Conectar
by Toshihisa Nakashima, Yoshihiro Noguchi, Rikuto Masuda, Tomoaki Yoshimura
This study evaluated the association between individual fluoroquinolones and tendon disorders in Japan using two spontaneous reporting systems: the Food and Drug Administration Adverse Event Reporting System (FAERS) and the Japanese Adverse Drug Event Report (JADER). Five agents—ciprofloxacin, levofloxacin, moxifloxacin, norfloxacin, and ofloxacin—were analyzed for “Muscle, tendon and ligament injuries” and “Tendon disorders.” All fluoroquinolones showed positive signals in the FAERS, whereas only levofloxacin demonstrated consistent and robust associations in the Japanese subset of the FAERS and the JADER. In the JADER, levofloxacin exhibited strong signals for muscle, tendon, and ligament injuries (reporting odds ratio [ROR] 30.6, information component [IC] 4.5) and tendon disorders (ROR 134.2, IC 5.8). Stratified analysis revealed markedly stronger signals in males, particularly those aged ≥70 years (relative ROR 12.21 and 25.67; IC delta 3.18 and 2.85, respectively). Oral levofloxacin was associated with higher reporting odds than intravenous administration. Time-to-onset analysis indicated that most tendon-related adverse events occurred within 14 days after drug initiation. Levofloxacin exhibited the most consistent and robust association with tendon disorders, especially in males aged ≥70 years in Japan. Therefore, clinicians in Japan should exercise caution when prescribing levofloxacin to older male patients.To estimate the annual and overall incidence rates (IRs) of herpes zoster (HZ) in adults with selected immunocompromising or chronic conditions by age and condition and to estimate HZ complications and recurrence in adults with immunocompromising or chronic conditions by age.
Retrospective observational cohort study using data from the UK Clinical Practice Research Database Aurum, with linkage to Hospital Episode Statistics and the Office for National Statistics data in England (January 2012–December 2019).
Adults ≥18 years with no record of HZ or HZ vaccination prior to the index date. Four study populations were identified and included individuals with: selected immunocompromising conditions (immunocompromised (IC) population, N=1 764 900), none of the selected immunocompromising conditions (IC-free population, N=12 867 750), selected chronic conditions (chronic disease (CD) population, N=6 423 633) and none of the selected immunocompromising or chronic conditions (IC-free/CD-free, N=8 235 858).
HZ IRs estimated per 1000 person-years (PY) with 95% CIs; percentage (with 95% CIs) of individuals with HZ who developed HZ complications; rate of HZ recurrence per 1000 PY with 95% CIs stratified by age group.
HZ IRs were higher in the IC and CD populations than in the IC-free and IC-free/CD-free populations and increased with age in all populations (eg, from 3.34 per 1000 PY (95% CI 3.26 to 3.42) in the 18–49 years group to 12.58 per 1000 PY (12.34 to 12.81) in the ≥80 years group in the IC population and from 2.45 per 1000 PY (2.42 to 2.48) in the 18–49 years group to 11.54 per 1000 PY (11.40 to 11.68) in the ≥80 years group in the CD population). A similar pattern was seen across individual immunocompromising and chronic conditions. The proportion of HZ complications increased with age and was higher in the IC and CD populations versus the IC-free and IC-free/CD-free populations. HZ recurrence rates were higher in the IC than IC-free population.
This very large, up-to-date, real-world study highlights the higher HZ IRs in adults with immunocompromising or chronic conditions in England compared with those without such conditions. This study reinforces the need for the current UK HZ vaccination programme in adults with immunocompromising conditions and can inform further research, clinical guidelines and immunisation policy discussions.
