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Context: Plantar intrinsic foot muscle strength training is difficult to master to a degree sufficient to elicit muscle hypertrophy in most individuals. It is possible that combining neuromuscular electrostimulation (NMES) and blood flow restriction (BFR) can elicit plantar intrinsic foot muscle hypertrophy regardless of the individual's technique. This study aimed to determine the effects of NMES training with BFR on acute muscle swelling in the abductor hallucis. Design: Randomized, controlled, single-blind trial design. Methods: Forty-eight participants were randomly allocated to the NMES + BFR, NMES, or Sham NMES + BFR groups. All participants received abductor hallucis NMES for 15 minutes. Participants in the NMES + BFR and Sham NMES + BFR groups received NMES with BFR. The intensity of NMES was the sensory threshold in the Sham NMES + BFR group. The cross-sectional area of the abductor hallucis was measured pretraining and posttraining using ultrasonography by a single investigator blinded to the participants' allocations. Results: After 15 minutes of training, the cross-sectional area of the abductor hallucis was significantly increased in the NMES + BFR (P<.001) and the Sham NMES + BFR (P = .004) groups. Moreover, the rate of increase was significantly higher in the NMES + BFR group than in the NMES or the Sham NMES + BFR groups (P<.001 and P = . 001, respectively). Conclusions: Since it is possible that the amount of muscle swelling immediately after training correlates with muscle hypertrophy when training is continued, the results of this study suggest that NMES training with BFR is a training method that can be expected to produce plantar intrinsic foot muscle hypertrophy. Further studies are needed to confirm the long-term effects of NMES training with BFR. [ABSTRACT FROM AUTHOR]

Background: Atezolizumab, one of the immune checkpoint inhibitors, has been approved as an adjuvant treatment following resection and platinum‐based chemotherapy in patients with stage II–IIIA non‐small cell lung cancer with 1% or more programmed death ligand‐1 (PD‐L1) expression. The Food and Drug Administration (FDA) has approved SP263 as a companion diagnostic assay for adjuvant treatment with atezolizumab; however, in clinical practice, the 22C3 assay is most commonly used for advanced non‐small cell lung cancer. Therefore, our study aimed to compare two PD‐L1 assays, SP263 and 22C3, to evaluate whether 22C3 could replace SP263 when deciding whether to administer adjuvant atezolizumab. Methods: We retrospectively and prospectively analyzed 98 patients who underwent surgical resection at Kanagawa Cancer Center (Japan). An immunohistochemistry assay was performed for all the cases with both SP263 and 22C3. We statistically analyzed the concordance of PD‐L1 expression between SP263 and 22C3 assays. Results: The concordance between the two assays using Cohen's kappa was κ = 0.670 (95% CI: 0.522–0.818) at the 1% cutoff and κ = 0.796 (95% CI: 0.639–0.954) at the 50% cutoff. The Spearman correlation coefficient of 0.874 (p < 0.01) indicated high concordance. PD‐L1 expression with 22C3 resulted slightly higher than that with SP263. Conclusions: This study showed a high concordance of PD‐L1 expression with the SP263 and 22C3 assays. Further studies examining the therapeutic effects of adjuvant atezolizumab are required. [ABSTRACT FROM AUTHOR]

Objectives It is well known that low educational attainment is associated with cognitive function decline in older age. Childhood book availability may help to preserve cognitive function in older adults with low education. The study objective was to examine the association between childhood book availability and cognitive function among older adults with low educational attainment, and to investigate the mediating effect of the volume of reading-related brain regions (e.g. superior temporal cortex). Methods A cross-sectional study of community-dwelling older Japanese adults aged 65–84 years was conducted (n  = 474). Cognitive function was assessed using the Mini-Mental State Examination (MMSE). Childhood book availability was assessed using a retrospective questionnaire. Brain region volume was measured using magnetic resonance imaging. Multivariate regression modeling and structural equation modeling were used for analysis. Results Both high educational attainment and childhood book availability were independently associated with high MMSE score. Stratification of educational level showed that childhood book availability was positively associated with MMSE score among participants with low educational attainment (coefficient = 1.48, 95% confidence interval [CI]: 0.31 to 2.66), but not among those with moderate or high educational attainment (coefficient = −0.01, 95% CI: −1.44 to 1.42 and −1.21, 95% CI: −3.85 to 1.42, respectively). Among participants with low educational attainment, left superior temporal cortex volume mediated the association between childhood book availability and MMSE score. Discussion The availability of books in childhood helps to preserve cognitive function in older adults with low education via left superior temporal cortex volume. Further research is needed to replicate these findings. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study is to analyse the risk factors for unplanned readmissions within 1 month after hospital discharge to develop a seamless support system from discharge to home care. Background: With shorter hospital stay lengths, understanding the characteristics of patients with multiple risk factors is important to prevent rehospitalization. Design: This is a single‐centre retrospective descriptive study. Methods: Logistic regression and decision tree analyses were performed using eight items from the records of 3117 patients discharged from a university hospital between April–September 2017 as risk factors. Results: Unplanned readmission risk was significantly associated with emergency hospitalization (odds ratio [OR]: 3.12, 95% confidence interval [CI]: 2.04–4.77), malignancy (OR: 2.16, 95% CI: 1.44–3.24), non‐surgical admission (OR: 1.76, 95% CI: 1.07–2.88), hospital stay of ≥ 15 days (OR: 1.66, 95% CI: 1.14–2.43) and decline in activities of daily living owing to hospitalization (OR: 1.68, 95% CI: 1.06–2.64). The highest risk combinations for rehospitalization were as follows: emergency hospitalization and malignancy; emergency admission, non‐malignancy and a hospital stay of ≥15 days; and scheduled hospitalization, no surgery and a hospital stay of ≥15 days. Conclusions: Patients with multiple risks for unplanned readmission should be accurately screened and provided with optimal home care. Summary statement: What is already known about this topic? Although the characteristics of patients at high risk of rehospitalization include malignancy, heart failure, conditions such as chronic obstructive pulmonary disease and other diseases prone to recurrence, old age, reduced activities of daily living and emergency hospitalization, few studies have reported on cases with multiple risks. What this paper adds? The most frequent risk types for unplanned readmissions within a month were emergency admissions for malignant tumours, emergency admissions for non‐malignant tumours with a hospital stay of 2 weeks or more and scheduled admissions for non‐surgical purposes with a length of stay of 2 weeks or more. The implications of this paper: The risk of unplanned readmission within 1 month of discharge increased due to a combination of multiple risks.This study helps us identify patients who are at high risk for readmission early in the hospitalization process and in providing nursing support for transition to their homes. [ABSTRACT FROM AUTHOR]

Background: Understanding the etiology of psychosis is essential to the development of preventive interventions. The COVID‐19 pandemic provides a rare natural experiment that can expand our understanding of the role of social factors in the trajectories and etiology of psychosis across adolescence, particularly in Tokyo where the prevalence of actual COVID‐19 infection remained low. We hypothesized that the likelihood of self‐reporting psychotic experiences (PEs) would increase following the onset of the COVID‐19 pandemic. Methods: The Tokyo Teen Cohort (TTC) is a prospective cohort study of adolescents in the general population of the Tokyo metropolitan area, followed from age 10 to 16 years. We used multi‐level linear regression models to test the associations between the phase of the COVID‐19 pandemic and self‐reported PEs. Results: Among 1935 adolescents included in the analysis, a rapid increase in PEs occurred at the onset of the COVID‐19 pandemic, following approximately 6 years of steady decline across prior waves. This association was more pronounced for boys compared to girls. This increase became more pronounced as the pandemic moved into later phases, defined based on contemporaneous sociopolitical changes in Tokyo (i.e. changes to school closure, social distancing guidelines, and the state of emergency status). Conclusions: The steady decline in PEs across adolescence was halted and reversed concurrent with the COVID‐19 pandemic onset, despite very low rates of COVID‐19 infection. This implicates COVID‐19 related socioenvironmental factors as contributory etiological factors in the development of PEs in this adolescent cohort. [ABSTRACT FROM AUTHOR]

Aim: Efforts to combat frailty and preserve good health in older adults have highlighted oral frailty as an early indicator of overall frailty. Individuals showing oral frailty are at an elevated risk of insufficient nutritional intake compared with those without oral frailty; however, underlying mechanisms remain poorly explored. In this cross‐sectional study, we aimed to examine the link between oral frailty and undernutrition, especially regarding poor appetite and low dietary diversity. Methods: The analysis included 2727 late‐stage older adults (mean age 79.9 ± 4.3 years) who underwent dental checkups in a prefecture in Japan from 2016 to 2020. The examination involved a questionnaire survey (covering basic information, frailty screening index, appetite index: Simplified Nutritional Appetite Questionnaire; and dietary variety: Dietary Variety Score) and a measurement survey (including intraoral confirmation, oral diadochokinesis and masticatory efficiency test). Individuals with three or more indications of poor oral function, identified through oral function assessment, were defined as showing oral frailty. Binomial logistic regression and path analyses examined associations among oral frailty, Simplified Nutritional Appetite Questionnaire and Dietary Variety Score. Results: Among those analyzed, 1208 (44.3%) participants were categorized into the oral frailty group. Binomial logistic regression analysis showed that Simplified Nutritional Appetite Questionnaire (odds ratio for oral frailty per 1‐point increase 0.88, 95% confidence interval 0.84–0.93) and Dietary Variety Score (odds ratio 0.95, 95% confidence interval 0.92–0.98) were significantly associated with oral frailty. The path analysis showed individual associations between each examined factor. Conclusions: Oral frailty was associated with decreased appetite and dietary variety in late‐stage older adults. Geriatr Gerontol Int 2024; 24: 626–633. [ABSTRACT FROM AUTHOR]

