Global health & medicine最新文献

Parents having new children during the coronavirus disease 2019 (COVID-19) pandemic were exposed to heightened parenting difficulties. However, pandemic-specific parenting difficulties and unmet support needs among these parents, especially fathers and parents with multiple children, remain underexplored. We conducted a study to clarify parenting difficulties and support needs of such parents by using quantitative text analysis of free-form descriptions collected from 809 Japanese parents in 2022 (first-child group: 163 fathers and 222 mothers; second-child group: 192 fathers and 232 mothers). Quantitative text analysis using KH Coder included co-occurrence network and correspondence analyses to identify parenting difficulties and support needs, stratified by sex, household income, and the presence of parenting consultants. Regarding parenting difficulties, fathers more often emphasized children's behavioral challenges, whereas mothers reported emotional struggles. Pandemic-related restrictions directly amplified parenting difficulties, including limited childcare resources, reduced social interaction, and infection-related concerns. Support needs across groups centered on financial assistance and childcare but varied by income, sex, and consultant availability. Fathers without consultants emphasized information and advice, while mothers without consultants stressed temporary childcare needs or illness-related support. Parenting difficulties and support needs reflected cultural gender norms. Policy implications include sustaining financial aid, developing gender-tailored interventions, and establishing crisis-resilient support systems.

Intrinsic capacity (IC), introduced by the World Health Organization, is a core concept in the framework of healthy ageing. This study reviews the relevant concepts, epidemiology, assessments, influencing factors, adverse outcomes, and interventions concerning IC. IC refers to the composite of physical and mental capacities that an individual can draw on to live independently and thrive. Although IC is closely related to frailty and physiological reserve (PR), there are conceptual differences: IC represents the inherent functional reserve, frailty reflects the cumulative state of functional deficits, and physiological reserve emphasizes the ability to resist functional physical decline. IC assessments include comprehensive screening instruments of Integrated Care for Older People (ICOPE) and combinations of domain-specific scales; however, these approaches face challenges such as the inability to provide quantifiable results and the lack of standardized criteria, highlighting the urgent need to develop a standardized IC assessment system. Biomarkers may serve as supportive assessment tools, but their application is limited by cost and insufficient evidence, underscoring the need for future development of predictive models that integrate them. The main factors influencing IC include sociodemographic characteristics, physical health, psychosocial factors, and lifestyle. IC is strongly associated with health outcomes, serving as an effective predictor of several adverse outcomes. Interventions targeting IC primarily include ICOPE-guided multidomain interventions, along with other interventions such as multicomponent exercise, cognitive stimulation therapy, and dietary intervention; however, high-quality controlled trials remain limited, and the optimal timing and mechanisms of intervention require further investigation. This review offers important insights for clinical practice and research aimed at promoting healthy ageing among older populations.

Patients with hemophilia living with HIV-1 are at increased risk for coronary artery disease (CAD) due to overlapping factors, including chronic vascular inflammation, antiretroviral therapy-associated dyslipidemia, and reduced physical activity from hemophilic arthropathy. However, longitudinal data on cardiovascular outcomes in this population have been scarce. In this two-year longitudinal follow-up study, 58 patients were evaluated. The cohort was stratified into three groups based on baseline CCTA findings and treatment history: 47 with normal-to-mild stenosis, 3 with prior PCI or CABG, and 8 with moderate-to-severe stenosis. Among the moderate stenosis group, 7 underwent repeat CCTA, and 4 showed progression of coronary lesions. Of these, 3 developed severe stenosis requiring percutaneous coronary intervention (PCI), despite improvement in LDL-C through pharmacologic and lifestyle interventions. Overall, LDL-C significantly decreased (p < 0.05); however, pulse wave velocity (PWV), an indicator of arterial stiffness, worsened in about half of patients. In the revascularization group, PWV deterioration was significant (p = 0.017). Our earlier cross-sectional analysis of this population demonstrated that a considerable proportion had moderate-to-severe stenosis requiring intervention, underscoring the need for longitudinal assessment. These findings suggest that even under guideline-based cardiovascular management, there remains a considerable risk for CAD progression in HIV-infected hemophilia patients with moderate or greater stenosis. Therefore, repeat CCTA at two-year follow-up could be considered to facilitate early detection and guide timely intervention. Continuous monitoring, including imaging, and early intervention targeting modifiable risk factors may be important to reduce long-term cardiac risk in this vulnerable population.

