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Background: Japan has witnessed an unusual increase in the number of suicides among women during the coronavirus disease 2019 pandemic. An analysis is required to identify the influencing factors during the pandemic and develop new measures for preventing suicides.Methods: Data on the number of monthly suicides were collected from the National Police Agency of Japan. The expected number of suicides among women during the pandemic was estimated using a time-series model based on pre-pandemic data, considering year-to-year trends. The observed-to-expected (O/E) ratio of suicides was estimated from March 2020 to October 2021 using job status, suicide motive, and age.Results: The number of suicides among women in Japan increased beyond the expected number until October 2021. The O/E ratio based on job status, suicide motive, and age (except self-employed, unknown job status, and women aged ≥80 years) was significantly above 1.0 from March–December 2020, and the increase in suicides continued in almost all categories in 2021.Conclusion: Although several reasons were reported for increased suicides among women in Japan during the pandemic (eg, economic downturn, financial instability, and loneliness), suicides increased irrespective of job status, suicide motive, or age. Comprehensive measures to prevent suicide might have been important during the pandemic, instead of limiting interventions to the reported specific population.

Background: Suicide amidst the coronavirus disease (COVID-19) pandemic is an important issue. In Japan, the number of suicides in April 2020 decreased by nearly 20% from that in 2019. To assess the impact of an infectious disease pandemic, excess mortality is often discussed. Our main purpose was evaluating excess mortality from suicide in Japan during the early pandemic period.Methods: We used data on suicides collected by the National Police Agency of Japan until June 2020. We estimated excess mortality during the early pandemic period (March–June 2020) using a time-series model of the number of suicides before the pandemic. A quasi-Poisson model was employed for the estimation. We evaluated excess mortalities by the categories of age and sex, and by prefecture.Results: No significant excess mortality was observed throughout the early pandemic; instead, a downward trend in the number of suicides for both sexes was noted. For males, negative values of excess mortalities below the lower bound of the 95% prediction interval were observed in April and May. All numbers of females during the period were included in the interval, and the excess mortalities in June were positive and higher than those in April and May. In Tokyo, the number of suicides was below the lower bound throughout the period.Conclusion: Our results suggest that various changes, such as communication, and social conditions amid the early COVID-19 pandemic induced a decrease in suicides in Japan. However, continuous monitoring is needed to evaluate the long-term effects of the pandemic on suicides.

Background Living alone without someone to cook meals for them can happen more frequently in aging due to bereavement, divorce, or other family changes. Health risks to older adults due to poor cooking skills may be more pronounced among those living alone. We aimed to examine whether cooking skills are associated with mortality according to cohabitation status in older Japanese people. Methods Participants in the Japan Gerontological Evaluation Study, a population-based cohort of independent older adults, were followed for three years (n = 10,647). Cooking skill was assessed using a scale with good validity and modified for Japanese people in the baseline survey. After stratification by living alone or together, participants with high and low cooking skills were matched on demographic, socioeconomic, health-related factors, and availability of food stores using propensity score matching. All-cause mortality risks were compared between high and low cooking skills using Cox regression models. Results During the follow-up, 520 of the 10,647 participants died. One hundred and seventy-one pairs of high and low cooking skills were matched among those living alone, and 2,161 pairs among those living with others were matched as well. The hazard ratio of the low level of cooking skills (vs. high) was 2.50 (95% confidence interval [CI]: 1.10–5.68) among those living alone, while 1.05 (95% CI: 0.82–1.33) among those living with others. Conclusion Lower cooking skills were associated with a higher risk of mortality only among those living alone. Cooking skills may be important for older adults who live alone to reduce mortality risk.

Although the economic burden of multimorbidity is a growing global challenge, the contribution of multimorbidity in patients with high medical expenses remains unclear. We aimed to clarify multimorbidity patterns that have a large impact on medical costs in the Japanese population. We conducted a cross-sectional study using health insurance claims data provided by the Japan Health Insurance Association. Latent class analysis (LCA) was used to identify multimorbidity patterns in 1,698,902 patients who had the top 10% of total medical costs in 2015. The present parameters of the LCA model included 68 disease labels that were frequent among this population. Moreover, subgroup analysis was performed using a generalized linear model (GLM) to assess the factors influencing annual medical cost and 5-year mortality. As a result of obtaining 30 latent classes, the kidney disease class required the most expensive cost per capita, while the highest portion (28.6%) of the total medical cost was spent on metabolic syndrome (MetS) classes, which were characterized by hypertension, dyslipidemia, and type 2 diabetes. GLM applied to patients with MetS classes showed that cardiovascular diseases or complex conditions, including malignancies, were powerful determinants of medical cost and mortality. MetS was classified into 7 classes based on real-world data and accounts for a large portion of the total medical costs. MetS classes with cardiovascular diseases or complex conditions, including malignancies, have a significant impact on medical costs and mortality.