Aim: Whether serum concentration of procalcitonin (PCT), brain natriuretic peptide (BNP) and albumin (Alb) have an association with the outcome of hospitalized older patients is unclear. We investigated clinical outcomes and any predictive factors in hospitalized Japanese older patients with a risk of infection. Methods: In the retrospective study, 820 Japanese patients were followed up for 30 days or until death. During the observation period, 656 patients survived and 164 patients died. The predictive factors of death were analyzed according to demographic and clinical variables. Results: The survival rate was decreased as the serum PCT increased from <0.5 to ≥10 ng/mL, as was also the case with BNP from <300 to ≥300 pg./mL, whereas low Alb (<2.5 g/dL) showed a lower survival rate than high Alb (≥2.5 g/dL; P < 0.01). Using the Cox regression model, the multivariable‐adjusted hazard ratios (95% confidence interval) were as follows: PCT 0.5–2 versus <0.5 ng/mL: 1.61(1.04–2.49), PCT 2–10 versus <0.5 ng/mL: 1.91(1.15–3.16), PCT ≥10 versus <0.5 ng/mL: 2.90(1.84–4.59), high BNP 1.26 (0.89–1.76) and low Alb 0.68 (0.52–0.87). The mortality rate increased as the number of scores (PCT + BNP + Alb) increased. Conclusions: Concentration‐dependent high PCT, high BNP and low Alb were positive risk factors associated with poor prognosis in hospitalized older patients with a risk of infection. Geriatr Gerontol Int 2024; 24: 571–576. [ABSTRACT FROM AUTHOR]

Aim: We investigated whether the Dementia Assessment Sheet for Community‐based Integrated Care System‐21 Items (DASC‐21), a questionnaire that assesses cognitive function, including activities of daily living (ADL), was predictive of in‐hospital death and prolonged hospital stay in elderly patients hospitalized for heart failure. Methods: We retrospectively assessed the DASC‐21 score at the time of admission, in‐hospital death, length of hospital stay, and change in the Barthel index in 399 patients hospitalized for heart failure between 2016 and 2019. Results: The mean patient age was 85.8 ± 7.7 years (61.3% women). The median DASC‐21 score was 38 (64.7% higher than 31). On multivariate logistic regression analysis, a higher DASC‐21 score was associated with an increased risk of in‐hospital death (odds ratio [OR] = 1.045 per 1 point increase, 95% confidence interval [CI]: 1.010–1.081, P = 0.012), even after adjusting for confounding factors, including atrial fibrillation, ejection fraction, and B‐type natriuretic peptide. Difficulties (3 or 4) with the self‐management of medication in instrumental ADL inside the home (OR = 3.28, 95% CI: 1.05–10.28, P = 0.042), toileting (OR = 3.66, 95% CI: 1.19–11.29, P = 0.024), grooming (OR = 6.47, 95% CI: 2.00–20.96, P = 0.002), eating (OR = 7.96, 95% CI: 2.49–25.45, P < 0.001), and mobility in physical ADL (OR = 5.99, 95% CI: 1.85–19.35, P = 0.003) were identified as risk factors for in‐hospital death. Patients in the highest tertile of the DASC‐21 score had a significantly longer hospital stay (P = 0.006) and a greater reduction in the Barthel index (P < 0.001). Conclusions: In elderly patients hospitalized for heart failure, higher DASC‐21 scores were associated with an increased risk of in‐hospital death, prolonged hospital stay, and impaired ADL. Geriatr Gerontol Int 2024; 24: 546–553. [ABSTRACT FROM AUTHOR]

Aim: Advanced glycation end‐products (AGEs) are irreversibly and heterogeneously formed compounds during the non‐enzymatic modification of macromolecules, such as proteins. Aging and lifestyle habits, such as high‐fat and high‐protein diets, and smoking, promote AGEs accumulation. This study aimed to investigate the relationship between fall risk and AGEs in community‐dwelling older adults. Methods: This cross‐sectional study included patients from the 2022 Yakumo Study who were evaluated for fall risk index 5‐items version, locomotive syndrome stage and AGEs. AGEs were evaluated using Skin autofluorescence (SAF) measured by the AGE reader (DiagnOptics Technologies BV, Groningen, the Netherlands). We divided the participants into two groups according to the presence or absence of fall risk (fall risk index 5‐items version ≥6 or not), and investigated the factors associated with fall risk. Results: The fall risk group had a higher age and SAF, and a higher proportion of locomotive syndrome stage >2 than the without fall risk group in patients aged ≥65 years (P < 0.01). The multivariate logistic regression analysis after adjustment of age, sex and body mass index showed that locomotive syndrome stage ≥2 and SAF were independent associators of fall risk in older adults (odds ratio 3.26, P < 0.01, odds ratio 2.96, P < 0.05, respectively). The optimal cutoff value of the SAF for fall risk was 2.4 (area under the curve 0.631; 95% CI 0.53–0.733; sensitivity 0.415; specificity 0.814; P < 0.05). Conclusion: The accumulation of AGEs in skin tissues can be used to screen for fall risk comprehensively. Geriatr Gerontol Int 2024; 24: 517–522. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the association between housing and psychological damage caused by the Great East Japan Earthquake (GEJE) and modifiable risk factors (MRFs) of dementia for general population of older adults. Methods: This cross‐sectional study enrolled 29 039 community‐dwelling older adults (mean age 69.1 ± 2.9 years, 55.5% women). We evaluated disaster‐related damage (by complete or not complete housing damage) and psychological damage (by post‐traumatic stress reaction [PTSR]) after the GEJE using a self‐report questionnaire. MRFs encompassed the presence of depression, social isolation, physical inactivity, smoking, and diabetes. We examined the association between disaster‐related damage and MRFs using ordinary least squares and modified Poisson regression models adjusted for sociodemographic and health status variables. Results: Complete housing damage and PTSR were identified in 2704 (10.0%) and 855 (3.2%) individuals, respectively. The number of MRFs was significantly larger for the individuals with complete housing damage (β = 0.23; 95% confidence interval [CI]: 0.19–0.27) and PTSR (β = 0.60; 95% CI: 0.53–0.67). Prevalence ratios (PRs) for depression and physical inactivity were higher in individuals with complete housing damage. The PRs for all domains of the MRFs were significantly higher in individuals with PTSR. Conclusions: Housing and psychological damage caused by the GEJE were associated with an increased risk factor of dementia. To attenuate the risk of dementia, especially among older victims who have experienced housing and psychological damage after a disaster, multidimensional support across various aspects of MRFs is required. Geriatr Gerontol Int 2024; 24: 509–516. [ABSTRACT FROM AUTHOR]

Purpose: The previous studies that examined the effectiveness of unsupervised machine learning methods versus traditional methods in assessing dietary patterns and their association with incident hypertension showed contradictory results. Consequently, our aim is to explore the correlation between the incidence of hypertension and overall dietary patterns that were extracted using unsupervised machine learning techniques. Methods: Data were obtained from Japanese male participants enrolled in a prospective cohort study between August 2008 and August 2010. A final dataset of 447 male participants was used for analysis. Dimension reduction using uniform manifold approximation and projection (UMAP) and subsequent K-means clustering was used to derive dietary patterns. In addition, multivariable logistic regression was used to evaluate the association between dietary patterns and the incidence of hypertension. Results: We identified four dietary patterns: 'Low-protein/fiber High-sugar,' 'Dairy/vegetable-based,' 'Meat-based,' and 'Seafood and Alcohol.' Compared with 'Seafood and Alcohol' as a reference, the protective dietary patterns for hypertension were 'Dairy/vegetable-based' (OR 0.39, 95% CI 0.19–0.80, P = 0.013) and the 'Meat-based' (OR 0.37, 95% CI 0.16–0.86, P = 0.022) after adjusting for potential confounding factors, including age, body mass index, smoking, education, physical activity, dyslipidemia, and diabetes. An age-matched sensitivity analysis confirmed this finding. Conclusion: This study finds that relative to the 'Seafood and Alcohol' pattern, the 'Dairy/vegetable-based' and 'Meat-based' dietary patterns are associated with a lower risk of hypertension among men. [ABSTRACT FROM AUTHOR]

Background: In the recent years, a high risk of developmental delay not only in very low birth weight infants and late preterm infants but also in early term infants (37–38 weeks) have increasingly been reported. However, in Japan, there are virtually no studies regarding the development delays in early term infants. Methods: This study used the data from the Japan Environment and Children's Study (JECS), a birth cohort study conducted in Japan. Data were selected for analysis from the records of 104,065 fetal records. The risk of neurodevelopmental delays at 6 months and 12 months after birth was evaluated using multivariate analysis for infants of various gestational ages, using the 40th week of pregnancy as a reference value. Neurodevelopment was evaluated at 6 months and 12 months after birth using the Ages and Stages Questionnaires, Japanese translation (J-ASQ-3). Results: The proportion of infants born at a gestational age of 37 to 38 weeks who did not reach the J-ASQ-3 score cutoff value was significantly higher in all areas at both 6 months and 12 months after birth, when compared to that of infants born at 40 weeks. The odds ratio decreased at 12 months after birth compared to that at 6 months after birth. Conclusion: Early term infants in Japan are at an increased risk of neurodevelopmental delay at 12 months after birth. Significance: What's known on this subject: Early term infants with gestational ages of 37 to 38 weeks and not only premature babies may be at an increased risk of developmental delay. What this study adds: This study was conducted using data from a birth cohort of 104,065 fetal records. Early term infants had an increased risk of developmental delay at 6 months, and while the risk decreased by 12 months after birth, it was still high. [ABSTRACT FROM AUTHOR]

