Services In Japan Research Articles

Donors in the COVID-19 era: How did donor characteristics change in Japan?

The COVID-19 pandemic caused significant disruptions to the blood service in Japan. Stay-at-home policies in schools, organizations and companies made it challenging to access potential blood donors, leading to a substantial decline in blood donation rates. This study aimed to examine the profile of blood donors during the pandemic and compare it with that in the pre-pandemic period. Blood donors who contributed to the Japanese Red Cross Blood Services between April 2018 and March 2021 were evaluated based on age, gender, occupation, donation site, height, body weight (BW) and donation status (first-time [FT] or repeat). Factors influencing the return of FT donors who contributed before and during the pandemic were also explored. During the initial phase of the pandemic, a significant decrease in blood donations was observed, particularly in Tokyo. Despite intermittent drops, the required blood volume was ultimately collected. Donations by both female and male repeat donors increased, although the number of male repeat donors decreased, with only female repeat donors experiencing an absolute increase. Before the pandemic, younger age, 200-mL donation, higher body mass index and fixed donation sites were significantly associated with FT donor returns. During the pandemic, higher age (for males) and 400-mL donation (for females) emerged as significant factors. With changes in donor profiles during the pandemic, there was a noticeable shift in the characteristics of FT donors who returned for a subsequent donation within the following year, particularly in terms of age and blood donation volume. Despite the challenges, the required blood volume was successfully collected, thanks to increased donations from repeat blood donors. Recruiting and retaining committed donors is essential for maintaining sustainable blood services, especially during crisis situations.

Factors associated with preventive health services use by older war-displaced Japanese returning from China and by older Korean residents of Japan: a descriptive correlational study

BackgroundAmong the people with diverse backgrounds and cultural customs living in Japan, two important groups, namely, war-displaced Japanese returning from China and South and North Korean nationals who are naturalized citizens residing in Japan, will experience population aging in the same way as the general Japanese population. In old age, physical function generally declines, multiple diseases are more likely to occur, and health issues that need to be addressed increase in number. The aim of this study was to identify the factors associated with the use of preventive health services in Japan by older Korean residents and war-displaced Japanese returning from China.MethodsThe study conducted a cross-sectional study in Japan using a self-administered questionnaire. Respondents comprised 754 people aged 65 or over, including 220 Japanese, 200 war-displaced Japanese returnees from China, and 334 Korean residents of Japan. The behavioral model of health services use served as the analytical framework. Questionnaire items were based on predisposing factors, enabling factors, and need factors. Logistic regression analysis was used to examine the relationship between preventive health services use and each factor.ResultsThe results of the logistic regression analysis showed that being ethnically a war-displaced Japanese returning from China (OR = 0.04; 95% CI [0.00, 0.74]) and being ethnically Korean residents of Japan (OR = 0.13; 95% CI [0.03, 0.62]) were associated with the use of preventive health services.ConclusionsThe use of preventive health services by older people in Japan is influenced by ethnicity. For these reasons, war-displaced Japanese returning from China and Korean residents of Japan need support to encourage their greater use of preventive health services.

Regional differences in the provision of home-visit rehabilitation services in Japan

Regional differences in the provision of home-visit rehabilitation services in Japan

Exploring the Development Model of Senior Care Industry and the Application of Smart Senior Care based on Multi-Country Practices

The purpose of this paper is to explore the development status and practice mode of the global elderly care industry. Through in-depth analysis of the elderly care industry in the United States, Japan, the United Kingdom, Australia, Berlin, Germany, and Singapore, this paper reveals the differences and similarities between the countries in terms of the main body of the elderly care industry, types of services, service modes, operation modes, and typical cases. Meanwhile, this paper also focuses on the application of smart elderly care in different countries, such as the advanced technology support in the United States, the meticulous service in Japan, the community elderly care model in the United Kingdom, the management of nursing homes in Australia, the smart residential system in Berlin, Germany, and the all-round service system in Singapore. By analyzing these practice cases, this paper aims to provide useful reference and inspiration for the development of China's elderly care industry, and to promote the wide application and development of smart elderly care in China. This paper argues that smart aging will become the future development trend of the aging industry, and countries should strengthen exchanges and cooperation to jointly promote the innovation and development of the aging industry.

