University of Tokyo Health Sciences

Japan's aging society concentrates pneumonia burden across communities, long‑term care, perioperative pathways, and hospitals. Adult pneumococcal and influenza vaccination are supported by trials and meta‑analyses and are often cost‑effective; yet, realized value depends on targeting, measurement, financing, and pairing with bedside prevention such as oral care and hospital‑acquired pneumonia bundles. This viewpoint proposes a formative, indicator‑driven architecture linking cost‑effectiveness to operations by aligning vaccination with complementary oral‑care prevention and value‑based payment under the existing policy infrastructure. Working within the Ministry of Health, Labour and Welfare/Central Social Insurance Medical Council health technology assessment framework, Center for Outcomes Research and Economic Evaluation for Health methods, and claims-electronic health record linkage via My Number insurance card, we specify a compact national indicator set: vaccination coverage and timeliness, nonventilator hospital‑acquired pneumonia, ventilator‑associated pneumonia, postoperative and stroke‑associated pneumonia, antibiotic days of therapy, and length of stay, with pragmatic risk adjustment and present‑on‑admission flags. Value levers first reward reliable reporting and adherence to evidence‑based bundles and then share verified, risk‑adjusted savings. Long‑term care facilities receive add‑ons for professional oral care in high‑risk residents; hospitals receive quality add‑ons and shared savings; perioperative pathways may incorporate oral health management; and stroke units standardize oral hygiene with dysphagia screening. A phased roadmap details the pilot co‑design, governance, risk‑adjusted reporting with equity safeguards, and iterative recalibration by using real‑world evidence. The learning loop-measure, report, improve, generate evidence, adapt cost‑effectiveness, recalibrate payment-converts modeled value into lived experience: fewer pneumonias, reduced antibiotic exposure, shorter stays, improved function, and dignity at favorable or potentially lower costs, context-depending on baseline pneumonia rates, implementation fidelity, and local unit costs.

ABSTRACT Background Despite improvements in surgical techniques and perioperative management, the incidence of postoperative surgical site infection after pancreatoduodenectomy remains high. This study aim to assess whether broad‐spectrum antibiotic prophylaxis can reduce complications after pancreatoduodenectomy compared with standard care antibiotics. Methods Data of patients who underwent pancreatoduodenectomy between July 2010 and March 2022 were extracted from a nationwide Japanese inpatient database. First‐ and second‐generation cephalosporins were designated as narrow‐spectrum, and third‐ and fourth‐generation cephalosporins and piperacillin–tazobactam as broad‐spectrum antibiotics. Patients who received either narrow‐ or broad‐spectrum antibiotics on the day of surgery were included in the analysis. Using propensity‐score stabilized inverse probability of treatment weighting, the postoperative complications were compared between patients who received antimicrobial prophylaxis with narrow‐spectrum antibiotics versus broad‐spectrum antibiotics. Results From among 45 099 eligible patients, 36 742 (81.5%) and 8357 (18.5%) patients received narrow‐ and broad‐spectrum antibiotics, respectively. After stabilized inverse probability of treatment weighting, the use of broad‐spectrum antibiotics bore a significant association with the reduction in intra‐abdominal infections [risk difference (RD), −7.4; 95% confidence interval (CI), −8.7 to −6.0], postoperative pancreatic fistula (RD, −3.0; 95% CI, −4.0 to −1.9), post‐pancreatectomy hemorrhage (RD, −1.5; 95% CI, −1.9 to −1.1). The use of broad‐spectrum antibiotics was also associated with a shorter postoperative length of hospital stay and lower total hospitalization costs. The proportion of Clostridioides difficile infection did not differ between the groups. Conclusions The administration of broad‐spectrum antibiotics as antimicrobial prophylaxis was associated with better in‐hospital postoperative outcomes compared with narrow‐spectrum in patients undergoing pancreatoduodenectomy.

This cross-sectional study aimed to determine the factors influencing street food purchasing among Malaysian consumers and to examine the relationship between these factors and the frequency of street food consumption. In an online self-administered questionnaire, participants were required to rate their agreement on ten influencing factors being studied using a 5-point Likert scale. Results among a total of 1,434 participants revealed significant differences in the factors influencing street food purchasing across consumption frequency groups for time, environment, and nutritional factors, including fat, sugar, and energy content (p < 0.05). Post-hoc analyses indicated that frequent consumers placed greater importance on these factors compared to less frequent consumers. Multinomial logistic regression further identified time and fat content as significant predictors of consumption frequency, where higher importance on time and fat content increased the likelihood of more frequent street food consumption. These findings suggest that time convenience, environmental appeal, and nutritional considerations are key drivers of purchasing behavior among Malaysian street food consumers.

