Ebetsu Active Future Study (EAFS) conducts comprehensive annual surveys of individuals who are independent in activities of daily living (ADLs) to track age-related physical and mental changes. These surveys include a variety of assessments such as cognitive function tests, physical function tests, blood tests, self-administered questionnaires about lifestyle and health, and interviews regarding medical and family history. In addition, serum, plasma and DNA samples from these assessments are stored at –80°C to facilitate future analyses and accommodate the potential addition of new measurement items. The purposes of this study are: (1) to identify potential blood-based biomarkers applicable to the detection of various types of mild cognitive impairment (MCI), (2) to explore diet-based strategies for preventing MCI and the progression of dementia, (3) to examine the relationship between urban characteristics, individual attributes and healthy life expectancy in Ebetsu City and (4) to return the research findings to the city.

From August to October 2023, EAFS invited Ebetsu residents to participate in the study. As a result, 1340 individuals applied and 1189 residents aged between 55 and 75 years who were independent in ADLs participated in the baseline survey for the first year.

EAFS initiated a follow-up of 1189 participants (38.9% male; 64.5±5.6 years) in the baseline year of 2023 and maintained a high follow-up rate of 98.5% by wave 3 (2025). The Montreal Cognitive Assessment-Japanese demonstrated that 53.6% of the participants had operational MCI. The proportion of participants with operational MCI increased with ageing. Regarding the APOE4 gene, which is associated with an increased risk of Alzheimer’s disease, 1.2% of the total population were homozygous carriers and 22.1% were heterozygous carriers.

EAFS will conduct annual follow-up surveys until 2032. In addition to analysing data for each objective, we also plan to perform further analysis of the stored specimens.

The Philippines faces physician shortages, exacerbated by their propensity to practise in urban centres. Despite government placement programmes, recruitment and retention of physicians in many areas throughout the country remain difficult. This study aims to: (1) describe the distribution of general physicians and board-certified specialist physicians and (2) identify the individual, work environment, local environment, national environment and international environment factors that may influence physicians to establish their practice in areas with below-optimal physician-to-population ratios in the Philippines.

To describe the distribution of general physicians and board-certified specialist physicians, we will map Philippine Health Insurance Corporation (PhilHealth)-accredited physicians at the regional and at the provincial level, superimposing medical schools and corresponding training institutions. To identify the individual, work environment, local environment, national environment and international environment factors that may influence physicians to establish their practice in areas of the Philippines with below optimal physician-to-population ratios, we will conduct three rounds of data collection: (1) an online survey of current Philippine Department of Health (DOH)-deployed physicians; (2) online or face-to-face focus group discussions and key informant interviews with a subset of DOH-deployed physicians, senior general and specialist physicians practising in Metro Manila and outside and DOH personnel involved in the implementation of these physician placement programmes at the national, regional and local level; and (3) a stated preference experiment administered to resident physicians of the specialties under study to determine which government interventions can encourage them to establish their practice in areas with lower than optimal physician-to-population ratios in the Philippines.

We have obtained ethics clearance from the Ateneo de Manila University School of Medicine and Public Health Research Ethics Committee. We will disseminate our findings in online or face-to-face dissemination sessions with the DOH, Philippine Health Insurance Corporation, Association of Philippine Medical Colleges, the Philippine Statistics Authority, the Professional Regulation Commission Board of Medicine, the Commission on Higher Education and partner specialty societies. We will also publish our results in peer-reviewed medical or public health journals.

Decisions regarding life-sustaining treatment and end-of-life care are among the most ethically complex and emotionally challenging decisions encountered in emergency departments and intensive care units. Such decisions frequently involve uncertainty regarding prognosis, limited time for deliberation and situations in which patients may lack decision-making capacity, requiring family members or surrogate decision-makers to participate in the decision-making process. Shared decision-making (SDM) has increasingly been recommended as an approach to align treatment decisions with patients’ values and preferences. Decision aids are evidence-based tools designed to support informed and value-congruent healthcare decisions by presenting available options, potential benefits and harms and opportunities for values clarification. Although decision aids have been extensively studied in chronic disease management and preference-sensitive healthcare decisions, their use in life-sustaining treatment and end-of-life care in emergency and intensive care settings remains fragmented and has not yet been comprehensively mapped. This scoping review aims to identify and map the existing literature on decision aids and related interventions that support SDM for life-sustaining treatment and end-of-life care in emergency and intensive care settings.