Optimal Machine Learning Models for Developing Prognostic Predictions in Patients With Advanced Cancer.

Accurate prognosis prediction for cancer patients in palliative care is critical for clinical decision-making and personalized care. Traditional statistical models have been complemented by machine learning approaches; however, their comparative effectiveness remains underexplored. To assess the prognostic accuracy of statistical and machine learning models in predicting 30-day survival in patients with advanced cancer using objective data, such as the result of the blood test. A secondary analysis of the Japan-Prognostic Assessment Tools Validation (J-ProVal) study was performed from September 2012 to April 2014.We used data from 58 palliative care services in Japan and enrolled 915 patients. Four models, fractional polynomial (FP) regression, Kernel Fisher discriminant analysis (KFDA), Kernel support vector machine (KSVM), and XGBoost, were compared using 17 objective clinical characteristics. Models were evaluated with the area under the receiver operating characteristic curve (AUC) as the primary metric. The KSVM model demonstrated the highest predictive accuracy (AUC: 0.834), outperforming the FP model (AUC: 0.799). XGBoost showed comparatively lower performance; however, it was likely limited by the size of the dataset. Machine learning, particularly KSVM, has high predictive accuracy in palliative care when sufficient data are available. However, our findings suggest that traditional statistical models offer advantages in stability and interpretability, underscoring the importance of tailored model selection based on data characteristics.

High monetary valuation of regulating forest ecosystem services in Japan: integrating the best-worst scaling and contingent valuation methods

ABSTRACT Effective forest management requires an understanding of socially prioritized forest ecosystem services and their integration into forest management design. Approximately 70% of Japan, our study area, is covered by forests. Therefore, prioritization-based resource allocation play a fundamental role in forest management in Japan. However, there is a lack of clarity regarding which forest ecosystem services the public evaluate the most. Thus, this study evaluates the social priority of 13 forest ecosystem services based on public preferences by employing the best-worst scaling (BWS) technique. Our study also assesses the value of such services by integrating a contingent valuation method with BWS. The survey was conducted using an online questionnaire for Japanese citizens enrolled in a survey company as representatives of the Japanese public in January 2017; 720 responses were analyzed. The BWS results revealed that the freshwater stock was the most valued forest ecosystem service, followed by carbon storage. However, citizens considered cultural ecosystem services to be of lower importance. The mean willingness to pay (WTP) for freshwater stock was approximately USD 23.77, while the mean WTP for inspiration for culture and art was lower at USD 1.13. Our findings indicate that the values of cultural and provisioning services are lower than Japanese taxes for forest management and suggest that forest management should prioritize regulating ecosystem services.

Mental health and psychiatry in Japan

Mental health services in Japan are fully integrated into the broader healthcare system, and patients have access to a wide range of services and specialists. In addition, psychiatry services are part of comprehensive mental healthcare that provides social support to address the whole person's needs. However, there are still challenges in the mental health system in Japan, including overuse of hospital beds and coercive practices such as involuntary admission, restraint and seclusion. This article will explore the current state of mental health services, the challenges the country still faces and the efforts being made to address these challenges.

Impact of the COVID-19 Pandemic on Home Medical Care Utilization in Japan: An Interrupted Time Series Analysis.

The COVID-19 pandemic affected healthcare utilization worldwide, but changes in home medical care utilization have not been fully revealed. This study aims to clarify the changes in the use of home medical care services in Japan due to the pandemic. Interrupted time series analysis of national medical claims data. Individuals with home medical care use occurring in Japan between April 2019 and March 2022. The declaration of a state of emergency (April 2020) by the Japanese government. The outcomes were the monthly uses of regular home visits, emergency house calls, terminal care, and in-home deaths. Terminal care was stratified by care setting (home or nursing home) and the type of home medical care facilities (enhanced home care support clinics and hospitals (HCSCs), conventional HCSCs, and general clinics and hospitals). Regular home visits showed no significant change, but emergency house calls exhibited an upward trend (1258 uses/month, 95% CI 43to2473). Both terminal care and in-home deaths experienced an immediate increase in level (1116 uses/month, 95% CI 549to1683; 1459 uses/month, 95% CI 612to2307), followed by a gradual increase in trend (141 uses/month, 95% CI 73to209; 215 uses/month, 95% CI 114to317). The immediate increase of terminal care occurred only for home patients. Enhanced HCSCs showed the most prominent increase in both level and trend, followed by conventional HCSCs, and general clinics and hospitals. The COVID-19 pandemic increased the use of emergency house calls and terminal care among home medical care in Japan, particularly for home patients and enhanced HCSCs. These findings suggest that the pandemic revitalized the importance of home medical care as a patient-centered care delivery model and highlight the need for strategic healthcare planning and home medical care resource allocation to anticipate future pandemics.

