Objective: This study examines how artificial intelligence (AI) technologies are used to address loneliness among older adults in Japan and aims to clarify emotional, social, and institutional dynamics of AI-supported elder care through analysis of unstructured, practice-based materials.

Materials and Methods: An exploratory qualitative analysis was conducted using Japanese-language blogs, case reports, policy documents, and technical articles identified through targeted keyword searches. Narrative segments were coded for emotional tone, expectations, anxieties, and institutional barriers. Themes were developed inductively through iterative review, with attention to lived context and relational dynamics.

Results: Analysis of six documents yielded 78 codes and five themes: (1) longing for connection, in which AI provided emotional comfort; (2) technological anxiety and resistance; (3) institutional and relational barriers; (4) reconstruction of relationality through AI-mediated expression; and (5) invisibility of loneliness and limitations of AI in detection and response.

Conclusion: AI technologies show promise in mitigating loneliness among older adults; however, effectiveness depends on emotional receptivity, institutional readiness, and relational context. Support systems must move beyond contact frequency to foster narrative expression and recognize loneliness as a legitimate target of care. These findings provide a foundation for ethically sensitive, context-aware intervention design.

Objective: To explore the effects of social isolation and vulnerability on loneliness among rural residents of Japan by testing the hypothesis that social support can alleviate loneliness.

Materials and Methods: A questionnaire-based cross-sectional survey was conducted using the University of California, Los Angeles Loneliness Scale score as the outcome to analyze the correlation between loneliness and social support.

Results: Among the 975 respondents, 46.7% were men, the mean age was 63.9 years, and 58.1% were aged ≥65 years. The three most common risk factors for loneliness and social vulnerability were living alone (29%), eating alone (15.4%), and mobility issues (12.6%). The three most frequent emotional support factors were spouses (62%), friends (45%), and siblings (32.4%), whereas the three most frequent physical support factors were spouses (65.5%), siblings (36.6%), and children living together (30.9%). Our multivariate analysis showed a significant correlation with the Loneliness Scale score in people with mobility issues (coefficient 0.47) and a trend towards an association with the score in childcare and elderly care households. The correlation coefficient was higher for childcare households than for eldercare households. Multivariate analysis of social support showed that emotional support from friends (coefficient −0.71) and instrumental support from a spouse (coefficient −0.62), siblings (coefficient −0.24), and friends (coefficient −0.37) reduced the Loneliness Scale score.

Conclusion: Mobility issues should be prioritized to alleviate loneliness in rural areas. Among societies with a declining birthrate and an aging population, loneliness may be a more serious problem for childcare than for older-person care households. To alleviate loneliness, emotional support from spouses or siblings and emotional and instrumental support from friends may be effective. It is important to promote social support and create systems that enable acquaintances and neighbors to become friends.

Objective: This study aimed to identify factors that enhance or hinder job satisfaction among public health physicians in Nagoya City, Japan.

Methods: We conducted semi-structured interviews with 20 public health physicians employed by local government agencies, representing various ages, sexes, years of experience, and departmental affiliations. The interviews were audio-recorded, transcribed verbatim, and analyzed using qualitative content analysis. Codes were generated inductively, grouped into categories, and synthesized into overarching themes. Member checking and triangulation among researchers were performed to enhance the study’s credibility.

Results: Three themes were identified as key promoters of job satisfaction: (1) contributing to public health policy through professional expertise, which allowed participants to apply knowledge gained through medical practice to preventive medicine and evidence-based policymaking; (2) a sense of contribution to the community, fostered by collaborative efforts with local organizations to improve residents’ health and quality of life; and (3) work-life balance and career flexibility, enabling alignment between professional responsibilities and personal values. Conversely, two themes emerged as barriers: (1) limited opportunities for professional growth and self-efficacy due to the routine nature of tasks and a lack of specialized training, and (2) difficulty adapting to the organizational culture and decision-making processes of public administration, often accompanied by unclear role definitions.

Conclusion: Enhancing the motivation and retention of public health physicians requires creating work environments that support the meaningful application of expertise, foster a strong sense of community impact, and facilitate adaptation to the administrative organizational culture. Additionally, providing structured opportunities for professional development and strengthening career pathways could reinforce physicians’ professional identities and long-term engagement in public health practice.

