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Aim Methods Results Conclusions As aging populations shift health care from hospitals to communities, Japan has implemented policies to promote home health care. This study explored regional differences in home health care recipients among older adults and related factors.We used nationwide data from 2020 to describe the proportion of older adults receiving regular home visits and the medical institutions utilized across secondary medical areas: urban, middle and depopulated areas. We examined factors associated with the proportion of patients receiving regular home visits. Exposures included each secondary medical area's medical and long‐term‐care (LTC) resources, adjusted for the older adult population; proportion of single‐person households; and regional factors. We performed a multivariate negative binomial distribution analysis.A total of 333 secondary medical areas were included. Urban areas had more patients receiving regular home visits, primarily from enhanced home care support clinics/hospitals (HCSCs). Fewer patients received regular home visits in depopulated areas, and conventional HCSCs were more common. Multivariate analysis revealed that the number of conventional HCSCs (coefficient, 0.17 [95% confidence intervals (CI), 0.08 to 0.26]), enhanced HCSCs (coefficient, 0.21 [95% CI, 0.14 to 0.29]) and population density (coefficient, 0.10 [95% CI, 0.02 to 0.19]) were positively associated with higher home‐visit rates. Beds in LTC welfare facilities (coefficient, −0.10 [95% CI, −0.19 to −0.01]) and beds in LTC health facilities (coefficient, −0.09 [95% CI, −0.17 to 0.00]) were negatively associated.Policies to promote home health care have led to high home‐visit rates in urban areas. Medical and LTC resources and regional factors influence disparities. As Japan's population ages, it is crucial to recognize these disparities and develop medical and LTC systems tailored to each region's characteristics. Geriatr Gerontol Int 2024; ••: ••–••. [ABSTRACT FROM AUTHOR]

Background: The coronavirus disease 2019 (COVID‐19) pandemic has markedly affected end‐of‐life care, notably increasing home deaths among cancer patients in Japan. This study investigated the characteristics of cancer patients who died at home during the pandemic and the associated factors before and during the pandemic. Methods: Vital statistics from January 2015 to December 2022 were analyzed to evaluate trends in home deaths among cancer patients aged 0 to 113 years, pre‐pandemic (January 2015 to March 2020) and during the pandemic (April 2020 to December 2022). Home deaths were assessed by demographics, including age, sex, marital status, and residential location. Multivariable modified Poisson regression analyses were performed to identify factors associated with home deaths in both periods. Results: Among 3,010,374 individuals, 11.6% (226,571/1,959,304) and 20.8% (218,429/1,051,070) died at home before and during the pandemic, respectively. In subgroup analysis depicting the trend of in‐home deaths by patient characteristics, only the age group showed a differential trend: the proportion of in‐home deaths was higher among older people before the pandemic, whereas it was higher among younger people during the pandemic. The multivariable analysis revealed the excess risk of in‐home deaths among people aged ≥65 years before the pandemic and among those aged <65 years during the pandemic. Conclusions: The pandemic has increased home‐based end‐of‐life care for terminal cancer patients, particularly younger individuals, possibly due to hospital visit restrictions. Ensuring sufficient resources for both home and hospital care is vital to allow individuals to receive end‐of‐life care in their preferred settings. [ABSTRACT FROM AUTHOR]