Trends in the integration of medical corporation hospitals in Japan: a national wide longitudinal study between 2017 and 2021

BackgroundMedical corporations, which are non-profit organizations that aim to operate hospitals, clinics, or long-term care facilities, account for more than half of all hospital beds and play a central role in the health care system in Japan. However, limited analysis of hospital integration has been performed. Examining the hospital integration trends of medical corporations can provide valuable insights for optimizing health care delivery and resource allocation in Japan. This study conducted a comprehensive analysis of trends in the hospital integration of medical corporations and market concentration in Japan using nationwide longitudinal data.MethodsThis longitudinal study evaluated the hospital integration of medical corporations in Japan between 2017 and 2021 using medical corporation financial data provided by the Neostage Company. The target population was medical corporations that own hospitals in Japan. The primary outcomes were the horizontal and vertical integration of medical corporation hospitals. Horizontal integration was defined as the integration of two or more hospitals within the same corporation, while vertical integration was defined as the integration of a hospital with different types of health care facilities, such as clinics or long-term care facilities, within a single medical corporation. The Herfindahl–Hirschman Index (HHI) was calculated to measure hospital market concentration using hospital bed data for medical corporations in all prefectures.ResultsThe number of hospitals and hospital beds within medical corporations decreased from 5,670 to 848,174 in 2017 to 5,486 and 814,462 in 2021, respectively. Both horizontal and vertical integration among medical corporation facilities showed a gradual upward trend, increasing from 24.92% to 55.75% in 2017 to 26.92% and 59.42% in 2021, respectively. The mean (standard deviation [SD]) HHI increased slightly from 262.7 (178.6) in 2017 to 275.2 (187.9) in 2021, with rural areas being more concentrated than urban areas, although both remained unconcentrated.ConclusionsThis longitudinal study revealed a gradual downward trend in the number of hospitals and hospital beds owned by medical corporations, while horizontal and vertical integration gradually progressed without any particular medical corporation dominating the market. These findings are expected to contribute to policymaking efforts aimed at providing optimal health care services in Japan.

A Comparative Study of Access Analysis Service Utilization on Japanese Medical Institutions' Websites with GDPR-Compliant Cases.

The browsing history of a medical institution's website can potentially reveal or identify information about the health condition of the website visitor through browser cookies and fingerprints. In Japan, although the Personal Information Protection Law was revised in April 2022, the use of access analysis services to collect browsing history on medical institution websites has not been investigated. Therefore, this study investigates the actual usage of access analysis services on Japanese medical institution websites and compares it with the current situation in France, which follows the General Data Protection Regulation. The results revealed that the larger the size of the hospital, the higher the percentage of adoption of access analytics services in Japan. However, the implementation of a system for obtaining consent for the use of access analysis in Japan was found to be poor compared to that of French medical institutions. While access analysis tools are used in the websites of several medical institutions in Japan, the implementation of the process of obtaining consent to acquire browsing history is poor.

Characteristics to consider for home pharmaceutical care for older adults who initiate visiting pharmacist services in Japan.

This study aimed to clarify patient characteristics regarding medication-taking behaviors, their understanding of medication instructions and specific medication management for older adults who initiated visiting pharmacist services. By analyzing long-term care certification data, participants using visiting pharmacist services required more medication-taking support and had a poorer understanding of daily schedules.