Objective: The Hyodo scoring system, applied during flexible endoscopic evaluation of swallowing (FEES), has been proposed as a useful tool for assessing oral intake. However, patients hospitalized with aspiration pneumonia often present with severe dysphagia, making it difficult to advance their diets even when their Hyodo scores are relatively good. This study aimed to evaluate the ability of the Hyodo score to predict swallowing function outcomes in patients with aspiration pneumonia.

Methods: FEES was performed in patients with aspiration pneumonia. The relationship between the Hyodo score and swallowing function at discharge was analyzed.

Results: A total of 57 patients with aspiration pneumonia were included. At the time of discharge, 9 of 11 patients (82%) with scores below than 5, 15 of 29 patients (52%) with scores between 5 and 8, and 3 of 17 patients (18%) with scores above 8 were able to consume pureed diets.

Conclusion: The Hyodo score appears to be a useful indicator for predicting swallowing function and dietary status at discharge among patients with aspiration pneumonia.

Objective: To explore the factors that contribute to the improvement in the annual change in the estimated glomerular filtration rate (eGFR slope) in patients with diabetic nephropathy at high risk of disease progression, particularly those with an eGFR of less than 30 mL/min/1.73 m².

Methods: We analyzed 64 patients with diabetic nephropathy who underwent treatment to prevent dialysis. We compared data between the eGFR slope maintenance improvement and worsening groups and explored the factors associated with improvement in eGFR slope using multivariable analyses (UMIN000050610).

Results: The mean eGFR before the interventions was 29.6 ± 11.6 mL/min/1.73 m², and the eGFR slope was −4.1 ± 7.7 mL/min/1.73 m²/year. In the univariable analyses, the eGFR slope was improved by treatment with sodium-glucose cotransporter 2 inhibitor (SGLT2i) (−5.0 ± 8.3 to −1.1 ± 4.6 mL/min/1.73 m²/year, P<0.01) and glucagon-like peptide-1 receptor agonists (GLP-1RAs) (−5.5 ± 7.3 to −1.3 ± 4.5 mL/min/1.73 m²/year, P<0.01) before and after the interventions. In multivariate analyses, no significant association was observed between eGFR slope and BMI, blood pressure, or HbA_1c level. However, there was a significant association between the eGFR slope and treatment with GLP-1RAs ([95% CI −10.17 to −2.70], P<0.01).

Conclusions: GLP-1RAs treatment was notably associated with improvement in eGFR slope in patients with diabetic nephropathy. However, this study has several limitations, including its retrospective design, small sample size, and lack of distinction between monotherapy and combination therapy.

Objective: As more women continue their careers, health support throughout their life has become crucial. Menopausal symptoms, influenced by hormonal shifts and complex social roles, often lead to reduced work performance and even job attrition among working women. This study aimed to identify the physical, psychological, and social health challenges faced by working women during menopause and the underlying factors for the same. Our goal was to provide foundational insights to enable development of effective support strategies.

Patients and Methods: We recruited 20 working women aged 37–67 years, primarily care workers, a profession with a high proportion of female employees. The participants were selected using snowball sampling. Semi-structured interviews were conducted with 3 to 6 participants per group. Each session lasted approximately 60 minutes and took place through direct meetings using social networking service chat functions. The collected data were analyzed using qualitative content analysis.

Results: Physical health challenges included fatigue, decreased concentration, and emotional fluctuations; these non-specific symptoms were often difficult for individuals to recognize. From a psychological perspective, anxiety about ageing and reduced self-esteem have been identified as hindering women’s self-acceptance of menopause. Socially, the taboos surrounding menopause and feelings of workplace isolation are evident, acting as barriers to appropriate workplace support. The findings indicated that an unsupportive workplace environment and lack of social support further exacerbated these menopausal health problems.

Conclusion: Supporting working women during menopause requires a comprehensive approach that addresses physical, psychological, and social aspects. Key priorities include disseminating accurate information, promoting women’s self-acceptance, and establishing supportive systems within the workplace.

Objective: The balance ball is an exercise suitable for beginners; it incorporates diverse elements such as aerobic and anaerobic exercise, stretching, and balance training, with easily adjustable intensity and difficulty. Under instructor guidance, it can be practiced safely and effectively within a short period. Furthermore, online formats allow participation from home, making them suitable for busy women to establish exercise habits. Previous research on the effects of balance ball lessons has primarily focused on improvements in physical and cognitive functions, with little attention paid to the holistic effects. This study aimed to clarify the impact of online balance ball lessons on women’s subjective health perceptions.