The relationship between chronic pain and the occurrence of falls in healthy older adults has been clarified in previous studies, but its relationship in older adults with disabilities has not. This study aimed to determine whether chronic pain is related to the occurrence of falls in older adults with disabilities. The participants were 101 older adults above 65 years old who used long-term care insurance services in Japan. Of these, 30 were fallers and 71 were non-fallers. Chronic pain, defined as pain lasting more than three months, was assessed using questionnaires, and the falls' occurrence was followed up for six months using a fall calendar. Logistic regression analysis was used to analyze the data, with falls as the dependent variable, chronic pain as the independent variable, and age, sex, body mass index, number of drugs, sleep disorders, and depression as covariates. After adjusting for covariates, chronic pain significantly influenced the occurrence of falls (odds ratio: 3.168, 95% confidence interval: 1.057–9.495, p =.04). Chronic pain was related to the occurrence of falls in older adults with disabilities. There is a need to focus on chronic pain presence in falls' prevention among older adults with disabilities. [ABSTRACT FROM AUTHOR]

The sexual imagination hypothesis predicts that gender differences in jealousy emerge from the differences in explicit imagination between men and women. In particular, men strongly respond to partners' sexual infidelity because they can imagine sexual stimuli explicitly. In contrast, women strongly respond to emotional infidelity because they can effortlessly envision emotional infidelity. We hypothesised that higher sexual and romantic imaginations were associated with greater distress over partners' sexual and emotional infidelity, respectively. Participants (226 women and 135 men) answered questions regarding experiences with personal sexual and emotional infidelity and the degree of distress they felt over their partners' sexual and emotional infidelity. They completed the scales for sexual and romantic imaginations. Multiple regression analyses showed that the sexual imagination hypothesis provided a unique explanation for gender differences in jealousy beyond the effects of gender, including relationship experience and experiences with personal sexual and emotional infidelity. Additionally, individuals with relationship experience and experiences with personal sexual and emotional infidelity reported higher sexual and romantic imaginations than those without such experiences. Furthermore, our findings imply that responses to partners' infidelity, considering gender, are more similar than different. [ABSTRACT FROM AUTHOR]

Background: Intracorporeal mechanical gastrogastrostomy (IMG) techniques have recently been developed and their short-term safety was presented in their initial evaluation. However, whether they are comparable to extracorporeal hand-sewing gastrogastrostomy (EHG) remains unclear. The aim of the study is to establish the safety of IMG in totally laparoscopic pylorus-preserving gastrectomy (TLPPG) compared to EHG in laparoscopy-assisted pylorus-preserving gastrectomy (LAPPG). Methods: We retrospectively analyzed the short-term outcomes of patients with middle-third early gastric cancer who underwent LAPPG or TLPPG between 2005 and 2022. The primary objective of this study was to evaluate the non-inferiority of IMG to EHG in terms of safety, with the primary endpoint being the risk difference in anastomosis-related complications (ARCs). The sample size required to achieve a statistical power of 80% for the non-inferiority test was 971 with a one-sided alpha level of 5% and non-inferiority of 5%. Results: The analysis included a total of 1,021 patients who underwent LAPPG or TLPPG during the study period. Among them, 488 patients underwent EHG, while 533 underwent IMG. The incidences of ARCs were 11.3% and 11.4% in EHG and IMG, respectively. The observed difference in incidence was 0.0017 (90% confidence interval − 0.0313 to 0.0345), which statistically demonstrated the non-inferiority of IMG to EHG in the incidence of ARCs. Among other complications, the incidence of wound infection in IMG was lower than that in EHG. Conclusion: IMG is safe regarding ARCs compared with EHG. These results will encourage surgeons to introduce IMG for patients with early middle gastric cancer. [ABSTRACT FROM AUTHOR]

Background: Although basic laparoscopic hepatectomy (LH) has become the standard procedure for hepatectomy, the safety of advanced LH remains to be clarified, especially in elderly patients. We investigated the safety of advanced LH in elderly Japanese patients. Methods: Elderly patients (≥ 65 years) who underwent advanced LH between 2016 and 2021 were analyzed using a nationwide claims database in Japan. The perioperative outcomes of patients who underwent open hepatectomy (OH group) or LH (LH group) were compared using propensity score matching (PSM). The primary outcome was in-hospital mortality. The E-value method was performed to assess the strength of the outcome point estimates against possible unmeasured confounding factors. Results: Among 5,021 patients, eligible patients were classified into the OH (n = 4,152) and LH (n = 527) groups. The median patient age was 74 years in both groups. Hepatocellular carcinoma and metastatic liver tumors were the major indications for hepatectomy (OH: 52.5% versus 30.6%; LH: 60.7% versus 26.4%). After PSM, in-hospital mortality rates for OH and LH were 1.7 and 0.76%, respectively. The risk ratio was 0.45 (95% confidence interval, 0.16–1.25; E-value = 3.87). Compared with OH, LH was associated with a longer anesthesia time (411 versus 432 min), lower rate of blood product use (red blood concentrate: 33.5% versus 20.3%; fresh frozen plasma: 29.2% versus 17.1%), and shorter hospital stay (13 versus 12 days). Conclusions: In elderly patients, the safety of advanced LH was similar to that of advanced OH, or might be better in Japan under the current policy of hospital accreditation. [ABSTRACT FROM AUTHOR]

Background: Resuscitative endovascular balloon occlusion of the aorta (REBOA) has been used to control massive hemorrhages. Although there is no consensus on the efficacy of REBOA, it remains an option as a bridging therapy in non-trauma centers where trauma surgeons are not available. To better understand the current landscape of REBOA application, we examined changes in its usage, target population, and treatment outcomes in Japan, where immediate hemostasis procedures sometimes cannot be performed. Methods: This retrospective observational study used the Japan Trauma Data Bank data. All cases in which REBOA was performed between January 2004 and December 2021 were included. The primary outcome was the in-hospital mortality rate. We analyzed mortality trends over time according to the number of cases, number of centers, severity of injury, and overall and subgroup mortality associated with REBOA usage. We performed a logistic analysis of mortality trends over time, adjusting for probability of survival based on the trauma and injury severity score. Results: Overall, 2557 patients were treated with REBOA and were deemed eligible for inclusion. The median age of the participants was 55 years, and male patients constituted 65.3% of the study population. Blunt trauma accounted for approximately 93.0% of the cases. The number of cases and facilities that used REBOA increased until 2019. While the injury severity score and revised trauma score did not change throughout the observation period, the hospital mortality rate decreased from 91.3 to 50.9%. The REBOA group without severe head or spine injuries showed greater improvement in mortality than the all-patient group using REBOA and all-trauma patient group. The greatest improvement in mortality was observed in patients with systolic blood pressure ≥ 80 mmHg. The adjusted odds ratios for hospital mortality steadily declined, even after adjusting for the probability of survival. Conclusions: While there was no significant change in patient severity, mortality of patients treated with REBOA decreased over time. Further research is required to determine the reasons for these improvements in trauma care. [ABSTRACT FROM AUTHOR]

Aims Osteoporosis is prevalent and is associated with poor prognosis in patients with heart failure (HF). However, bone mineral density measurement by a dual-energy X-ray absorptiometry (DEXA) scan is not always available in a daily clinical setting or large-scale population-based studies. Methods and results A single-centre, cross-sectional observational study was conducted with 387 patients [median age: 77 years (interquartile range: 68–83 years); 37% women]. Bone mineral densities were measured by DEXA scans, and osteoporosis was diagnosed as ≤−2.5 standard deviation of the bone mineral densities in healthy young adults. Osteoporosis risk assessment score (ORAS) was developed using significant predictors from a logistic regression model for osteoporosis and was subsequently validated. Osteoporosis was found in 103 (27%) of the 387 HF patients. Multivariate logistic regression analyses yielded the ORAS based on sex, body mass index, handgrip strength, and anti-coagulant therapy utilization. The C -index of ORAS in the developmental set (0.796, 95% confidence interval: 0.747–0.845) was similar to the bootstrap validation of the prediction model (0.784) and tended to be higher than that of the osteoporosis self-assessment tool for Asians (OSTA). A nomogram of ORAS, established on the basis of the final logistic regression model, demonstrated 100% sensitivity at the lowest score (35 points), with an optimal cut-off point of 127 points, yielding 85% sensitivity and 62% specificity. Conclusion Osteoporosis risk assessment score exhibits superior predictive performance to OSTA in predicting osteoporosis in HF patients, establishing itself as a valuable tool for early detection in both daily clinical practice and large-scale population-based studies. [ABSTRACT FROM AUTHOR]

INTRODUCTION Although conventional cigarette smoking has been linked to an increased risk of hearing loss, the association between heated tobacco products (HTPs) and hearing loss is unknown. The objective of this study was to investigate the association between cigarette and HTP use and hearing loss. METHODS This cross-sectional study examined the data of 7769 employees from five companies (Study I) and 34404 employees from a large company (Study II), all participants in the Japan Epidemiology Collaboration on Occupational Health Study. The participants were categorized into five groups based on their self-reported tobacco use: never smokers, former smokers, exclusive cigarette smokers, exclusive users of HTPs, and those who used both cigarettes and HTPs. Hearing levels were measured using pure-tone audiometry at 1 and 4 kHz frequencies. Separate analyses were carried out for each study, and the results were then combined using fixed-effect models to pool the estimates. RESULTS The analysis included 42173 participants, with a prevalence of 12.9% for exclusive cigarette smoking, 9.8% for exclusive HTP use, and 5.5% for dual use. The pooled adjusted odds ratios with 95% confidence intervals for unilateral hearing loss at 4 kHz were 1.21 (95% CI: 1.10-1.33) for former smokers, 1.83 (95% CI: 1.64-2.05) for exclusive cigarette smokers, 1.46 (95% CI: 1.28-1.67) for exclusive HTP users, and 1.66 (95% CI: 1.41-1.96) for dual users, compared to never smokers. Additionally, the adjusted odds ratios for hearing loss at 4 kHz among exclusive cigarette smokers, exclusive HTP users, and dual users increased with the intensity of cigarette/HTP consumption (all p for trend <0.001). No significant associations were found between exclusive HTP use, dual use, and hearing loss at 1 kHz, apart from exclusive cigarette smoking. CONCLUSIONS In this cross-sectional study, associations were found between exclusive cigarette smoking, exclusive HTP use, dual use, and hearing loss, particularly at 4 kHz. Further research is needed to confirm these findings. [ABSTRACT FROM AUTHOR]

