Background: The globalization of economic activities has led to a significant increase in international business travelers (IBTs), exposing them to various health risks, including infectious diseases, physical and psychological stress, and inadequate access to medical care. However, comprehensive research on IBTs' health remains limited. This study aims to assess IBTs' health concerns through a scoping review, focusing on illnesses during travel, the impact on daily life and well-being, and corporate health management.

Methods: A scoping review was conducted following the Arksey and O'Malley framework and the Joanna Briggs Institute methodology. Extensive searches were performed in MEDLINE, Web of Science, and Ichushi-Web, targeting studies for studies published between 2013 and 2022. Eligible studies addressed IBTs' physical and mental health or healthcare access. A two-step screening process was applied, and relevant data were extracted and categorized.

Results: A total of 31 studies were included. Health risks for IBTs were classified into three categories: (1) travel-related illnesses, including infectious diseases and medical emergencies; (2) physical and psychological health impacts, such as sleep disturbances, obesity, and mental stress; and (3) corporate health management strategies. Limited pre-travel consultations and vaccinations were notable concerns, particularly among Japanese IBTs.

Conclusions: IBTs face significant health risks that require improved prevention strategies, including vaccination programs, corporate health policies, and psychological support. As global business travel resumes post-pandemic, comprehensive health management tailored to IBTs' needs is essential to ensure their well-being and operational efficiency.

Myopia has emerged as a major global health concern due to its rising prevalence and the associated risk of irreversible visual impairment. Although scleral and choroidal changes have traditionally received emphasis, recent studies highlight the retina as a key contributor to the onset and progression of myopia. This review incorporates recent advances across three interrelated domains: visual pathway modulation, functional impairment, and metabolic remodeling. Abnormal ON pathway signaling—particularly under mesopic lighting—disrupts emmetropization feedback and promotes ocular elongation. As myopia progresses, retinal dysfunction unfolds in a temporal cascade, beginning in the inner retina and eventually leading to widespread structural and functional degeneration. Concurrently, the retina exhibits stage-dependent metabolic shifts, progressing from early mitochondrial and lipid metabolism changes to mid-phase destabilization of membrane integrity, and culminating in late-stage oxidative stress, inflammation, and metabolic remodeling. Collectively, these findings redefine myopia as a progressive retinal disorder and underscore the potential of retina-targeted interventions to preserve homeostasis and mitigate long-term degeneration.

Population-scale human whole-genome sequencing (WGS) projects are ongoing worldwide. At a time when such large-scale genome projects were uncommon, the Tohoku Medical Megabank Project initiated genome analysis of the general population in Japan, aiming to build a foundation for personalized medicine and prevention. Recently, we have completed the WGS of 100,000 participants, and research utilizing this genomic foundation is in progress. Early in the project, we realized that standard protocols were not always suitable for large-scale sequencing, necessitating the development of optimized operations and quality control methods. To accommodate various sequencing platforms and adapt protocols to the scale of analysis, we have continuously refined our methods. As multiplex sequencing analysis became standard, we aimed to ensure uniform data quantity across samples. With the advent of large-scale analyses, streamlining operations has also been a critical focus. In this paper, we share the details of our WGS operations and quality control methods developed over a decade, highlighting the unique methods and know-how we have established.

There has been an increase in the number of older populations globally leading to a higher likelihood of multi-morbidities necessitating the use of multiple medications. This often poses the risk of potentially inappropriate medications (PIMs) and polypharmacy among older adults, but their data in the Nepalese context are lacking. This scoping review aimed to examine the published literature regarding the use of PIMs and polypharmacy in older people in Nepal. A literature search was conducted using three databases: PubMed, Embase, and Google Scholar. Articles published in English from 2011 to 2024 were retrieved for analysis to identify studies from Nepal, including the prevalence of PIMs and polypharmacy in older people aged ≥60 years. Studies were screened using Covidence (a web-based platform to perform reviews) and data were extracted using a specially designed form. The average values of the prevalence of PIMs and polypharmacy were derived from the selected studies. Seven articles involving 2341 older adults were included. The overall prevalence rates of PIMs and polypharmacy were 28.5% and 39.48%, respectively. Regional representation from Nepal included four studies from central Nepal and one each from western and eastern Nepal. The most common PIMs were benzodiazepines and non-steroidal anti-inflammatory drugs. PIM usage and polypharmacy are widely prevalent in Nepal. Hence, it is imperative to undertake effective measures to promote rational prescription practices for the geriatric population in Nepal.

Background: Trunk muscle mass decreases with age; this decrease is reported to be related to physical function and activities of daily living. Bioelectrical impedance analysis (BIA) may be used to effectively evaluate trunk muscle mass as an alternative to conventional measurement methods such as computed tomography and magnetic resonance imaging. This scoping review aimed to comprehensively examine existing knowledge on types and frequency of BIA devices and the relationship between trunk muscle mass and clinical outcomes.

Methods: We systematically reviewed studies involving older adults aged ≥65 years. We searched PubMed, Web of Science, and Scopus databases; observational studies (cohort, case-control, and cross-sectional) published between January 2000 and October 2023 were reviewed. Three independent reviewers summarized the BIA device model, BIA frequency, study design, study objectives, and outcomes.

Results: In total, 7 of 744 identified studies were reviewed. Most participants included in this review were community-dwelling older adults and older patients with stroke. The main research design was a prospective or retrospective cohort study. In addition, a multi-frequency model was used for the BIA device. Common clinical outcome indicators were physical function (swallowing) and activities of daily living.

Conclusions: The findings of this review suggest that BIA is an effective method for evaluating trunk muscle mass in older adults. However, the causal relationship between trunk muscle mass and clinical outcomes is unclear, necessitating the accumulation of more data from additional clinical studies.

In medicine, treatment or intervention is typically prioritized for individuals at high risk of diseases or mortality. This high-risk approach, which focuses on "high-risk" patients, has been a cornerstone of clinical decision-making. Additionally, recent advancements in precision medicine, especially those using multi-omics data to assess disease risk, have frequently been framed within this approach. However, it is not always the case that individuals at high risk of disease benefit most from the treatment of interest. In this context, we previously proposed a novel targeting strategy called the "high-benefit approach." By applying machine learning technologies to data from randomized controlled trials or observational studies, this strategy allows us to identify subpopulations likely to experience substantial benefits from the treatment and to target them, rather than those who are simply at high risk of diseases. The high-benefit approach contributes not only to effective resource allocation but also to the potential mitigation of health disparities by identifying individuals with limited or no benefits and offering alternative approaches that would be effective for them. This review paper explains the overall concept of the high-benefit approach and its potential for application in healthcare literature, particularly in advancing future precision medicine and public health.

Cigarette smoking is increasingly recognized as a significant modifiable environmental factor in the pathogenesis of rheumatoid arthritis (RA). This review discusses the potential mechanisms through which smoking contributes to the development of RA, particularly in genetically susceptible individuals. Research has indicated that the onset of autoimmune diseases, including RA, is often preceded by a prolonged prodromal phase characterized by autoantibodies such as anti-citrullinated peptide antibodies and rheumatoid factor. Smoking has been demonstrated to increase the risk of RA, especially in individuals with specific human leucocyte antigen subtypes, and modulate the disease activity. The pathological impact of tobacco smoke may involve the induction of cellular damage and death, leading to the production of neoantigens that trigger autoimmune responses. In addition, smoking may disrupt the microbiota in the respiratory tract and intestines, which may further influence disease progression. Thus, avoiding smoking from an early age is strongly suggested in decreasing the risk of developing autoimmunity and also as a means to establish of developing preventive strategies against autoimmune diseases such as RA.

Background: Since the increased interest in post-intensive care syndrome (PICS) and PICS-family, many studies have been conducted. However, the longitudinal changes in PICS symptoms are not clearly understood. This study aimed to summarize the longitudinal symptom changes in each PICS domain, including physical, cognitive, mental health, quality of life, and family.

