Background Population aging and depopulation pose substantial challenges to the sustainability of healthcare and long-term care systems in rural and remote communities. This study aimed to describe temporal trends in out-of-municipality long-term care insurance (LTCI) benefits and contemporaneous public hospital management indicators in two remote island areas in Japan. Methods We conducted an exploratory descriptive ecological study using aggregated municipality-level LTCI and population data and hospital-level management data from fiscal year (FY) 2015 to FY2023 in the Oki Islands, Shimane Prefecture, Japan. We described trends in the Dozen region and Okinoshima Town, including population structure, the proportion of out-of-municipality LTCI benefits, inpatient and outpatient revenue, bed occupancy rates, and financial indicators. Percentage changes, annualized percentage changes, and outpatient-to-inpatient revenue ratios were calculated descriptively. No inferential hypothesis testing was performed. Results The population decreased in both areas. In the Dozen region, the proportion of out-of-municipality LTCI benefits increased overall from 9.5% in FY2015 to 21.9% in FY2023, whereas it remained relatively stable in Okinoshima Town, ranging from 2.6% to 3.2%. In Dozen Hospital, inpatient revenue decreased from JPY 330.8 million to JPY 260.6 million (-21.2%), while outpatient revenue increased from JPY 226.0 million to JPY 267.9 million (+18.6%). In Oki Hospital, inpatient revenue decreased from JPY 1,294.3 million to JPY 1,082.5 million (-16.4%), while outpatient revenue increased from JPY 1,035.5 million to JPY 1,116.2 million (+7.8%). The outpatient-to-inpatient revenue ratio increased from 0.68 to 1.03 in Dozen Hospital and from 0.80 to 1.03 in Oki Hospital. Conclusions The increase in out-of-municipality LTCI benefits in the Dozen region coincided with a comparatively large shift in the composition of Dozen Hospital revenue from inpatient toward outpatient services. These hypothesis-generating ecological findings do not demonstrate individual relocation or establish a causal relationship. Out-of-municipality LTCI benefits may warrant further evaluation as an administrative indicator alongside individual-level care utilization, residential histories, service capacity, and patient-flow data before being used to inform health policy or resource allocation.
Despite recent advances, data on allogeneic hematopoietic stem cell transplantation (allo-HSCT) in patients aged ≥70 years remain limited. We identified prognostic factors and developed a risk score to guide transplant eligibility. Using the Japanese Transplant Registry Unified Management Program, we retrospectively analyzed 929 patients aged ≥70 years who underwent their first allo-HSCT for hematologic malignancies between 2000 and 2022. Prognostic factors were identified by multivariate Cox regression to construct a scoring system. The median patient age was 71 years (range, 70-88), with acute myeloid leukemia being the most common disease. The 2-year overall survival (OS) rate was 34.2%. Multivariate analysis identified age ≥75 years, ATL, lymphoma, high disease risk, hematopoietic cell transplant-specific comorbidity index ≥5, and performance status ≥2 as adverse factors. Using the hazard ratio-based scoring system derived from multivariate analysis, patients were stratified into low- (0), intermediate-1- (1), intermediate-2- (2-3), and high-risk (4-5) groups, with 2-year OS rates of 57.1%, 35.0%, 18.3%, and 2.5%, respectively (p < 0.01). We identified prognostic factors and developed a scoring system stratifying survival in patients aged ≥70 years, potentially facilitating the selection of older candidates most likely to benefit from allo-HSCT.
BACKGROUND:Identifying factors related to physicians' specialty choice is crucial to ensure a sustainable healthcare workforce. However, knowledge regarding the factors influencing the choice of pediatrics remains inadequate. This study aimed to clarify physicians' background characteristics associated with choosing pediatrics and factors associated with hospital-based practice among pediatricians in Japan. METHODS:This cross-sectional study, comprising an online survey of eligible physicians (N = 6415), was conducted in June 2022 via the Nikkei Medical Online website. The primary outcome was the choice of pediatrics, whereas factors associated with hospital-based pediatricians were examined in a secondary analysis. Multivariate logistic regression analyses were used to assess the association between physician background characteristics and outcomes. RESULTS:Among 6415 physicians, 340 (5.3%) were pediatricians. Factors associated with choosing pediatrics included being female (adjusted odds ratio [aOR] 1.84, 95% CI 1.39-2.44), having children (aOR 1.71, 95% CI 1.27-2.29), and graduating from a public university (aOR 1.67, 95% CI 1.24-2.26). Analyses restricted to pediatricians demonstrated that willingness to work in rural areas (aOR 3.24, 95% CI 1.05-10.04) was positively associated with hospital-based practice, whereas age (per 1-year increase; aOR 0.93, 95% CI 0.90-0.95), an urban hometown (aOR 0.54, 95% CI 0.29-0.98), and having a physician father (aOR 0.40, 95% CI 0.19-0.83) were negatively associated. CONCLUSION:These findings indicate that pediatric healthcare workforces may be shaped by structural factors, such as educational environment, regional background, and family background, in addition to individual preferences.
The prevalence of cerebral small vessel disease (SVD) among individuals who consume moderate amounts of alcohol remains unclear. This study aimed to evaluate the association between alcohol consumption and the severity of SVD markers. This cross-sectional study included participants who underwent brain health checkups at a single facility. Drinkers were categorized as occasional (three or fewer times per week) and frequent (four or more times per week). Alcohol intake was assessed in units of one glass of sake, a traditional Japanese alcoholic beverage. The severity of periventricular hyperintensity (PVH), deep subcortical white matter hyperintensity (DWMH), cerebral microbleeds (CMB), and enlargement of perivascular spaces in the basal ganglia (PVS-BG) and perivascular spaces in the centrum semiovale (PVS-CSO) were evaluated as SVD indicators. A total of 64,659 participants were included in this study. In multivariable ordinal logistic regression analysis, frequent drinkers had higher odds of PVS-BG enlargement (odds ratio [OR] = 1.09, 95