Evaluate a comprehensive geriatric assessment service framework targeting frail older people who had high risk of requiring long-term care services in Japan: a community-based pilot study

BackgroundFrailty has become a key concern in an aging population. A comprehensive geriatric assessment (CGA) service framework was developed and evaluated aiming to target and connect frail older adults who are at high risk of requiring long-term care services.MethodsA community-based pilot study was conducted in fiscal year 2016 and 2017 in Kure city, Hiroshima, Japan. Participants aged 65 and over living in Kure city, and 393 persons were extracted from the Kihon Check List (KCL) responses. Among the eligible individuals, 101 consented to participate and received CGA and referred to services based on individual health needs. The efficacy was evaluated by referral rate of services, continuity of the service usage, evaluation of participant’s health condition and the quality of life (QoL) after the 6-month follow-up.ResultsNinety-nine (98.0%) participants needed support for the instrumental activity of daily living, 97 (96.0%) were categorized as locomotive syndrome, and 64 (63.4%) had a depressive tendency. Afterward, 60 participants (59.4%) subsequently accepted the referral services, however, 34 (33.7%) used the services and the remaining 26 (25.7%) did not use the services. The health condition improvements in the service-uses group were statistically significant (p < 0.001), however, QoL score did not change between the baseline and 6th -month.ConclusionKCL extracted high-risks older people, and CGA revealed related diseases and health conditions. However, the high refusal rate of referral services indicates a necessity to modify the service framework such as by collaborating with community general support centers, which could increase the efficacy of service framework.

Last year of life care transitions between long-term care insurance services in Japan: Analysis of long-term care insurance claims data.

We determined the number of care transitions in the year before death among older adults requiring long-term care (LTC) and those receiving public LTC insurance (LTCI) services in Japan, along with care transition pathways and factors associated with the number of care transitions. This study used data from the Japanese LTCI claims, which store national information on certification of needed LTC and LTCI claims data. Services received in the year before death were classified as in-home, facility, mixture of in-home and facility, and not using LTCI services. The transition count is presented, and Sankey diagrams are produced to visualize care transition pathways. We used a multivariable analysis to identify factors associated with the number of care transitions. Of the participants, 276 896 (65.2%) experienced at least one transition in LTCI care settings in the year before death. Further, 72.0% of those requiring mild LTC underwent one or more transitions. Participants who were 75-84 years old (vs. 65-74 years old), male, without medical care needs, with symptoms of dementia, and with changes in LTC needs in the year before death were more likely to require care transitions. Moreover, participants with higher baseline LTC needs were less likely to require transitions. Over half the participants requiring LTC underwent one or more care transitions in the year before death. Policy deliberations regarding enhancing care under the LTCI system at the end of life and optimizing care transitions are necessary. Geriatr Gerontol Int 2024; 24: 883-890.

Estimation of private-use prices of at-home care services in Japan: Data from a survey of housekeeper employment agencies

ABSTRACT This study examined housekeeper referral agencies’ operations in Japan, their services, and fee standards. This promoted an estimation of the standard price of housekeeping services in Japan if insurance coverage was excluded. Questionnaires were distributed to 399 housekeeping agencies whose addresses were available on the website of the Japan Association of Nursing and Welfare Placement Agencies as of October 2022, and 101 agencies responded (response rate: 25.3%). Surveys were completed in February–March 2023. Two-thirds (65%) of the housekeeper placement agencies had a long-term care (LTC) insurance office. Housekeeper referrals were mostly for 1–4 h; the fee varied according to city size and service provider type, which tended to be higher in larger cities. The fees were lower for attached LTC providers than for stand-alone providers. Most managers (60%) of housekeeper referral agencies rated their fees as ‘somewhat low’ or ‘very low’, requesting an increase in users’ burden and housekeepers’ compensation. LTC insurance keeps the prices of services provided by housekeeper referral agencies low. In the future, daily living support services for the lightly insured may be excluded from LTC insurance coverage in Japan, and the demand for housekeeper agencies’ services is expected to increase.

Association of frailty assessed by a ten-item frailty index (FI-CGA-10) with health-related quality of life in older adults with cancer.