Background/Objectives: Oral microbial homeostasis is crucial for overall health. Nonetheless, the relationship between probiotics and the oral environment remains unclear. This study investigated the association between continuous consumption of yogurt containing Lactobacillus delbrueckii ssp. bulgaricus OLL1073R-1 (LbR1 yogurt), salivary antimicrobial proteins (AMPs), tongue-coating microbiota, and upper respiratory tract infection (URTI) frequency. Methods: This observational study was conducted on 53 nursing home care workers, categorized into a group who consumed LbR1 yogurt daily for over 1 year (n = 40, yogurt group) and a non-intake group (n = 13, non-yogurt group). Salivary and tongue-coating samples were collected. Results: The yearly URTI frequency was lower in the yogurt group than in the non-yogurt group (p = 0.003). The salivary β-defensin-2 (HBD2) and β-defensin-3 (HBD3) flow rates were higher in the yogurt group than in the non-yogurt group (p = 0.02 and p = 0.0009, respectively). Fusobacterium nucleatum (F. nucleatum) ssp. animalis abundance was lower in the yogurt group than in the non-yogurt group (p = 0.04). Bayesian network analysis indicated an association between yogurt consumption and the yearly URTI frequency and salivary HBD2 and HBD3 flow rates. Conclusions: Continuous consumption of LbR1 yogurt was associated with elevated salivary HBD2 and HBD3, reduced abundance of F. nucleatum ssp. animalis, and decreased URTI frequency. Thus, LbR1 yogurt intake is associated with modulated oral immunity and microbiota, suggesting a potential link to reduced URTIs. However, as an observational pilot study, its results should be interpreted with caution.

Abstract Introduction The Japanese Ministry of Health, Labour, and Welfare proposed increased copayments for over-the-counter (OTC)-like drugs, with possible special consideration for certain chronic diseases, although the specific diseases to be included were not clarified as of January 2026. The costs attributable to OTC-like drugs indicated for chronic diseases in adults remain unclear. Methods Using the DeSC database (individual-level claims data) in fiscal year 2023, we estimated the average per-person annual costs of the study OTC-like drugs indicated for adults with representative chronic diseases. The estimates were stratified by sex and age. We also computed the national estimates of the numbers of adults with representative chronic diseases who would need OTC-like drugs and the costs attributable to these drugs by applying stratum-specific estimates from the DeSC database to national population counts and aggregated claims data from the National Database of Health Insurance Claims Open Data. The study OTC-like drugs included oral acetaminophen, oral nonsteroidal anti-inflammatory drugs (NSAIDs), topical anti-inflammatory patches, oral second-generation antihistamines, and heparinoid-containing topical preparations. Results The average per-person annual costs were several hundred yen for acetaminophen and several thousand yen for the other drug categories, with marked variation by drug category, chronic disease, age, and sex. In the national estimates, the proportion of OTC-like drug users with representative chronic diseases was &lt;10% in every disease–age–sex stratum; nevertheless, the maximum stratum-specific shares of total OTC-like drug costs attributable to these groups were high (up to 50–60% for osteoarthritis for acetaminophen/NSAIDs/patches and up to ∼60% for atopic dermatitis/asteatosis for heparinoids). Conclusions The average per-person annual costs for OTC-like drugs varied substantially across drug categories and patient subgroups. Indicated chronic diseases in adults may account for substantial OTC-like drug costs within some strata, despite representing a small fraction of users.

Background: Pulmonary atresia (PA) with ventricular septal defect (VSD) and major aortopulmonary collateral arteries (MAPCAs), a life-threatening congenital heart defect (CHD), is frequently associated with abnormal pulmonary blood flow and vascular remodeling, causing hypoxia and heart failure. Segmental pulmonary hypertension (PH), a distinct PH type, may exist in some patients. Pulmonary vasodilators have been considered for treatment; however, evidence of their efficacy and safety remains lacking. Methods: A systematic review was conducted using PubMed, MEDLINE, The Cochrane Library, and Ichushi Web, encompassing studies from inception to May 2023. Inclusion criteria focused on patients with PA/VSD/MAPCAs treated with PH medications. Results: Of 86 studies screened, 6 met the inclusion criteria, including 1 cohort study and 5 case reports, comprising 22 patients. The most frequently administered medications were sildenafil (14 cases) and bosentan (12 cases), with 16 patients receiving monotherapy. Clinical improvements were observed in pulmonary vascular resistance (8/8 patients), oxygen saturation (8/19 patients), and symptoms (19/21 patients). Adverse effects were noted in five patients, including treatment discontinuation in two. Conclusions: PH medications may benefit some patients with PA/VSD/MAPCAs; however, the extremely limited sample size (n = 22) and substantial heterogeneity in anatomy, age, surgical status, and treatment regimens severely limit interpretability and clinical applicability. Considering the potential benefits and risks associated with these medications, their use should be considered cautiously and restricted to specialized centers with expertise in CHD and PH management.