by Yen Hai Le, Judith Dzifa Azumah, Diep Thi Khong, Thang Nam Nguyen, Cornelia Appiah-Kwarteng, Kazuaki Matsui, Mayumi Yamamoto, Kaori Tanaka, Yoshimasa Yamamoto
In this study, we investigated the prevalence and abundance of the mercury resistance gene merA in human feces, retail chicken meat, and environmental water samples collected from Japan, Vietnam, and Ghana. A real-time PCR assay developed in this study demonstrated high specificity toward merA sequences from more than 12 bacterial species. Using this assay, merA was detected in 6.8% of human fecal samples in Japan (n = 29), in contrast to significantly higher rates observed in Vietnam (70.2%, n = 47) and Ghana (97.4%, n = 39). Similar geographic trends were evident in the chicken meat samples: 18.5% in Japan (n = 27), 66% in Vietnam (n = 91), and 90% in Ghana (n = 10). Environmental water samples showed a consistently high merA detection rate across all countries (75–100%, n = 21), with substantially higher gene copy numbers in Vietnam and Ghana than in Japan. merA was detected in some water samples, even when total mercury concentrations were below the detection limit, indicating that molecular detection may offer greater sensitivity than traditional physicochemical methods. Mercury-resistant bacteria were successfully isolated and cultured, and Citrobacter freundii was identified as the representative strain. Genomic analysis revealed that merA was located on an IncFIB plasmid, flanked by insertion sequences, suggesting its potential for horizontal gene transfer. These findings highlight merA as a promising biomarker for environmental mercury exposure and support the utility of fecal merA analysis as a proxy for assessing mercury-related public health risks.Multidimensional frailty among community-dwelling older adults has emerged as an important issue in ageing research, given its close association with declines in health status, functional independence and overall quality of life. This scoping review aims to map longitudinal evidence on multidimensional frailty in community-dwelling older adults, including its measurement, prevalence, changes over time and associated risk factors. The findings will be used to generate insights for future research and inform the development of interventions targeting multidimensional frailty.
This scoping review will be conducted in accordance with the methodological guidance of the Joanna Briggs Institute and the framework originally proposed by Arksey and O’Malley. The primary objective is to identify longitudinal evidence on risk factors associated with multidimensional frailty in community-dwelling older adults. A comprehensive literature search will be performed across six electronic databases (MEDLINE, Embase, CINAHL, the Cochrane Library, Web of Science and Scopus), covering studies published from 1 January 2010 to the date of the final search (anticipated August 2026). Only peer-reviewed studies published in English and using longitudinal designs will be included. Study selection will be guided by the Population–Concept–Context framework. The review findings will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines.
Ethical approval is not required for this review as it is based solely on analysis of data from previously published studies. The results are expected to contribute to the development of interventions targeting multidimensional frailty among community-dwelling older adults. Findings will be disseminated through peer-reviewed journal publications, academic conferences and scholarly forums.
by Yuta Nemoto, Fumie Otsuka, Shihoko Suzuki, Saori Kataoka, Tomoko Nakanishi, Takuya Ueda, Susumu Ogawa, Sumika Karasawa, Mikiko Shimaoka, Hiroto Narimatsu, Ung-il Chung
BackgroundEsports (competitive and organised video gaming) may enhance physical and cognitive health in older adults. The aim of this study was to examine the feasibility and effects of a multicomponent program incorporating esports on physical and cognitive function in community-dwelling older adults.
MethodsThis parallel, non-randomised controlled trial was conducted in Yokosuka, Kanagawa, Japan. Twenty-six participants who 1) were aged 60 years or older, 2) had no cognitive impairment, 3) had no major health problems, and 4) had no prior experience with digital games were allocated to either the intervention (n = 12) or the control (n = 14) group. Participants in the intervention group attended weekly 90-minute sessions consisting of health education, exercise, and esports for 12 weeks. The feasibility of the program was assessed based on adverse events, participant retention, adherence to the program, engagement in digital games outside the program, enjoyment of the program, and willingness to continue playing esports after the study period. Additionally, psychological status, physical and cognitive function, and body composition were assessed.
ResultsNo adverse events were reported; 10 of the 12 participants attended ≥80% of the sessions, all participants reported enjoying the program, and no participants dropped out during follow-up. Positive psychological status scores increased from before to after each session among participants in the intervention group. Furthermore, adjusted analyses showed more favourable changes in gait speed and balance in the intervention group than in the control group (p < 0.05). However, the effects on physical function remain uncertain because the analyses were exploratory.
ConclusionsThe program showed potential for high retention and adherence among older adults, with no adverse events. Larger-scale trials are needed to confirm the effectiveness of this intervention program, as the analyses in this study were exploratory.