Purpose: This study examines workplace support and resilience's influence on psychological distress in Japanese employees. Method: A 1-year prospective online cohort study was conducted. Logistic regression analyzed prevalence odds ratios and 95% confidence intervals for psychological distress. Participants were grouped based on their support and resilience levels. Results: Prevalence odds ratios for psychological distress followed this pattern for low and high resilience groups: "necessary but not received" (prevalence odds ratio and 95% confidence interval for low/high resilience: 9.71, 6.88-13.69 and 4.72, 2.97-7.52, respectively), "received" (6.65, 4.29-10.29 and 2.27, 1.21-4.25), and "not necessary" (4.43, 3.30-5.95 and reference). Workplace support had a stronger impact on psychological distress in low-resilience employees. Conclusions: We provided evidence that the combination of the need for support from the workplace and resilience affects psychological distress in employees. [ABSTRACT FROM AUTHOR]

Aim: The incidence of factors associated with emergency cesarean section (ECS) in patients with gestational diabetes mellitus (GDM) have not been well investigated. Methods: We conducted a retrospective cohort study of patients diagnosed with GDM between 2011 and 2020 at a tertiary care hospital in Japan. Clinical data, vital signs, and laboratory results of the patients were collected from electronic medical records. We constructed a multivariate logistic regression model to identify the clinical characteristics associated with ECS. Results: We included 1189 patients diagnosed with GDM, the mean maternal age was 33 years, and 507 (42.6%) patients were aged ≥35 years. In total, 114 patients underwent ECS (9.6%). The previous assisted reproductive technology (ART) use (odds ratio [OR], 1.81; 95% confidence interval [CI], 1.12–2.93), previous artificial abortion (OR, 1.94; 95% CI, 1.13–3.33), high pre‐pregnancy body mass index (BMI) (OR, 1.07; 95% CI, 1.02–1.11), and late diagnosis of GDM (OR, 1.02; 95% CI, 1.003–1.05) were independently associated with ECS. Conclusions: One of every 10 GDM patients required ECS. Previous ART use, previous artificial abortion, high pre‐pregnancy BMI, and late diagnosis of GDM were risk factors for ECS in GDM patients. [ABSTRACT FROM AUTHOR]

Purpose: To clarify the influence of surgical volume on the mortality and morbidity of gastrointestinal perforation in children in Japan. Methods: We collected data on pediatric patients with gastrointestinal perforation between 2017 and 2019, from the National Clinical Database. The surgical volumes of various institutions were classified into three groups: low (average number of surgeries for gastrointestinal perforation/year < 1), medium (≥ 1, < 6), and high (≥ 6). The observed-to-expected (o/e) ratios of 30-day mortality and morbidity were calculated for each group using an existing risk model. Results: Among 1641 patients (median age, 0.0 years), the 30-day mortality and morbidity rates were 5.2% and 37.7%, respectively. The 30-day mortality rates in the low-, medium-, and high-volume institutions were 4.9%, 5.3%, and 5.1% (p = 0.94), and the 30-day morbidity rates in the three groups were 26.8%, 39.7%, and 37.7% (p < 0.01), respectively. The o/e ratios of 30-day mortality were 1.05 (95% confidence interval [CI] 0.83–1.26), 1.08 (95% CI 1.01–1.15), and 1.02 (95% CI 0.91–1.13), and those of 30-day morbidity were 1.72 (95% CI 0.93–2.51), 1.03 (95% CI 0.79–1.28), and 0.95 (95% CI 0.56–1.33), respectively. Conclusion: Surgical volume does not have significant impact on the outcomes of pediatric gastrointestinal perforation in Japan. [ABSTRACT FROM AUTHOR]

Aim: Although the maintenance and improvement of quality of life (QoL) through holistic care are important in geriatric medical care, care priorities might differ depending on three essential aspects of QoL: the quality of daily living, satisfaction and happiness from birth to death, and human vitality, which are "Seikatsu," "Jinsei," "Seimei" in Japanese, respectively. We aimed to clarify these priorities in terms of medical care and examined how the definitions of QoL affected these priorities' rankings. Methods: This cross‐sectional study involved community‐dwelling older adults aged ≥65 years living in Kashiwa City, Chiba Prefecture, Japan. The number of participants was 1550 (mean age, 76.1 ± 5.8 years; 699 women [45.1%]). A self‐administered questionnaire distributed in advance was used to rank 12 items sought in medical care. Participants were randomly assigned to one of three groups and sent the corresponding questionnaire, which differed only in the definition of QoL. Results: The top priorities for medical care were "effective treatment of illness," "improvement of physical function," and "maintaining a high level of activity." When QoL was defined as "the quality of daily living, satisfaction and happiness from birth to death, and human vitality," participants were significantly more likely to rank QoL improvement as one of the top three items (adjusted odds ratio, 1.46; 95% confidence interval, 1.03–2.05). Conclusions: As a medical care priority, older adults desire improvement of multidimensional elements of life, including human vitality. Health care providers should consider this when making medical care decisions. Geriatr Gerontol Int 2024; 24: 493–498. [ABSTRACT FROM AUTHOR]

Background: Stoma prolapse (SP) is a common stoma-related complication, particularly in loop colostomies. This study aimed to investigate potential risk factors for SP development after laparoscopic loop colostomy. Methods: In total, data from 140 patients who underwent laparoscopic loop colostomy were analyzed between September 2016 and March 2022. Risk factors for SP were investigated retrospectively. Results: The median follow-up duration after colostomy was 12.5 months, and SP occurred in 33 (23.6%) patients. Multivariate analysis showed that being overweight (body mass index ≥ 25; odds ratio [OR], 8.69; 95% confidential interval [CI], 1.61–46.72; p = 0.012) and having a thin rectus abdominis penetration of the stoma (< 8.9 mm; OR, 8.22; 95% CI, 2.50–27.05; p < 0.001) were independent risk factors for SP. Other patient characteristics and surgical factors associated with stoma construction were unrelated to SP development. Conclusions: Being overweight and the route penetrating the thinner rectus abdominis during stoma construction was associated with a significantly higher incidence of SP after laparoscopic loop colostomy. Selecting a construction site that penetrates the thicker rectus abdominis muscle may be crucial for preventing SP. [ABSTRACT FROM AUTHOR]

Introduction: Since patients with pharyngeal squamous cell carcinoma (SCC) often have multiple pharyngeal lesions, evaluation of pharyngeal lesions before endoscopic resection (ER) is important. However, detailed endoscopic observation of the entire pharyngeal mucosa under conscious sedation is difficult. We examined the usefulness of endoscopic surveillance with narrow band imaging (NBI) and lugol staining for detection of pharyngeal sublesions during ER for pharyngeal SCC under general anesthesia (endoscopic surveillance during treatment; ESDT). Methods: From January 2021 through June 2022, we examined 78 patients who were diagnosed with superficial pharyngeal SCC and underwent ER. They underwent the ESDT and for patients who were diagnosed with new lesions of pharyngeal SCC or high-grade dysplasia (HGD) that were not detected in the endoscopic examination before treatment, ER were performed simultaneously for new lesions and the main lesions. The primary endpoint of this study was the detection rate of new lesions of pharyngeal SCC or HGD in the ESDT. Results: Fifteen of the 78 patients were diagnosed as having undetected new pharyngeal lesions in the ESDT and 10 (12.8%) (95% CI 6.9–22.2%) were histopathologically confirmed to have new lesions of pharyngeal SCC or HGD. Among the 13 lesions of SCC or HGD, 8 were found by NBI observation; however, 5 were undetectable using NBI but detectable by lugol staining. All of the 13 lesions had endoscopic findings of pink color sign on lugol staining. Conclusions: Endoscopic surveillance for pharyngeal sublesions during ER for pharyngeal SCC is feasible and useful. [ABSTRACT FROM AUTHOR]

Background and aims: Conversion to laparotomy is among the serious intraoperative complications and carries an increased risk of postoperative complications. In this cohort study, we investigated whether or not the Endoscopic Surgical Skill Qualification System (ESSQS) affects the conversion rate among patients undergoing laparoscopic surgery for rectal cancer. Methods: We performed a retrospective secondary analysis of data collected from patients undergoing laparoscopic surgery for cStage II and III rectal cancer from 2014 to 2016 across 56 institutions affiliated with the Japan Society of Laparoscopic Colorectal Surgery. Data from the original EnSSURE study were analyzed to investigate risk factors for conversion to laparotomy by performing univariate and multivariate analyses based on the reason for conversion. Results: Data were collected for 3,168 cases, including 65 (2.1%) involving conversion to laparotomy. Indicated conversion accounted for 27 cases (0.9%), while technical conversion accounted for 35 cases (1.1%). The multivariate analysis identified the following independent risk factors for indicated conversion to laparotomy: tumor diameter [mm] (odds ratio [OR] 1.01, 95% confidence interval [CI] 1.01–1.05, p = 0.0002), combined resection of adjacent organs [+/−] (OR 7.92, 95% CI 3.14–19.97, p < 0.0001), and surgical participation of an ESSQS-certified physician [−/+] (OR 4.46, 95% CI 2.01–9.90, p = 0.0002). The multivariate analysis identified the following risk factors for technical conversion to laparotomy: registered case number of institution (OR 0.99, 95% CI 0.99–1.00, p = 0.0029), institution type [non-university/university hospital] (OR 3.52, 95% CI 1.54–8.04, p = 0.0028), combined resection of adjacent organs [+/−] (OR 5.96, 95% CI 2.15–16.53, p = 0.0006), and surgical participation of an ESSQS-certified physician [−/+] (OR 6.26, 95% CI 3.01–13.05, p < 0.0001). Conclusions: Participation of ESSQS-certified physicians may reduce the risk of both indicated and technical conversion. Referral to specialized institutions, such as high-volume centers and university hospitals, especially for patients exhibiting relevant background risk factors, may reduce the risk of conversion to laparotomy and lead to better outcomes for patients. Trial Registration: This study was registered with the Japanese Clinical Trials Registry as UMIN000040645. [ABSTRACT FROM AUTHOR]

