The COVID-19 pandemic exposed critical gaps in regional health security mechanisms, prompting ASEAN to establish the ASEAN Centre for Public Health Emergencies and Emerging Diseases (ACPHEED), with functions distributed across Indonesia, Thailand, and Vietnam. This policy analysis examines strategic development approaches for ACPHEED through comprehensive benchmarking of the European Centre for Disease Prevention and Control (ECDC), Africa Centres for Disease Control and Prevention (Africa CDC), and Gulf CDC, supported by consultations in Indonesia (2024) and Sweden (2025) involving ASEAN member states and international partners. A comparative analysis reveals distinct organizational models: the ECDC operates within European Union (EU) institutional frameworks emphasizing functional specialization; the Africa CDC employs decentralized Regional Coordination Centers; and the Gulf CDC implements hybrid governance via Permanent Communication Networks. Each model offers valuable lessons for ACPHEED's development, particularly concerning governance structures that balance regional coordination with national sovereignty. ACPHEED faces unique challenges due to ASEAN's consensus-based, nonlegislative institutional nature and its tri-country operational structure. Critical success factors include phased surveillance emphasizing a defined scope and capacity building; inclusive governance mechanisms ensuring equitable member-state ownership; and operational frameworks applying subsidiarity principles to complement existing ASEAN mechanisms. Sustainable financing remains paramount given ASEAN's limited budgetary authority. Japan's strategic partnership should capitalize on its technical expertise in laboratory systems, digital surveillance, and disaster preparedness through comprehensive institutional support. ACPHEED's success depends on sustained political commitment, realistic financial arrangements, and effective integration into global health security architectures. This analysis provides a strategic roadmap for ACPHEED's preparatory phase so that it can serve as a regional health security leader while addressing ASEAN-specific institutional constraints.

Japan's rapidly aging population presents significant demographic pressures, and yet the country maintains high standards of healthcare delivery with remarkably low rates of preventable and treatable mortality. According to the latest data from the Organization for Economic Co-operation and Development (OECD), Japan ranks 36th among 38 countries in physician density (2.6 per 1,000 population), and yet it records 12.1 physician consultations per person per year–among the highest in the OECD. This article analyzes this paradoxical situation–where high medical performance is maintained despite relatively few physicians–by examining both institutional strengths and emerging vulnerabilities. The strengths include universal health insurance with high public funding; a resource-intensive medical infrastructure; and a robust support network of allied healthcare professionals. Simultaneously, we identify the following vulnerabilities: increasing demand intensity; shortages and an uneven distribution of physicians; hospital financial losses; the limitations of effective gatekeeping under free access systems; and the amplified workload resulting from the concentration of authority and responsibility among physicians. Moreover, we examine initiatives needed to ensure the sustainability of insurance-based healthcare, including: redesigning supply-demand planning and education policies; expanding task sharing and securing funding sources; designing incentives for essential and regional healthcare services; and restructuring access models to value-based utilization and need-based care.

Young children are susceptible to infectious diseases due to their developing immune systems and close contact in group care settings. During the coronavirus disease 2019 (COVID-19) pandemic, infection prevention measures may have altered the epidemiology of common childhood infections, yet evidence on variations by facility type and region remains limited. In this study, the occurrence of COVID-19 and child-specific infectious diseases in childcare and early childhood education facilities in Japan was examined with particular focus on facility type and regional population density. A nationwide mail survey was conducted between January and April 2023 among 5,000 facility managers, and 710 valid responses were analysed. Over 90% of facilities reported at least one COVID-19 case within the previous year. The occurrence of child-specific infectious diseases, including adenovirus infection, hand, foot, and mouth disease, herpangina, streptococcal infection, norovirus infection, and respiratory syncytial virus infection, was lower in kindergartens serving children aged ≥ 3 years than in children in daycare centres or certified childcare centres (p < 0.05). Hand, foot, and mouth disease and influenza virus infection showed significant linear associations with population density, with lower reporting rates in less densely populated regions (p < 0.05). Conversely, rotavirus infection was more frequently reported in low-density regions (p < 0.05), whereas other child-specific infectious diseases exhibited heterogeneous and non-linear regional patterns, indicating that population density alone does not explain regional variation. These results highlight the importance of facility-, age-, and region-specific approaches to infection prevention in childcare settings beyond the COVID-19 pandemic.