Methods: In this secondary analysis study, we identified the studies that conducted longitudinal PICS assessments published between 2014 and 2022. The most frequently used assessment tools in each domain were defined as representative methods, and results of included studies were summarized by each PICS domain. The collected data were grouped by the following: within 3 months (baseline), at 3 months, 6 months, and annually thereafter. The Wilcoxon rank-sum test was used to compare changes from baseline.

Results: Of the 5,160 studies screened, 76 studies were selected in this study. The percentage predicted value of the 6-minute walk test as an indicator of physical function significantly improved from baseline to 6 months (median [interquartile range], from 45.9 [32.0-63.0] to 65.0 [57.8-72.8], p = 0.04), and continued to improve during the 5-year follow-up period. Montreal Cognitive Assessment for cognitive assessment and Impact of Event Scale-Revised for mental health assessment did not show statistically significant change. The anxiety score of the Hospital Anxiety and Depression Scale (HADS) improved from baseline to the 12-month follow-up (from 6.8 [4.0-8.5] to 4.3 [3.3-5.3], p = 0.04). The anxiety and depression scores of the HADS in family members did not show statistically significant change. The physical component summary of the Short Form-36 for quality of life assessment increased from baseline to the 12-month follow-up (from 31.3 [25.5-37.1] to 40.6 [36.9-50.0], p = 0.03); however, the mental component summary of the Short Form-36 was not changed with statistical significance.

Conclusions: Although the physical and mental domains showed significant longitudinal improvements, PICS symptoms were long-lasting in all domains with varying severity.

Introduction: Although prior research has investigated the health benefits of paid work in old age, its effect on social isolation, a crucial societal issue, remains unclear. Moreover, not only employment status but also the motivation for working may play a vital role in understanding social isolation. This study aimed to investigate the effect of employment status and motivations on the onset of social isolation in older Japanese people.

Methods: Longitudinal data were collected from self-administered questionnaire surveys of residents aged 65 and older dwelling in an area in Ota Ward in the Tokyo Metropolitan area in 2015 (baseline) and 2018 (follow-up). This study included 1,556 participants who were not socially isolated at baseline. Social isolation was defined as face-to-face or non-face-to-face interactions occurring less than once per week. Employment status was categorized as having or not having paid work, whereas motivations for working were classified as "financial reasons only," "non-financial reasons only (such as health, ikigai, social contribution, and social connection)," or "both financial and non-financial reasons."

Results: Among the total participants (men: 38.2%, average age: 72.9 years), 36.1% were employed at baseline, and 20.1% became socially isolated at follow-up. A binary logistic regression analysis with the adjustment for potential covariates showed no significant association between employment status and the onset of social isolation. However, individuals who worked only for financial reasons were more likely to experience social isolation than were those who did not work or worked for non-financial reasons.

Conclusions: Although employment status was not directly associated with social isolation, the motivations for working influenced its onset. Non-financial motivations for work in later life may reduce the risk of social isolation.

Introduction: This study examines patient behavior in Tokyo, Japan, during the early phase of the coronavirus disease 2019 (COVID-19) pandemic.

Methods: As part of a prospective cohort study on gastric cancer screening participants, we conducted a cross-sectional survey from April 2021 to March 2022. The survey included 1,554 participants (40.5% men, median age: 62, age range: 32-92). Specifically, we investigated whether participants continued hospital follow-up visits and underwent medical checkups and disease prevention screenings during the initial state of emergency in Japan (April to May 2020). We also explored changes in daily life and the psychological effects of COVID-19.

Results: During the state of emergency, 12.7% of men and 20.4% of women discontinued follow-up visits, with the primary reason being a desire to avoid human contact. Additionally, 6.5% of men and 14.2% of women ceased medical checkups and screenings. Among women, those who reported increased time spent on housework and family care, or experienced heightened stress and conflicts with housemates, were significantly more likely to discontinue or delay follow-up visits or treatment (odds ratio [OR] 1.55 [1.08-2.23], OR 1.53 [1.06-2.21]).

Conclusions: Our findings indicate that some middle-aged and elderly Japanese residents in urban areas avoided healthcare services to reduce the risk of COVID-19 infection. A subset of individuals continued this behavior even after the pandemic subsided. It is crucial to prioritize regular checkups for managing chronic illnesses and preventing new conditions. Effective communication strategies should be developed in collaboration with national and local governments.

Introduction: Atherosclerotic cardiovascular disease (ASCVD) risk profiles vary among populations. In Japan, a prediction model for the 10-year estimate of ASCVD risk, integrating coronary artery disease and atherothrombotic cerebral infarct risk assessments, has been developed based on the Hisayama Study. While hyperuricemia can promote atherosclerosis, serum uric acid levels are not included as a risk factor in the 10-year ASCVD prediction model.

Methods: We investigated the association between serum uric acid levels and 10-year ASCVD risk in 5,984 Japanese adults (3,285 males, 2,699 females) aged 40-79 years who underwent health check-ups between 2020 and 2022. The 10-year ASCVD risk scores were calculated using the aforementioned prediction model.

Results: Participants in the lowest quartile of serum uric acid levels (3.8 ± 0.6 mg/dL) had a mean 10-year ASCVD risk of 2.1 ± 3.2%, while those in the highest quartile (7.2 ± 0.7 mg/dL) had a mean risk of 4.3 ± 4.6% (p < 0.001). A significant positive correlation was observed between serum uric acid levels and 10-year ASCVD risk scores (r = 0.34, p < 0.001). Multiple linear regression analysis also revealed that serum uric acid levels remained an independent predictor of 10-year ASCVD risk after adjusting for other risk factors (β = 0.02, p < 0.001).

Conclusions: This study indicates that serum uric acid levels may serve as a useful marker for ASCVD risk assessment, particularly in the Japanese population.

Introduction: Unplanned pregnancy is associated with maternal-infant abuse. We investigated the association between unplanned pregnancy and maternal abusive behaviors and whether this relationship is mediated by bonding impairment.

Methods: We analyzed data from a sample of mothers with 3-4-month-old infants in Japan (n = 5,706). Multivariable logistic regression models were used to assess the associations among unplanned pregnancy, bonding impairment, and maternal-infant abuse. Causal mediation analysis was conducted to estimate the mediating effect of bonding impairment on the relationship between unplanned pregnancy and maternal-infant abuse.

Results: Among mothers who engaged in infant abuse, 24.8% reported an unplanned pregnancy, compared to 17.7% among those who did not. Unplanned pregnancy was significantly associated with an increased risk of maternal-infant abuse in a multivariable analysis (adjusted odds ratio [OR] = 1.36; 95% confidence interval [CI], 1.02-1.80). After adjusting for bonding impairment as a mediator, the association was attenuated (OR = 1.28; 95% CI, 0.96-1.70). Causal mediation analysis revealed a natural direct effect of unplanned pregnancy on maternal-infant abuse (OR = 1.28; 95% CI, 0.96-1.70), as well as a natural indirect effect through bonding impairment as a mediator (OR = 1.06; 95% CI, 1.03-1.09). Bonding impairment accounted for 20.1% of the association between unplanned pregnancy and maternal-infant abuse.

Conclusions: Bonding impairment partially mediates the relationship between unplanned pregnancy and maternal-infant abuse.

Introduction: Medical students are expected to contribute to society by applying their clinical knowledge and skills, particularly during times of crisis such as a pandemic. However, during the coronavirus disease 2019 pandemic, Japanese medical students faced strict restrictions on clinical involvement, which limited both educational opportunities and their ability to contribute. This study aimed to explore Japanese medical students' experiences of clinical training under these conditions and to investigate their awareness of social contribution.

