusion: For poorly controlled T2DM on DPP-4i-based OAD therapy, switching to single-dose liraglutide to enhance incretin signaling is as effective as dose-titrated basal IGlar, but significant BW reduction was only seen in the liraglutide group. These results suggest that enhancing incretin signaling with a single-dose injectable GLP-1 RA might be an alternative to dose-titrated basal insulin therapy in patients with T2DM poorly controlled with DPP-4i-based OAD therapy. These findings should be confirmed in a longer and larger trial

The Actual Conditions of creation and utilization of the Records of Children with Disabilities during the School Transition Period: A Survey of Early Childhood Facilities and Elementary Schools

The purpose of this study is to clarify the actual conditions of personal records such as “support files” and “transition support sheets” created by early childhood facilities (kindergartens and nursery schools) to provide transition support to children with disabilities. The study seeks to examine how these records are created by early childhood facilities and used by elementary schools. A nationwide questionnaire survey targeting public and private kindergartens, nursery schools, and elementary schools was carried out. The survey results show that about half of the early childhood facilities created these records and that the records were being effectively utilized by the elementary schools that received them. However, there were also differences based on the type of institution: for instance, the rate of record creation was high at public kindergartens and low at private kindergartens and nursery schools. In terms of record content, there is a possibility of a gap between the information recorded by early childhood facilities and that sought by elementary schools. Based on these actual conditions, this study identifies issues to be considered in the effective creation and utilization of records.本研究は平成28年度文科省委託「幼児期の教育内容等深化・充実調査研究」（調査研究課題：幼保小接続における学習機会の保障としての合理的配慮に関する研究，研究受託機関：名古屋市立大学）の助成を受けて行われた研究成果の一部である。なお，本稿の一部は日本教育心理学会第59回総会において発表した

A Survey on Cooperation between Early Childhood Facilities and Elementary Schools regarding Children with Disabilities

This survey aimed to reveal the current conditions of cooperation between early childhood facilities and elementary schools regarding children with disabilities. A nationwide questionnaire was administered to 172 nursery schools (public), 242 nursery schools (private), 200 kindergartens (public), 481 kindergartens (private), and 592 elementary schools. Overall, for cooperation with elementary school for children with disabilities, the percentage of practice with kindergarten (public) was highest among early childhood facilities. In particular, for “Exchange activities between early childhood facilities and elementary schools” and “Introduction of approach curriculum,” the percentage of practice with kindergarten (public) was higher when compared with that in other early childhood facilities. The newly found information in this survey was that nursery schools (public) were most likely to take advantage of the “Individual education program.” The major problem was that nursery school and kindergarten teachers were willing to cooperate on early childhood education and care with elementary school teachers, but elementary school teachers answered that it was difficult to cooperate with many of the early childhood facilities. The ideal method for cooperation between early childhood facilities and elementary schools needs to be considered within each community.本研究は平成26年度文部科学省委託「幼児教育の改善・充実調査研究」（研究代表者：山崎 晃）及び平成25～27年度科学研究費・基盤研究（C）（研究課題番号：25381325，研究代表者：山崎 晃）の助成を受けて行われた研究成果の一部である

放送大学におけるデジタル・リテラシー教育の展開と成果

　放送大学では、自宅や職場で学習する多様な学生のニーズに応えるため、Webによる授業配信、オンライン履修登録、電子図書館サービスを含むICTを活用した学生サービスを提供しているが、十分な利用には至っていない。これは、放送大学にパソコンやインターネットの利用経験が少ない高齢学生が在籍するためだと思われる。そこで、学生によるICT環境の学習への活用を促進しWebを通じた学習の機会を拡張すべく、面接授業「初歩からのパソコン」を2010年度２学期から全国50箇所の学習センターで毎年少なくとも年１回開設し、共通シラバス、共通テキストを用いた実習を含む12時間の集中授業を、アシスタントの協力を得て本部教員が担当した。FDセミナーや実践報告の共有を含むPDCAサイクルを通じた教材と授業内容の改訂により、授業改善を行ってきた。各学生の学習目標の達成度と自己効力感を測るため、事前・事後に記入してもらったチェックリストによる学習効果を測定した結果、一定の学習効果が認められた。また、事前に記入してもらったチェックリストを年齢により比較した結果、高齢学生のICTスキルが低い傾向が認められた。この授業の受講を希望する学生が許容できる人数を超えたことにより、年に複数回開設して学習センターの非常勤講師が担当するケースも生じている。また、本部教員が地域に学習共同体を構築するのが困難なことにより、2013年２学期以降は主に各学習センターの非常勤講師がこの授業を担当している

放送大学におけるデジタル・リテラシー教育 : 習得スキルの定着

　本研究は、面接授業「初歩からのパソコン」の受講で習得した放送大学生のデジタル・リテラシー・スキル（以下「DLスキル」）の定着状況把握を目的に実施した。この授業を2010年度２学期から2013年度１学期の間に受講した在学生に2013年11月に郵送アンケートを実施した。調査結果は、DLスキルの種類により、定着したもの、低下したもの、向上したものがあること、DLスキルの定着には、受講生の年齢、受講生のパソコン・インターネットの利用頻度が影響を及ぼしていること、DLスキルの向上とパソコン・インターネット利用頻度の間に相関があること、DLスキルの定着には、受講生のその後の学習方法が影響を及ぼしていることを示した。受講直後から本調査の期間に低下したDLスキルについて、授業後のスキル活用の機会を増加させる必要性が示唆された。また、定着効果のあるテレビ授業「遠隔学習のためのパソコン活用」の受講と同好会等への参加を促す必要性が示唆された

Low Lipoprotein(a) Concentration Is Associated with Cancer and All-Cause Deaths: A Population-Based Cohort Study (The JMS Cohort Study)

Background: Experimental studies support the anti-neoplastic effect of apo(a), but several clinical studies have reported contradictory results. The purpose of this study was to determine whether a low lipoprotein(a) [Lp(a)] concentration is related to mortality from major causes of death, especially cancer. Methods The subjects were 10,413 participants (4,005 men and 6,408 women) from a multi-center population-based cohort study in Japan (The Jichi Medical School cohort study). The average age at registration was 55.0 years, and the median observation period was 4,559 days. As the estimated hazard ratio was high for both the low and very high Lp(a) levels, we defined two Lp(a) groups: a low Lp(a) group [Lp(a)<80 mg/L] and an intermediate-to-high Lp(a) group [Lp(a)≥80]. Participants who died from malignant neoplasms (n = 316), cardiovascular disease (202), or other causes (312) during the observation period were examined. Results: Cumulative incidence plots showed higher cumulative death rates for the low Lp(a) group than for the intermediate-to-high Lp(a) group for all-cause, cancer, and miscellaneous-cause deaths (p<0.001, p = 0.03, and p = 0.03, respectively). Cox proportional hazards analyses with the sex and age of the participants, body mass index, and smoking and drinking histories as covariates showed that a low Lp(a) level was a significant risk for all-cause, cancer, and miscellaneous-cause deaths (p<0.001, p = 0.003, and p = 0.01, respectively). The hazard ratio (95% CI) [1.48, 1.15–1.92] of a low Lp(a) level for cancer deaths was almost the same as that for a male sex (1.46, 1.00–2.13). Conclusions: This is the first report to describe the association between a low Lp(a) level and all-cause or cancer death, supporting the anti-neoplastic effect of Lp(a). Further epidemiological studies are needed to confirm the present results