Participants and Methods: This study involved 21 working women aged 31–67 years who participated in online lessons conducted by a balance ball instructor. Semi-structured interviews were conducted in groups of 3–6 participants, each lasting approximately 60 minutes, and utilized SNS chat functions. The collected data were analyzed using qualitative content analysis.

Results: Regarding physical health, participants found that “anyone can continue” with the balance ball once they learn the “basic posture”. Continuation led to a sense of “maintaining weight and body shape” and “improved physical fitness”, contributing to health management. Psychologically, “changes in awareness of body shape” were observed. The refreshing effect provided “mental healing” and enhanced “subjective well-being”. Socially, the online lessons facilitated the building of “new connections” outside work.

Conclusion: Online balance ball lessons holistically enhanced the subjective health perceptions of the participating women from physical, psychological, and social perspectives. This could be a new option for holistic health promotion in future community health support and health promotion initiatives.

Objective: This study aimed to identify the characteristics of non-cohabiting family caregivers who preferred to share or delegate the responsibility of accompanying cancer survivors to outpatient chemotherapy appointments in rural settings. The analysis was based on the hypothesis that greater transport-related burdens would be associated with stronger preferences for delegation.

Materials and Methods: A cross-sectional survey was conducted among caregivers of patients undergoing outpatient chemotherapy. Data on caregiver demographics, employment status, income, scheduling flexibility, and support preferences were collected. Geographic information systems (GIS) were used to visualize spatial relationships between caregivers and medical facilities. Descriptive and inferential statistical analyses were performed to examine caregiver characteristics and support preferences. Fisher’s exact test was used for categorical comparisons, and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated to assess effect sizes. Statistical analysis of geographic factors was not conducted because of the wide variation in travel distances and the limited sample size.

Results: Of the 40 individuals approached, 27 responded (67.5%), and 26 completed all survey items (65.0%). A preference for shared transport options was significantly associated with an annual income below 5 million yen (OR=15.75, 95% CI: 1.07–232.52) and the need to adjust personal schedules for caregiving responsibilities (OR=18.33, 95% CI: 2.71–124.00). GIS analysis indicated a median travel time of 95.5 min (interquartile range [IQR]: 70.5–169.6) and a median travel distance of 97.7 km (IQR: 44.7–173.8). The longest recorded travel route required 588.7 min and covered 442.2 km.

Conclusion: The findings indicate substantial caregiving burdens among caregivers with limited finances and employment constraints who do not live with care recipients. Long-distance travel affects caregivers’ employment and well-being, highlighting the need for support systems that alleviate the burden of transporting cancer survivors.

Objective: The majority of antiemetic administration for preventing aspiration in stroke patients is reported to occur after hospital admission. There are no reports on pre-hospital antiemetic administration or outcomes regarding stroke patients. Therefore, this retrospective study of stroke patients was conducted using data from the Japanese Society Aeromedical Services Registration System (JSAS-R).

Material and Methods: Information on patients diagnosed with stroke was collected from the JSAS-R database, including age, sex, vital signs at the time of patient contact by helicopter staff at the rendezvous point, stroke type (cerebral ischemia, cerebral hemorrhage, or subarachnoid hemorrhage), medical interventions, and survival or death within one month. The exclusion criteria were cardiac arrest at emergency medical technician contact and unknown final outcome. Subjects were divided into two groups for each type of stroke, according to whether antiemetics were administered or not, and comparisons were made between the paired groups.

Results: During the study period, 1,420 cerebral ischemia, 1,250 cerebral hemorrhage, and 445 subarachnoid hemorrhage cases were included. For cerebral ischemia, there was no association between antiemetic use and outcome. However, in cases of cerebral hemorrhage, the rate of tracheal intubation was lower and the survival rate higher for the antiemetic group than the non-antiemetic group. For subarachnoid hemorrhage, the antiemetic group was older, had a better level of consciousness, a lower rate of tracheal intubation, and a higher survival rate than the non-antiemetic group. Additional multivariate analysis of the subarachnoid hemorrhage group was conducted, but antiemetic treatment was not selected as an independent factor for survival.