Methods: This qualitative study involved semi-structured, peer-to-peer online interviews with 21 medical students from 19 universities across Japan. All participants had commenced hospital-based clinical training by September 1, 2022. Interviews were conducted between August and September 2022. Verbatim transcripts were analyzed using inductive thematic analysis.

Results: Three main themes were developed: (1) Commitment to supporting patients and healthcare teams; (2) Decline in direct clinical learning opportunities; and (3) Online practicum: balancing benefits and drawbacks. While many students were eager to contribute, legal uncertainty, lack of practical training, and concerns about how patients perceived them acted as psychological and institutional barriers. At the same time, students emphasized the value of in-person clinical experience and demonstrated a growing awareness of professional identity.

Conclusions: Despite limited clinical opportunities, Japanese medical students deepened their sense of professional responsibility and desire for social contribution during the pandemic. Medical education should provide clearer role definitions, institutional support, and hybrid models incorporating hands-on training to prepare students for future healthcare emergencies.

Introduction: Clinical guidelines recommend exercise therapy to modify an unhealthy lifestyle among individuals with chronic conditions (CCs), including hypertension, diabetes, and dyslipidemia. However, it remains unclear whether individuals with CCs engage in higher physical activity levels than do healthy individuals or whether implementing exercise therapy causes achieving sufficient daily physical activity levels for this population. We investigated steps/day as a measure of total physical activity levels in this group.

Methods: Participants aged ≥20 years were identified from the Japanese National Health and Nutrition Examination Survey (2007-2019). Age-adjusted steps/day by health status were estimated using the analysis of covariance. The proportions of those meeting the physical activity recommendations (≥8,000 steps/day) among individuals with CCs who practiced exercise therapy were confirmed by density plots.

Results: The data of 59,703 participants were analyzed. Age-adjusted steps/day in the multiple CC group (i.e., combinations of hypertension, diabetes, and dyslipidemia) were 480 steps/day fewer than those in the healthy group and 341 steps/day fewer than those in the single CC group. Furthermore, among the participants who engaged in exercise, the proportions of those not meeting physical activity guidelines were 51.2%, 56.7%, and 60.7% in the healthy, single CC, and multiple CC groups, respectively. Participants with diabetes (46.6%) showed the lowest proportion of those not meeting the physical activity guidelines among exercisers.

Conclusions: Despite physical activity recommendations by clinical guidelines, steps/day in individuals with CCs were very low. More than half of individuals with CCs did not meet the physical activity guideline targets, even for those who reported engaging in exercise. This suggests that focusing only on exercise is not an appropriate strategy to increase total daily physical activity. Healthcare providers need to effectively promote physical activity in clinical settings, especially advocating for increasing not only exercise but also daily lifestyle physical activities.

Introduction: Reportedly, electronic-Health (eHealth) literacy is lower in younger people than in those in their 40s and 50s, despite the Internet being an essential information source for the youth. We developed Japanese and Indonesian versions of the e-Health Literacy Scale (e-HLS).

Methods: Conceptual equivalence was verified using the forward-backward translation method. First- to fourth-year nursing students at two universities in Japan and Indonesia were surveyed using a web-based questionnaire, including a 12-item e-HLS. Data analysis involved item analysis, factor analysis, and validation of convergent and discriminant validity, reliability, discriminative validity, and cross-cultural validity. The study was approved by the Indonesian and Japanese ethics boards.

Results: Ninety-nine Japanese and 407 Indonesian participants responded to the survey (response rate: Japan 23.9%, Indonesia 89.6%). Neither country showed item distribution skewness, and no ceiling or floor effects were detected. Confirmatory factor analysis supported the same three-factor structure as the original e-HLS. Discriminative validity indicated that fourth-year students had higher overall, functional, and interactive health literacy scores than first- to third-year students. There were no significant differences between the two groups in terms of critical health literacy. Cronbach's alpha coefficients were 0.86 overall and 0.74-0.83 for each of the three domains. Regarding cross-cultural validity, configural invariance and full metric invariance models showed a good fit, but scalar invariance was not supported.

Conclusions: From the results, the content validity, construct validity (structural, cross-cultural, convergent, and discriminant validity), and reliability (internal consistency) of the Japanese and Indonesian versions of the e-HLS were confirmed.

Introduction: This study aimed to determine the effects of the sequence of a hybrid class on learning outcomes for clinical judgment development in nursing students.

Methods: This was a quasi-randomized controlled trial. The study participants consisted of 85 second-year nursing university students. The class was conducted in a hybrid format consisting of a simulation of providing nursing care to a patient with diabetes and an on-demand lecture on blood sugar regulation, insulin secretion, and action. The Japanese version of the Lasater Clinical Judgment Rubric (LCJR) was used to evaluate participants' clinical judgment. The Shapiro-Wilk test confirmed non-normal distribution for all items. The Mann-Whitney U test compared groups with a significance level of p < 0.05. This study was based on the "Development and Validation of Guidelines for Reporting Evidence-Based Practice Educational Interventions and Teaching."

Results: No differences were found between the groups at baseline. No differences were found between the groups in achievement based on the LCJR items, total scores, or learning goals after the hybrid class.

Conclusions: The results suggest that the sequence of simulations and on-demand lectures for clinical judgment development did not affect LCJR scores or learning goal achievement following a hybrid class.

Introduction: Japan's aging population and rising healthcare costs have prompted initiatives like the National Health Program to promote preventive care. The transtheoretical model (TTM) assesses readiness for behavior change, focusing on diet and exercise. This study compared health behaviors and outcomes between Japanese men in the "precontemplation" stage (no intention to change) and those in the "contemplation or higher" stage over four years.

Methods: This retrospective study analyzed data from 10,812 men aged 40-70 using the 2013-2017 Specific Health Checkups. Participants were grouped by TTM stages and matched by propensity scores to minimize confounding. Outcomes, including body mass index (BMI), blood pressure, and self-reported behaviors, were compared using χ² and t-tests.

Results: At baseline, precontemplation-stage men had better health metrics but exhibited higher rates of unhealthy behaviors, such as smoking. After four years, significant differences were observed only in high-density lipoprotein (HDL) and creatinine levels for men under 49, and in HDL, BMI, dyslipidemia medication, and eating speed for those 49 or older (p < 0.05).

Conclusions: Men in the precontemplation stage face challenges related to health awareness and readiness for change. Tailored interventions, including health education and motivational interviewing, support long-term health improvements. Future research should explore personalized interventions and broader health determinants for sustained behavior change.

Introduction: This study aimed to determine the association between long-term care (LTC) risk and nonresponse to a subsequent survey.

Methods: Community-dwelling older adults aged ≥75 years without certified care needs residing in Hachioji City, Tokyo, who participated in the annual frailty screening program, were evaluated. Among the fiscal year (FY) 2020 survey respondents, those invited to the FY 2021 survey were included. The exposures of interest were LTC risk assessed using the seven domains of the Kihon Checklist (KCL) and frailty status in the FY 2020 survey. Frailty status was categorized based on total KCL scores. The outcome of interest was nonresponse to the FY 2021 survey. We conducted multivariable logistic regression analysis to evaluate these associations.

Results: Among 35,425 participants, 9,456 (26.7%) did not respond to the subsequent survey. Among seven KCL domains, activities of daily living limitation (adjusted odds ratio, 95% confidence interval 1.38, 1.27-1.50), low physical strength (1.17, 1.10-1.26), isolation (1.32, 1.22-1.44), memory decline (1.23, 1.17-1.30), and depressive mood (1.10, 1.04-1.16) were associated with nonresponse to the subsequent survey. In addition, frailty status was associated with nonresponse in a dose-responsive manner (prefrailty: 1.19, 1.12-1.26; frailty: 1.63, 1.53-1.73).

Conclusions: Although the annual frailty screening program aimed to identify those with high LTC risk, older adults with LTC risk were less likely to respond to the survey. Thus, conventional survey methods may need to be modified or different approaches may need to be adopted to identify older adults with high LTC risk.