Abstract Background Sexual well-being (SWB) is a component of quality of life and should not be overlooked in holistic care. Previous studies have shown that inflammatory bowel disease (IBD) affects SWB through abdominal pain, incontinence, fatigue, body image concerns, and treatment-related side effects. However, little is known about how people living with IBD cope with these SWB challenges. Clarifying coping strategies is essential to improve patient education, peer support, and clinical care. This study aimed to identify and characterize such strategies. Methods Participants were recruited via flyers providing access to an online questionnaire at seven outpatient IBD clinics in Japan. A total of 1,347 flyers were distributed. Of the 251 individuals who described SWB-related experiences and coping, non-substantive responses (e.g., ‘cannot recall’) were excluded, leaving 246 for analysis. Data were analysed using content analysis. Two researchers independently categorized the data, and categories were developed through iterative comparison and review. Disagreements were resolved through discussion and consensus, ensuring credibility and trustworthiness. Interrater reliability was confirmed with a Cohen’s kappa of 0.88. Results The average age of participants was 38.3 years (range: 19–67), including 130 with ulcerative colitis and 116 with Crohn’s disease (131 males, 115 females). Content analysis identified four main categories and 12 subcategories of coping experiences related to SWB. Participants described multiple, overlapping coping strategies. The most frequent was ‘Active barrier management,’ such as avoiding sexual activity, discussing concerns, or preparing for the risk of soiling, reported by 63% of participants. ‘Social and professional support,’ including partners and healthcare professionals, was noted by 40%. ‘Cognitive reframing,’ including positive thinking, was reported by 5%, while 28% of participants were classified under the category ‘Passive or resignation coping.’ Conclusion These findings underscore the need for healthcare professionals to initiate empathetic discussions about SWB, provide relevant knowledge, and integrate this aspect into IBD care. Conflict of interest: Wakai, Sayaka: No conflicts Kawakami, Aki: No conflicts Tanaka, Makoto: Lecture fee: Takeda Pharmaceutical Co. Ltd. (2024) Research support: Awarefy lnc. (2025)

Neurotoxicity of acrylamide has been demonstrated both in humans and animals, while the mechanisms remain largely unknown. We recently reported TNF-α deletion suppressed acrylamide-induced neurotoxicity in mice at low dose. Here we further investigated expression of antioxidant and proinflammatory cytokines to explore roles of TNF-α. Wild type and TNF-α KO mice were exposed to acrylamide at 0/12.5/25 mg/kg bw for 28 days. The results showed that acrylamide significantly decreased body weight at 12.5 and 25 mg/kg bw, but decreased brain weight only at 25 mg/kg bw. TNF-α deletion didn't alleviate the above effects. Also, TNF-α deletion didn't alleviate decrease of grip strength at 25 mg/kg bw. Immunohistochemical results showed that TNF-α deletion alleviated noradrenergic axon degeneration in cortex S1FL and S1HL regions at 12.5 mg/kg bw, but not 25 mg/kg bw. Moreover, TNF-α deletion suppressed acrylamide-induced upregulation of TGF-β and NF-κB, but didn't suppress upregulation of IL-6, suggesting possible roles of IL-6 in acrylamide-induced neurotoxicity, particularly at high concentration. Moreover, this study showed a dipolar effect of TNF-α deletion on oxidative stress pathways, i.e., at 25 mg/kg bw, TNF-α deletion suppressed upregulation of oxidative stress (Keap1/HO-1/Gclc/Gclm/Sod/Cat/Gstm/MT-1); however, at 12.5 mg/kg bw, TNF-α deletion accelerated upregulation of Nqo1/Gclm/Sod1/Cat/Gsr. Taken together, genetic TNF-α ablation, at least partially, alleviated acrylamide neurotoxicity at low concentration. Limited alleviation effects at high concentration generated a hypothesis that this may be due to IL-6 signaling and dipolar regulating effects of TNF-α deletion on oxidative stress pathway. This study provided new insights into acrylamide neurotoxicity and TNF-α-targeting strategy.