Introduction Early-onset hyperbilirubinemia (EOH) is a clinical issue for premature infants. We predicted that EOH management would be improved by fast results from common laboratory tests. Total serum bilirubin (TSB) level and the albumin/globulin ratio may contribute to improving the management of EOH. Objective The aim of the study is to examine the relationship between EOH and perinatal variables among infants born weighing 1,000 to 2,499 g. Study Designs A single center study was undertaken at Ohta Nishinouchi Hospital between April 1, 2016 and January 31, 2022, using blood samples prospectively collected from infants admitted to the neonatal intensive care unit that were assessed by univariate analyses and multivariate logistic regression analysis. Due to a correlation between gestational age (GA) and birth weight (BW), each variable was entered separately into Model 1 (including GA) and 2 (including BW). Results A total of 508 infants were analyzed (270 in the non EOH group and 238 in the EOH group). No infants experienced feto-maternal transfusion syndrome or hemolytic diseases such as blood type (ABO or Rh) incompatibility or glucose-6-phosphate dehydrogenase deficiency during perinatal period. Significant relationships were observed between EOH and BW (p <0.01, odds ratio [OR], 0.997; 95% confidence interval [CI], 0.996–0.997), albumin (p <0.01, OR, 0.278; 95% CI, 0.129–0.599), albumin/globulin ratio (p <0.01, OR, 2.695; 95% CI, 1.378–5.270), TSB (p <0.01, OR, 2.774; 95% CI, 1.795–4.287), and antenatal corticoid therapy (p = 0.02, OR, 1.852; 95% CI, 1.108–3.097) in Model 2. Per receiver operating characteristic curves, an albumin/globulin ratio of 1.84 could predict EOH at a sensitivity of 50.0% and specificity of 75.6% (AUC = 0.652, p <0.01, 95% CI, 0.603–0.700). Conclusion Albumin/globulin ratio among infants born weighing 1,000 to 2,499 g may be a useful indicator of EOH. Key Points Early-onset hyperbilirubinemia (EOH) is a clinical issue for premature infants. EOH management expected to be improved through the use of common laboratory tests. Albumin/globulin ratio among low birth weight infants may be a useful indicator of EOH. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to investigate the impact of memory function and social capital on depressive symptoms during the COVID‐19 pandemic among older adults in rural Japan. Methods: A retrospective study with longitudinal data was conducted during COVID‐19 from May 2021 to November 2021 (T2) in Kurogawa, Japan. The candidate population for this study was 145 with the following requirements: (1) older individuals aged 65 years or above who were registered in the Kurogawa study, and (2) those with previous data (from November 2016 to February 2020; T1 as pre‐pandemic). Memory function was assessed using the Wechsler Memory Scale‐Revised Logical Memory II delayed recall part A (LM II‐DR). Depressive symptoms were assessed using the Japanese version of the 15‐item Geriatric Depression Scale (GDS‐15). Social capital was evaluated through civic participation, social cohesion, and reciprocity. Fear of the COVID‐19 infection (FCV‐19S) was evaluated. Results: The final analysis included 96 participants (mean age = 81.0 years, SD = 4.8) Multivariate analysis for GDS‐15 score by Mixed Model Repeated Measures (MMRM) revealed significant associations between LM II‐DR (β = −0.13, 95% CI: −0.21–0.05, p = 0.002) and FCV‐19S during COVID‐19 (β = 0.08, 95% CI: 0.01–0.15, p = 0.02) with GDS‐15 score. However, civic participation, social cohesion and reciprocity were not associated with GDS‐15 score. Conclusions: Among older adults in rural Japan, memory function and fear of the COVID‐19 infection were significantly associated with depressive symptoms in MMRM analysis. However, social capital was not associated with depressive symptoms. This highlights the need to address memory function and fear of the COVID‐19 infection in interventions for older adults during crises like the COVID‐19 pandemic. Key points: This study examined the impact of memory function and social capital on depressive symptoms during the COVID‐19 pandemic among older adults in rural Japan.LM II‐DR and FCV‐19S were significantly associated with GDS‐15 scores, under considering within‐individual correlation and time points (before and during COVID‐19) in Mixed Model Repeated Measures (MMRM) analysis.However, civic participation, social cohesion and reciprocity were not associated with depressive symptoms in MMRM analysis.This highlights the need to address memory function and fear of the COVID‐19 infection in interventions for older adults during crises such as the COVID‐19 pandemic. [ABSTRACT FROM AUTHOR]

Simple Summary: Lockdowns and health service disruptions during the COVID-19 pandemic led to concerns about a potential decrease in essential health screenings, even after the pandemic. It is crucial to understand how the pandemic affected women's participation in breast cancer screenings in Japan and whether getting the COVID-19 vaccine influenced their participation rates. We analyzed data from over 6110 women aged 40 to 74 years from a large online survey conducted in 2021 and 2022. Our findings showed that the number of women getting screened for breast cancer did not decrease after the pandemic. Moreover, women who were vaccinated against COVID-19 were more likely to attend their screenings compared to those who were not vaccinated. This result aligns with the observation that vaccinated individuals tend to be more proactive about their health. There is limited information on whether the COVID-19 pandemic was associated with decreased breast cancer screening uptake and if COVID-19 vaccination was associated with an increase in screening uptake. Our study explored the uptake of breast cancer screening in Japan after the COVID-19 pandemic and assessed its association with the COVID-19 vaccination. We analyzed data from the Japan COVID-19 and Society Internet Survey (JACSIS), a web-based prospective cohort survey, and we included 6110 women without cancer history who were aged 40 to 74 years that participated in the 2012 and 2022 surveys. We examined the regular breast cancer screening uptake before and after the pandemic and employed a multivariable Poisson regression model to seek any association between COVID-19 vaccination and screening uptake. Of 6110, 38.2% regularly participated in screening before the pandemic and 46.9% did so after the pandemic. Individuals unvaccinated due to health reasons (incidence rate ratio (IRR) = 0.47, 95% CI: 0.29–0.77, p = 0.003) and for other reasons (IRR = 0.73, 95% CI: 0.62–0.86, p < 0.001) were less likely to undergo screening compared to fully vaccinated individuals. There was no long-term decrease in breast cancer screening uptake after the pandemic in Japan. Vaccination was linked to increased uptake, but there was no dose relationship. [ABSTRACT FROM AUTHOR]

Background: Living in rural areas is a major contributor of health inequity. Tackling health inequity is important for primary care physicians. Therefore, it is important to compare the quality of primary care between rural and urban areas. To the best of our knowledge, this is the first study to examine the association between rurality and patient experience (PX) in Japan using validated measures. Methods: This cross-sectional study was conducted using online surveys. Participants were selected using a stratified random sample based on sex and age. The Japanese version of the Person-Centered Primary Care Measure (PCPCM) was used as an indicator of PX. We used the Rurality Index for Japan (RIJ) to measure rurality. Furthermore, we used multivariate linear regression analysis to examine the relationship between the RIJ and PCPCM after adjusting for confounders. Results: Of the 1112 eligible participants, 800 responded to the survey (response rate:71.9%). The mean PCPCM scores were 2.46 (standard deviation: 0.73) and median RIJ was 15 (interquartile range: 6–33). The crude and adjusted coefficients of rurality were − 0.02 (− 0.006–0.001, p = 0.114) and − 0.02 (− 0.005–0.001), respectively, demonstrating that rurality was not significantly associated with the total PCPCM score. Subgroup analyses were similar to the main analyses. Conclusion: We found that PX in primary care did not differ by rurality in the general Japanese population. [ABSTRACT FROM AUTHOR]

Background: Pembrolizumab has been widely used in patients since its release, but information on cardiac Adverse Events (AEs) related to pembrolizumab remains lacking, particularly in Japanese populations. Objectives: This study aims to evaluate time to onset, incidence rates, and outcomes for pembrolizumab-induced cardiac AEs in patients with cancer using the Japanese Adverse Drug Event Report database. Methods: We analysed data for the period from April 2004 to March 2022. Data on cardiac AEs were extracted and relative risks of AEs were estimated using the reporting odds ratio. Results: We analysed 2,021,907 reports and identified 15,306 reports of AEs caused by pembrolizumab. Of these, 399 cardiac AEs were associated with pembrolizumab. Signals were detected for six cardiac AEs: myocarditis, immune-mediated myocarditis, pericardial effusion, cardiac tamponade, pericarditis, and pericarditis malignant. A histogram of median times to onset showed occurrence from 33 (21–97) days for immune-mediated myocarditis to 138 (67–168) days for pericarditis malignant, but some cases occurred even more than 1 year after the start of administration. Among these, myocarditis was the most frequently reported (27.1%), with fatal cases also reported. Conclusion: This study focused on cardiac AEs caused by pembrolizumab as post-marketing AEs. Patients should be monitored not only at the time of administration, but also over time for signs of these AEs, especially myocarditis, as some patients may have serious outcomes. [ABSTRACT FROM AUTHOR]