Aim: In Japan's public health system, dentists can assess and intervene in oral hypofunction cases. However, the associations between oral hypofunction and health outcomes and costs remain unclear. This study aimed to identify these associations. Methods: This retrospective cohort study using a Japanese health insurance claims database included 45 916 individuals aged ≥65 years who underwent dental examinations for oral hypofunction. The primary outcomes were incidence rates of aspiration pneumonia, femoral or vertebral fractures and all‐cause mortality. Secondary outcomes were annual medical and dental costs. We used competing risk regression and Cox models to estimate primary outcomes, and gamma regression models for secondary outcomes. Results: The adjusted hazard ratios were 0.84 (95% CI 0.74–0.96) for the incidence of aspiration pneumonia, 1.11 (1.02–1.21) for the incidence of femoral or vertebral fractures and 1.27 (1.07–1.50) for all‐cause mortality in individuals with oral hypofunction compared with those without. The adjusted relative risk was 1.05 (1.01–1.10) for annual medical costs and 0.94 (0.81–1.09) for annual dental costs in individuals with oral hypofunction compared with those without. Conclusions: Individuals with oral hypofunction were at increased risk of femoral or vertebral fractures and all‐cause mortality, and they incurred significantly higher annual medical costs, compared with those without this condition. Notably, they showed a lower risk of aspiration pneumonia, suggesting potential benefits of dental intervention. Integrating dental care into medical strategies might be necessary to improve health outcomes and reduce healthcare costs for those with oral hypofunction. Geriatr Gerontol Int 2024; 24: 1053–1059. [ABSTRACT FROM AUTHOR]

Glioblastoma (GBM) harbors subpopulations of therapy-resistant tumor-initiating cells (TICs) that are self-renewing and multipotent. To understand the regulation of the TIC state, we performed an image-based screen for genes regulating GBM TIC maintenance and identified ZFHX4, a 397 kDa transcription factor. ZFHX4 is required to maintain TIC-associated and normal human neural precursor cell phenotypes in vitro, suggesting that ZFHX4 regulates differentiation, and its suppression increases glioma-free survival in intracranial xenografts. ZFHX4 interacts with CHD4, a core member of the nucleosome remodeling and deacetylase (NuRD) complex. ZFHX4 and CHD4 bind to overlapping sets of genomic loci and control similar gene expression programs. Using expression data derived from GBM patients, we found that ZFHX4 significantly affects CHD4-mediated gene expression perturbations, which defines ZFHX4 as a master regulator of CHD4. These observations define ZFHX4 as a regulatory factor that links the chromatin-remodeling NuRD complex and the GBM TIC state.

Aims and Objectives: This study aimed to examine the association between physical restraint duration and undesirable outcomes amongst inpatients comorbid with dementia and pneumonia in acute care hospitals. Background: Physical restraints are frequently used in the management of patients, especially amongst patients with dementia. No previous study investigated the potential undesirable effects of physical restraints in patients with dementia. Methods: This was a cohort study using a nationwide discharge abstract database in Japan. Patients aged ≥65 years with dementia hospitalised for pneumonia or aspiration pneumonia between April 1, 2016 and March 31, 2019 were identified. The exposure was physical restraint. The primary outcome was hospital discharge to the community. Secondary outcomes included hospitalisation costs, functional decline, in‐hospital mortality, and institutionalisation for long‐term care. Results: A total of 18,255 inpatients with pneumonia and dementia in 307 hospitals were included in this study. Of them, 21.5% and 23.7% had physical restraint during full and partial days of hospital stays, respectively. Discharge to the community incidence rates was lower in the full‐restraint vs. the no‐restraint group (27 vs. 29 per 1000 person‐days; HR, 1.05 [95% CI, 1.01–1.10]) and the partial‐restraint vs. the no‐restraint group (17 vs. 29 per 1000 person‐days; HR, 1.79 [95% CI, 1.71–1.87]). The risks of functional decline were higher in the full‐restraint vs. the no‐restraint group (27.8% vs. 20.8%; RR, 1.33 [95% CI, 1.22, 1.46]) and the partial‐restraint vs. the no‐restraint group (29.2% vs. 20.8%; RR, 1.40 [95% CI, 1.29, 1.53]). Conclusions: The use of physical restraints was associated with a lower incidence rate of discharge to the community and an increased risk of functional decline at discharge. Further research is needed to judge the benefit–risk balance of physical restraints in acute care settings. Relevance to Clinical Practice: Understanding the risk of physical restraints allows medical staff to improve the process of decision making in everyday practice. No Patient or Public Contribution. Reporting Methods: The reporting of this article conforms to the STROBE statement. [ABSTRACT FROM AUTHOR]