Trial registrationThe study protocol was registered with the UMIN-CTR (ID: UMIN000055350; date of first registration: 27 August 2024).
by Hidetaka Onda, Yuma Kuramatsu, Toyoaki Yamamoto, Atsunori Nishimatsu, Mami Kaneko, Daichi Tsutsui, Mizuki Kojima, Shinya Higuchi, Shinya Takeuchi, Kingo Nishiyama, Masato Miyauchi
BackgroundIdentifying patients at risk of very early emergency department revisits may help support discharge decision-making, but the extent to which routinely available index‑visit data can predict unplanned returns within 24 h remains unclear. Prior studies suggest that revisits are heterogeneous and influenced by factors beyond the initial encounter, underscoring the need to clarify—not overstate—the predictive value of simple, pragmatic tools.
MethodsWe conducted a single‑center retrospective study of 2,774 emergency department discharge visits in 2024 in which blood tests were performed. The primary outcome was an unplanned revisit within 24 h to the same emergency department. Two physicians independently adjudicated revisits using administrative and chart data. Candidate predictors included arrival mode, initial vital signs, and routinely available laboratory variables. Continuous variables were screened across prespecified percentile‑based cutoffs, and a simple additive score was constructed from dichotomized items. Internal validation used 2,000 bootstrap resamples with full repetition of item selection and cutoff search. Calibration was assessed using the calibration slope, intercept, and Brier score.
ResultsThere were 91 unplanned revisits (3.28%). Five dichotomized variables were retained: no ambulance use, C‑reactive protein ≥0.39 mg/dL, lymphocyte percentage ≤13.7%, red cell distribution width ≥13.5%, and mean corpuscular volume ≤87 fL. The odds ratio for revisit per 1‑point increase was 1.55 (95% confidence interval, 1.32–1.82). Apparent discrimination was modest (area under the curve, 0.651; 95% confidence interval, 0.592–0.711), with an optimism‑corrected area under the curve of 0.633. Apparent calibration in the derivation cohort was acceptable (slope 1.000; intercept 0.000; Brier score 0.0313). At a ≥ 4‑point threshold, specificity was 92.77% and sensitivity 20.88%.
ConclusionsA five‑item score based on index‑visit information showed a graded association with 24‑h revisit risk but modest predictive performance. This highlights the limitations of prediction using discharge‑time data alone and emphasizes the need for external validation and prospective evaluation before clinical implementation.
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,
Chronic diseases driven by modifiable risk factors (MRFs), such as poor diet, physical inactivity, tobacco use and harmful alcohol consumption, disproportionately affect ethnic minority groups worldwide and within multi-ethnic societies such as Singapore. Although culturally tailored interventions and implementation strategies exist, there is limited synthesis of what has been used, for whom and under which contextual conditions these approaches produce equitable reductions in MRFs. EQUATOR aims to identify and synthesise policies, programmes and implementation strategies that have been tailored for ethnic and cultural minority populations and to develop explanatory mid-range programme theories describing how, why and under what circumstances such tailoring produces equitable outcomes.
We will conduct a scoping review with a realist synthesis as the analytical approach. Searches will be run in PubMed and Scopus for studies published from January 2010 onwards, restricted to English. Eligible studies include experimental, quasi-experimental, qualitative, mixed-methods studies and reviews that evaluate or report outcomes for tailored strategies addressing MRFs in ethnic minority populations and explicitly examine equity-focused outcomes or mechanisms. A piloted data extraction form will capture study characteristics, contextual details, intervention/strategy descriptions, theoretical underpinnings and outcomes using a RE-AIM lens (reach, effectiveness, adoption, implementation, maintenance) and equity indicators. Extracted data will support (1) an inductive typology of strategies/interventions for each MRF and (2) realist S/ICMO (Strategy/Intervention–Context–Mechanism–Outcome) configurations to generate mid-range programme theories explaining how tailoring works (or fails) across contexts.
Ethical approval is not required for this literature synthesis. Findings will be disseminated through peer-reviewed publications, presentations to policymakers and practitioners and stakeholder briefings to emphasise actionable recommendations for culturally tailored strategies to reduce MRFs and promote health equity in multi-ethnic settings.