Conclusion: In the case of cerebral hemorrhage after stroke, pre-hospital antiemetic administration may contribute to an improved outcome.

Objective: Hospital and obstetric unit closures in U.S. counties often lead to expansion of maternal healthcare deserts, defined as counties without a birth center offering obstetric care. This study describes the maternal demographic profile and geographic scarcity of obstetric care across the large and sparsely populated west Texas region.

Materials and Methods: Aggregate population data are obtained from the U.S. Census and American Community Survey. Maternal healthcare centers for 107 counties across west Texas, defined here as public health regions 1, 2, 9, and 10, are identified using data from the Texas Collaborative for Healthy Mothers and Babies.

Results: Across west Texas, 76 of 107 counties are maternal healthcare deserts, with no available obstetric care. Approximately 82,000 women of childbearing age live in these counties, with about 5,000 reporting having given birth in the past 12 months. Level II or higher obstetric care is available in just 12 (about 11%) of west Texas counties.

Conclusion: A majority of rural counties across the large geographic area of west Texas lack labor and delivery services, leading expectant mothers to travel to neighboring counties for obstetric care, or further for high-risk care. Greater coordination between higher level maternal care centers and rural hospitals and providers, as well as telehealth and community health worker outreach, may provide some level of connection to obstetric services for women in rural areas.

Objective: Japan has the fastest aging population globally, with a growing demand for home medical care among older adults. The number of home visits by physicians is regarded as a key process indicator for evaluating the home medical care delivery system. Understanding the social factors affecting home visits by physicians may contribute to more equitable and effective care delivery. This study aimed to investigate the social factors associated with the number of home visits by physicians across 47 prefectures in Japan.

Materials and Methods: This ecological study used 2019 data from the National Database (NDB), Open Data, and other government sources. The outcome was the number of physician home visits per 1,000 people aged ≥65 years. Social variables included the number of home care support clinics/hospitals (HCSCs), population density, proportion of single-elderly-person households, educational attainment, and other factors. Pearson’s correlation coefficients and multiple regression analyses were performed.

Results: Variables with Pearson correlation coefficients ≥0.4 were the number of HCSCs, the proportion of single-elderly-person households, population density, and the percentage of individuals whose highest level of education was college or higher. Multiple regression revealed that the number of HCSCs (β=0.546, P<0.001), population density (β=0.311, P=0.004), and the percentage of individuals whose highest level of education was college or higher (β=0.260, P=0.009) were significantly associated with physician home visits (adjusted R²=0.780).

Conclusion: This study revealed that, in addition to healthcare system indicators such as the number of HCSCs, social determinants, including population density and educational attainment, were significantly associated with the number of physician home visits.

Objective: To assess the correlation between lifelong learning for physical therapists and regional differences in the provision of rehabilitation services.

Materials and Methods: We conducted an ecological study using open data from the 2019 National Database of Health Insurance Claims and Specific Health Checkups. We investigated claims for disease-specific rehabilitation. The standardized claims ratio (SCR) for each of the 47 prefectures was calculated to evaluate regional differences. We also examined the number of certified physical therapists (CPTs) and specialist physical therapists (SPTs) in each prefecture certified by the Japan Physical Therapy Association across specialty fields. Population-adjusted therapist density was expressed per 100,000. Prefecture-level correlations between the SCR for each disease-specific rehabilitation program and therapist density were evaluated using Spearman’s rank correlation. Multiple tests were performed using Storey’s q-value method.

Results: The SCRs for disease-specific rehabilitation showed regional variation. The SCR for respiratory rehabilitation had the largest range (32.2–192.5). The population-adjusted numbers of CPTs and SPTs ranged from 3.9–14.7 and 0.4–6.9 per 100,000 population, respectively. The SCR for cardiovascular rehabilitation was positively correlated with the CPT field, “orthopedic disorders” (ρ=0.54, q<0.01) and the SPT field, “orthopedic physical therapy” (ρ=0.45, q<0.05). The cerebrovascular rehabilitation SCR was positively correlated with the CPT field, “prevention for frail elderly” (ρ=0.45, q<0.05).