Background: Community-level group sports participation is a structural aspect of social capital that can potentially impact individual health in a contextual manner. This study aimed to investigate contextual relationship between the community-level prevalence of group sports participation and the risk of all-cause, cardiovascular disease (CVD), and cancer mortality in older adults. Methods: In this 7-year longitudinal cohort study, data from the Japan Gerontological Evaluation Study, a nationwide survey encompassing 43,088 functionally independent older adults residing in 311 communities, were used. Cause of death data were derived from the Japanese governmental agency, The Ministry of Health, Labour and Welfare, for secondary use. "Participation" was defined as engaging in group sports for one or more days per month. To analyze the data, a two-level survival analysis was employed, and hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated. Results: Among the participants, 5,711 (13.3%) deaths were identified, with 1,311 related to CVD and 2,349 to cancer. The average group sports participation rate was 28.3% (range, 10.0–52.7%). After adjusting for individual-level group sports participation and potential confounders, a higher community-level group sports participation rate was found to be significantly associated with a lower risk of both all-cause mortality (HR: 0.89, 95% CI: 0.83–0.95) and cancer mortality (HR: 0.89, 95% CI: 0.81–0.98) for every 10% point increase in the participation rate. For CVD mortality, the association became less significant in the model adjusted for all covariates (HR: 0.94, 95% CI: 0.82–1.09). Conclusions: Our findings support the existence of a preventive relationship between community-level group sports participation and the occurrence of all-cause and cancer mortality among older individuals. Promoting group sports within communities holds promise as an effective population-based strategy for extending life expectancy, regardless of individual participation in these groups. [ABSTRACT FROM AUTHOR]

Background: The workload of public health nurses (PHNs) working for local governments has been increasing as health issues become more diverse and complicated. Even amidst the ongoing administrative and fiscal reforms, there is an urgent need to ensure how effectively and efficiently public health nurses can practice in health service development. The objective of this research was to clarify the actual conditions of best practice transfer (BPT) and its related factors. Methods: An anonymous postal and self-administered questionnaire survey was conducted among PHNs working at 334 sites, including the local government offices and health centers across Japan, and analysed mainly through logistic regression analysis. Results: One hundred eighty-five of the 334 institutions (55.4%) agreed to participate, and of the 966 questionnaire forms distributed, 709 forms (73.4%) were collected, of which 702 responses (72.7%) were valid. Although less than half (43.2%) have experience in BPT in health service development, more than 80% are willing to perform going forward. Significant factors for both the group with experience in BPT and the group with willingness to perform include an organizational culture that promotes BPT, as well as multiple elements of the workplace environment and facilitating factors related to knowledge and learning. The experienced group recognised the needs for criteria to evaluate the adaptability of best practice, while the willing group, to evaluate the quality of practice. Conclusions: Through a nationwide survey, this research elucidated for the first time the actual conditions of BPT by PHNs in Japan and related factors. The results indicated the importance of developing a system to promote BPT at the workplace level, also highlighted the importance for practitioners and experts, including researchers, to work together to develop practical guidelines to ensure evidence-based practices. Urgent actions are needed for the national and local governments to develop a system to promote BPT from diverse perspectives, building on the findings of this research. [ABSTRACT FROM AUTHOR]

Simple Summary: Surgery is the most effective treatment for early-stage lung cancer, but it poses a heavy physical burden. Accordingly, understanding the perioperative daily life conditions of patients is important to maintain their health status and to provide appropriate treatment. We performed a prospective study to examine the socioclinical factors associated with the physical quality of life of patients who underwent surgery for lung cancer at Shonan Kamakura General Hospital, Kanagawa, Japan. In the preoperative setting, living alone and lower performance status were independently associated with worse physical quality of life. In the postoperative setting at 6 months, later smoking cessation, lower performance status, living alone, and higher comorbid burden were independently associated with worse physical quality of life. In order to maintain quality of life and provide enough treatment, perioperative management should include taking care of the patient's physical condition, lifestyle, smoking, and comorbid status. Surgery is the most effective treatment for early-stage lung cancer; however, it poses a higher physical burden than other treatment options. Therefore, understanding the perioperative course of patients is important. Using the Short Form Health Survey 36, we prospectively measured the physical quality of life of patients who underwent anatomical pulmonary resection for non-small cell lung cancer at Shonan Kamakura General Hospital, Kanagawa, Japan (n = 87). In the preoperative setting, patients who had lower performance status and lived alone had significantly worse physical quality of life scores on multivariate analysis (regression coefficient (95% confidence interval), −9.37 (−13.43–−5.32) and −10.22 (−13.74–−7.40), respectively, p < 0.0001 for both). At 6 months postoperatively, patients who stopped smoking within 1 year preoperatively (stopped smoking within 1 year vs. remote or never smokers, 41.0 ± 10.5 vs. 48.6 ± 7.2, p = 0.002), had lower performance status (0 vs. 1–2, 49.3 ± 6.6 vs. 38.6 ± 9.6, p < 0.0001), lived alone (living alone vs. living with somebody, 41.6 ± 9.7 vs. 48.1 ± 7.9, p = 0.021), and had higher comorbid burden (Charlson comorbidity index <3 vs. ≥3, 48.2 ± 6.9 vs. 39.1 ± 14.7, p = 0.003) had significantly worse physical quality of life scores on univariate analysis. More recent smoking (regression coefficient (95% confidence interval), −4.90 (−8.78–1.0), p = 0.014), lower performance status (8.90 (5.10–12.70), p < 0.0001), living alone (5.76 (1.39–10.13), p = 0.01), and higher comorbid burden (−6.94 (−11.78–−2.10), p = 0.006) were significant independent predictors of worse postoperative physical quality of life on multivariate analysis. Therefore, patients with these conditions might need additional support to maintain their physical condition after anatomical lung cancer surgery. [ABSTRACT FROM AUTHOR]

Teenage pregnancy increases the threat of depression because of its many factors. Pregnancy during young adulthood may also have several risk factors for depression compared to older pregnancies. However, data on depression in young adult pregnancies are lacking. This study investigated the association between teenage and young adult pregnancy and depression. Data from the Japan Environment and Children's study was used as a nationwide multicenter prospective cohort study. A multivariate logistic regression was performed to investigate the association between age groups (14–19, 20–24, 25–29, 30–34, ≥ 35 years) and depression, adjusted for behavioral and sociodemographic characteristics. Depression was assessed using the Kessler Psychological Distress Scale. In total, 96,808 pregnant women responded to the questionnaire. Teenage (14–19 years) and young adult (20–24 years) pregnancy were associated with an increased risk of depression compared to older pregnancy (≥ 35 years) (teenage: OR 4.28, 95% confidence interval, CI [3.24–5.64]; young adult: OR 3.00, 95% CI [2.64–3.41]). After adjusting for covariates, the magnitude of the risk of depression was attenuated. However, teenage and young adult pregnancy remained at a significantly increased risk of depression compared to older pregnancy (teenage: OR 2.38, 95% CI [1.77–3.21]; young adult: OR 2.14, 95% CI [1.87–2.46]). Our findings indicate that teenage and young adults' pregnancy are at an increased risk of depression compared to older pregnancy. These findings suggest prioritizing teenage and young pregnant women for prevention and interventions related to depression. [ABSTRACT FROM AUTHOR]

Objective: Discriminatory treatment against those with emerging infection is a long-standing problem. The present study investigateswhetherworkers infected or in close contact with COVID-19 were susceptible to workplace mistreatment during the pandemic in Japan. Methods: This Internet-based cross-sectional study analyzed a total of 18,170 workers aged 20 to 60 years in Japan in December 2020. Odds ratios (ORs) for workplacemistreatment were estimated. Results: For workers with close contact or infection, ORs for workplace mistreatment in a model adjusted for socioeconomic factors were 7.64 (95% CI: 5.52-10.6, P < 0.001) and 10.7 (95% CI: 8.44-13.6, P < 0.001), respectively. Conclusions: Workers with infection or close contact were significantly more likely to experience workplace mistreatment. Actions against workplace mistreatment for workers with emerging infection are still required. [ABSTRACT FROM AUTHOR]

Aim: We developed a self‐assessment scale—Older Adults' Perceptions of Community‐based Connectedness with People—to assess older adults' comprehensive perceptions of their connectedness with others in the community. A specific aim of this study is to evaluate the reliability and validity of this scale. Methods: Participants consisted of 1000 men and women aged 65 years or older, living in Sapporo, Hokkaido, Japan. Factorial validity was assessed using exploratory and confirmatory factor analysis, while concurrent validity was assessed using correlation analysis. Reliability was confirmed by Cronbach's α coefficient using the internal consistency method, and the stability coefficient was confirmed using the test–retest method. Results: Responses were received from 380 participants, and 358 participants who responded to all items were included in the analysis. The developed scale comprised 22 items with three factors: "Perception of Inclusion" (α =.947), "Perception of Reciprocity through Reception" (α =.937), and "Perception of Reciprocity through Provision" (α =.910). Correlation analyses indicated that concurrent scales were positively correlated with Ikigai and negatively correlated with loneliness on the total scale. The model fit was comparative fit index = 0.933, goodness‐of‐fit index = 0.854, adjusted goodness‐of‐fit index = 0.818, and root mean square of approximation = 0.081. The stability coefficient of the total scale scores was 0.875 (95% CI: [0.830, 0.908]). Conclusions: The developed scale had adequate reliability and validity. The perceptions of connectedness measured using this scale can be used by public health and nursing care professionals to prevent loneliness and isolation among older adults living in the community. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to clarify the relationship between depressive symptoms and infection prevention measures and daily lifestyle habits during the coronavirus disease 2019 pandemic among community‐dwelling Japanese older adults. Methods: This cross‐sectional study was conducted on older residents (age ≥65 years) living in the Tama area of Tokyo and Sapporo, Hokkaido, in 2021. A self‐administered questionnaire survey was conducted to collect data on demographics, the impact of the pandemic on physical condition, and depressive symptoms, infection prevention measures, and daily lifestyle habits during the pandemic. The Geriatric Depression Scale was used to assess depressive symptoms. Results: In total, 554 respondents were included in the analysis. The results of multiple logistic regression analyses revealed that refraining from going out and visiting medical institutions were associated with depressive symptoms. Furthermore, those who went out almost every day were less likely to have depressive symptoms than the others, those who exercised almost every day were less likely to have depressive symptoms than were those who almost never exercised, and those who slept 6–7 h were less likely to have depressive symptoms than were those who slept ≤5 h. Conclusions: The findings of the present study suggest the necessity of having a place where older adults with physical and lifestyle concerns can consult with healthcare providers in a location other than a medical institution, even during infectious disease outbreaks. In addition, increasing the frequencies of going out and independent exercise and sleeping 6–7 h may help prevent depression among older adults. [ABSTRACT FROM AUTHOR]