Drug-resistant tuberculosis (DR-TB) poses a critical public health challenge in Jiangxi Province, China, where regional resistance patterns remain understudied. This retrospective study analyzed 9,041 suspected TB patients (2022-2023), identifying 3,104 Mycobacterium tuberculosis (M. tuberculosis) cases via PCR-reverse blot hybridization assay (PCR-REBA). Among M. tuberculosis-positive cases, 19.3% exhibited drug resistance, including mono- (9.2%), double- (4.6%), triple- (3.8%), and quadruple-drug resistance (1.7%). Males had higher odds of rifampicin (OR = 1.407, 95% CI: 1.086-1.824, p = 0.01) and isoniazid (OR = 1.959, 95% CI: 1.538-2.495, p < 0.001) resistance. Dominant mutations included rpoB Ser531Leu (32.1%) for rifampicin and katG Ser315Thr (53.6%) for isoniazid resistance. Extrapulmonary TB showed higher susceptibility than pulmonary TB (e.g., rifampicin: 93.47% vs. 87.25%, p = 0.002). These findings highlight the urgent need for rapid molecular diagnostics and targeted interventions in Jiangxi to address distinct DR-TB patterns and demographic disparities.

This article synthesizes six years (2019-2024) of the "Super Active Ageing Society" (SAAS) international conference series, which reconceptualizes ageing not as a burden to society but as a source of societal vitality. The SAAS conferences uniquely integrate three traditionally isolated domains -health, economic resilience, and welfare -into a cohesive framework that positions older adults as active contributors to society. In addition to themes such as preventive health, asset longevity, and extended workforce participation, the conferences promote intergenerational collaboration and financial sustainability. To achieve what older adults aspire to -remaining healthy, economically secured, and socially connected -demands a cross-sectoral response. Evolving from interdisciplinary presentations to strategic dialogues, the conferences were attended by a diverse range of participants, including but not limited to policymakers, researchers, practitioners, students, industry leaders, and civil society representatives. Collaboration with the Well Aging Society Summit Asia-Japan (WASS) fostered dialogue on Japan's ageing-related industries, in synergy with the SAAS. In these bilingual (Japanese and English) conferences, over 40% of on-line participants tuned in to the English channel, underscoring the international interest in the ageing discourse. Over the course of six conferences, the concept of a super active ageing society -integrating health, financial well-being, and social participation -is refined, offering new perspectives for both domestic and international policies and business strategies. The outcomes of this conference series clearly underscore the need for innovation and social transformation in ageing societies, and provide valuable insight for ongoing and future policy and institutional design.

The coronavirus disease 2019 (COVID-19) pandemic exposed the fragility of global immunization programs and intensified measles vaccine hesitancy, with global measles-containing-vaccine first-dose (MCV1) coverage falling from 86% in 2019 to 81% in 2021, with the number of unvaccinated children rising to 18 million. Using the 7C model of vaccine readiness, we highlight how Confidence, Complacency, Constraints, Collective responsibility, risk Calculation, Compliance, and Conspiracy beliefs shape parental decision-making in the post-pandemic era. Declining trust, low perceived disease risk, misinformation, and service barriers threaten progress towards measles eradication. We argue that recovery requires more than restoring coverage: resilient immunization strategies must address both structural barriers and psychological drivers of hesitancy. Clinician-led communication, accessible and free vaccination services, targeted social media engagement, and transparent informational dashboards are all essential tools for achieving effective disease management. Ultimately, vaccine readiness is not only about access -it is about trust, values, and resilience. Without decisive action, measles control will remain vulnerable to future global crises.