Conclusion: Japanese prefectures with greater densities of CPTs or SPTs delivered higher volumes of rehabilitation services. Our findings suggest that the unequal distribution of postgraduate educational opportunities and certified personnel may contribute to these regional differences. Strengthening access to lifelong learning and specialty certifications in underserved regions may help reduce geographic disparities in rehabilitation services.

Objective: To elucidate the relationships between metabolic syndrome (MetS)-related factors and all-cause mortality over a 28-year follow-up in O City, Ehime Prefecture, Japan.

Materials and Methods: Using the Basic Resident Registration System, we analyzed data from 3,931 participants aged 40–74 years (1,360 men and 2,571 women) who underwent annual medical examinations based on the Geriatric Health Care Law between 1996 and 1998. Cox proportional hazards regression was used to assess associations between all-cause mortality and nine variables, adjusted for sex and age: MetS; body mass index (BMI: underweight, <18.5 kg/m²; normal weight, 18.5 to <25.0 kg/m²; overweight, ≥25.0 kg/m²); height; waist circumference abnormality; elevated blood pressure/hypertension; dyslipidemia; prediabetes/diabetes; alcohol consumption; and smoking.

Results: Of the participants, 1,938 died. In both men and women, MetS was not associated with all-cause mortality. Underweight status (hazard ratio [HR]=1.93, 95% confidence interval [CI]: 1.43–2.60 for men; HR=1.51, 95% CI: 1.16–1.97 for women), prediabetes/diabetes (HR=1.35, 95% CI: 1.13–1.62 for men; HR=1.36, 95% CI: 1.12–1.66 for women), and smoking (HR=1.45, 95% CI: 1.25–1.67 for men; HR=1.95, 95% CI: 1.48–2.58 for women) were significantly associated with all-cause mortality.

Conclusion: Avoiding smoking, underweight status, and prediabetes/diabetes may help extend life expectancy.

Objective: Assertiveness is a communication skill that enables individuals to express themselves with ease while protecting their own rights and respecting those of others. This study aimed to examine changes in assertiveness among psychiatric day care users over a one-year period and to identify associated background factors.

Patients and Methods: Two questionnaire surveys based on the Japanese version of the Rathus Assertiveness Schedule (J-RAS) were conducted among 985 psychiatric day care users with schizophrenia between April 2013 and August 2014.

Results: Of the 985 users approached, 298 (30.3%) were enrolled in the study. The mean J-RAS score was –10.2 ± 21.7 in the first survey and –9.1 ± 20.0 in the second survey, with no statistically significant difference observed. Factors associated with J-RAS scores in the second survey included J-RAS scores from the first survey and the purpose of day care use, particularly enjoyment of daily living. These findings suggest that day care support contributed to the maintenance of relatively high assertiveness levels over the one-year period.

Conclusions: Psychiatric day care support enabled users to maintain an appropriate level of assertiveness over a one-year period.

Objective: To summarize emergency transport cases related to bamboo shoot activities treated at a single center and review the relevant literature.

Methods: We retrospectively reviewed cases presented to a hospital in Japan from April 2015 to June 2025 involving bamboo shoot harvesting-related incidents. The collected data included patient sex, age, month of consultation, clinical history, diagnosis, and outcomes. Additionally, literature searches were conducted using Ichushi, PubMed, and general Internet sources to identify related case reports and studies.

Results: Nine patients (six males and three females) aged 63–80 years (mean: 71.6 years) were included. Six patients sustained injuries from falls or slips while harvesting bamboo shoots, and three experienced cardiopulmonary arrest (CPA) during the activity. All patients with CPA died, whereas those with traumatic injuries survived. A literature review revealed a wide variety of incidents related to bamboo shoot harvesting, including: getting lost in forests, animal attacks, parasitic and tick-borne infections, exertion-induced endogenous illnesses, harvesting-related trauma, allergic reactions following consumption, and postprandial ileus.

Conclusion: Emergency medical conditions related to bamboo shoot harvesting predominantly affect older males and often involve trauma from falls or slips. Notably, the literature also indicates a wide spectrum of possible emergencies related to this seasonal activity.

Objective: To describe a rare case of esophageal submucosal hematoma associated with apixaban therapy.

Patient and Methods: A 74-year-old female on apixaban for atrial fibrillation presented with retrosternal chest pain and hematemesis. Imaging and endoscopy revealed a large submucosal hematoma in the mid-to-lower esophagus. Conservative treatments including fasting, intravenous fluids, and proton pump inhibitor therapy were initiated, and apixaban treatment was discontinued.