Parenting interventions have shown promise in improving mental well-being for parents and children and strengthening family relationships. Parenting for lifelong health (PLH) is an open-access, evidence-informed programme that aims to improve positive parenting practices, reduce family violence and promote mental health, particularly in low-resource settings. This study will evaluate the implementation and (cost-)effectiveness of an adapted version of the PLH for Parents and Teens programme. It will focus on supporting positive parenting, communication, mental health and well-being of adolescents and their caregivers in North Macedonia and Moldova.
This multicountry hybrid type 1 effectiveness-implementation randomised waitlist-controlled trial will recruit 660 adolescents aged 10–14 years and their caregivers through schools, Youth Clinics and community partner organisations, including vulnerable and linguistically diverse families. The intervention group will receive the adapted PLH programme with assessments conducted postintervention and at 6-month follow-up. The waitlist control group will receive the adapted PLH programme after completion of the intervention group’s 6-month post-baseline assessment. Primary outcomes include adolescent emotional problems, family functioning, parenting practices, adolescent and caregiver quality of life. Secondary outcomes assess a range of mental well-being, family and other psychosocial outcomes. Other prespecified outcomes include implementation and cost outcomes. Primary analyses will compare intervention and waitlist control groups at postintervention and 6-month follow-up using intention-to-treat, baseline-adjusted linear mixed models. A within-trial economic evaluation will include cost–utility analysis and cost-effectiveness analysis. A macroeconomic analysis will assess broader economic impacts using public financing and budget impact analysis. The study uses a mixed-methods process evaluation, and integrates qualitative data, budget impact analysis and simulation modelling to inform scale-up considerations.
The study has received ethical approval from all relevant sites. Results will be disseminated through peer-reviewed publications, scientific conferences and webinars, newsletters, social media and open-access platforms, alongside engagement with researchers, clinicians, policymakers and the public. The Family-Focused Adolescent & Lifelong Health Promotion project uses a targeted communication and dissemination strategy for families, implementers and policy stakeholders to promote the adoption and scale-up of evidence-informed, open-access parenting interventions for adolescents and caregivers in low-resource settings. Dissemination focuses primarily on North Macedonia and Moldova while also engaging actors across the wider Eastern European region.
Japan’s physician-staffed helicopter emergency medical services (HEMS) are widely deployed but published evidence is heterogeneous across indications, outcomes and study designs. We aimed to map the internationally reported, English-language literature evaluating physician-staffed HEMS in Japan and to identify evidence gaps requiring further research.
Scoping review was conducted using established methodological frameworks and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR).
MEDLINE, Web of Science, CINAHL and the Cochrane Library, supplemented by backward and forward citation tracking.
Original studies evaluating physician-staffed HEMS in Japan and reporting patient outcomes for any emergency condition published in English-language journals.
We conducted a systematic database search using terms related to physician-staffed HEMS in Japan. The original search (28 May 2024) was updated on 25 February 2026 using the same eligibility criteria. Two reviewers independently performed title/abstract screening followed by full-text screening to determine eligibility. We additionally performed backward and forward citation tracking of the included studies. We summarised characteristics of eligible studies descriptively using counts and proportions.
The updated search identified 341 records, and citation tracking identified 16 further studies, yielding 76 included studies. Publications increased over time (2016–2020: 32.9%; 2021–2026: 52.6%). Most studies were single-centre observational (55.3%) or registry-based (39.5%), with few multi-centre studies (5.3%). Trauma was the most frequent study population (25.0%), and mortality the most common primary outcome (35.5%). First authors were university-affiliated in 88.2% of studies, 39.5% appeared in a single aeromedical journal, and no study compared physician-staffed with non-physician HEMS.
The internationally reported, English-language literature on physician-staffed HEMS in Japan has expanded over time, but remains dominated by retrospective observational designs, is produced largely by university-affiliated authors, and is concentrated in a small number of journals. Prospective multi-centre evaluation, comparison with non-physician HEMS, functional and longer-term outcomes, and economic evaluation were absent from the identified literature.