Aim: Anger expression is associated with an increased risk of cardiovascular disease. This positive association was confined to individuals with lower perceived social support and outdoor recreational activity. However, the effects of retirement status remain unclear. This study aimed to investigate whether retirement status after the age of 60 years modifies the association between anger expression and the risk of cardiovascular disease in the Japanese population. Methods: This longitudinal study included 499 community-dwelling retired and employed workers aged 60-79 years, who completed a cardiovascular risk survey in 1997. A Cox proportional hazards model was used to estimate the hazard ratios and 95% confidence intervals of incident cardiovascular disease (ischemic heart disease and stroke) according to anger expression in retired and employed workers after adjusting for potential cardiovascular risk factors. Results: A total of 37 participants experienced incident cardiovascular disease during the mean follow-up period of 14.8 years (standard deviation 5.5 years). In retired workers, anger expression was associated with an increased cardiovascular disease risk, whereas no such association was observed in employed workers. The respective hazard ratio per one-standard deviation increment of total anger expression was 1.77 (95% confidence interval 1.29-2.43) and 1.03 (95% confidence interval 0.64-1.66; P for interaction = 0.036) among retired and employed workers, respectively. Conclusions: A positive association between anger expression and the risk of cardiovascular disease was confined to retired workers, suggesting that continuing work after retirement age could reduce anger expression-related cardiovascular disease risk. [ABSTRACT FROM AUTHOR]

Aim: Grip strength (GS) as a surrogate for muscular strength, waist circumference (WC) as a surrogate marker of visceral fat, and body mass index (BMI) as a surrogate marker of obesity should also be considered markers for the management of risks associated with type 2 diabetes mellitus (T2DM). However, in terms of the management of T2DM in elderly patients, the accentuated heterogeneity of sarcopenic change might modify the associations between those factors and glycemic control. In this cross-sectional study, we aimed to clarify the impact of GS, WC, and BMI on hemoglobin A1c (HbA1c) in elderly Japanese patients with T2DM. Methods: GS, WC, and BMI were measured in 327 patients. Odds ratios (ORs) and 95% confidence intervals (CIs) for good glycemic control (HbA1c < 7.0%) were investigated to analyze the three variables as numerical values by dividing them into tertiles. All results were expressed after adjustment was made for the confounders of age, sex, and number of diabetes medications being used by the study participants. Results: The ORs of GS, WC, and BMI for well-controlled HbA1c were 1.056 (95% CI, 1.016-1.098), 0.986 (95% CI, 0.960-1.013), and 1.032 (95% CI, 0.959-1.111), respectively. The OR of 3.726 (95% CI, 1.831-7.581) in the high tertile for GS was significantly higher than the OR in the low tertile, and no differences were observed among the tertiles for WC and BMI. Conclusions: Based on that result, GS was found to have more potential as an effective marker of glycemic control than WC or BMI among elderly Japanese patients with T2DM. [ABSTRACT FROM AUTHOR]

Aim: To investigate the factors associated with introducing visiting-pharmacist services for community-dwelling older adults in Japan. Methods: We conducted a nested case-control study using claims data in a cohort from a city in Tokyo. Patients aged =65 years who received visiting-pharmacist services for the first time between April 2014 and March 2020 were considered case patients. A maximum of four controls to each case patient were randomly selected on the basis of sex, age, health insurance systems, and month-year. Medical and long-term care service usage and patient condition were assessed using claims data from the index and preceding months, along with long-term care needs certification data. Multivariable conditional logistic regression analysis was conducted to estimate the adjusted odds ratios with 95% confidence intervals for factors associated with visiting-pharmacist service introduction. Results: A total of 22 949 participants (4591 cases and 18 358 controls) were included, with a median age of 85 years; 59.3% were women. The adjusted odds ratios (95% confidence intervals) of the three most related factors were 27.61 (23.98-31.80) for physicians' home visits, 5.83 (5.08-6.70) for hospitalization, and 4.97 (4.16-5.95) for designated-facility admission. Factors such as prescribing ≧10 medications, visiting nursing, and cancer were positively associated. In contrast, low household income and a high need for support due to cognitive function or disability were negatively associated. Conclusions: This study provides insights into the introduction of visiting-pharmacist services for older adults in Japan. [ABSTRACT FROM AUTHOR]

Aim: This cross-sectional study had two aims: to assess the prevalence of oral frailty (OF), according to the Oral Frailty 5-Item Checklist (OF-5), among community-dwelling older adults; and to examine the associations among oral frailty, dietary variety, social engagement, and physical frailty. Methods: We pooled data from two population-based studies (the Otassha Study and the Itabashi Longitudinal Study on Aging). With the OF-5, OF is characterized by the presence of two or more of the following: (i) fewer teeth, (ii) difficulty in chewing, (iii) difficulty in swallowing, (iv) dry mouth, and (v) low articulatory oral motor skills. We calculated the OF prevalence for each sex. We assessed dietary variety, social engagement, and physical frailty. Generalized structural equation modeling was employed to investigate the associations among oral frailty, low dietary variety (dietary variety score =3), social isolation (Lubben Social Network Scale score <12), and physical frailty (Japanese version of the Cardiovascular Health Study score =3). Results: A total of 1206 individuals (626 women and 580 men) with a mean age of 74.7 years were included. The prevalence of OF was 36.7%, and it increased with age; however, there was no significant sex difference. OF was significantly indirectly associated with physical frailty via low dietary variety (odds ratio, 1.43; 95% confidence interval, 1.04-1.97) and social isolation (odds ratio, 1.42; 95% confidence interval, 1.04-1.94). Conclusions: Two of five community-dwelling older adults exhibited OF. Low dietary variety and social isolation are potential underlying mechanisms through which OF is indirectly associated with physical frailty. [ABSTRACT FROM AUTHOR]

Background: The Late-Stage Elderly Questionnaire has been incorporated into health assessments for older adults in Japan, encompassing three self-administered questions on subjective physical function: subjective gait speed decline, recent fall history, and exercise habits. Nevertheless, its efficacy in predicting new fracture occurrences remains uncertain. Methods: This retrospective cohort study utilized Japan's DeSC database, a large commercially available claims database. Participants were older adults aged =75 years and provided complete responses to the Late-Stage Elderly Questionnaire at health check-ups. We performed two Cox regression analyses for new fractures based on the responses to the three questions (Model 1) and on age, sex, and responses to the three questions (Model 2). The predictive abilities of the 1-year occurrence of new fractures were compared between the two models. Results: Of 11 683 eligible older adults, 927 (7.93%) experienced new fractures. Model 1 revealed significant associations between new fractures and subjective gait speed decline (hazard ratio [HR], 1.63; 95% confidence interval [CI], 1.40-1.89), recent fall history (HR, 2.03; 95% CI, 1.77-2.33), and absence of exercise habits (HR, 1.29; 95% CI, 1.13-1.47). Model 2 demonstrated superior predictive ability (area under the curve, 0.677; 95% CI, 0.659-0.695) compared with Model 1 (area under the curve, 0.633; 95% CI, 0.614-0.652), with a net reclassification improvement of 0.383 (95% CI, 0.317-0.449). Conclusion: Three subjective physical well-being factors were significantly associated with new fracture development in older adults. These results suggest that the three-question assessment may be a valuable screening tool for identifying new fractures. [ABSTRACT FROM AUTHOR]

Background: Patients receiving long-term oxygen therapy are in a state of progressive respiratory dysfunction and have high mortality. However, the predictors of mortality in these patients have not yet been established. Objectives: This prospective observational study aimed to identify the predictors of two-year mortality in patients receiving long-term oxygen therapy. Design, Setting/Subjects: This two-year prospective observational study included 96 patients who received long-term oxygen therapy in the outpatient department of the National Hospital Organization Nishiniigata Chuo Hospital in Japan. Measurements: The updated Charlson Comorbidity Index, body mass index, handgrip strength, modified British Medical Research Council scale (mMRC), Barthel Index (BI), and Montreal Cognitive Assessment (MoCA) were collected in 2019 as a baseline. Outcome was defined as mortality due to chronic respiratory disease during the two-year follow-up period, and predictors were estimated using age- and sex-adjusted Cox proportional hazards model. Results: The 83 patients that were followed up, 30 (36%) died. The Cox proportional hazards model estimated handgrip strength (adjusted hazard ratio [HR]: 0.89; 95% confidence interval [CI]: 0.84–0.94; p < 0.01; Wald: 14.38.), mMRC (adjusted HR: 1.96; 95% CI: 1.36–2.83; p < 0.01; Wald: 13.16.), BI (adjusted HR: 0.95; 95% CI: 0.93–0.98; p < 0.01; Wald: 17.07.), and MoCA (adjusted HR: 2.17; 95% CI: 1.31–3.59; p < 0.01; Wald: 9.06) as predictors. Conclusions: This study indicated that handgrip strength, dyspnea, activities of daily living, and cognitive function were predictors of two-year mortality in patients receiving long-term oxygen therapy. [ABSTRACT FROM AUTHOR]