Introduction: Poor subjective health perception is a well-known risk factor for morbidity and mortality. This study aimed to investigate the relationship between social capital (SC) and health confidence among older individuals in a community setting.

Methods: The study included 884 individuals aged 60-79 years residing in a city in the Hokuriku region (460 men and 424 women; mean age: 70.32 ± 4.03 years). The analysis considered the following variables: residential area, sex, age, presence or absence of cohabitants, SC (general trust in the community, reciprocity among community members, attachment to the region, and engagement in hobbies and other community activities), health counseling-related resources, and lack of health confidence. The multivariate logistic regression analysis used lack of health confidence as the dependent variable. Multiple models were constructed.

Results: Of the 884 participants who provided data for the analyses, 176 (19.9%) reported a lack of confidence in their health. Women and individuals aged 70-79 years had significantly higher odds ratios (ORs) for reporting lack of health confidence (OR: 1.78 and 1.60, respectively). In men, the odds for reporting lack of health confidence were significantly higher among those who reported having no access to health or care counseling resources (OR 3.58, 95% confidence interval 1.47-8.72) and those who did not participate in sports-related group or club activities (OR 2.11, 95% confidence interval 1.15-3.86). In contrast, no significant associations were observed between SC factors and lack of health confidence among women.

Conclusions: The findings suggest that, particularly among men, access to health counseling resources and participation in community activities contribute to greater confidence in own health.

Introduction: Medical expenses, including ocular expenses, have been increasing annually in Japan. This study investigated national trends in the number of ocular examinations and examination expenses.

Methods: This descriptive study used two national data sources: national medical expense estimates and statistics on medical care activities under public health insurance. We analyzed the medical expenses in Japan from 2008 to 2021 and estimated the proportions of different types of medical services.

Results: Over 14 years, total medical expenses increased from 1.71 trillion yen to 2.31 trillion yen, with ocular medical expenses increasing from 64.5 billion yen to 96.0 billion yen. The total examination expenses increased from 155.2 billion yen to 231.5 billion yen, with ocular examination expenses increasing from 24.3 billion yen to 32.8 billion yen over 14 years. The examination expense category accounted for 32.3% of ocular medical expenses, although the overall examination expense category amounted to 10.0% of nationwide medical expenses in 2021. In particular, expenses related to optical coherence tomography (OCT) surged by 875.6%, visual field testing increased by 81.2%, corneal curvature measurement increased by 61.0%, and corneal endothelial cell density measurement increased by 59.3%. Only contact lens (CL) examination fees expenses decreased by 10.9%. In 2020, the coronavirus disease 2019 (COVID-19) pandemic caused a 24.8% and 22.0% decrease in ocular and nationwide examination expenses, respectively.

Conclusions: Over 14 years, ocular medical expenses in Japan have increased by 49.0%, and nationwide medical expenses have increased by 35.1%. In addition, ocular examination expenses have increased by 35.0% over the past 14 years, although nationwide examination expenses have increased by 49.1%. All examination expenses increased except for CL examination fees. In particular, the OCT category witnessed a rapid increase. The COVID-19 pandemic has affected ocular examination expenses.

Introduction: High salt intake has been linked to various diseases. However, measuring an individual's salt intake level may be challenging. This study aimed to identify the characteristics of individuals with high salt intake using a salt intake check sheet.

Methods: This is a cross-sectional study that used data from the Longevity Improvement & Fair Evidence (LIFE) Study. Participants were individuals who underwent a specific medical examination between April 2023 and March 2024 and also completed a salt intake check sheet. Individuals with missing data from the health examinations or the salt intake check sheet were excluded from the study. Individuals taking antihypertensives were also excluded.

Exposure factors were defined as participant sex, age range (40-64 and 65-74 years old), smoking, alcohol consumption, regular exercise, body mass index (BMI; <25 kg/m² or ≥25 kg/m²), and the presence of hypertension during specific health examinations (systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg). The salt intake level of participants, based on scores from the salt intake check sheet, was evaluated as the outcome in this study. Using these scores, participants were categorized into two groups: the low salt intake group (0-13 points) and the high salt intake group (>14 points). To evaluate the factors related to salt intake, the salt intake levels (high or low) of participants were set as the response variable, while the exposure factors were set as the explanatory variables. Modified Poisson regression analysis was then conducted.

Results: This study comprised 5,157 participants, with 3,745 in the low salt intake group (72.6%) and 1,412 in the high salt intake group (27.4%). Results from the modified Poisson regression analysis conducted to evaluate the correlation between individual salt intake levels and exposure factors showed statistically significant correlations between the following factors and high salt intake: smoking (relative risk [RR] = 1.35, 95% confidence interval [CI]: 1.21-1.50, p < 0.001); alcohol consumption (RR = 1.19, 95% CI: 1.09-1.30, p < 0.001); and BMI >25 kg/m² (RR = 1.32, 95% CI: 1.19-1.47, p < 0.001). Conversely, participants in the low salt intake group were at lower risk for hypertension compared to those in the high salt intake group; however, the difference was not statistically significant (RR = 0.92, 95% CI: 0.85-1.01, p = 0.08).

Conclusions: The results of this study showed that smoking, alcohol consumption, and having a BMI of ≥25 kg/m² were related to high salt intake.

Introduction: Residents who use multifunctional wheelchairs before nursing home admission often face discontinuation of such devices after nursing home admission. However, basic data on this issue remain limited. Therefore, in this study, we aimed to provide preliminary data by investigating the occurrence of fall-related fractures after nursing home admission, stratified by the type of wheelchair used before nursing home admission.

Methods: We used linked long-term care claims data, care-need certification survey data, and medical claims data from Ibaraki Prefecture, Japan. Participants were older adults who were newly admitted to nursing homes directly from home between July 2018 and February 2019 and had used wheelchair rental services before nursing home admission. We divided the wheelchairs into two types using long-term care claims data: multifunctional and standard wheelchairs. The outcomes of interest were newly occurring fall-related fractures within the first month of nursing home admission, identified from medical claims data. Fracture incidence was compared between the two wheelchair types, and information of residents with fracture were described.

Results: The study included 215 participants. The participants' median age was 88 years (interquartile range, 83-93); 153 (71.2%) were female, and 96 (44.7%) used a multifunctional wheelchair before nursing home admission. There are no fall-related fractures occurred among standard wheelchair users, whereas five fractures were observed among multifunctional wheelchair users.

Conclusions: Residents who used multifunctional wheelchairs experienced more fall-related fractures after admission than those who used standard wheelchairs before nursing home admission. Further research is needed to better understand the issue of service continuity by investigating wheelchair use after nursing home admission and the circumstances of fall-related fractures.

Introduction: Financial stability during the coronavirus disease 2019 (COVID-19) pandemic was crucial for accessing health care services, including treatment for conditions such as diabetes mellitus. Understanding the relationship between non-payment of salaries and treatment interruption is vital.

Methods: This cohort study investigated the association between non-payment of salaries and treatment interruption in Japanese patients with diabetes. Data from web-based nationwide surveys conducted between July and October 2020 and from January to March 2021 were used.

Results: This study followed up 655 patients with diabetes over time. Of these participants, 15 (2.3%) had recently experienced non-payment for their treatment, whereas 36 (5.5%) had experienced non-payment in the past. Compared with those who received payment for their treatment, the risk ratios (RRs) of treatment interruption were 4.58 (95% confidence interval [CI] 2.34-8.97) for those with recent non-payment and 2.00 (95% CI 0.92-4.36) for those with past non-payment. The RRs for the 548 male participants were 3.67 (95% CI 1.58-8.51) and 2.06 (95% CI 0.88-4.86) for recent and past non-payment, respectively.