The aim of this study was to identify frailty profiles using latent class analysis (LCA) and examine their associations with intrinsic capacity (IC) among Chinese elderly cancer survivors. A total of 308 elderly cancer survivors were recruited from a tertiary hospital in Nantong, China between November 2023 and April 2024, and data were collected through questionnaires and clinical assessments. LCA was used to classify frailty subtypes, univariate analysis and multinomial logistic regression (reference: robust group) were used to identify associated factors, and one-way ANOVA was used to compare IC differences across subtypes. Three frailty profiles were identified ― frail (31.5%), pre-frail (19.8%), and robust (48.7%) ― with significant IC variations. Lower monthly household income (odds ratio (OR) = 16.00, p = 0.028), smoking (OR = 8.76, p = 0.013), malnutrition (OR = 5.25, p = 0.044), activities of daily living (ADL) (OR = 71.31, p < 0.001), depression (OR = 15.91, p = 0.048), and fatigue (OR = 33.43, p < 0.001) were independent risk factors. These findings indicate that Chinese elderly cancer survivors exhibit heterogeneous frailty profiles and that IC decline is positively associated with the severity of frailty. The identified risk factors and subtype characteristics provide a basis for devising tailored interventions to improve health outcomes in this population.

Anticholinergic medications can cause constipation in older adults. The Japanese Anticholinergic Risk Scale (JARS), released in May 2024, is not yet sufficiently validated clinically. We examined the association between total anticholinergic burden based on JARS and laxative prescriptions. This cross-sectional study utilized community pharmacy dispensing claims for outpatients aged ≥ 65 years who were registered with a family pharmacist between November 1 and December 31, 2024. Chronic medication use was defined as prescriptions totaling ≥ 28 days during the study period. The primary analysis focused on patients receiving 5–9 concomitant chronic medications. Among the 9,838 patients (mean age 81.1 ± 7.3 years; 61.1% female), 39.4%, 33.2%, 14.7%, 7.0%, 3.1%, and 2.5% demonstrated JARS scores of 0, 1, 2, 3, 4, and ≥ 5, respectively. Compared with JARS = 0, adjusted odds ratios (aORs) for laxative prescriptions were 0.85 (95% confidence interval [CI]: 0.76–0.94, p = 0.003) for JARS = 1; 0.79 (0.69–0.91, p = 0.001) for JARS = 2; 0.94 (0.79–1.13, p = 0.537) for JARS = 3; 1.20 (0.93–1.55, p = 0.153) for JARS = 4; and 1.64 (1.24–2.16, p < 0.001) for JARS ≥ 5. This indicated a stepwise pattern with positive association at the highest burden. Furthermore, use of a drug rated 3 on the JARS revealed association with higher odds of laxative prescription (aOR: 1.71, 95% CI: 1.38–2.12, p < 0.001). Both a total JARS burden ≥ 5 and drugs rated 3 on the JARS were significantly associated with laxative prescribing.

Prasugrel reduces the recurrence of atherosclerotic cardiovascular disease and restenosis after percutaneous coronary intervention (PCI). However, its actual dosage in Japan has not been well studied. This study aimed to compare different prasugrel doses after PCI using retrospective data from the Clinical Deep Data Accumulation System (CLIDAS) database. A retrospective observational study was conducted using the CLIDAS-PCI database with a 2-year follow-up after PCI. There were 2,869 and 52 patients in the 3.75- and 2.5 mg groups, respectively. The 2.5 mg group was comprised of significantly more female, older, shorter, and lower-body-weight patients and included more patients with a history of coronary artery bypass grafting, stroke, peripheral arterial disease, or active malignancy than the 3.75 mg group. Concomitant medications included antiplatelets, anticoagulants, and statins. Laboratory data showed substantially lower hemoglobin and platelet counts in the 2.5 mg group. Most patients weighed < 50 kg; however, fewer had an estimated glomerular filtration rate < 30 mL/min/1.73 m². Major adverse cardio- and cerebrovascular events were similar between groups. The 2.5 mg group had more non-fatal strokes and major bleeding associated with antithrombotic therapy. In Japan, prasugrel 2.5 mg should be considered to reduce major bleeding in patients with low body weight, older adults, women, those receiving concomitant antithrombotic therapy, and those with low platelet counts.