Methadone exerts analgesic effects through μ-opioid receptor affinity and N-methyl-D-aspartate receptor antagonism, which may benefit refractory cancer pain with neuropathic components. Methadone can be introduced by the ‘stop-and-go’ (SAG) method or the ‘add-on’ (AO) method, in which low-dose methadone is added to existing opioids. Observational studies suggest AO may improve pain control but no double-blind randomised controlled trial (RCT) has evaluated this approach. Therefore, the primary aim of this study is to assess the feasibility of conducting a double-blind RCT comparing methadone AO therapy with opioid dose escalation according to standard practice for refractory cancer pain while also exploring safety and preliminary efficacy signals.
A two-centre, randomised, double-blind, two-arm feasibility trial will enrol 22 patients with advanced or recurrent cancer and inadequately controlled pain (oral morphine equivalent daily dose 60–300 mg). Participants will be allocated 1:1 to the methadone AO or opioid-escalation group using a web-based randomisation system with the minimisation method. The primary endpoint is the completion rate of the 2-week study treatment. Secondary outcomes include pain intensity (Brief Pain Inventory), time to adequate pain control, achievement of a personalised pain goal, adverse events (Common Terminology Criteria for Adverse Events (CTCAE)/Patient-Reported Outcomes version of the CTCAE) and quality of life (European Organisation for Research and Treatment of Cancer-Quality of Life Questionnaire Core 15-PAL). Feasibility will be determined based on achieving a treatment completion rate of 70% or higher.
The protocol was approved by the Certified Review Board of the National Cancer Centre Hospital (CRB3180008). Written informed consent will be obtained from all participants. The trial is registered in the Japan Registry of Clinical Trials. Results will be published in peer-reviewed journals and presented at international conferences.
jRCTs031240220.
by Takefumi Yoshida, Koubun Wakashima, Gen Takagi, Mayumi Sakuraba, Sara Smock Jordan, Kazuma Sakamoto, Ranno Haruyama
This study examined the effects of solution building and resilience on school refusal behavior. The participants were 587 elementary school students (280 boys, 306 girls, and one student who did not report gender) who completed a self-report questionnaire. The results showed that resilience skills had a direct negative effect on the intensity of school refusal behavior among boys and an indirect negative effect mediated by solution building. However, among girls, resilience skills did not directly affect the intensity of school refusal behavior, but had a negative indirect effect through solution building. These findings suggest that school refusal behavior is less intense among children with higher resilience and strong solution-building skills. This study provides evidence that may inform the development of effective support strategies aimed at reducing the intensity of school refusal behavior.by Chisho Takeoka, Tetsushi Yada, Toshimasa Yamazaki, Yoshiyuki Kuroiwa, Toshiaki Hirai, Kimihiro Fujino, Hidehiro Mizusawa, Masaki Takao, Yasuo Terao, Masahito Yamada
Prion disease is a general term for a disease that causes cognitive disorders due to the accumulation of abnormal prion protein in the brain. Creutzfeldt-Jakob disease (CJD) is the most common case of prion disease, and sporadic Creutzfeldt-Jakob disease (sCJD) accounts for more than 70% of CJD cases. Early and accurate diagnosis of sCJD remains challenging. The aim of this study is to classify 6 sCJD patients from 10 healthy older adults and 23 Alzheimer’s disease (AD) patients using resting-state scalp-recorded electroencephalogram (EEG)-derived indices. Power spectrum, SL values by Synchronization Likelihood (SL), and graph metrics by SL values were calculated for 5 frequency bands as EEG-derived indices. In addition, power spectrum and SL values were standardized and exponentially transformed for each subject and each frequency band. Graph metrics were calculated by these SL values. These indices were used as features for classification. Classifiers were constructed by features selected by Recursive Feature Elimination (RFE). The highest classification accuracy was 97.44% using a 12-dimensional feature. This accuracy was confirmed by indices after standardization and exponential transformation. Additional validation analyses were performed to assess the reliability of the selected classifier. Accuracy of nested LOOCV was 84.62%, supporting meaningful classification ability under a leakage-controlled validation framework. An analysis of robustness removing a group of subjects with high similarity with many others showed that the selected classifier maintained a micro-F1 score of 90.32%. Permutation test indicated that the observed performance was significantly higher than chance level, and repeated stratified 10-fold cross-validation showed relatively stable performance across different data partitions. These findings suggest that resting-state EEG-derived indices may provide useful candidate features for classification of sCJD, AD, and healthy older adults. However, further validation using larger independent cohorts is required to establish the generalizability and clinical reliability of the proposed classifier.This study aimed to estimate the incidence and predictors of loss to follow-up (LTFU) among adults after antiretroviral therapy (ART) initiation at five provincial referral hospitals in Sierra Leone.