This scoping review will be conducted in accordance with the Joanna Briggs Institute (JBI) methodology for scoping reviews and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). Electronic searches will be performed in PubMed, Web of Science, the Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL and Ichushi-Web. Studies published in English or Japanese from January 2000 onwards will be eligible. Quantitative, qualitative, mixed-methods and descriptive studies addressing decision aids or related interventions designed to support SDM regarding life-sustaining treatment and end-of-life care among adult patients, family members, surrogate decision-makers or healthcare professionals in emergency and intensive care settings will be included. Two reviewers will independently screen studies, assess eligibility and chart data. Findings will be synthesised descriptively and presented in narrative and tabular formats.

Ethics approval is not required because this review will analyse data from publicly available literature and will not involve human participants. Findings will be disseminated through publication in a peer-reviewed journal and presentation at relevant scientific conferences.

Older adults are at an increased risk of influenza-related hospitalisation and mortality due to a combination of risk factors. Severe influenza and excess mortality in this population remain major public health concerns, underscoring the need for novel treatment strategies.

This multicentre, investigator-initiated, randomised, double-blind clinical trial evaluated the efficacy and safety of the investigational drug favipiravir injection (T-705IV) in combination with oseltamivir phosphate, compared with oseltamivir monotherapy in hospitalised patients with influenza aged ≥65 years. Both T-705IV and oseltamivir phosphate will be administered for 5 days. The primary endpoint is time from randomisation to recovery within 15 days. Recovery is defined as either actual hospital discharge or sustained clinical status permitting discharge for 3 consecutive days. Clinical status will be assessed using a 7-point ordinal scale based on hospitalisation status and oxygen requirement. The primary analysis employs a Bayesian Cox proportional hazards model with a non-informative prior to estimate the posterior probability that the HR exceeds 1.0. The secondary endpoints include the distribution of 7-point scale scores over a 29-day period; rates of clinical worsening at days 15 and 29; duration of fever; all-cause mortality; intensive care unit admission within 29 days; pneumonia complication rate at 15 days; and changes in viral titre and viral RNA load on days 1, 2, 3 and 7. Safety will be assessed through the collection of adverse events (AEs) up to day 29. Pharmacokinetic evaluation will include measurement of plasma favipiravir concentrations on day 3. The planned sample size is 80 patients (40 per group).

Written informed consent will be obtained from all participants. This study was approved by the Center Hospital of the National Center for Global Health and Medicine Institutional Review Board (approval number: NCGM-I-022-24a) and registered in the Japan Registry of Clinical Trials. Study findings will be disseminated through peer-reviewed publications and/or presentations at academic conferences.

jRCT2031240586,

To quantify the clinical burden and healthcare resource use (HCRU) associated with difficult-to-treat (D2T) rheumatoid arthritis (RA) compared with non-D2T RA and evaluate clinical characteristics and factors associated with D2T RA as well as treatment patterns in Japan.

Longitudinal, retrospective observational study using electronic medical record data from 1992 to 2024 and a physician survey administered between November 2022 and November 2025.

A single academic medical centre real-world clinical practice setting in Japan.

A total of 1581 patients with RA were included.

The primary outcome measures were the comparisons of clinical burden and HCRU in the D2T RA group compared with the non-D2T RA group. D2T RA status was defined according to the European Alliance of Associations for Rheumatology definition. Clinical burden included disease activity, physical function, patient-reported outcomes, serological markers and renal function. HCRU included outpatient visits and hospitalisations evaluated over 12-month, 24-month and 36 month windows pre-index using overlap weighting and regression models. Factors associated with D2T RA status were evaluated using logistic regression. Treatment patterns were reconstructed longitudinally as lines of therapy across biologic and targeted synthetic disease-modifying antirheumatic drugs.

Among 1581 patients with RA, 102 (6.5%) met the D2T criteria. Treatment trajectories showed earlier escalation and frequent switching across biologic and targeted synthetic disease-modifying antirheumatic drugs in the D2T RA group. The D2T RA group had modestly elevated outpatient visit rates (rate ratio 1.08–1.09) and were more likely to be hospitalised (OR 4.35–6.12) than the non-D2T RA group. Factors associated with D2T RA included RA onset at age

In this real-world Japanese cohort, D2T RA was associated with higher disease burden and HCRU, particularly hospital-based care. Earlier identification and targeted management of D2T RA may help reduce the overall clinical and healthcare burden in RA.

To assess the impact of non-communicable diseases (NCDs) by number and pattern on productivity loss costs (PLCs) and health-related quality of life (HRQoL) in a large working-age population in Japan.

Cross-sectional analysis of linked claims—survey data with sex-stratified multivariable regression.

Employment-Based Health Insurance Associations in Japan. Administrative claims using International Classification of Diseases, Tenth Revision codes were linked to an online questionnaire (November 2022).

Insured workers and families aged 18–65 years who completed the survey (n=18 236; mean age 48.7 years; 66.2% men).

