Gastric cancer remains a significant health burden, especially in Asia. Potassium-competitive acid blockers (P-CABs) provide stronger acid suppression than proton pump inhibitors (PPIs), but their long-term impact on metachronous gastric cancer (MGC) remains unclear. This study evaluated the incidence and duration-dependent risk of MGC in P-CAB/PPI users. This multicenter retrospective cohort study included patients from 15 institutions in Japan who underwent endoscopic or surgical resection for gastric cancer between 2014 and 2022. After exclusions, 7172 patients who had received H. pylori eradication were analyzed. Chronic use of P-CAB/PPI was defined as administration for more than 3 months. The primary outcome was the incidence of MGC. Cox regression models were used, along with subgroup analyses based on duration and initial treatment type (endoscopy versus surgery). During a median follow-up of 5.8 years, MGC developed in 342 patients. The incidence was highest among P-CAB users (20.9 per 1,000 person-years), followed by PPI users (13.5) and non-users (7.1). Both P-CAB and PPI use were independently associated with increased MGC risk (hazard ratio 3.89 and 1.75, respectively). The association between P-CAB use and MGC was stronger with longer durations of use (hazard ratio 3.44 for < 1 year, 3.95 for 1–3 years, and 9.36 for > 3 years) and was particularly evident in the post-endoscopic group (hazard ratio 4.22) in subgroup analyses. Chronic use of P-CAB/PPI were associated with MGC. Longer duration may be associated with increased risk of MGC. Further studies are warranted to validate these findings.
AIM:This scoping review mapped quantitative evidence on men's preconception care (PCC) focusing on: (1) knowledge, (2) behaviours and attitudes, (3) reproductive intentions and (4) outcomes of educational or counselling interventions. The review also sought to identify evidence gaps and inform future policies and practices to enhance male engagement in reproductive health. METHODS:Quantitative studies involving men aged ≥18 years from high- and upper-middle-income countries were included. Studies focusing on couples, non-English-language publications, qualitative research, reviews and commentaries were excluded. Quantitative designs were prioritised to map measurable determinants and outcomes of engagement in PCC. Searches were conducted across seven databases in September 2025, following the PRISMA-ScR framework. No critical appraisal was performed, consistent with scoping review methodology. RESULTS:Fourteen studies (n=18 733 men) were included, most of which were observational. Findings indicated low fertility awareness, inconsistent engagement in preconception behaviours, and minimal use of supplements or healthcare services. Differences were noted by age, education and fatherhood status. One intervention improved knowledge but did not address systemic barriers. CONCLUSIONS:Men remain underrepresented in PCC. Gender-transformative, system-level reforms integrating men into primary care, health education and public messaging are needed. Future research should test context-specific, equity-oriented interventions to promote inclusive PCC for all.
BackgroundWorkplace health promotion interventions are effective in improving employee health. However, most interventions are temporary and cannot be sustained, and a comprehensive understanding of the factors that influence implementation is limited. Therefore, using the implementation framework, this scoping review aims to identify the barriers and facilitators influencing the implementation of workplace health promotion interventions for the prevention of non-communicable diseases.MethodsWe searched databases such as PubMed, Web of Science, and Scopus from January 1986 to August 2022 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Consistent with the Arksey and O’Malley framework, two independent reviewers reviewed the titles and abstracts for eligibility, followed by full-text screening using a data extraction form. Subsequently, a narrative summary of the barriers and facilitators identified from the included articles was synthesized and categorized into the Consolidated Framework for Implementation Research (CFIR). The identified barriers and facilitators were stratified according to the implementation outcomes.ResultsOf the 38,384 articles identified, 610 articles were eligible for full-text screening, and 53 articles were included in the final analysis. Over 80% of the studies had applied a qualitative or mixed-methods approach, and the most common topics of intervention were reducing physical inactivity and promoting exercise (36%); moreover, 60% of the studies targeted interventions in medium- to large-sized organizations. Most factors were identified in the inner setting domain of the CFIR. The predominant facilitators were evidence strength and quality and leadership engagement, whereas structural characteristics, relative priority, and available resources were the most identified predominant barriers to the implementation of workplace health promotion interventions.ConclusionThe barriers and facilitators identified in this study can be used to implement a process to develop a strategy that targets the identified determinants to improve workplace health promotion interventions and their implementation.
BACKGROUND:Pre-pregnancy underweight (BMI <18.5 kg/m2) is notably prevalent among reproductive-aged Japanese women, affecting approximately 20%, compared to less than 10% in Western countries. However, its overall impact on maternal and infant outcomes in Japanese populations has not been systematically evaluated. METHODS:We conducted a systematic review and meta-analysis following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. MEDLINE, EMBASE, CINAHL, PsycINFO, Cochrane Library, and Ichushi were searched from inception to February 2024. Cohort and case-control studies examining associations between pre-pregnancy underweight and perinatal outcomes in Japanese women with singleton pregnancies were included. Primary outcomes were low birth weight (LBW), small for gestational age (SGA), and preterm birth (PTB). Random-effects models calculated pooled odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS:Thirty-four studies were analyzed. Pre-pregnancy underweight significantly increased risks of LBW (OR 1.61; 95% CI, 1.38-1.86), SGA (OR 1.59; 95% CI, 1.55-1.63), and PTB (OR 1.23; 95% CI, 1.19-1.26). Mean birth weight was 115.02 g lower (95% CI, -128.05 to -101.99) in underweight mothers. CONCLUSION:Pre-pregnancy underweight among Japanese women is significantly associated with increased risks of adverse perinatal outcomes. Notably, these elevated risks persist despite the high background prevalence of underweight, suggesting that their adverse effects are not diminished in populations where it is more common. These findings underscore the importance of increasing awareness of preconception care and emphasize the need to optimize pre-pregnancy weight.
Randomized trials are used to evaluate health care interventions because they minimize confounding and selection bias through randomization. Harms reporting in trials remain suboptimal, despite established guidelines. To improve transparency and clinical relevance, trialists should share information about harms-whether assessed systematically or nonsystematically. Nonsystematically assessed adverse events warrant greater attention, as they are often underreported or inconsistently documented. Trialists should specify what was measured, when, and by whom. For each study arm, tables or data should be available that include all harms observed. For dichotomous outcomes, tables or data should include the number of people who experienced each harm in each group: the number of participants at risk of harms (ie, randomized individuals); the number of deaths; participants with one or more adverse events; withdrawals (discontinuations) due to harms; and the total number of events, if appropriate. Thresholds should not be used to limit the sharing of information about harms. Zero events should be included for harms systematically assessed. For combined adverse events, such as the proportion of participants with one or more serious adverse events, researchers should report or share data for all component events (eg, deaths, major cardiovascular events, cancers, infections, and psychiatric events). Better harms reporting could improve evidence synthesis, enhance interpretability, and support informed clinical decision-making as well as patient safety.