Background: Little information is available on the association between gender nonconformity during adolescence and subsequent mental health. While the distress related to gender nonconformity may be socially produced rather than attributed to individual-level factors, further research is needed to better understand the role of psychosocial factors in this context. Method: We analyzed data from the Tokyo Teen Cohort, obtained through random sampling of adolescents born between 2002 and 2004. We used inverse probability weighting to examine the association of gender nonconformity at ages 12 and 14 as a time-varying variable with subsequent mental health at age 16, while accounting for time-fixed and time-varying confounders. Furthermore, we used a weighting approach to investigate the mediating role of modifiable psychosocial factors in this association, addressing exposure-mediator and mediator–mediator interactions. Results: A total of 3171 participants were analyzed. Persistent gender nonconforming behavior at ages 12 and 14 was associated with subsequent depression (β = 2.02, 95% confidence interval [CI] 0.85 to 3.19) and psychotic experiences (β = 0.33, 95% CI 0.14 to 0.52) at age 16. The results remained robust in sensitivity analyses. Approximately 30% of the association between gender nonconformity and depression was consistently mediated by a set of psychosocial factors, namely loneliness, bullying victimization, and relationships with mother, father, and friends. Conclusions: Persistent gender nonconformity during adolescence is associated with subsequent mental health. Psychosocial factors play a vital mediating role in this association, highlighting the essential need for social intervention and change to reduce stigmatization and ameliorate mental health challenges. [ABSTRACT FROM AUTHOR]

Ozoralizumab is a bispecific NANOBODY compound that binds tumor necrosis factor alpha (TNFα) and human serum albumin. Ozoralizumab inhibits the TNFα physiological activity while maintaining long‐term plasma retention owing to its human serum albumin–binding ability. A population pharmacokinetic (PK) model was developed using data from 494 Japanese patients with rheumatoid arthritis in Phase II/III and Phase III trials to assess the effects of potential PK covariates. The ozoralizumab PK after subcutaneous administration was described using a 1‐compartment model with first‐order absorption and first‐order elimination processes. A proportional error model was used for inter‐ and intra‐individual variabilities, with covariance set between inter‐individual variabilities of the apparent clearance and apparent distribution volume. Body weight, sex, antidrug antibody status, estimated glomerular filtration rate, and concomitant methotrexate use were identified as covariates for apparent clearance, while body weight and sex were covariates for apparent distribution volume in the final model. Body weight had the greatest effect on the PK of ozoralizumab, while the other covariates had minor effects. When administered at 30 mg every 4 weeks, the predicted steady‐state plasma trough concentration in a patient weighing 83.2 kg exceeded the trough concentration required to maintain efficacy of ozoralizumab, and the estimated exposure in a patient weighing 42.5 kg did not exceed the mean exposure at 80 mg, a well‐tolerated dose, throughout 52 weeks. We developed a population PK model that adequately described the ozoralizumab PK in Japanese patients with rheumatoid arthritis, and none of the evaluated covariates showed clinically relevant effects on the PK of ozoralizumab. [ABSTRACT FROM AUTHOR]

Background: The prevalence and risk factors of cholelithiasis in individuals with severe or profound intellectual and motor disabilities (SPIMD) are poorly characterised. Thus, we aimed to investigate the prevalence and risk determinants of cholelithiasis in a cohort with SPIMD under medical care in a residential facility. Methods: We categorised 84 patients in a residential hospital for persons with SPIMD into groups: those with (Group CL) and without (Group N) cholelithiasis. Gallstones were detected via computed tomography, ultrasonography or both. We evaluated gastrostomy status, nutritional and respiratory support, constipation, and bladder and kidney stones. Data were significantly analysed using univariate and multivariate logistic regression analyses. Results: The prevalence rate of cholelithiasis in our SPIMD cohort was 27%. There were no significant differences in sex, age, weight, height, or Gross Motor Function Classification System between the two groups. However, more patients received enteral nutrition (39.13% vs. 6.56%; P = 0.000751) and were on ventilator support (56.52% vs. 19.67%; P = 0.00249) in Group CL than in Group N. Enteral nutrition [odds ratio (OR) 10.4, 95% confidence interval (CI) 1.98–54.7] and ventilator support (OR 20.0, 95% CI 1.99–201.0) were identified as independent risk factors for the prevalence of cholelithiasis in patients with SPIMD. Conclusions: Patients with SPIMD demonstrated an increased prevalence of cholelithiasis, with a notable association between nutritional tonic use and respiratory support. Therefore, to emphasise the need for proactive screening, it is crucial to devise diagnostic and therapeutic strategies specific to patients with SPIMD. Further investigation is essential to validate our findings and explore causative factors. [ABSTRACT FROM AUTHOR]

Purpose: In clinical practice, teicoplanin (TEIC) is typically administered at a trough concentration of 15–40 µg/mL. TEIC has a protein binding rate of approximately 90%, and its concentration rarely exceeds 40 µg/ml. Nevertheless, an increase in the free blood trough concentration may result in renal dysfunction. However, the relationship between the free blood trough concentration and the occurrence of renal dysfunction remains unclear. This study aimed to examine the impact of the predicted free blood concentration on the development of renal dysfunction. Methods: This retrospective study included patients who underwent TEIC and had at least one trough concentration measurement. The association between the frequency of renal dysfunction occurrence and the predicted free blood concentration was evaluated using the following equation: free TEIC concentration = total TEIC concentration/(1 + 1.78 × serum albumin level). Results: Of the 170 patients included in this study, 18% (31/170) developed renal dysfunction. The predicted free trough concentration was significantly higher in the renal dysfunction onset group than in the nononset group. However, the total trough concentration was not significantly associated with the development of renal dysfunction. The odds ratio for developing renal dysfunction was 4.5 (95% confidence interval, 1.9–10.5; P < 0.001) when the predicted free trough concentration was > 4.0 µg/mL. Conclusion: Elevated free trough concentrations of TEIC were associated with an increased risk of renal dysfunction. Controlling the increase in the predicted free blood concentration may effectively prevent the development of renal dysfunction. [ABSTRACT FROM AUTHOR]

Background: Both malnutrition and at‐risk of malnutrition are prevalent among older patients receiving home medical care. Discontinuation of home medical care usually occurs when an older patient is admitted to a hospital or nursing home or dies. This study aimed to assess prospective associations between nutritional status and discontinuation of home medical care in older patients. Methods: Three hundred and thirty‐three Japanese older patients receiving home‐visit nursing care services were included in this study. Their nutritional status was assessed using the Mini Nutritional Assessment®‐Short Form, and patients were classified into three groups (well‐nourished, at‐risk of malnutrition and malnourished). Outcomes were confirmed at the 1‐year follow‐up survey. Hazard ratios (HRs) and 95% confidence intervals (CIs) for discontinuation of home medical care based on nutritional status were calculated using a Cox proportional hazard model. Covariates included age, sex, living status, economic status, activities of daily living, comorbidities and dysphagia status. Results: In total, 297 patients (median age: 84 years) were analysed. At baseline, 48.5% of the patients were at‐risk of malnutrition and 18.9% were malnourished. During the observation period of 1 year, 27.6% patients discontinued their home medical care. In the adjusted model, the HR for discontinuation of home medical care among those at‐risk of malnutrition was 2.44 (95% CI: 1.34–4.45) times than that of the well‐nourished group, although the malnourished group was not significantly associated with discontinuation of home medical care (HR: 1.69, 95% CI: 0.77–3.72; referent: well‐nourished). Conclusions: At‐risk of malnutrition was associated with discontinuation of home medical care among older patients. Key points: Older patients receiving home medical care are already at risk for discontinuation of home medical care when they are at‐risk of malnutrition.The at‐risk of malnutrition is a stage of great opportunity for preventing malnutrition, as its early recognition and appropriate nutritional management may lead to the prevention of malnutrition, eventually contributing to an increase in the length of home medical care.Future studies are warranted to investigate whether nutritional interventions for those at‐risk of malnutrition contribute to prolonging the length of home medical care by improving nutritional status. [ABSTRACT FROM AUTHOR]

Context: The incidence of low back pain (LBP) is high among high school male soft tennis players. In some sports for which the rotational component of the body is important, an association between restricted hip internal rotation of the nondominant leg and LBP has been reported; however, whether this association holds in soft tennis is unknown. Therefore, this study aimed to evaluate the association between hip internal rotation, hip external rotation, hamstring flexibility, iliopsoas flexibility, and LBP incidence. Design: This study was designed as a cross-sectional study, conducted at a sports training center. Methods: Participants comprised 113 male elite high school soft tennis players (age: 16.1 [0.7] y) from 9 elite-level teams. The main outcome measures were the hip internal and external rotation range of motion, hamstring flexibility on the straight leg raise test, and iliopsoas flexibility on the Thomas test. Multiple logistic regression analysis was performed to examine the influence of main outcomes on LBP incidence in the past 1 year. Results: A total of 35 participants had LBP (LBP group); 78 participants did not have LBP (non-LBP group). Multiple logistic regression analysis revealed that the odds ratio for height was 1.08 (95% confidence interval, 1.00–1.16; P =.043) and for the hip internal rotation range of motion in the nondominant leg was 0.90 (95% confidence interval, 0.85–0.95; P <.001), indicating significant associations with LBP. Conclusion: Hip internal rotation range of motion in the nondominant leg and height were crucial factors related to LBP in male elite high school soft tennis players. [ABSTRACT FROM AUTHOR]