Primary: PLC, estimated from the Work Productivity and Activity Impairment instrument using the Human Capital Method (annual US$).

HRQoL measured using the EuroQoL 5-Dimension 5-Level index. Exposures were NCD categories, multimorbidity counts and high-impact disease combinations. Models adjusted for sex, age and the number of other conditions.

Multimorbidity (≥2 conditions) was present in 58.4% (56.3% men; 62.5% women); 29.3% had ≥5 conditions. Women had higher NCD prevalence (76.9% vs 70.0%), higher median PLC (US$3683 vs US$117) and lower median HRQoL (0.89 vs 1.00) than men. In adjusted analyses, neuropsychiatric conditions were associated with higher PLC in both sexes (men: US$2393 (95% CI 1966 to 2820); women: US$2097 (US$1442 to US$2751)). Musculoskeletal disorders were statistically significant in men but not in women (US$809 (US$381 to US$1236)), whereas genitourinary disorders were statistically significant in women but not in men (US$701 (US$121 to US$1282)). Neuropsychiatric disorders were associated with lower HRQoL in both sexes (men: –0.040 (–0.045 to –0.034); women: –0.044 (–0.053 to –0.035)); musculoskeletal disorders showed similar decrements (men: –0.031 (–0.037 to –0.025); women: –0.040 (–0.049 to –0.031)). Combinations involving sleep and neuropsychiatric disorders produced the highest PLC (eg, depressive episode and sleep disorder: men: US$5219.9 (US$3646.4 to US$6793.4); women: US$5858.5 (US$2634.4 to US$9082.5)). Each additional condition was independently associated with higher PLC and lower HRQoL.

In this cross-sectional study of Japanese workers, specific combinations of chronic conditions, particularly neuropsychiatric conditions co-occurring with sleep disorders and musculoskeletal disorders, were associated with greater productivity loss and lower HRQoL than predicted by the number of co-occurring diseases alone. These findings suggest that workplace health strategies addressing high-impact disease combinations may warrant further investigation in longitudinal studies.

Japan’s dementia policies have mandated establishing at least one medical centre for dementia (MCD) in each secondary healthcare area (SHA) and ensure equitable access to specialised dementia care services across regions. This study aimed to identify the geographical and climatic characteristics of MCDs and examine geographical accessibility to MCDs, and to clarify the geographical characteristics of SHAs in which MCDs have not been established, despite the policy that an MCD should be established in each SHA.

A geocomputational analysis using publicly available geographical datasets

We conducted a geocomputational overlay analysis of the spatial distribution of the three types of MCDs across areas with heavy snowfall, mountainous areas, agricultural areas, peninsulas and remote islands. We then reviewed prefectural development policies and municipal dementia care pathway documents in SHAs without MCDs. Finally, catchment analysis was performed to estimate geographical accessibility to the nearest MCD in areas where SHAs without an MCD were concentrated. We used the datasets of municipalities, secondary healthcare areas, heavy snowfall, mountainous areas, agricultural areas, peninsulas and remote islands, provided by the Ministry of Land, Infrastructure, Transport and Tourism and the dataset of MCDs provided by the Ministry of Health, Labour and Welfare.

Overall, 509 MCDs were identified nationwide: 109 (19.8%) in areas of heavy or extremely heavy snowfall, 12 (2.4%) in mountainous areas, 72 (14.1%) in agricultural areas, 29 (5.7%) on peninsulas and 11 (2.2%) on remote islands. Of the 344 SHAs, 18 (5.2%) did not have an MCD, encompassing 105 municipalities. The MCDs comprise three categories: 21 core, 388 regional and 100 affiliated centres. While only one core centre (4.8%) was located in an agricultural area, 46 regional centres (11.9%) and 25 affiliated centres (25.0%) were located in agricultural areas. dementia care pathways analysis revealed that these municipalities either did not designate any MCDs (41%), designated MCDs in adjacent municipalities (21%) or listed all MCDs within the prefecture (36%). Municipalities that did not designate an MCD in their dementia care pathways were primarily located in geographically or climatically disadvantaged areas, including heavy-snowfall regions and peninsulas. Catchment area analysis using 30 km driving isochrone from the nearest MCD revealed that mountainous terrain, heavy snowfall and the presence of a large lake limited catchment coverage in municipalities that did not designate an MCD in their dementia care pathways.

While the nationwide expansion of MCDs has largely achieved regional coverage, gaps remain in geographically disadvantaged areas where SHAs lack an MCD. Future dementia care planning should consider geographical accessibility in addition to administrative coverage to ensure equitable access to specialised dementia services.

Sanitation workers experience elevated occupational health risks due to hazardous exposures and social marginalisation. This study assessed access to safe sanitation services and examined Health Belief Model-based factors associated with personal protective equipment (PPE) use among sanitation workers in Ethiopia.