Conclusions: In this longitudinal study of Japanese patients with diabetes, we identified an association between non-payment of salary and treatment interruption. Patients who experienced recent non-payment were more likely to experience interruptions in their scheduled care during the COVID-19 pandemic than those who experienced non-payment in the past.

Introduction: Acute post-streptococcal glomerulonephritis (APSGN) is traditionally classified as an intrinsic form of acute kidney injury (AKI). However, previous reports suggest that its pathophysiology may resemble prerenal AKI, particularly regarding low fractional excretion of sodium (FENa) in the acute phase. This study aimed to evaluate the paradoxical coexistence of reduced renal blood flow and fluid overload in APSGN.

Methods: We retrospectively analyzed patients with APSGN (≤15 years old) hospitalized between 2010 and 2019 who exhibited ≥5% weight gain and brain natriuretic peptide (BNP) ≥100 pg/mL. The acute phase was divided into three periods: peak (3 days), early recovery (2 days), and late recovery (up to 30 days). Patients with FENa and BNP recorded in at least two periods were included.

Results: Among 10 patients (median age: 7 years, interquartile range: 5-7), BNP levels peaked during the acute phase and decreased in the recovery phases. Conversely, FENa was low during the peak phase but increased during recovery, despite decreasing BNP levels.

Conclusions: In APSGN, FENa remained paradoxically low during the peak phase despite fluid overload (indicated by high BNP). These findings suggest that the acute phase of APSGN involves transient renal hypoperfusion and renin-angiotensin-aldosterone system activation, leading to sodium retention and volume overload. This mechanism supports the hypothesis that APSGN exhibits characteristics of prerenal AKI in its early stage.

Introduction: Despite progress in hypertension management, blood pressure (BP) control remains insufficient, and this so-called hypertension paradox is an urgent issue. Following the 2019 revision of the Guidelines for Hypertension Management, we reported that patients requiring stringent BP regulation highlight the unachieved goals of hypertension management. BP management is a basic and validated strategy for patients with chronic kidney disease (CKD) but its achievement rate has been under-reported.

Methods: We collected and compared cross-sectional data of patients with hypertension in Kanagawa, Japan for 2011 and 2014 by accessing the Japan Medical Association Database of Clinical Medicine.

Results: Patients with and without CKD were included as follows: 316/488 in 2011, 152/946 in 2014, and 396/385 in 2021, respectively. In the 2021 study, the target office BP (130/80 mmHg) and home BP (<125/75 mmHg) were achieved in 36.3% and 57.9% of patients with CKD, respectively, and this was a significant improvement over the results reported in the 2014 study (p < 0.05). In contrast, the 2021 study on patients without CKD had a significantly lower achievement rate for a stringent BP target compared to the 2014 study (p < 0.05), especially for patients without diabetes (p = 0.004). Unlike trends in patients without CKD, home BP control in patients with hypertension and CKD has improved over the past decade.

Conclusions: The stringent BP target achievement rate remains insufficient in patients with CKD, indicating that CKD campaigns or resolution of clinical inertia resulting from an insufficient number of concomitant drugs is warranted.

Introduction: Oral frailty, defined as an age-related decline in oral function, represents a significant risk factor for adverse health outcomes, though it can be mitigated through early intervention. The Oral Frailty Five-item Checklist (OF-5), introduced in 2023, assesses oral frailty using 5 indicators: reduced number of teeth, difficulty chewing, difficulty swallowing, dry mouth, and low articulatory oral motor skills. Designed for use beyond dental clinics, the OF-5 has demonstrated predictive validity for physical frailty and mortality. Similarly, the Oral Frailty Index-8 (OFI-8) comprises 8 items evaluating oral health, social participation, and dental habits.

Methods: This study compared the OF-5 and OFI-8 tools and investigated their associations with physical and biological markers. A cross-sectional analysis was conducted on 270 Japanese participants aged ≥65 years (median age: 78 years). The assessments included blood tests, physical measurements, and grip strength evaluation. Participants were categorized by sex and oral frailty risk based on OF-5 scores (non-frailty: ≤1; frailty: ≥2).

Results: Oral frailty, defined as an OF-5 score ≥2, was observed in 40.7% of the participants (33.8% in men and 47.4% in women). Both the OF-5 and OFI-8 scores were higher in women than in men. Sex-specific differences in physical and biological markers were evident; men exhibited higher grip strength, whereas women had a higher prevalence of anemia and osteoporosis. Women were also more likely to report reduced masticatory ability and lower levels of social participation. A high concordance rate of over 80% was observed between oral frailty (OF-5 score ≥2) and high-risk oral frailty (OFI-8 score ≥4).

Conclusions: These findings highlight the utility of subjective questionnaires in assessing oral frailty and emphasize the need for longitudinal studies to evaluate their predictive accuracy for physical frailty.

Introduction: It remains unclear which treatments are effective for addressing mental disorders in patients with acute myocardial infarction (AMI). Therefore, we evaluated the changes over time in anxiety and depression from intensive care units (ICUs) to outpatient departments (OPDs), as well as the post-discharge prevalence of anxiety and depression in AMI patients who underwent percutaneous coronary intervention (PCI) and received treatments based on the ABCDEFGH bundle, including nurse-led continuous follow-up.

Methods: This retrospective cohort study involved 29 patients who were hospitalized in the ICU for treatment of AMI. All patients received PCI and treatment based on the ABCDEFGH bundle. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS) at three phases: ICU, general ward (GW), and OPD. First, we compared changes in anxiety and depression scores over time using HADS across the three phases. Second, we assessed the prevalence rate of anxiety and depression after hospital discharge based on HADS scores.

Results: Of the 29 patients, the mean age was 67 ± 14 years, and 66% were male. For the anxiety subscale (HADS-A), scores improved from ICUs to OPDs (6.4-3.9 points, p = 0.001). For the depression subscale (HADS-D), there were no significant changes between ICU and GW, or between ICU and OPD (5.4-6.7, 5.4-5.2 points, respectively; all not significant). At the OPD stage, 14% of patients were in an anxiety state, and 34% were in a depression state.

Conclusions: In AMI patients who received PCI and treatments based on the ABCDEFGH bundle, the depression state remained unchanged from ICUs to OPDs, while the anxiety state improved after hospital discharge. The prevalence of anxiety was 14%, and the prevalence of depression was 34% after hospital discharge.

Introduction: We previously reported that combination therapy with SGLT2 inhibitors (SGLT2i) and GLP-1 receptor agonists (GLP-1Ra) was beneficial for the progression of diabetic kidney disease. However, sex differences in renal outcomes and metabolic markers with combination therapy remain unclear. To clarify this, we performed a post hoc analysis of the differences in renal outcomes between males and females.

Methods: Among 643 individuals with type 2 diabetes (T2D) who had received their preceding medication for ≥6 months and concomitant medication for ≥12 months, data from 361 males and 282 females were analyzed in this post hoc study. Renal outcomes and changes in metabolic markers were analyzed. To adjust for confounding factors at baseline, a propensity score analysis with inverse probability weighting (PS-IPW) was adopted, and a generalized linear model was used for the comparison.

Results: In the PS-IPW model, the incidence of renal composite outcomes was 28% in the male group and 26% in the female group, with an odds ratio of 0.90 (95% confidence interval: 0.56-1.44, p = 0.65). Significantly lower levels of diastolic blood pressure (DBP), mean arterial pressure, and alanine aminotransferase, and larger decreases in the body mass index and DBP were observed in the female group than in the male group.

Conclusions: DBP reduction differed between males and females with T2D treated with a combination of SGLT2i and GLP-1Ra. Sex differences need to be considered clinically in combination therapy, and their impact on cardiovascular events should also be investigated in the future.

Introduction: Numerous reports have suggested a relationship between asthma and migraine. We have encountered patients who presented with migraine attacks in association with asthma attacks.

