For achieving equity of the accessibility to primary healthcare, measuring potential geographical accessibility is essential. The provider-to-population ratio is the most frequently used measure. However, it is difficult to be used in closer region because it does not take into consideration the people and health services beyond its boundary. In order to overcome this problem, we measured the potential access to hospital, using both distance measures and the enhanced two-step floating catchment area (E2SFCA) method. The aim of this study was to compare the number of hospitals in the neighborhood and the E2SFCA score with regard to the amount and equity for access to hospitals. This descriptive study used publicly available data from 2010. The E2SFCA score and number of neighborhood hospitals were obtained from Tochigi province in Japan using a geographic information system. Dataset of four measures by each census tract was obtained. The measures were E2SFCA score, number of hospitals within the 5 km range, number of hospitals within the 10 km range, and number of hospitals within the 15 km range. Correlation and disparity analyses with the Lorenz curve and Gini coefficient were performed. The measures were obtained in a smaller area than municipality considering adjacent areas using a geographical approach. The E2SFCA score was 5.3 [3.2–7.3] hospitals/million (median [quantile range]), compared to 5.6 hospitals/million in total for the given district. The median number of hospitals within the 5 km, 10 km, and 15 km ranges were 1, 39, and 47, respectively. There was no hospital within the 5 km range in one third of the blocks. Both the number of hospitals within the 10 km range and those within the 15 km range were well correlated. Regional difference became smaller as the distance to count the number of hospitals increased. The gap between small number of hospitals and the high E2SFCA score indicated the location of community hospital in depopulated areas. The E2SFCA method is superior for analyzing spatial access to hospital, because it provides information in the closer sub-regions. Regional differences were hardly seen in access to hospital beyond the 10 km range. Further studies in other regions and countries are needed for precise assessment.

Background: The current research into single nucleotide polymorphisms has extended the role of genetic testing to the identification of increased risk for common medical conditions. Advances in genetic research may soon necessitate preparation for the role of genetic testing in primary care medicine. This study attempts to determine what proportion of patients would be willing to undergo genetic testing for salt-sensitive hypertension in a primary care setting, and what factors are related to this willingness. Methods: A cross-sectional study using a self-report questionnaire was conducted among outpatients in primary care clinics and hospitals in Japan. The main characteristics measured were education level, family medical history, personal medical history, concern about hypertension, salt preference, reducing salt intake, and willingness to undergo genetic testing for salt-sensitive hypertension. Results: Of 1,932 potential participants, 1,457 (75%) responded to the survey. Of the respondents, 726 (50%) indicated a willingness to undergo genetic testing. Factors related to this willingness were being over 50 years old (adjusted odds ratio [ad-OR] = 1.42, 95% Confidence interval = 1.09 - 1.85), having a high level of education (ad-OR: 1.83, 1.38 - 2.42), having a family history of hypertension (ad-OR: 1.36, 1.09 - 1.71), and worrying about hypertension (ad-OR: 2.06, 1.59 - 2.68). Conclusions: Half of the primary care outpatients surveyed in this study wanted to know their genetic risk for salt-sensitive hypertension. Those who were worried about hypertension or had a family history of hypertension were more likely to be interested in getting tested. These findings suggest that primary care physicians should provide patients with advice on genetic testing, as well as address their anxieties and concerns related to developing hypertension.

Background: Few studies have assessed the potential of telemedicine to improve end-of-life care quality in rural and remote areas. We investigated health care services needed for end-of-life care at home and examined their associations with willingness to die at home, testing the hypothesis that telemedicine facilitates at-home death in rural and remote settings. Methods: A cross-sectional survey was conducted with a target population of 6,382 residents aged ≥20 years living in designated rural and remote areas of Shunan City, Yamaguchi, Japan. Stratified random sampling was employed to select survey participants, resulting in 3,767 individuals who were mailed self-administered questionnaires. First, we assessed health care services needed for end-of-life care at home (telemedicine, home doctor visits, home nursing care, home personal care services, home support services, and senior day care). Multivariable logistic regression analysis was then performed to determine which services were independently associated with willingness to die at home. Results: Of 3,767 eligible participants, 1,884 (50.0%) responded, and 1,451 were included in the analysis. Among them, 608 (41.9%) were male, 1,166 (80.3%) were aged ≥60 years, and 733 (50.5%) expressed a wish to die at home. Home doctor visits were the most frequently selected service (776 participants [53.5%]), while telemedicine was selected by 193 (13.3%). After adjustment for all measured variables, telemedicine (adjusted odds ratio, 1.41 [95% confidence interval, 1.01–1.98], p = 0.045) and home doctor visits (adjusted odds ratio [OR], 1.50 [95% confidence interval, 1.19–1.90], p < 0.001) were independently associated with willingness to die at home. Discussion: These findings suggest that physician-provided services are central to enabling at-home death. Integrating telemedicine with traditional home doctor visits may improve end-of-life care and facilitate at-home death in rural and remote settings.

Sex differences in gut microbiota may affect health and aging, but evidence in elderly populations is limited and inconsistent. This study examined sex-specific similarities and differences in gut microbiota diversity and composition among apparently healthy elderly Japanese individuals using shotgun metagenomic sequencing. A cross-sectional study was conducted in 100 community-dwelling adults aged 75–83 years (54 males, 46 females). Fecal samples underwent metagenomic sequencing. Alpha and beta diversity were assessed across six taxonomic levels, and taxonomic differences were evaluated using non-parametric tests. No significant sex differences were observed in alpha diversity indices (Shannon, Simpson, evenness, Chao1) at any taxonomic level. Beta diversity based on Bray–Curtis dissimilarity and PCoA also showed no sex-specific clustering. However, certain taxa differed in relative abundance. Males showed higher abundances of Bacteroidota (phylum), Bacteroidia and Betaproteobacteria (class), and Bacteroidales and Burkholderiales (order) (p < 0.05). No significant differences were detected at the family, genus, or species levels. Overall, gut microbial diversity and community structure were largely similar between elderly males and females, with only modest sex-associated differences at higher taxonomic levels. These findings suggest that biological sex may have a limited influence on gut microbiota composition in advanced age and provide population-level reference data for future longitudinal and interventional studies in elderly cohorts.