11047 Background: A 10-item frailty index based on a comprehensive geriatric assessment (FI-CGA-10) is a recently developed measure of frailty in the geriatric oncology setting [Oncologist, 26, e1751 (2021)]. Our objective was to investigate the association between frailty defined by the FI-CGA-10 and health-related quality of life (HRQOL) in older adults with cancer. Methods: This study included 1015 consecutive older adults with cancer who underwent a CGA before cancer treatment decision at a geriatric oncology service in Japan from February 2020 through September 2023. Fitness and frailty level was evaluated using the FI-CGA-10 that assesses 10 domains: cognition, mood, communication, mobility, balance, nutrition, base and instrumental activities of daily living, social support, and comorbidity. Deficits in each domain were scored as 0 (no problem), 0.5 (minor problem), and 1.0 (major problem). FI-CGA-10 scores (range 0-1) were calculated by dividing the sum of the scores for each domain by 10 and then categorized as fit (&lt;0.2), pre-frail (0.2–0.35), and frail (&gt;0.35). HRQOL was measured by the EQ-5D-5L index score and visual analogue scale (VAS) at the CGA consultation. The minimally important difference (MID) values for the EQ-5D-5L Japan-based index and VAS scores are 0.048 and 7, respectively. Associations between EQ-5D-5L and FI-CGA-10 scores were analyzed by Pearson’s correlation and linear regression models adjusting for covariates (age, sex, cancer type, and stage). Results: Median age was 80 years, 60% were male, and 68% had gastrointestinal cancer. The mean +- SD of the FI-CGA-10 score was 0.35 +- 0.19. The FI-CGA-10 negatively correlated with the EQ-5D-5L index (Pearson’s r = -0.69; 95% CI -0.72 to -0.66; P&lt;.001) and VAS (r = -0.47; 95% CI -0.52 to -0.42; P&lt;.001) scores. After adjusting for the covariates, each 0.1 unit increase in FI-CGA-10 score was associated with 0.070 decrease in EQ-5D-5L index (95% CI -0.075 to -0.066; P&lt;.001) and 4.9 decrease in VAS scores (95% CI -5.5 to -4.4; P&lt;.001). Using the three-level classification, 22% of patients (n = 221) were categorized as fit, 38% (n = 384) as pre-frail, and 40% (n =410) as frail. Overall, the fit group had the highest EQ-5D-5L index and VAS scores followed by the pre-frail and frail groups (table). The score differences between the frailty categories were statistically significant and clinically meaningful according to the MID values. Conclusions: This study demonstrated that frailty assessed by the FI-CGA-10 cross-sectionally correlated with HRQOL measured by the EQ-5D-5L in older Japanese adults with cancer. The observed association further supports construct validity of the FI-CGA-10 as a CGA-based frailty measure. [Table: see text]

Symptom management through electronic patient-reported outcome (ePRO)-based intervention in patients with breast cancer treated with abemaciclib: Primary results from the LIBRA study, a phase II randomized controlled trial.

11110 Background: We have developed a system using LINE, a widely-used social network service in Japan, for rapid collection of ePROs based on the PRO-CTCAE criteria. To evaluate the effectiveness of intervention through this system in reducing diarrhea frequency and enhancing quality of life (QOL) in patients treated with abemaciclib, we conducted a randomized controlled trial. Methods: Patients with hormone receptor-positive advanced breast cancer scheduled to begin abemaciclib treatment were randomized to the intervention and control arms with 1:1 ratio. The LINE-ePRO system was used to monitor symptoms daily in both arms. In the intervention arm, expert medical staffs contacted patients via phone when symptoms met certain criteria, whereas patients in the control arm received standard care. The primary endpoint was the increase in the number of defecations from baseline during 28 days. The secondary endpoints included the increase in the number of defecations from baseline during 56 days, other symptoms monitored via the LINE-ePRO system, QOL evaluated by EORTC QLQ C-30 and EQ-5D-5L, relative dose intensity (RDI), treatment interruption rate, progression-free survival (PFS), and overall survival (OS). This study (LIBRA, UMIN000045432) is funded by Eli Lilly. Results: Between Jan 2022 and Apr 2023, 60 women were enrolled and 58 (29 in each arm) were analyzed in this study. Median age was 57.5 years (range 43-80), 93% of patients were post-menopausal, 71% received abemaciclib as first-line treatment, and 74% were treated in combination with aromatase inhibitors. The increase in the number of defecations from baseline was significantly lower in the intervention arm compared to the control arm both during 28 days (0.64 vs. 1.21 per day, p=0.003) and during 56 days (0.55 vs. 1.18 per day, p=0.0004). No significant difference was observed in other symptoms between the arms. In the EORTC QLQ C-30 scales, global health status/QOL (mean score change from baseline to after one cycle of abemaciclib treatment: 0 vs. -13.5, p=0.038) and diarrhea (20.7 vs. 32.2, p=0.049) were better in the intervention arm. The treatment interruption and dose reduction rates were 41.4 and 31.0% in the intervention arm, and 31.0 and 27.6% in the control arm, respectively. The mean RDI of abemaciclib was numerically lower in the intervention arm (73.5% vs. 84.8%). Conclusions: This study is the first randomized trial to demonstrate that the intervention based on daily ePROs reduces the frequency of diarrhea in patients with advanced breast cancer treated with abemaciclib. Clinical trial information: UMIN000045432.