A facility-based retrospective cohort study.
This study was conducted at five provincial government referral hospitals in Sierra Leone from January 2020 to December 2024.
HIV patients aged 15 and above who initiated ART between 1 January 2020, and 31 December 2020, and attended at least one follow-up visit at the five national referral hospitals.
The primary outcome in this study was LTFU. LTFU was defined as absence from care, operationalised as no documented clinical encounter and/or ART refill for ≥90 days after the last expected clinical contact among patients not recorded as dead or transferred out.
Of the 1544 patients (67.7% female), the median follow-up was 4.25 years (IQR not stated), totalling 5748.6 PY. Outcomes were 550 LTFU (35.6%), 853 in care (55.2%), 64 (4.1%) transferred and 77 (5.0%) died. The LTFU incidence was 9.57 per 100 PY (95% CI 8.78 to 10.37). Multivariable analyses revealed several factors significantly associated with higher LTFU: lack of tuberculosis (TB) screening (HR=4.47; 95% CI 3.66 to 5.46), WHO stage III/IV (HR=1.51; 95% CI 1.20 to 1.89), no regimen change (HR=5.12; 95% CI 2.39 to 11.00), non-disclosure of HIV status (HR=1.63; 95% CI 1.19 to 2.25), underweight body mass index (BMI) at follow-up (HR=1.37; 95% CI 1.05 to 1.78) and residence in the Southern (HR=1.97; 95% CI 1.57 to 2.48) or Eastern region (HR=2.13; 95% CI 1.49 to 3.03). Conversely, rural residence was associated with lower LTFU (HR=0.58; 95% CI 0.43 to 0.79).
The study found a substantial incidence of LTFU. Risk factors of LTFU were gaps in TB screening, advanced clinical stage, absence of timely regimen adjustments, non-disclosure, low BMI and regional disparities. Strengthening integrated TB/HIV services, nutritional support, disclosure-enabling counselling and region-specific retention strategies, especially in urban, Southern and Eastern areas, may improve retention.
To determine the level and predictors of micronutrient intake inadequacy among pregnant women attending antenatal public health facilities in Bahir Dar City, Northwest Ethiopia.
A multicentre, cross-sectional study.
The study was conducted in public health facilities in Bahir Dar City, Northwest Ethiopia from January to March 2024.
About 420 pregnant women aged 18 years and older attending antenatal care at public health facilities in Bahir Dar. Pregnant women diagnosed with chronic diseases, sick and unable to communicate, and who had attended weddings, birthday celebrations or religious festivals within the past 24 hours were excluded.
Micronutrient intake inadequacy among pregnant women was measured using a single multiphasic 24-hour dietary recall. The Nutria-Survey Food Processor software, the Ethiopian food composition table and the World food composition table were used for the calculation of the nutrient value of micronutrients. The nutrient intakes were assessed by nutrient adequacy ratio and mean adequacy ratio. Data were analysed using SPSS V.26. Multivariable logistic regression analysis was done to identify the predictors of micronutrient intake inadequacy.
A total of 411 pregnant women were recruited in the study, yielding a 97.8% response rate. The overall prevalence of micronutrient intake inadequacy was 76.4% (95% CI 72.0% to 80.3%). The proportions of zinc, vitamin A, iron and calcium intake inadequacies were 48.2%, 66.7%, 14.8% and 74%, respectively. Having nutrition counselling (adjusted ORs (AOR)=3.5; 95% CI 2.00 to 6.48), having
Micronutrient intake among pregnant women was lower than the recommended levels. Therefore, strengthening community efforts to promote the consumption of a diversified diet for pregnant women, encourage nutrient-dense food production and enhance food security is essential.
