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BackgroundsIncome reduction in poor households affects healthcare demands for impoverished population. However, the impact of reduced benefits for public assistance recipients, who can use medical services for free, on healthcare costs has not been examined. We hypothesised that marginal cuts in benefits increase recipients’ medical expenditure by extra demand for medical care. We tested this hypothesis using public assistance databases of Japan.MethodsThe study population comprised households in five municipalities receiving public assistance between April 2016 and September 2018. The households have a child aged 12–60 months and receive a monthly child-support income of US$150, which reduces by US$50 when the child turns 36 months of age. Our analysis comprised an age-based sharp regression-discontinuity study.ResultsWe observed 4893 household-months (11 032 person-months). When a firstborn child reached 36 months, their frequency of outpatient visits and healthcare costs by recipients, except for the firstborn child, increased (0.45, 95% CI: 0.30 to 0.61; US$111.2, 95% CI: 20.7 to 201.7), while those of the firstborn child did not increase significantly. The monthly medical expenditure per household increased by US$248.6 (95% CI: 25.4 to 471.7). Inpatient medical costs increased significantly (US$64.3, 95% CI: 8.4 to 120.2).ConclusionsGovernment savings through income reduction were offset by increased medical expenditure. This may be due to recipients’ behavioural change and their worsening health conditions. To prevent excessive medical expenditure, policymakers should consider how income reduction affects the behaviour and health of the impoverished population.

BackgroundThe high suicide rate among older adults is an important public health issue. Financial insecurity has been linked to suicidal behaviour. Despite this, as yet, there has been little research on suicide-related behaviours among older recipients of public welfare. This study will examine if suicidal ideation and suicide attempts are more prevalent in older recipients of public welfare assistance in Japan.MethodsThis cross-sectional study analysed data from 16 135 adults aged ≥65 years who participated in the 2019 wave of the Japan Gerontological Evaluation Study. Information was obtained on receiving public welfare assistance, lifetime suicidal ideation and attempts, and a variety of covariates. Poisson regression analysis with robust variance estimates was used to examine associations.ResultsSuicidal ideation was reported by 4.8% of the participants, while the corresponding figure for attempted suicide was 2.2%. In fully adjusted analyses public welfare recipients had an almost 1.5 times higher prevalence of lifetime suicidal ideation (prevalence ratio, PR 1.47, 95% CI 1.02 to 2.13), and an almost two times higher prevalence of attempted suicide (PR 1.91, 95% CI 1.20 to 3.04) when compared with their counterparts not receiving public welfare assistance.ConclusionOlder recipients of public welfare have a higher prevalence of suicidal behaviour in Japan. An urgent focus is now warranted on this vulnerable population to determine the specific factors underlying this association.

Background: To establish refined risk prediction models for mortality in patients with microscopic polyangiitis (MPA) by using comprehensive clinical characteristics. Methods: Data from the multicentre Japanese registry of patients with vasculitis (REVEAL cohort) were used in our analysis. In total, 194 patients with newly diagnosed MPA were included, and baseline demographic, clinical, laboratory, and treatment details were collected. Univariate and multivariate analyses were conducted to identify the significant risk factors predictive of mortality. Results: Over a median follow-up of 202.5 (84–352) weeks, 60 (30.9%) of 194 patients died. The causes of death included MPA-related vasculitis (18.3%), infection (50.0%), and others (31.7%). Deceased patients were older (median age 76.2 years) than survivors (72.3 years) (P< 0.0001). The death group had shorter observation periods (median 128.5 [35.3–248] weeks) than the survivor group (229 [112–392] weeks). Compared to survivors, the death group exhibited a higher smoking index, lower serum albumin levels, higher serum C-reactive protein levels, higher Birmingham Vasculitis Activity Score (BVAS), higher Five-Factor Score, and a more severe European Vasculitis Study Group (EUVAS) categorization system. Multivariate analysis revealed that higher BVAS and severe EUVAS independently predicted mortality. Kaplan–Meier survival curves demonstrated lower survival rates for BVAS ≥20 and severe EUVAS, and a risk prediction model (RPM) based on these stratified patients into low, moderate, and high-risk mortality groups. Conclusions: The developed RPM is promising to predict mortality in patients with MPA and provides clinicians with a valuable tool for risk assessment and informed clinical decision-making.

We aimed to determine risk factors associated with rates of contaminated blood cultures in the emergency department (ED).

Dehydration of ethanol to ethene on acidic OH groups of zeolites was observed by infrared (IR) spectroscopy and temperature programmed desorption (TPD). The rate of decomposition of surface ethoxy groups was measured by measuring the amount of recovered acidic OH groups by IR, while confirming the evolution of ethene using a mass spectrometer, for the estimation of activation energy. The obtained activation energies for the evolution of ethene from ethoxy groups on hydrogen form mordenite, ZSM-5, and ferrierite zeolites were 161 ± 6, 181 ± 2, and 188 ± 2 kJ·mol−1, respectively. A tendency was found that the activation energy became larger in smaller-pored zeolite. The cause of the difference of three zeolites in activation energy for ethene evolution from ethoxy species is discussed along with an energy diagram described from reported theoretical examinations.