Over 80% of patients develop bone metastases in the advanced stages of prostate cancer, resulting in a poor prognosis. To date, no study has explored the relationship between the type of bone metastasis and patient outcomes. The objective of this study was to compare the clinical features and prognoses of patients with osteoblastic and osteolytic bone metastases. Among the 63 patients diagnosed with bone metastases from prostate cancer at our institution between May 2011 and September 2023, 51 were classified as having osteoblastic metastases and 12 as having osteolytic metastases based on imaging findings. Overall survival was analyzed using Kaplan–Meier survival curves, and differences between groups were assessed using the log-rank test. Clinical parameters were compared using the Mann–Whitney U test. Univariate and multivariate Cox proportional hazards analyses were conducted to identify the prognostic factors. No significant differences were observed between the osteoblastic and osteolytic groups in terms of clinical or laboratory parameters, except for a higher platelet count in the osteoblastic group (p = 0.0181). The five-year overall survival rate was significantly higher in the osteoblastic group than in the osteolytic group (49.5% vs. 30.0%, p = 0.0437), with median survival times of 59 months and 38.5 months, respectively. In both univariate and multivariate Cox analyses, the type of bone metastasis was the only factor significantly associated with increased hazard ratios. Patients with osteolytic bone metastases from prostate cancer have a markedly lower five-year overall survival than those with osteoblastic metastases.

Over-the-counter (OTC) medicine overdose among adolescents and young adults is an increasingly visible concern in Japan, intersecting with suicide prevention priorities and unmet psychosocial needs. In this article, we share frontline perspectives from a semi-structured group interview with five peer supporters (women in their 20s–30s) who provide street outreach, social networking service (SNS) consultation, and drop-in place-making for young people, including those who overdose on OTC medicines. Using an inductive, data-driven thematic approach to organize participants' accounts, we highlight practice-relevant insights: i) an ecology shaped by offline isolation, SNS normalization, and easy access to OTC products; ii) low-threshold, non-judgmental engagement as a first door to care grounded in peer support principles; and iii) fragility and safety risks as complexity escalates, underscoring the need for structured professional backup, supervision, explicit escalation criteria, and reliable referral and crisis pathways.

Since 2025, in addition to financing, the core values of global health—including community engagement, equity, evidence-informed practices, and multilateral collaboration—have been challenged by powerful global leaders. The 8th Global Symposium on Health Systems Research (HSR2024), held in Nagasaki, Japan, in November 2024, generated momentum for health systems strengthening (HSS) not only at the national and subnational levels but also globally, despite growing headwinds. HSR2024 deepened the discussions on key contemporary HSS aspects, including community engagement, health systems resilience in the face of crises, equity, and evaluation of the impacts of HSS interventions from a cross-national perspective. Notably, the Symposium pursued people-centered and rights-based approaches to civic participation in health systems planning and policymaking, and emphasized the crucial interlinkage between health security, including climate resilience and pandemic preparedness, and HSS. By addressing these issues, HSR2024 effectively revitalized the global community's commitment to the core values of global health.

Artificial intelligence (AI) has the potential to transform how drug development and clinical trials are conducted. The 2025 Infectious Disease Clinical Research Network with National Repository (iCROWN) Symposium held in Japan on January 26, 2026 brought together experts from academia, industry, and research ethics to discuss current applications, limitations, and ethical considerations of AI in clinical trials, with a particular focus on emergency infectious disease research. Presentations highlighted a wide range of use cases for generative AI, including protocol writing; generating and reviewing clinical trial documents such as the statistical analysis plan (SAP) and the clinical study report (CSR); patient matching; data monitoring; and query creation. These applications are expected to accelerate and streamline clinical trials while maintaining quality and reducing costs. Standardization of digital data flows in clinical trials further facilitates the adoption of AI. Drawing on the FDA–EMA guiding principles for good AI practice, discussions emphasized the importance of accountability, explainability, fairness, and generalizability, while addressing risks such as overreliance, bias, and deskilling. The symposium concluded that while AI may enable more efficient clinical trial deployment during future public health crises, its challenges must be recognized and addressed.