We aimed to examine the association between loneliness and developing alcohol dependence or hazardous alcohol use. A cohort study was conducted utilizing data from a nationwide internet survey in 2021 and 2022 in Japan. A total of 15,854 follow-up participants (55% men, with a mean age of 52.8 years) were divided based on AUDIT scores: nondrinkers (AUDIT: 0), low-risk drinkers (AUDIT: 1–7), medium-risk drinkers (AUD: 8–14), high-risk drinkers (AUDIT: 15–19), and probable alcohol dependence (AUDIT: 20–40). The University of California, Los Angeles Loneliness Scale (Version 3), a short-form three-item scale, was used to assess loneliness (high loneliness score of ≥6). The prevalence of high loneliness was higher in nondrinkers than that in low- and medium-risk drinkers, i.e., 22%, 18%, and 17%, respectively, as well as in high-risk drinkers (32%) and those with probable alcohol dependence (43%) compared to non-high-risk drinkers (19%). After adjusting for various factors (sociodemographic, social isolation, psychological distress, and smoking), non-high-risk drinkers (AUDIT: 0–14) with high loneliness were more likely to become high-or-over-risk drinkers (AUDIT: 15–40) than those without high loneliness, with adjusted risk ratios of 1.45 (95% confidence interval: 1.08–1.96) through multivariable binary logistic regression. Among non-high-risk drinkers, people with high loneliness scores at baseline were associated with increased high-risk drinking patterns with probable alcohol dependence.

Background: Evidence is still limited on the prevalence of multimorbidity and complex multimorbidity in Japan, as well as their associated factors. Additionally, no studies regarding multimorbidity and complex multimorbidity in Japan have used patient data obtained directly from medical records. The primary objective was to clarify the prevalence of multimorbidity and complex multimorbidity using patient data obtained directly from medical records. The secondary objective was to elucidate factors associated with multimorbidity and complex multimorbidity. Methods: We conducted a cross-sectional study at Tarama Clinic on Tarama Island, a remote island in Okinawa, Japan. Among patients who visited Tarama Clinic from April 1 to June 30, 2018, those who were ≥ 20 years of age, lived on Tarama Island, and had capacity to give consent were eligible for study inclusion. We collected the following data using medical records, medical expense receipts, and self-administered questionnaires: multimorbidity and complex multimorbidity, participants’ characteristics, and potentially associated factors. Multimorbidity was defined as having ≥ 2 among 17 chronic health conditions, in accordance with previous studies conducted in Japan, and having ≥ 2 among 16 chapters of the International Classification of Primary Care, 2nd edition (ICPC-2). Complex multimorbidity was defined as having ≥ 3 among 16 chapters of the ICPC-2. Results: We included 355 study participants. Descriptive analysis showed multimorbidity prevalence measured using the 17 chronic health conditions in this area was 30.0% (age ≥ 20 years) and 57.5% (age ≥ 65 years). Multimorbidity prevalence measured using the ICPC-2 was 32.9% (age ≥ 20 years) and 60.3% (age ≥ 65 years). We also found a 20.9% (age ≥ 20 years) and 45.1% (age ≥ 65 years) prevalence of complex multimorbidity, respectively. Poisson regression with robust error variance showed that age ≥ 60 years was associated with multimorbidity. Age ≥ 60 years (adjusted prevalence ratio [aPR] 1.887 and 1.831 for ages 60–79 and ≥ 80 years, respectively) and being unemployed (aPR 1.251) were associated with complex multimorbidity. However, having hazardous drinking or more was inversely associated with complex multimorbidity (aPR 0.745). Conclusions: The population-based prevalence of multimorbidity and its upward trend with increasing age on a remote island in Japan was consistent with previous reports in the country. Multimorbidity was associated with age 60 years or older, and complex multimorbidity was associated with age 60 years or older, being unemployed, and not having hazardous drinking or more. Our study findings indicated a possible association between the coexistence of diseases and social determinants of health (SDH) in Japan. To improve care for patients with multimorbidity and complex multimorbidity, more research that takes SDH into account is warranted, and evidence-based policymaking is essential for Japan. The present study can provide a foundation for accumulating such evidence.

Objectives The objective was to clarify the relationship between alcohol consumption/alcohol use disorders and patient complexity. Design Cross-sectional study. Setting A clinic located on a remote island in Okinawa, Japan, providing general outpatient practices and round-the-clock emergency services. Participants Patients who lived on the island, visited Tarama Clinic from 1 April 2018 to 30 June 2018, were aged ≥20 years and had decision-making capacity were judged to be eligible for this study. Main outcome measures Alcohol consumption/alcohol use disorders as measured by the Alcohol Use Disorders Identification Test (AUDIT) and patient complexity as scored by the Patient Centered Assessment Method (PCAM). Results During the 3-month study period, 355 patients (163 women and 192 men) with mean (SD) age of 66.4 (13.6) years were included. Multiple regression analysis of PCAM scores showed that, after adjusting for age, sex, education, occupation, physical activity, smoking, annual medical expenses and number of family members living with the patient, AUDIT scores classified as ‘dependence likely’ were associated with PCAM scores (p value=0.040). Conclusions Alcohol consumption and alcohol use disorders classified as dependence likely are associated with patient complexity.