Methods: In this study, we retrospectively evaluated the relationship between the condition of asthma (controlled or not) and the intensity of migraine attacks in 35 patients with asthma and migraine. We investigated the degree of changes in symptoms (change in fractional exhaled nitric oxide [FeNO], change in peak expiratory flow [PEF], and change in Asthma Control Test [ACT]) during exacerbation of asthma and observed the intensity of the headache (change in visual analog scale [∆VAS]). Next, we investigated the correlation between ∆VAS and biomarkers of bronchial asthma.

Results: When migraine was aggravated, indexes of asthmatic symptoms (ACT, PEF, and FeNO) were also exacerbated. We found a linkage between insufficiently controlled asthma and aggravation of migraine. Moreover, the three indexes of asthma (ACT, PEF, and FeNO) reviewed in this study showed a close correlation. There was a positive correlation between the degree of exacerbation of migraine symptoms and the degree of change in the three indexes. In 14 of 35 patients, administration of a short-acting β2 agonist for asthma attacks indirectly relieved headache.

Conclusions: There is a close correlation between the condition of asthma attacks and the intensity of migraine attacks.

Introduction: The integration of artificial intelligence (AI) in the United Kingdom's National Health Service may enhance patient care and alleviate systemic pressures. However, adoption of medical AI is challenged by limited educational access, low confidence among staff, and concerns regarding transparency and ethics. We evaluated the National Health Service National AI Conference on its impact on the understanding and attitudes of health care professionals regarding AI.

Methods: A before-and-after study design was employed using anonymized surveys distributed to conference attendees. The survey assessed participants' roles, prior experience with medical AI, and perceptions of AI's risks, benefits, and applications. Using a 5-point Likert scale, responses were analyzed via Wilcoxon's signed-rank test, after trialing McNemar's test, with statistical significance defined as p < 0.05.

Results: The survey was completed by 43 attendees. Most were clinical professionals (53.49%), with 65.12% having never attended a similar conference. Most participants (pre-conference: 69.77% vs. post-conference: 85.05%, p = 0.0868) understood the benefits and uses of AI, agreed that AI has the potential to improve patient care (93.02% vs. 95.35%, p = 1.00), were interested in pursuing a career in medical AI (62.79% vs. 67.44%, p = 0.824), and were concerned about the use of AI in health care (65.12% vs. 53.49%, p = 0.419). We observed an increase in understanding of AI after the conference among participants (p = 0.0367). Participant confidence and empowerment increased from 53.49% to 69.77% (p = 0.00319) and from 51.16% to 67.44% (p = 0.00596), respectively; these increases, alongside the increase in understanding of AI, reached statistical significance when analyzed using Wilcoxon's test, but not when dichotomized and analyzed with McNemar's test.

Conclusions: Our conference may increase AI understanding, confidence, and empowerment among health care professionals, encouraging further research into targeted medical AI education. A national AI curriculum, transparent governance, and robust information technology infrastructure are recommended to support the adoption of AI internationally.

Introduction:This study aimed to evaluate the peritoneal computed tomography (CT) attenuation values and investigate their predictive impact for the severity of peritonitis in patients with upper gastrointestinal tract (UGI) perforations.

Methods:Overall, 112 consecutive patients with UGI perforations who underwent plain CT were included in this study. Peritoneal CT attenuation values expressed in Hounsfield units (HUs) were measured on a workstation and investigated in relation to laboratory data obtained on admission, severity of illness, and hospital mortality.

Results: Peritoneal CT attenuation values were significantly negatively correlated with the Acute Physiology and Chronic Health Evaluation II (p < 0.01, R² = 0.17) and sequential organ failure assessment (SOFA) (p < 0.01, R² = 0.30) scores. Peritoneal CT attenuation values of hospital nonsurvivors (n = 7, 12.4 ± 11.0 HU) were significantly lower than those of hospital survivors (n = 105, 34.3 ± 15.8 HU). There was a significant negative correlation between peritoneal CT attenuation values, serum C-reactive protein levels (p < 0.01, R² = 0.11), and the time after the onset of abdominal pain (p < 0.01, R² = 0.08). Multivariate analysis revealed that the SOFA score was significantly associated with peritoneal CT attenuation values.

Conclusions: Evaluation of peritoneal CT attenuation values in patients with UGI perforation is simple and can be used to objectively assess the severity of peritonitis, which can serve as a reference for treatment strategies.

Introduction: Imeglimin is a new oral antidiabetic agent that became available in Japan in 2021. It is not recommended for patients with an estimated glomerular filtration rate (eGFR) <45 mL/min per 1.73 m² because of the lack of data regarding such patients. However, imeglimin may be beneficial for patients with chronic kidney disease because basic studies have shown its ability to decrease albuminuria and suppress kidney fibrosis.

Methods: We performed a retrospective study of the safety of imeglimin for patients with an eGFR <45 mL/min per 1.73 m². Side effects, renal function, liver function, pH, hydrogen carbonate, carbon dioxide, and glycated hemoglobin A1c when imeglimin was initiated and 3 months after treatment initiation were compared. Fifteen patients (10 male and five female patients) who were newly prescribed imeglimin treatment between October 1, 2021, and April 30, 2024, and had an eGFR <45 mL/min per 1.73 m² at that time were enrolled in this study. However, one patient self-interrupted treatment because of lightheadedness; therefore, 14 patients (10 male and four female patients) were included in the analysis.

Results: No deterioration in renal and hepatic functions occurred. Proteinuria decreased significantly, pH increased significantly, hydrogen carbonate remained unchanged, and carbon dioxide showed a decreasing trend. Subjective symptoms such as hypoglycemia and gastrointestinal symptoms were not observed.

Conclusions: Short-term imeglimin treatment may be safe for patients with an eGFR <45 mL/min per 1.73 m². Further studies of the safety of long-term imeglimin use are warranted.

Introduction: Comparing diabetes care across different regions of Japan is essential for informing future healthcare policy. Additionally, since many patients with diabetes receive treatment from non-specialist physicians, it is important to determine whether differences exist between diabetes specialists and non-specialists in terms of medical care and to identify specific areas, if any, where these differences occur.

Methods: To investigate this, we utilized data from J-DOME (Japan Medical Association Database of Clinical Medicine), a patient registry established as a nationwide project by the Japan Medical Association. Patients with type 2 diabetes were categorized into seven regional groups based on Japan's prefectural divisions, and a regional comparison was conducted. Differences between specialists and non-specialists were also examined.

Results: A total of 116 medical institutions encompassing 2,938 patients were included in the analysis. The nationwide mean glycated hemoglobin level was 6.96% (standard deviation [SD]: 0.46), with no statistically significant regional variations. Similarly, the nationwide mean blood pressure was 129.7/73.0 mmHg (SD: 6.1/5.7 mmHg), with no significant regional differences observed.

The average rates of regular ophthalmologic visits and urinary albumin quantification testing were 63.7% (SD: 31.3) and 40.2% (SD: 38.4), respectively. These rates were significantly higher in institutions led by diabetes specialists compared to those managed by non-specialists (regular ophthalmologic visit rate: non-specialists institutions: 53.9% [SD: 33.8]; diabetes specialist institutions: 78.5% [SD: 19.5], p < 0.001; urinary albumin quantification test rate among patients without macroproteinuria: non-specialist institutions: 33.5% [SD: 39.0]; diabetes specialist institutions: 62.5% [SD: 35.5], p < 0.001).

Conclusions: This survey revealed no significant regional differences in diabetes care. However, certain aspects of diabetes management differed significantly between diabetes specialists and non-specialist physicians.

Introduction: We examined the obstetric and neonatal outcomes of using mechanical methods (i.e., insertion of Dilapan as the synthetic equivalent in the cervical canal) for cervical ripening in cases with premature rupture of the membranes (PROMs) at term.