A concurrent mixed-methods cross-sectional study was conducted from November 2021 to June 2022. Quantitative data were collected through face-to-face interviews using a structured interviewer-administered questionnaire via multistage simple random sampling. Concurrently, qualitative data were collected through key informant interviews and focus group discussions guided by semistructured interview guides. The quantitative data were analysed using Stata V.14, and associations between variables were examined using multivariable logistic regression. The results were presented as adjusted ORs with 95% CIs, and statistical significance was set at p

The study was conducted in Addis Ababa, Ethiopia.

The quantitative survey included 821 sanitation workers, while the qualitative component comprised 12 key informants and 65 focus group participants.

The primary outcomes were access to safe sanitation services and PPE use.

Overall, 38.2% (95% CI 34.9% to 41.6%) of sanitation workers had adequate access to safe sanitation services and 54.3% (95% CI 50.8% to 57.8%) reported PPE use. PPE use was positively associated with larger household size, workplace PPE availability, supervision, higher cues to action and greater self-efficacy, whereas perceived barriers were associated with lower odds of PPE use. Qualitative findings complemented these results by showing that inconsistent PPE provision, inadequate occupational health training, weak enforcement of safety regulations, precarious employment conditions and persistent social stigma contributed to poor occupational safety practices.

Sanitation workers in Addis Ababa have limited access to safe sanitation services and suboptimal PPE use. Improving organisational support, consistent PPE provision, effective supervision and occupational health training may enhance PPE use and strengthen the health, safety and resilience of this essential workforce.

Blood pressure treatment response is variable in individual patients, and the choice of medical therapy is often dependent on clinician experience. Treatment choices could be personalised by patient empowerment and metabolomic profiles, and augmented by machine learning, but robust evaluation is lacking on how these can be combined to enhance clinical effectiveness. The HYPERMARKER trial will evaluate how an individualised choice of medication class can address the avoidable global health and economic burdens of hypertension.

The HYPERMARKER trial is a proof-of-concept, pragmatic, multicentre, adaptive, open-label strategy trial embedded into routine clinical practice with stratified individual patient randomisation. The trial was co-designed with a patient and public involvement team. The intervention is a digital portal that supports shared decision-making on hypertension therapy class using clinical features plus metabolomic profiles determined with liquid chromatography-mass spectrometry.

Eligible patients are aged≥18 years with a systolic blood pressure≥140 mm Hg and a clinical indication for antihypertensive therapy. 400 participants will be randomised to the usual standard of care for treatment selection or to the intervention group. Remote follow-up will occur through a patient smartphone application and linked blood pressure monitor to assess the primary outcome of change in home systolic blood pressure during a 4-week period after medication changes. Secondary outcomes will include patient-reported adverse effects and quality of life, treatment withdrawal, healthcare utilisation and a health economic analysis. In the second phase of the trial, all participants will receive an updated version of the intervention regardless of the original randomised group.

Ethical approval will be obtained for all sites. Approval in England: North West – Greater Manchester West Research Ethics Committee (REC) (25/NW/0296). Trial results will be disseminated via peer-reviewed publications and plain-language patient summaries.

NCT07294794 and ISRCTN29385951.

Africa faces a substantial health burden characterised by a dual burden of communicable and non-communicable diseases compounded by persistent health system and infrastructure constraints. Digital health interventions offer scalable opportunities to strengthen healthcare delivery. Interactive voice response (IVR), an automated telephone-based technology, shows promise across African health settings; however, existing evidence is dispersed across isolated studies and demonstrates variability in outcomes and implementation approaches. This scoping review maps existing evidence on the use of IVR in healthcare in Africa, focusing on applications, outcomes and implementation experiences.

Eligible studies will include all designs that evaluate IVR-based health interventions in African healthcare settings, while non-voice digital interventions and non-empirical publications will be excluded. We will conduct a scoping review guided by the Arksey and O’Malley framework and the Joanna Briggs Institute and report findings using Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. We will systematically search bibliographic databases and grey literature from 2000 to the end of 2025. Two independent reviewers will screen studies, extract data and chart evidence on IVR characteristics, implementation strategies, barriers and facilitators and outcomes. A third reviewer will resolve disagreements. We will synthesise findings descriptively and thematically, presenting results in tables, visual maps and an equity-focused analysis guided by PROGRESS-Plus.

Ethical approval is not required because this scoping review synthesises previously published, publicly available literature and does not involve human participants or primary data collection. We will share the findings through a peer-reviewed publication and conference presentations, and we will discuss the results with digital health stakeholders, clinicians and policymakers to inform future IVR work in Africa.