The National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB), provided by the Ministry of Health, Labour and Welfare (MHLW), is an exhaustive repository that can be used to understand the nationwide epidemiology of hepatocellular carcinoma (HCC) in Japan. This study was conducted to clarify the geographic distribution of patients with HCC and treatments performed in each region of Japan using data from the NDB. A retrospective analysis was performed to determine the number of patients diagnosed, with HCC (International Classification of Diseases, 10th edition, code C22.0), who received treatment between 2016 and 2020. Number of incidences of HCC per 100,000 individuals in each Japanese region are 76 (Hokkaido), 63 (Tohoku), 55 (Kanto), 58 (Tokai), 74 (Hokuriku), 77 (Kinki), 93 (Chugoku), 101 (Shikoku), 93 (Kyushu), and 37 (Okinawa). Transarterial embolization/transarterial chemoembolization and curative treatments, including laparoscopic liver resection (LLR), open liver resection, and radiofrequency ablation, were the most frequently performed treatments in all regions, followed by systemic therapy. The proportion of patients receiving LLR was lowest in the Shikoku region (6.7%), which also had the lowest frequency of institutions certified by the Japanese Society of Hepato-Biliary-Pancreatic Surgery (JSHBPS) relative to the number of patients with HCC. Although the incidence of HCC varies across regions in Japan, the most frequently performed treatments remain consistent nationwide. This suggests that HCC treatment practices are largely standardized, regardless of geographic location. Certification by the JSHBPS appears to play a role in patient access to LLR.

In 2024, we conducted a study to evaluate the effectiveness of a Mongolian non-governmental organization (NGO) stigma reduction program, "We are Living Under the Same Sky" (LUSS), by assessing the association between the program and two human immunodeficiency virus prevention outcomes, recognition of the Undetectable = Untransmittable (U=U) and the need for pre-exposure prophylaxis (PrEP), in 223 men who have sex with men (MSM). Results showed that the LUSS program was associated with the recognition of U=U and PrEP need by Mongolian MSM. The recognition of U=U was associated with coming-out experience and marital status. LUSS was associated with the PrEP need, which, in turn, was associated with MSM who engaged in active sexual behaviors. The LUSS program has increased the recognition of U=U and PrEP need among MSM, and it can be incorporated into new prevention interventions targeting MSM. LUSS has the potential to effectively raise awareness among MSM and other populations such as youth, educators, and healthcare providers.

Intrahepatic cholangiocarcinoma (ICC) has a poor prognosis, with low rates of surgical eligibility and high recurrence. Effective perioperative strategies are essential. For adjuvant treatment, capecitabine (based on the BILCAP trial) and S-1 (from the ASCOT trial) have become standard regimens. Neoadjuvant therapy using gemcitabine-platinum combinations and locoregional strategies such as hepatic artery infusion chemotherapy (HAIC) and yttrium-90 radioembolization (Y-90 TARE) have improved resectability and survival outcomes. Molecular profiling has revealed actionable alterations in nearly 70% of ICCs. FGFR2 fusions, IDH1 mutations, and BRAF V600E mutations can be targeted with inhibitors such as pemigatinib, ivosidenib, and dabrafenib-trametinib, respectively, showing promising response rates in clinical trials. Immunotherapy has demonstrated efficacy in the microsatellite instability-high (MSI-H) subtype. Combination strategies involving PD-1 inhibitors with radiotherapy or anti-angiogenic agents are further expanding the potential for treatment. Future efforts should focus on standardizing resectability criteria, expanding access to molecular profiling, and accelerating Phase III trials.

Zoonoses pose serious public health challenges. In Lao People's Democratic Republic, where > 70% of population engages in agriculture and livestock farming, public awareness of zoonoses remains unclear. We conducted a nationwide population-based survey with 347 individuals aged 12-40 years across 40 villages in 20 districts. Logistic regression analysis was used to identify factors associated with zoonoses awareness. Awareness was approximately 42.9% and was significantly higher among females and livestock owners. Lower awareness was observed among individuals with primary or secondary education compared with those with higher education, whereas no significant difference was found for those with no formal education. These findings highlight the need for targeted health education programs for populations with limited access to formal education and health information. A One Health approach, integrating human, animal, and environmental health sectors, should be prioritized to improve zoonoses awareness and reduce transmission risks, especially in rural and marginalized communities.