This study examined temporal changes in burnout and working environments among Japanese resident physicians across the COVID-19 period and the preparation and implementation phases of the national workstyle reform. Furthermore, it assesses associated changes in their working environments.
This study was conducted as a multicentre repeated cross-sectional study.
Data were used from the General Medicine In-Training Examination surveys conducted in 2020, 2022, 2023 and 2024.
Participants included postgraduate year 1 (PGY-1) and PGY-2 residents across Japan.
Data on working hours, emergency duties, inpatient load, self-study time and burnout were collected through standardised questionnaires. Multivariable logistic regression was performed to assess associations between workstyle reform phases and burnout, adjusting for demographic and institutional characteristics.
Altogether, 25 368 residents participated (6816 in 2020; 6063 in 2022; 6584 in 2023; 5905 in 2024). Burnout prevalence was the highest during the COVID-19 pandemic in 2020 (21.7%), which decreased to 13.3% in 2024. Weekly working hours of ≥80 hours declined from 19.9% to 2.3%, and those working
Residents’ burnout was the highest in 2020 and subsequently declined in parallel with improvements in job satisfaction, working hours and clinical workload. These findings suggest that system-level efforts to improve workload balance may be associated with better resident well-being, while causal attribution to the reform should be interpreted cautiously.
To describe preconception care health literacy among medical students and examine knowledge–behaviour gaps across academic years and by future parenthood intention.
Cross-sectional online survey.
Kawasaki Medical School, Japan.
Medical students in years 1–6. A total of 613 students were included in the analysis.
Preconception care health literacy was assessed using a validated Japanese preconception care-specific scale comprising a knowledge domain (13 true/false/do not know items; total score 0–13) and a behaviour/skills domain (25 4-point Likert items; total score 25–100). Domain scores were compared across academic years and future parenthood intention groups. Multivariable linear regression analyses were performed adjusting for age.
The mean age of participants was 22.53 years (SD 2.19). The mean knowledge score was 9.99 (SD 2.60) and the mean behaviour/skills score was 73.66 (SD 12.25). Knowledge scores increased with academic progression (year 1, 8.47 (SD 3.00); year 6, 11.14 (SD 1.34); p
Integrating skills-based training and reflective life-planning components into medical curricula may help strengthen preconception-related behaviours in medical students and may have indirect implications for their future readiness to support preconception care.
To quantify Scope 1 and Scope 2 greenhouse gas (GHG) emissions associated with surgical care and identify key modifiable drivers at the institutional level, including operative duration and operating room (OR) type.
Retrospective cohort study.
A tertiary university hospital with 17 ORs in Japan.
All 6996 elective surgeries were performed under general anaesthesia between 1 January and 31 December 2022.
The primary outcome was per-case total Scope 1 and Scope 2 carbon dioxide equivalent emissions (CO2e) emissions. Secondary analyses evaluated emission differences across specialties, surgical approaches (open, endoscopic, and robotic), and temporal electricity consumption patterns. Multivariable linear regression was performed to assess the associations between per-case scope 2 emissions, operative time, and OR type.
Total emissions were 1943.4 t CO2e, of which Scope 1 accounted for 71.0%, predominantly driven by desflurane (69.2% of total emissions). Although scope 2 accounted for 29.0% of total institutional emissions, scope 1 emissions dominated the carbon footprint of most individual procedures because of volatile anaesthetic use. Weekday daytime electricity consumption accounted for only 47.7% of total weekly use, with more than half occurring during nighttime and weekend periods, largely due to continuous heating, ventilation and air conditioning (HVAC) operation. Regression analysis demonstrated that operative time had a limited independent effect on per-case scope 2 emissions, whereas OR type—including hybrid and bio-clean rooms—was strongly associated with higher emissions.