Results: Serial endoscopy revealed a progressive resolution of the hematoma, followed by ulcer formation and eventual healing. No arrhythmia recurrence occurred during hospitalization. Anticoagulation was discontinued, and the patient was discharged in good condition. A follow-up endoscopy confirmed complete healing without recurrence.

Conclusion: This case highlights the potential risk of esophageal submucosal hematoma in a patient receiving direct oral anticoagulants. Prompt recognition and appropriate conservative management can lead to favorable outcomes. Clinicians should maintain a high index of suspicion of esophageal submucosal hematoma in patients receiving anticoagulation therapy presenting with chest pain and upper gastrointestinal bleeding.

Objective: To describe a case of acute acalculous gangrenous cholecystitis in a non-elderly man taking opioids, highlighting the diagnostic value of ultrasound in the absence of abdominal pain.

Patient and Methods: A man in his 50s with a history of advanced right oropharyngeal cancer was referred to us with fever and liver dysfunction. Ultrasound examination revealed an enlarged gallbladder and wall thickening with fullness of biliary sludge and intraluminal membranes. Murphy sign was not detected by ultrasound examination. Contrast-enhanced computed tomography also confirmed acute gangrenous cholecystitis with ascitic fluid.

Results: Urgent surgery was successfully performed. Acute gangrenous cholecystitis was confirmed. He is now well at 1 year post-admission.

Conclusion: We reconfirmed that ultrasound examination is useful for the diagnosis of acute gangrenous cholecystitis in patients presenting with abnormal liver function tests, even if they are free of abdominal symptoms. In patients taking opioids, even without abdominal symptoms, the presence of fever and abnormal liver function tests should prompt high suspicion for gangrenous cholecystitis and warrant aggressive imaging. Careful attention should be paid to painless cholecystitis in patients taking opioids.

Objective: Remnant cystic duct cancer is a rare disease, with only a few reported cases. We report a case of remnant cystic duct cancer that gradually increased in size.

Patient: A 78-year-old woman with a history of cholecystectomy presented with a gradually enlarging mass at the porta hepatis after laparoscopic liver resection for hepatocellular carcinoma.

Results: Diagnostic imaging, including computed tomography and magnetic resonance imaging, showed a mass at the porta hepatis near a surgical staple, which gradually increased in size over two years. Endoscopic ultrasonography revealed a mass in the cystic duct enhanced with perfluorobutane. Resection of the extrahepatic bile duct with choledochojejunostomy was performed. Histopathological examination revealed a well-differentiated adenocarcinoma at the site where the cystic duct protrudes into the common bile duct opening. The patient remains alive two years after surgery without recurrence or metastasis.

Conclusion: Remnant cystic duct cancer is extremely rare and often presents at an advanced stage. This case demonstrated a slow, asymptomatic progression, offering new insight into its natural history.

Objective: Gastroepiploic artery aneurysms (GEAAs) are rare, comprising 4–5% of visceral artery aneurysms, and are typically diagnosed after rupture. Here, we report a rare case of an unruptured right GEAA incidentally detected during a routine health checkup that was successfully treated with laparoscopic resection.

Patient: An asymptomatic 74-year-old man presented with a 30-mm mass anterior to the pancreatic head that was incidentally detected during routine abdominal ultrasonography. Color Doppler confirmed internal arterial flow, and pulsed-wave Doppler imaging demonstrated a waveform consistent with an arterial aneurysm.

Results: Contrast-enhanced computed tomography revealed a solitary, unruptured right GEAA with a mural thrombus and no calcification, atherosclerosis, or additional visceral artery aneurysms. The aneurysm’s unclear etiology and favorable anatomical location supported the decision to perform a laparoscopic aneurysmectomy for diagnostic and therapeutic purposes. The surgery was performed without complications. The histopathological examination revealed a pseudoaneurysm with thrombus formation and atherosclerotic changes. The patient was discharged on day 5 with no signs of recurrence 3 months postoperatively.

Conclusion: Ultrasonography is a useful diagnostic tool to detect unruptured right GEAAs during routine health checkups. Laparoscopic resection may be a safe and effective treatment option for unruptured solitary GEAAs of uncertain origin.