Methods: The criteria for inclusion in this retrospective observational study were as follows: PROM, singleton pregnancy, cephalic presentation, gestational age of 37-41 weeks, and a Bishop score of 0-2 at the beginning of induction. During the study period, 85 women met the criterion, and mechanical methods were used for cervical ripening following PROM. We examined the rate of cesarean delivery, number of days from the start of induction to delivery, umbilical artery pH, the incidence of clinical intrauterine infection, and neonatal infection.

Results: In cases of using mechanical methods following PROM at term, the number of days from the start of induction to delivery was 2.1 ± 2 days. The rate of cesarean delivery was 26% (22/85). The incidence of clinical intrauterine infection during labor was 7% (6/85), while there were no cases of neonatal infection. In addition, the incidence of maternal fever after the third postoperative day was 1% (1/85).

Conclusions: The current results suggest the potential clinical utility of mechanical cervical ripening methods following PROM at term.

Introduction: Acquired hemophilia A (AHA) is a rare, life-threatening bleeding disorder caused by the development of autoantibodies against coagulation factor VIII. AHA represents a diagnostic challenge, particularly for non-hematologist physicians who may initially encounter these patients. This study aimed to evaluate the level of AHA awareness among non-hematologist physicians across various medical departments in Japan.

Methods: This was a prospective, cross-sectional, observational, web-based survey of non-hematologist physicians, conducted over a period of 2 weeks (April 1-12, 2024) in Japan. The primary endpoint was the participants' level of AHA awareness.

Results: In total, 4,835 candidate physicians were screened, with 1,701 participants included in the analysis population. Of these, 84.2% had heard of AHA but only 29.7% could identify AHA symptoms and pathologies. More than 45% of participants in the emergency, general medicine, oncology, and rheumatology and collagen medicine departments were familiar with the disease name, symptoms, and pathologies, compared with less than 20% in the geriatrics, neurosurgery, obstetrics and gynecology, orthopedics, respiratory surgery, and urology departments. Although a high proportion (80.4%) of participants reported no experience of examining patients with AHA, many (79.4%) had examined patients exhibiting symptoms of AHA, indicating that they may have encountered patients for whom AHA should have been suspected. When presented with a fictitious AHA case, 44.3% of participants suspected and 34.7% strongly suspected acquired coagulopathy, with substantial variation observed between the different medical departments. Provision of additional laboratory results for the fictitious AHA case increased the proportion of participants who strongly suspected acquired coagulopathy to 38.0%.

Conclusions: Awareness of AHA among non-hematologist physicians in Japan is limited and inconsistent across departments. Educational initiatives are needed to enhance awareness and disease-specific knowledge among physicians, particularly those who are most likely to encounter patients with AHA, which is essential for early diagnosis and treatment.

UMIN clinical trials registry identification: UMIN000053895.

Introduction: Long-term mortality and activities of daily living (ADLs) outcomes in older patients who received desflurane anesthesia in real-world settings have not been evaluated. Therefore, we aimed to investigate whether the postoperative long-term care level of older patients who received desflurane was less impaired than that of patients who received sevoflurane, as well as the effects of desflurane on long-term mortality and long-term care-need level in older patients.

Methods: We performed a retrospective, open-cohort study using medical and long-term care insurance (LTCI) claims data from Fukuoka Prefecture, Japan. Administrative medical claims data linked to LTCI claims data were analyzed. The study population included patients aged ≥75 years who underwent intra-abdominal surgery. The primary outcomes were 1-year mortality and deterioration in long-term care-need level after the desflurane and the sevoflurane anesthesia. An inverse probability weighting (IPW) analysis was performed to adjust for confounders. Generalized linear model analysis was performed to estimate the odds ratios (ORs) for the primary outcomes.

Results: Among the 11,798 participants, 63.1% received sevoflurane and 36.9% received desflurane. The C-statistic of the propensity score for desflurane use was 0.701. In the generalized linear model analysis after IPW adjustment, desflurane did not cause deterioration in long-term care-need levels (OR, 0.931; 95% confidence interval [CI], 0.831-1.044) or reduced 1-year mortality (OR, 0.891; 95% CI, 0.782-1.016).

Conclusions: Desflurane did not improve the long-term care-need level or 1-year mortality compared with sevoflurane in older patients. Therefore, we could not conclude whether desflurane improves long-term mortality or care levels.

Introduction: Clinical judgment is crucial for nurses because it directly impacts patient safety and outcomes. Simulation is an effective strategy for teaching clinical reasoning and judgment. This study investigated the relationship between simulation performance and foundational knowledge from previous academic subjects, as measured by clinical judgment performance on the Lasater Clinical Judgment Rubric (LCJR). This study aimed to determine the impact of simulation-based learning and previous academic achievement on LCJR scores among nursing students.

Methods: In this cross-sectional quantitative study, a questionnaire was administered to second-year undergraduate nursing students (n = 85) after they completed simulation-based learning. The questionnaire captured self-assessed achievement levels related to the simulation's learning objectives and previous academic subjects. Statistical analysis included normality tests, Cronbach's α, Spearman's correlation, and multiple regression, with simulation and subject achievement as independent variables and LCJR scores as the dependent variable.

Results: Achievement of learning objective 3 (the "expectation to initial grasp") within the simulation, along with self-reported achievement in physical assessment, critical thinking, and nursing processes from previous academic subjects, significantly affected the LCJR total score and the "Interpreting" dimension. Physical assessment, critical thinking, and nursing processes also significantly impacted the LCJR "Noticing" dimension. Achievement of learning objective 1 ("Gathering information from electronic medical records") and learning objective 3 affected the LCJR "Responding."

Conclusions: The achievement of physical assessment, critical thinking, and nursing process in the previous academic subjects affected the total LCJR scores and the scores of Noticing and Interpreting. Emphasizing these areas of nursing education may enhance the students' clinical judgment skills.

Introduction: Balancing preventive and symptomatic medications is crucial to minimizing polypharmacy in older adults with limited life expectancy. This study examined end-of-life medications among older adults with advanced-stage cancer receiving home medical care.

Methods: We conducted a retrospective cohort study using Japan's national claims database between October 2017 and September 2019 and selected adults aged ≥75 years who received comprehensive home medical care services for patients with advanced-stage cancer. We compared prescriptions for preventive and symptomatic medications during two periods: (1) within 180 days before the first claim for the service issued (index date) and (2) within 180 days after the index date or until death.

Results: Overall, the study included 8,463 participants, of whom 47% were women and 46% were aged ≥85 years. The median observation period after the index date was 57 days (interquartile range: 30-131 days). Among preventive drugs, antihypertensives were the most frequently prescribed before the index date (60.3%), followed by lipid-lowering drugs (25.4%) and antiplatelets (21.7%). Prescription of lipid-lowering drugs, vitamins, and drugs for osteoporosis decreased by approximately 70%-80% after the index date. In contrast, prescription of oral anticoagulants, antidiabetic drugs, and antidementia drugs declined by approximately 40%. Symptomatic drug prescriptions also decreased after the index date, except for opioids (from 42.2% to 51.9%).

Conclusions: This is the first nationwide study to examine the prescriptions of preventive and symptomatic drugs among older adults with advanced-stage cancer receiving end-of-life home medical care.

Introduction: Emergency departments (EDs) are increasingly tasked with addressing the complex needs of patients whose daily lives are threatened by non-biomedical factors. To optimize learning about social determinants of health in EDs, it is important to better understand residents' experiences and learning processes in this context.

Methods: This qualitative study aimed to explore how residents with positive attitudes toward treating patients with social difficulties in the ED approach such cases and what they learn from these interactions. We selected a hospital where many ED patients present with complex social needs. The hospital is committed to non-discriminatory and equitable medical care and welfare, with educational policies that integrate patients' social backgrounds into daily care. Physicians in postgraduate years 1-7 were recruited purposively. In-depth online interviews were conducted, and data were analyzed using thematic analysis (a framework approach).