Introduction Considering Japan's aging society, the number of older individuals who die at home is expected to increase. In Japan, there are challenges in utilizing and promoting home‐visit nursing services at the end of life for community‐dwelling older adults. We examined the use of home‐visit nursing services at the end of patients' lives and the recommended use patterns of this service (utilization, timing of initiation, and continuity) that contribute to reducing the medical care and long‐term care costs (total costs) in the last 3 months of life. Design This was a retrospective cohort study. Methods We examined 33 municipalities in Japan, including depopulated areas. The analysis included 22,927 people aged 75 or older who died between September 2016 and September 2018. We used monthly medical care and long‐term care insurance claims data. Participants were classified into five groups based on their history of home‐visit nursing service use: (1) early initiation/continuous use, (2) early initiation/discontinued or fragment use, (3) not‐early initiation/continuous use, (4) not‐early initiation/fragment use, and (5) no use. Univariate and multivariate linear regression analyses were performed to examine the association between total costs in the last 3 months of life and patterns of home‐visit nursing service use. Results Overall, the median age was 85, and 12,217 participants were men (53.3%). In the last half year before death, 5424 (23.7%) older adults used home‐visit nursing services. Multivariable linear regression analysis of the log10‐transformed value of total costs revealed that compared with the no use group, the early initiation/continuous use group was estimated to have 0.88 times (95% confidence interval: 0.84, 0.93) the total costs in the last 3 months of life (p < 0.001). Conclusion Early initiation use of home‐visit nursing services may contribute to reducing total costs in the last 3 months of life for Japanese people aged 75 years or older living at home as they approach the end of life. Clinical relevance When approaching the end of life, many older adults require daily life care and palliative care. Policymakers are strengthening end‐of‐life care for community‐dwelling older adults in Japan. Although the current results do not demonstrate the effectiveness of home‐visit nursing services, they provide a perspective from which to assess the use of home‐visit nursing services and its impact on older adults. The findings can be helpful in considering how to provide nursing care in home‐care settings for older adults who prefer to spend their final days at home.

Background Anthropometric measurements are crucial in pediatric critical care, but the impact of height on ICU outcomes is underexplored despite a substantial number of short-for-age children in ICUs. Previous studies suggest that short stature increases the risk of poor clinical outcomes. This study examines the relationship between short stature and ICU outcomes. Methods We conducted a retrospective cohort study using a Japanese nationwide database (the Japanese Intensive Care Patient Database; JIPAD), which included pediatric patients under 16 years admitted to ICUs from April 2015 to March 2020. Height standard deviation scores (SD scores) were calculated based on age and sex. Short-stature patients were defined as height SD score <  − 2. The primary outcome was all-cause ICU mortality, and the secondary outcome was the length of stay in ICU. Results Out of 6,377 pediatric patients, 27.2% were classified as having short stature. The ICU mortality rate was significantly higher in the short-stature group compared to the normal-height group (3.6% vs. 1.4%, p  < 0.01). Multivariable logistic regression showed that short stature was independently associated with increased ICU mortality (OR = 2.73, 95% CI 1.81–4.11). Additionally, the Fine–Gray subdistribution hazards model indicated that short stature was associated with a lower chance of ICU discharge for each additional day (HR 0.85, 95% CI 0.81–0.90, p  < 0.01). Conclusions Short stature is a significant risk factor for increased ICU mortality and prolonged ICU stay in critically ill children. Height should be considered in risk assessments and management strategies in pediatric intensive care to improve outcomes.

Background Detecting learners’ real-time reactions during learning is important. One potential approach is to utilize learners’ nonverbal information. Among nonverbal cues, facial expressions have been shown to influence educational outcomes. Recent technological advances have made quantitative facial expression analysis feasible. In this study, a machine learning tool, a core component of artificial intelligence, was used to quantify subtle facial movements of medical students and examine their relationship with lecture satisfaction. Methods Fifth-year medical students attended synchronous and asynchronous online lectures while being recorded. After the sessions, they completed a lecture satisfaction questionnaire. Learners’ facial expressions were analyzed using OpenFace 2.0, a machine learning tool capable of detecting “action units (AUs).” AUs, proposed by Ekman et al., represent subtle facial movements (e.g., AU1 “Inner brow raiser”). In this study, we focused on seven AUs, calculated the total minutes each AU was detected, and analyzed their association with the satisfaction levels reported in the questionnaire. Results Regression analysis revealed that overall satisfaction was significantly higher when AU45 (blink) frequency increased during synchronous lectures. A similar analysis using delivery satisfaction as the dependent variable showed that higher AU45 blink rates were significantly associated with greater satisfaction with lecture delivery in synchronous lectures. Conclusion Eye blinks, which were more frequent in synchronous lectures, were the only facial cue significantly associated with satisfaction, whereas other facial expressions showed no significant relationship. Further research on learners’ blinking is warranted to better understand real-time responses and to improve the quality of online lectures.