Examination of construct of “outcome” items evaluated by families of children with medical complexity using home-visit nursing services in Japan

This study aims to create “Outcome” items evaluated by families of children with medical complexity (CMC) (CF-Outcome) that are similar to the Home-visit Nursing Quality Indicators for Children (HNQIC) “Outcome” items, to examine the construct of “CF-Outcome.” This study was cross-sectional, and participants were 150 families of children with medical complexity. Based on the ten items of the HNQIC “Outcome” section, we developed ten outcome items evaluated with 5-point Likert scales, and tested the validity of the construct and internal consistency of the “CF-Outcome.” Spearman correlation coefficients were calculated to identify correlations between the “CF-Outcome” factors and five “Service user satisfaction” factors. The exploratory factor analysis yielded 8 items in 3 factors, with a Cronbach's α of 0.813. For the correlation between factors of “CF-Outcome” and “Service user satisfaction”, there was no statistically significant correlation between the second factor of “CF-Outcome” and the following three factors: “Service user satisfaction”: &lt;24-hour support&gt;, &lt;Care according to change&gt;, and &lt;Proactive patient care&gt;. However, there were statistically significant correlations among the other factors, from r = .165 (p &lt; .01) to r = .367 (p &lt; .001). The findings suggest the usefulness of the “CF-Outcome” for CMC families to evaluate the outcomes of home-visit nursing services. However, there is a need to improve the wording of items to eliminate variations in responses among raters. We need to clarify the concepts of the three factors further, and examine specific items that can measure the concepts.

Abstract 6238: Integrated multi-omic/modal profiling enables improved characterization of oncogenic processes, with impact to clinical actionability in the GenMineTOP tested population