Introduction The social determinants of health have been gaining recognition, confirming that multidimensional biopsychosocial assessment is essential to improving the health of individuals. This trend has led to the development of conceptual models and measurement tools assessing ‘patient complexity’, understood as a complex interplay of biopsychosocial factors, to improve the efficiency and effectiveness of care; however, the variety of meanings encompassed by the term has led to confusion in the interpretation of patient complexity such that there is no consensus regarding the definition or conceptualisation of patient complexity. The primary objective of this scoping review is to identify and map what is known about the key characteristics of patient complexity through multiple database searches. Methods and analysis This study will follow an established framework for conducting scoping reviews. The data will be extracted through searches of MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Embase, PsycINFO, The Cochrane Library and Google Scholar. Included articles will have: investigated participants aged 19 years or older, with any health condition; described patient complexity, a model for patient complexity, or a measurement tool for patient complexity; and been published in English from 1 January 1970 to April 2022. Article selection and data extraction will be conducted independently by two reviewers and if necessary for consensus, a third reviewer. A descriptive summary will be prepared to explain how the results apply to the scoping review questions. The findings will be a detailed mapping of the health dimensions that emerge from the classification of the extracted data. Subsequently, a definition of patient complexity will be developed. Ethics and dissemination This review does not require ethical approval, as we will use publicly available data. The study findings will be disseminated through a relevant conference presentation and a peer-reviewed journal. This protocol is registered on the Open Science Framework (www.osf.io/hpa3c).

Background: Primary care physician-nephrologist collaboration plays an important role in the management of chronic kidney disease (CKD). However, the benefits of such collaboration in patients with stage 5 CKD remain unclear. Methods: We conducted a retrospective cohort study of adult outpatients with stage 5 CKD across nine nephrology centers in Japan. The exposure of interest was primary care physician-nephrologist collaboration. We examined the association between primary care physician-nephrologist collaboration and clinical outcomes in adult outpatients with stage 5 CKD: dialysis initiation and cause-specific hospitalizations using the Fine–Gray models, which treat death and preemptive kidney transplantation and death and kidney replacement therapy as competing risk events, respectively. Results: Of the 570 patients included in the analysis, 91 (16.0%) received primary care physician-nephrologist collaboration, whereas the remaining patients were treated by nephrologists alone. During a median follow-up of 1.4 years, 399 (70.0%) patients started dialysis, 11 (1.9%) received preemptive kidney transplantation, and 53 (9.3%) died. There were no significant between-group differences in dialysis initiation and CKD- and cardiovascular-related hospitalizations (adjusted subdistribution hazard ratio [SHR] [95% confidence interval], 0.89 [0.64–1.23], 1.22 [0.78–1.90], and 0.95 [0.46–1.98], respectively). However, primary care physician-nephrologist collaboration was associated with a lower risk of infection-related hospitalization (adjusted SHR [95% confidence interval], 0.36 [0.15–0.87]). Conclusions: Our findings suggest that primary care physician-nephrologist collaboration in the management of stage 5 CKD is not associated with delayed dialysis initiation but is associated with a lower risk of infection-related hospitalization, indicating the potential benefits of primary care physician-nephrologist collaboration in stage 5 CKD. Graphical

Introduction: The Lesbian, Gay, Bisexual, and Transgender Development of Clinical Skills Scale (LGBT-DOCSS) is a validated self-assessment tool for health and mental health professionals who provide healthcare for sexual and gender minority patients. This study aimed to develop and validate a Japanese version of LGBT-DOCSS (LGBT-DOCSS-JP) and examine its psychometric properties. Methods: LGBT-DOCSS was translated into Japanese and cross-culturally validated using cognitive debriefing. We then evaluated the structural validity, convergent and discriminant validity, internal consistency, and test–retest reliability of LGBT-DOCSS-JP using an online survey. Results: Data were analyzed for 381 health and mental health professionals aged 20 years or older from three suburban medical institutions. The confirmatory factor analysis indicated that the original three-factor model did not fit well with LGBT-DOCSS-JP. Exploratory factor analysis revealed four new factors: Attitudinal Awareness, Basic Knowledge, Clinical Preparedness, and Clinical Training. Convergent and discriminant validity were supported using four established scales that measured attitudes toward lesbians and gay men, genderism and transphobia, authoritarianism and conventionalism, and social desirability. The internal consistency of LGBT-DOCSS-JP was supported by the Cronbach’s alpha values for the overall scale (0.84), and for each of its subscales (Attitudinal Awareness and Basic Knowledge both 0.87, Clinical Preparedness 0.78, and Clinical Training 0.97). The test–retest reliability for the overall LGBT-DOCSS-JP was supported by an intraclass correlation coefficient score of 0.86. Conclusions: LGBT-DOCSS-JP has the potential to serve as a valuable tool in the development and assessment of effective curricula for LGBT healthcare education, as well as a means to promote self-reflection among trainees and professionals.