Tumor progression and metastasis are regulated by endothelial cells undergoing endothelial–mesenchymal transition (EndoMT), a cellular differentiation process in which endothelial cells lose their properties and differentiate into mesenchymal cells. The cells undergoing EndoMT differentiate through a spectrum of intermediate phases, suggesting that some cells remain in a partial EndoMT state and exhibit an endothelial/mesenchymal phenotype. However, detailed analysis of partial EndoMT has been hampered by the lack of specific markers. Transforming growth factor‐β (TGF‐β) plays a central role in the induction of EndoMT. Here, we showed that inhibition of TGF‐β signaling suppressed EndoMT in a human oral cancer cell xenograft mouse model. By using genetic labeling of endothelial cell lineage, we also established a novel EndoMT reporter cell system, the EndoMT reporter endothelial cells (EMRECs), which allow visualization of sequential changes during TGF‐β‐induced EndoMT. Using EMRECs, we characterized the gene profiles of multiple EndoMT stages and identified CD40 as a novel partial EndoMT‐specific marker. CD40 expression was upregulated in the cells undergoing partial EndoMT, but decreased in the full EndoMT cells. Furthermore, single‐cell RNA sequencing analysis of human tumors revealed that CD40 expression was enriched in the population of cells expressing both endothelial and mesenchymal cell markers. Moreover, decreased expression of CD40 in EMRECs enhanced TGF‐β‐induced EndoMT, suggesting that CD40 expressed during partial EndoMT inhibits transition to full EndoMT. The present findings provide a better understanding of the mechanisms underlying TGF‐β‐induced EndoMT and will facilitate the development of novel therapeutic strategies targeting EndoMT‐driven cancer progression and metastasis. The stepwise changes during EndoMT. During EndoMT, endothelial cells transdifferentiate to full EndoMT cells via partial EndoMT states.

This study aimed to clarify the trajectory of BMI alongside age-related changes in height and weight among Japanese adults. Data from annual health checkups between 2015 and 2020 by the Japan Health Insurance Association were retrospectively analyzed. A total of 4,777,891 men and 3,378,003 women (age 35-69 years) were stratified into 14 subgroups based on sex and 5-year age categories. We used linear mixed-effects model to estimate values for each outcome, with six-time points (2015-2020) as the independent variable. Mean BMI changes were positive across all subgroups, indicating a trend of increasing BMI (men, 0.02 to 0.14 kg/m /year; women, 0.05 to 0.16 kg/m /year). In younger subgroups, the changed were relatively large, with the weight transitions mirroring those of BMI. However, the mean changes were negative (men, -0.06 kg/year; women, -0.01 kg/year) in the oldest subgroups. Height reduction increased with age across subgroups (men, -0.14 to -0.03 cm/year; women, -0.18 to -0.01 cm/year). In conclusion, BMI tended to increase with age in both sexes across all age groups of Japanese adults. The increase in BMI appeared to be influenced by weight gain in young to middle age, whereas height reduction influenced increased BMI in older age groups.

Background Statins are generally recommended to be discontinued once pregnancy is recognized; however, unintentional exposure during early pregnancy may occur in women receiving long-term lipid-lowering therapy, and clinical decision-making often requires careful consideration of potential risks and benefits. We aimed to evaluate the risk of congenital anomalies detected at 1 month and perinatal outcomes among infants born to women exposed to statins during early pregnancy (4–13 weeks of gestation) in Japan. Methods Using data from the Japan Drug Information Institute in Pregnancy database (2005–2017), we compared pregnant women exposed to statins during early pregnancy (statin-exposed group) and unexposed controls. Neonatal congenital anomalies at 1 month among live births were the primary outcome; secondary outcomes included pregnancy outcomes such as live birth, miscarriage, abortion, and stillbirth. Propensity score matching (1:1) was conducted to estimate the associations between statin exposure and pregnancy outcomes, and inverse probability weighting was performed using stabilized weights as a sensitivity analysis. Results Among 968 eligible pregnant women, 65 were in the statin-exposed group and 903 in the control group. After propensity score matching, the prevalence of congenital anomalies did not significantly differ between the statin-exposed (1.6%) and control (1.6%) groups, however, estimates were imprecise (odds ratio: 1.00; 95% confidence interval: 0.06–15.99). Increased risks of preterm birth (risk ratio: 4.26 [2.02–8.99]) and low birth weight (risk ratio: 3.32 [1.73–6.36]) were observed in the IPW analysis but not in the primary PSM analysis. Conclusions No increase was observed in congenital anomalies detected at 1 month among live births following early statin exposure, although the estimates were imprecise and the study was underpowered for rare outcomes. Higher risks of preterm birth and low birth weight were observed in weighted analyses but not in the primary propensity score–matched analysis. Further research is needed to clarify perinatal risks associated with statin use in pregnancy. These findings may help inform individualized shared decision-making for women who require statin therapy during pregnancy.