Anaesthetic choice and infrastructure-related energy demand are the principal determinants of surgical GHG emissions. Within direct and energy-related emissions, reducing volatile anaesthetic use and optimising OR energy consumption—particularly during non-operative periods—represent the most effective strategies for emission reduction.
by Masahiro Hemmi, Daisuke Sano, Reo Tanoshima, Nobuhiko Oridate
ObjectiveUnilateral vocal fold paralysis (UVFP) can lead to both voice impairment and dysphagia. Previous studies have suggested that surgeries aimed at improving voice function in patients with UVFP may also incidentally enhance swallowing. However, the preventive effect of such surgeries on pneumonia remains unclear. We evaluated the impact of laryngoplasty on the incidence of pneumonia in Japan using a large employment insurance claims database of corporate employees under 75 years of age and their family members.
MethodsThe study cohort consisted of patients diagnosed with UVFP between January 2013 and December 2022, identified from an insurance claims database. A propensity score–matched cohort was created using a 1:3 matching ratio between the treatment and non-treatment groups. Follow-up began at the index date, defined as the initial diagnosis of UVFP, and continued until the end of the study period. The primary analysis compared the cumulative incidence of pneumonia between treatment and non-treatment groups. The secondary analysis employed a self-controlled design to compare pneumonia incidence before and after laryngoplasty within treated patients.
ResultsThe full cohort included 7,641 patients with UVFP, of whom 914 comprised the matched cohort (treatment group, n = 230; non-treatment group, n = 684). The cumulative incidence of pneumonia tended to be higher in the treatment group than in the non-treatment group (hazard ratio, 1.39; 95% CI, 0.93–2.08; p = 0.098). In contrast, the self-controlled analysis demonstrated a lower pneumonia incidence after laryngoplasty compared with the pre-treatment period (incidence rate ratio, 0.36; 95% CI, 0.27–0.52; p Conclusions
Given the discordant findings across analytical approaches, no definitive conclusion regarding a preventive effect can be drawn from the present study. Further studies are needed to evaluate long-term outcomes and to clarify causal relationships.
by Noriko Yoshida, Yuko Kobayakawa, Kouta Funakoshi, Sakiko Kimura, Kazuhisa Hosoya, Yuya Shinkawa, Takuma Furukawa, Tsubasa Mitsutake, Toshimi Hoshiko, Ayako Takamori, Naoto Kawahara, Hiroto Terasaki, Akio Oishi, Hideki Koizumi, Toshihiro Inoue, Atsunobu Takeda, Yasuhiro Ikeda, Shigeo Yoshida, Yuki Morizane, Kazuaki Kadonosono, Makoto Inoue, Motohiro Kamei, Koji Todaka, Koh-Hei Sonoda, Hiroshi Enaida
Submacular hemorrhage (SMH), which may arise from age-related macular degeneration, retinal arterial macroaneurysm, and other causes, can result in severe vision loss and central visual field impairment. Although tissue plasminogen activator (tPA) is used off-label to treat SMH in many countries, no formulation has been approved for this indication. Because early intervention is critical when tPA is used for SMH, limited access to centers that can provide this treatment may delay care and reduce treatment opportunities. Decentralized clinical trials (DCTs) reduce or eliminate the need for participants to travel to trial sites. We therefore designed the investigator-initiated SACLA trial to evaluate subretinal tPA for SMH. The DCT framework is intended to reduce logistical barriers related to the disease severity and rarity. The SACLA trial is a phase II multicenter, open-label, single-arm surgical study with a pre-post comparison design (jRCT2071250003). Twenty eligible participants will undergo pars plana vitrectomy followed by subretinal injection of 0.1 mL (8,000 IU) of tPA. Participants will remain hospitalized at the trial site until the primary outcome, change in central foveal thickness (CFT) from baseline at Week 1, is assessed. Thereafter, follow-up visits will be conducted at either the trial site or partner sites within the DCT framework. Secondary efficacy outcomes include change in CFT from baseline, presence of a foveal hemorrhage measuring at least 1 disc diameter, best-corrected visual acuity (BCVA), and change in BCVA from baseline at Weeks 4 and 12. Adverse events will be collected throughout the 12-week observation period to assess safety. The protocol and related study documents were reviewed and approved by the Saga University Hospital Institutional Review Board. This study is designed to generate prospective evidence on the feasibility, short-term anatomical response, and safety of subretinal tPA for SMH.
FreshRSS 