Results: A total of 13 physicians participated, with three main themes emerging: (i) healing care in the ED, (ii) positive learning experiences, and (iii) conflict and resolution. Participants described providing healing care in the ED, noting the challenges they faced and the learning opportunities they gained. They emphasized the importance of understanding and responding to patients' needs while noting conflicts in the workplace.

Conclusions: Novice physicians who have a positive attitude toward social problems in EDs approached patients with a non-judgmental attitude, provided healing-oriented care, and aimed to foster their professional development. They often experienced conflict that experts in health professions education need to address to better support residents.

Introduction: Increased muscle mass may positively influence the recovery of balance function. In this study, we aimed to investigate the relationship between changes in muscle mass and improved balance in patients with cerebral infarction.

Methods: This study included patients with cerebral infarction aged ≥65 years. The Berg balance scale (BBS) was used to evaluate balance function upon admission and discharge.

Participants were categorized into two groups based on BBS improvement: those who achieved the minimal clinically important difference (BBS improvement group; 213 participants, 73.4%) and those who did not (no BBS improvement group; 77 participants, 26.6%). Multiple regression analyses were performed, with increase in BBS score as the primary variable of interest and gains in skeletal muscle mass index (SMI) (Model 1), trunk muscle mass index (TMI) (Model 2), and SMI and TMI (Model 3) as explanatory variables.

Results: A total of 290 participants were analyzed. BBS gain exhibited an independent association with TMI gain (coefficient = 3.72, 95% confidence interval [CI] = 0.99-6.45, p = 0.008); however, no significant association was observed with SMI gain (coefficient = 0.03, 95% CI = −2.28 to 2.33, p = 0.983). Furthermore, in Model 3, TMI gain (coefficient = 4.28, 95% CI = 1.35-7.20, p = 0.004) was independently linked to BBS gain. However, in the subgroup analyses stratified by tertiles of rehabilitation volume, this association was not statistically significant in any subgroup.

Conclusions: In patients with cerebral infarction, an increase in TMI was associated with greater improvements in balance function during hospitalization. These results suggest a potential role for trunk muscle mass in supporting balance recovery; however, owing to the observational nature of the study, the findings should be interpreted with caution and viewed as hypothesis-generating. In addition, the lack of association in the subgroup analyses underscores the potential influence of confounding factors, such as the amount and content of rehabilitation, and highlights the need for future studies to control for these variables.

Introduction: Many patients with cancer experience physical and/or psychological distress when undergoing Comprehensive Cancer Genome Profiling (CGP) after being diagnosed with cancer. However, not all of these patients necessarily visit palliative care clinics. This study aimed to clarify the extent to which patients who underwent the CGP test experience physical and emotional distress.

Methods: The "Ease of Living Questionnaire" was administered to 75 patients who visited our CGP outpatient clinic between November 2022 and July 2023, and patient backgrounds were investigated.

Results: Of the 75 patients, 8 (16%) had physical symptoms graded as ≥3/5, and five had visited a palliative care outpatient clinic. On the other hand, 14 patients (28%) had psychological symptoms graded as ≥6/10, but only eight visited the palliative care outpatient clinic.

Conclusions: Several patients who underwent CGP examinations at our hospital experienced physical and psychological distress, suggesting a strong need for palliative care. However, the number of patients who undergo interventions by palliative care physicians is not necessarily high. It is important to take advantage of the fact that CGP outpatient clinics provide sufficient time for healthcare professionals to meet with patients and their families, as well as to seek to connect patients in need of palliative care with appropriate palliative care CGP outpatient clinics in the future.

Clinical practice guidelines (CPGs) are traditionally defined as systematically developed recommendations designed to optimize patient care, primarily within clinical settings under physician supervision. However, the scope of health-related decision-making has expanded considerably, now encompassing interventions implemented by various health professionals and even the general public. This evolving landscape necessitates a broader and more nuanced classification of health-related guidelines.

In this opinion paper, we propose a revised framework that categorizes guidelines into three distinct types: CPGs, health care guidelines (HcGs), and health guidelines (HGs). CPGs remain focused on physician-led care but may include health-related practices outside clinical settings when relevant to patient outcomes. HcGs address evidence-based practices conducted by licensed non-physician professionals such as nurses, pharmacists, and physical therapists. HGs pertain to practices adopted by the general public-such as diet, exercise, and wellness behaviors-that do not require professional supervision.

We also differentiate between "guidelines," which provide comprehensive recommendations across a broad range of topics, and "guidance," which offers targeted recommendations on specific issues. Additionally, we discuss "consensus statements" as a valid alternative when systematic reviews are not feasible.

By clarifying terminology and aligning guideline types with their intended audiences and settings, this framework aims to reduce confusion, improve usability, and promote evidence-based practices across the health care and public spectrum. Adoption of this classification supports a whole-of-society approach to health, aligning with the World Health Organization's vision for integrated and equitable primary health care systems.

Japan's aging population and declining public transportation have reduced healthcare access, particularly for older adults in rural areas. Currently, innovative mobility services such as ridesharing, mixed cargo/passenger transport, and medical "Mobility as a Service" are being implemented or piloted alongside existing services for older adults, such as home-visit medical care and transportation subsidies. This letter highlights ongoing initiatives in Japan and their potential to improve healthcare access. It also explores opportunities to enhance these efforts by leveraging public infrastructure, such as the nationwide post office network.

Approximately 250,000 foreign nationals reside in Japan under the specified skilled worker (SSW) visa category. Due to Japan's aging population and declining birth rate, a labor shortage is anticipated, prompting an increase in the intake of SSWs. All SSWs are required to undergo pre-arrival health screenings, but renal function assessments, such as the estimated glomerular filtration rate (eGFR), are not currently included.

We present a case of a woman in her early 20s from Myanmar who developed severe anemia and renal dysfunction after arriving in Japan as an SSW. Before arrival, an initial health checkup identified anemia with a hemoglobin level of 10.3 g/dL, but renal function tests were not conducted. Ten months later, her hemoglobin had dropped to 7.7 g/dL, and her serum creatinine level was elevated to 7.83 mg/dL. Subsequent testing revealed severe renal dysfunction, and imaging showed extensive cysts in the right kidney and atrophy of the left kidney, suggesting a congenital malformation. She required immediate hemodialysis.

This case highlights the gap in SSW health screenings, where renal function tests are omitted. Given Japan's rising number of SSWs, we emphasize the importance of including kidney function assessments, such as eGFR, in pre-employment health checkups. Early detection could prevent delays in diagnosing conditions like chronic kidney disease. As hemodialysis initiation often complicates treatment continuity after returning home, appropriate screening is essential for patient safety and improved health outcomes.

In conclusion, we suggest updating the pre-employment health checkup protocol for SSWs to include kidney function tests to address this critical gap.

Informed consent, a recent focus in the Japanese medical field, has been gaining ever-increasing attention and significance amid growing globalization. However, its implementation has introduced unique challenges stemming from cultural nuances, and differences in interpretations. The translation of "informed consent" as "explanation and agreement/consent" has created linguistic and conceptual hurdles among physicians, impeding effective patient-provider communication. As Japan's medical ethics landscape progressively aligns with American and European standards, there is an urgent need for a thorough reconsideration of the meaning and significance of informed consent. This is further accentuated by the rising influx of foreign medical patients, emphasizing the necessity for a comprehensive reassessment of its true meaning and application. To address these challenges, a two-pronged approach could be highly effective. First, integrating the definition, evolution, and practical application of informed consent into medical school curricula would provide future physicians with a solid ethical foundation. Second, establishing a periodic informed consent training program, similar to certifications such as Basic Life Support would ensure that practicing physicians stay up-to-date with evolving global standards and best practices.