Abstract Introduction: It is becoming increasingly apparent that tumor gene expression and spatial H&amp;E profiling can be used to improve the accuracy of DNA-only tumor profiling for clinically relevant use-cases. Future development and deployment of integrative (multi-omic (DNA+RNA) and/or multi-modality (omics + imaging)) tests for treatment and clinical trial profiling hinges on the demonstration of clear robustness and performance gains of prognostic and predictive integrative predictors in a clinical setting. In this work we present several analyses quantifying the utility of integrative testing. We show that a multi-omic test combining tumor expression signatures with DNA profiles substantially improves tumor-of-origin prediction for cancers of unknown primary and also significantly improves MSI detection and resolution. We also show that a simple multi-modality model combining spatial features of tumor infiltrating lymphocytes of tumors with tumor expression is prognostic for MSI-positive patients. Methods: Multi-omicTumor-of-origin: 163 patient sample expression profiles were profiled using the GenMineTOP test. GenMineTOP is a tumor-normal, joint DNA+RNA capture PMDA-approved test in current clinical service in Japan. The samples were clustered using DNA-only, RNA-only, and joint DNA+RNA profiling signatures. MSI prediction: 940 samples from the TCGA COAD, UCEC, and READ cohorts with matched MMR IHC MSI-calling, DNA-NGS-based MSI calling, and RNA-seq data were utilized to train, test and validate an expression-based pan-cancer MSI caller. Additional orthogonal validation was carried out using GenMineTOP multi-omic profiles. Multi-modality Spatial context of TIL and tumor-expression: 158 MSI+ samples from the TCGA-UCEC cohort with matched fresh-frozen H&amp;E 20X images and RNA-seq data were utilized to mine spatial features of tumor-infiltrating lymphocytes and derive gene expression signatures, respectively. A Cox-proportional hazard model for patient survival using gene expression and spatial TIL features was constructed while regressing out tumor stage, gender, age, and ethnicity. Results &amp; Conclusions: Our multi-omic results quantify the benefit of combining DNA and RNA profiles from GenMineTOP to classify tumor-of-origin from unknown primaries reduces classification error by approximately 50%. Additionally, our expression-based MSI status prediction model not only significantly improves NGS DNA (MSI-sensor) based MSI prediction (log-ratio test, pval &amp;lt; 1e-7) but also strongly suggests that nonlinear differential expression drives the improvement in MSI prediction. Our multi-modality results demonstrate that mining the spatial context of endogenous tumor immune response has nontrivial prognostic utility (p &amp;lt; .05). Citation Format: Bojan Losic, Kenji Tatsuno, Vasanth R. Singan, Hiroki Ueda, Aya Shinozaki Ushiku, Vasanthan Jayakumar, Emi Hattori, Toshimitsu Ichijo, Takuma Sasa, Masakazu Akahori, Shinya Hayashi, Esther Hsiao, Stephanie Feupe, Dan Vo, Tiantian Geier, Shuichi Tsutsumi, Tetsuo Ushiku, Kousuke Watanabe, Katsutoshi Oda, Hidenori Kage, Joy Radecki-Crandall, Donavan T. Cheng, Hiroyuki Aburatani. Integrated multi-omic/modal profiling enables improved characterization of oncogenic processes, with impact to clinical actionability in the GenMineTOP tested population [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 6238.

Prediction of decline in activities of daily living using motor performance tests in older adults requiring long-term care

This study aimed to predict decline in activities of daily living (ADL) in older adults requiring long-term care, using motor performance tests. This prospective cohort study was conducted among 3948 older adults using day care services in Japan. ADL decline was assessed using the Functional Independence Measure at the start of day care service use and 12 months later. Grip strength (GS), one-leg standing (OLS), and comfortable walking speed (CWS) were measured as baseline motor performance tests. To predict ADL decline using motor performance tests, we calculated cut-off values using receiver operating characteristics curves and odds ratios using logistic regression analysis. In total, 521 participants had ADL decline at 12 months of follow-up. The cut-off values for each motor performance test were as follows (for men/women): GS < 24 kg/16 kg, OLS < 2 s/3 s, and CWS < 0.77 m/s/0.71 m/s. The odds ratios based on the number of items with scores below the cut-off were 1.84 for one item, 3.19 for two items, and 5.20 for three items. Motor performance tests are effective in predicting ADL decline in older adults requiring long-term care, and combining the results of multiple items is even more effective.

Relationship between the Number of Pharmacists per Pharmacy and the Provision of Home Healthcare Services in Japan

Home healthcare services provided by community pharmacists are essential for maintaining community care, especially in Japan's aging population. Personnel shortage in pharmacies is occasionally cited as the reason why pharmacies are unable to provide home healthcare services. This study examined the relationship between the number of pharmacists in each pharmacy and the provision of home healthcare services. The number of full-time and part-time pharmacists per pharmacy has a positive impact on the provision of home healthcare services. Moreover, the larger the number of pharmacists per pharmacy, the easier it is for the pharmacy to provide home healthcare services. With regard to pharmacies with one full-time pharmacist, there are more pharmacies that provide home healthcare services when the population density of municipalities where the pharmacy is located is high. However, the impact of the number of pharmacists on population density became obscure when the number of full-time pharmacists per pharmacy was three or more. Taken together, these findings indicate that the provision of home healthcare services by pharmacies is related to the number of pharmacists per pharmacy and the population density of the area. This could have implications for widening regional disparities in home healthcare services.