Micronutrients include vitamins, minerals and, trace elements that are required in minute quantities but play a vital role in normal human growth, development and physiological functioning. Micronutrient deficiencies, also known as hidden hunger, are a global issue, with particularly high prevalence rates in developing countries. Currently, Sri Lanka is experiencing the double burden of over- and undernutrition. This review describes the micronutrient status of Sri Lanka based on results of national surveys and related articles published from 2000. The available data suggest a higher prevalence of iron, zinc, calcium, folate, and vitamin A deficiencies. The prevalence of iodine deficiency has declined gradually following the implementation of a universal salt iodization program. Iron deficiency is the most common cause of anemia and low red blood cell indices. Females are more vulnerable to micronutrient deficiencies than males. The coexistence of multiple micronutrient deficiencies and concurrent macro- and micronutrient deficiencies is common. Studies have shown an association between micronutrient deficiencies and different demographic, socioeconomic, and dietary factors. Therefore, there is a need for comprehensive studies, nutritional policies, and nationwide intervention programs in Sri Lanka to improve the micronutrient status of the population.

Although dual-energy X-ray absorptiometry (DXA) and body impedance analysis are commonly used to measure skeletal muscle mass (SMM), a computed tomography (CT) scan is preferred in clinical practice. We aimed to propose the cut-off values of skeletal muscle mass index (SMI) calculated using CT scans, using DXA as the reference method. We retrospectively assessed 589 patients with chronic liver disease. The SMI was assessed using appendicular SMM by DXA and total muscle area at the level of the third lumbar vertebra (L3) calculated by CT. The cut-off value was determined with reference to the Asian Working Group for Sarcopenia criteria. DXA identified 251 (42.6%) patients as having presarcopenia. In men, the cut-off value of SMI for presarcopenia was determined to be 45.471 cm²/m², with an area under the curve (AUC) of 0.863 (95% confidence interval (CI): 0.823 to 0.903), and in women, this value was determined to be 35.170 cm²/m², with an AUC of 0.846 (95% CI: 0.800 to 0.892). Cohen’s kappa coefficient was 0.575 (95% CI: 0.485–0.665) in men and 0.539 (95% CI: 0.438–0.639) in women.

Disparities in accessing advanced stroke treatment have been recognized as a policy challenge in multiple countries, including Japan, necessitating priority solutions. Nevertheless, more practical healthcare policies must be implemented due to the limited availability of healthcare staff and financial resources in most nations. This study aimed to evaluate the supply and demand balance of mechanical thrombectomy (MT) and identify areas with high priority for enhancing stroke centers. The target area of this study was Hokkaido, Japan. We adopted the capacitated maximal covering location problem (CMCLP) to propose an optimal allocation without increasing the number of medical facilities. Four realistic scenarios with varying levels of total MT supply capacity for Primary stroke centers and assuming a range of 90 minutes by car from the center were created and simulated. From scenarios 1 to 4, the coverage increased by approximately 53% to 85%, scenarios 2 and 3 had 5% oversupply, and scenario 4 had an oversupply of approximately 20%. When the supply capacity cap was eliminated and 8 PSCs received 31 or more patients, they became priority enhancement targets. The CMCLP estimates demand coverage considering the supply and demand balance and indicates areas and facilities where MT supply capacity enhancement is a priority.

Blood transfusion, splenectomy, and partial splenic embolization (PSE) are generally performed for thrombocytopenia in patients with cirrhosis. Recently, thrombopoietin (TPO) agonists have become available, and investigations of patients who would benefit from them are necessary. Therefore, it is important to understand the fluctuations in cytokine levels associated with PSE. Therefore, fluctuations in platelet-associated immunoglobulin G (PAIgG), interleukin 6 (IL-6), and TPO levels with PSE were analyzed in this study. The study included 110 patients with liver cirrhosis and thrombocytopenia, with the aim of improving platelet counts. Fluctuations in PAIgG, IL-6, and TPO levels were investigated. The average splenic embolization ratio was 58.0% in patients with PSE. The platelet count rose significantly from 6.95 [5.40, 8.60] × 10⁴/mL to 14.05 [10.43, 18.05] × 10⁴/mL (P < .01), IL-6 rose significantly from 3.56 [2.53, 7.33] pg/mL to 18.90 [9.17, 32.95] pg/mL (P < .01), TPO rose significantly from 0.82 [0.52, 1.21] fmol/mL to 1.58 [0.97, 2.26] fmol/mL (P < .01), and PAIgG decreased significantly from 64.20 [38.33, 118.75] ng/10⁷ cells to 37.50 [22.25, 70.00] ng/10⁷ cells (P < .01). On multivariate analysis of factors related to the rate of platelet increase with PSE, primary biliary cholangitis (B = 0.475, P < .01), splenic embolization ratio (B = 0.75, P < .01), IL-6 change ratio (B = 0.019, P < .01), and PAIgG change ratio (B = −0.325, P < .01) were significant. When attempting to improve thrombocytopenia with PSE, adequate splenic embolization needs to be obtained together with improvements in IL-6, PAIgG, and TPO levels. With unsatisfactory improvement in thrombocytopenia, TPO agonist administration was considered.

Background and Aims: Japan is one of the oldest societies worldwide and manages a system of care for older adults in the community. In the 2000s, a community‐based integrated care system was introduced to enable older adults to live in their neighborhoods. Home visiting nursing (HVN) is a crucial component of this system; however, the current and future shortage of home visiting nurses is a concern. Thus, HVN services may not be available in some areas; however, no indicators of the accessibility of HVN services have been developed. Developing accessibility indicators will serve as a standard for considering the allocation of health care resources and supporting future nursing policies that improve regional disparities.Methods: We estimated the population‐weighted spatial accessibility index (PWSAI) of HVN services in Hokkaido, using the two‐step floating catchment area method (2SFCA). The 2SFCA comprised population, location of HVN agencies, number of home visiting nurses, and travel time. A multivariate regression model was run for the number of HVN users in each municipality as the objective variable to test the validity of the PWSAI; the number of home care support clinics, home care support hospitals, HVN agencies, home visiting nurses, home visiting nurses (24/7), total beds in health care facilities for older adults, and nursing homes for older adults were included as other explanatory variables.Results: The PWSAI was median 9.0 [interquartile range: 6.2−11.8]. The distribution of the PWSAI was mapped to visualize the existence of regional differences. As a result of the conditional autoregressive model, PWSAI and home visiting nurses (24/7) were significant, Exp(β) and 95% credible interval were 1.043 [1.015−1.076] and 1.021 [1.006−1.036], respectively.Conclusion: The PWSAI was positively correlated with the number of HVN users in each municipality and can serve as an indicator for assessing the accessibility of HVN.