Search Results (255)

Background: Vaccinations are highly effective in preventing infectious diseases, which otherwise present a serious challenge to the health of individuals and public health. To identify potential gaps in vaccination coverage, we examined childhood vaccination levels in Frankfurt am Main (FFM) and the Rhein Neckar district (including Heidelberg city, RNHD) prior to, during and following the COVID-19 pandemic. Moreover, we explored various factors that appear to contribute to lower vaccination levels in specific communities in either or both locations. The results are intended to guide strategies for designing and improving vaccination services for specific groups in local health settings. Methods: A retrospective analysis was conducted to examine the vaccination rates of children in Frankfurt am Main and the Rhein Neckar district (including Heidelberg city) by using anonymized data from school entry examinations spanning the years 2017 to 2024. Data pre-processing, analysis, and visualization were performed using R (5.4.2). Frequencies and percentages were calculated for sociodemographic and vaccination rates (the completeness of the vaccination schedule recommended by STIKO for children). Multivariate logistic regression was performed to determine factors with a significant impact on vaccination uptake. Results: Multinomial logistic regression with ‘measles-only’ (Measles) as the reference category revealed distinct predictor patterns across vaccination levels. In both regions, children who completed preventive medical check-ups had higher odds of completing the schedule of vaccination plus at least one additional vaccine (ScheduledPlus) versus, measles-only vaccination. In RNHD, children from Eastern European language families and low- and medium-social-status backgrounds showed higher odds of completing the scheduled vaccinations without the recently introduced rotavirus vaccination (ScheduledNotRota), versus measles-only vaccination. In FFM, strong interaction effects were observed between medical examination completion and migration background, with children from non-German birthplaces showing dramatically reduced odds of complete vaccination when preventive care was incomplete. Discussion: The proportion of children with a complete vaccination status remained stable over the study period in both locations, with no evidence of post-pandemic decline. Nevertheless, this stability masks important heterogeneity in vaccine coverage patterns across sociodemographic groups. Systematic identification and modeling of interactions between nationality, parental employment, and healthcare utilization tell a compelling “double jeopardy” story that the effects of these risk factors are not additive but synergistic. Regular medical check-ups remain an important factor in ensuring high vaccination coverage among children until they start school and underscore the justification for such established preventive care programs. A nuanced understanding, however, is crucial for moving beyond simplistic, one-size-fits-all public health messaging. Full article

Background: Low high-density lipoprotein cholesterol (HDL-C) is an established marker of cardiovascular risk. However, HDL-C levels may change over time in relation to metabolic status, lifestyle factors, and medication use, and the cardiovascular implications of longitudinal HDL-C changes remain incompletely understood. Methods: We conducted a retrospective cohort study using the JMDC Claims Database, including 3,387,924 adults who underwent at least two health checkups between 2005 and 2021. Participants were categorized into four groups based on HDL-C changes between two time points: persistently low, low to normal, normal to low, and persistently normal. The primary outcome was incident composite cardiovascular disease (CVD), including myocardial infarction, angina pectoris, stroke, heart failure, and atrial fibrillation. Cox proportional hazards models were used to estimate hazard ratios (HRs) with adjustment for demographic and clinical covariates. Results: During a mean follow-up of 4.3 years, persistently low HDL-C was associated with the highest risk of composite CVD compared with persistently normal HDL-C (HR 1.15, 95% CI 1.12–1.19). Both Low-to-Normal and Normal-to-Low groups also showed elevated risks (HR 1.10, 95% CI 1.06–1.14; HR 1.14, 95% CI 1.10–1.19, respectively). The strongest association was observed for myocardial infarction, whereas the association with stroke was modest and less consistent after full adjustment. Conclusions: Longitudinal changes in HDL-C were associated with cardiovascular risk after adjustment for cardiometabolic factors and medication use. Persistently low HDL-C conferred the greatest risk, and serial HDL-C patterns may provide additional information for cardiovascular risk assessment beyond a single baseline measurement. Full article

Hepatitis E virus (HEV) is a major zoonotic pathogen, with pigs serving as the principal animal reservoir. While consumption of raw or undercooked pig liver is a well-recognized risk factor, systematic data on HEV contamination in retail pork meat remain limited. In this study, 1546 retail pork samples collected from eight geographic regions across Japan were analyzed for HEV RNA using a validated nested RT-PCR method. Analytical sensitivity was determined using the World Health Organization (WHO) International Standard for HEV RNA, yielding a 95% limit of detection (LOD95) of 134 IU/g (95% CI: 105–193). Overall, 15 samples (1.0%) tested positive for HEV RNA, with no significant regional variation (0.4–1.8%; p = 0.8375) or difference between domestically produced (1.0%, 12/1260) and imported pork (1.0%, 3/286; p = 0.7478). Viral loads in quantifiable samples (n = 11) ranged from 9.3 × 10² to 1.0 × 10⁵ IU/g. Genotyping based on partial ORF2 sequences revealed subtype 3b as predominant (n = 7), followed by 3a (n = 5), 3f (n = 2), and 4c (n = 1). Each of the 15 strains showed high nucleotide sequence identity (98.8–100%) to its closest reported Japanese strain(s). Phylogenetic analysis showed that all strains clustered with their closest reported HEV strains, with high bootstrap support, despite genetic diversity within subtypes. These findings demonstrate that retail pork meat in Japan is contaminated with HEV RNA and may represent a potential source of human exposure. However, whether HEV RNA-positive retail pork meat contains infectious virus capable of causing human infection remains to be determined. Full article

Background/Aim: Routine ultrasonography now detects gallbladder polyps (GBPs) more often, but reported prevalence varies across populations. Jeju Island has South Korea’s highest obesity prevalence and red meat consumption, suggesting a rapid nutritional transition similar to that reported in Native Hawaiians. This study aimed to first analyze risk factors influencing GBP prevalence, including birthplace, and second compare clinical variables between JNs and JMs. Methods: Between May 2018 and October 2023, 28,751 individuals underwent medical checkups at Jeju National University Hospital. GBPs were diagnosed via ultrasonography, and risk factors including age, sex, birthplace, metabolic syndrome, hepatitis B virus antigen (HBsAg) positivity, lipid profiles, and alcohol consumption were assessed using univariate and multivariate logistic regression. Results: After exclusions, 15,219 participants were analyzed. The overall prevalence of GBPs was 10.3%. Male participants had a higher prevalence than females (11.4% vs. 9.1%, p < 0.001). The younger age group (20–49 years) showed the highest prevalence, while those aged ≥70 years had the lowest (11.6% vs. 8.6%, p = 0.001). Jeju Natives (JNs) exhibited a significantly higher prevalence than Jeju migrants (JMs) (10.6% vs. 9.0%, p = 0.004). Multivariate analysis identified female sex [odds ratio (OR) = 0.644, p < 0.001], age ≥ 70 years (OR = 0.601, p < 0.001), JN birthplace (OR = 1.260, p = 0.015), HBsAg positivity (OR = 1.347, p = 0.040), and high-risk alcohol drinking (OR = 0.758, p = 0.001) as independent predictors. Notably, the 60–69 age group did not reach statistical significance in the optimized model (p = 0.158). Compared to JMs, JNs were older and had a higher prevalence of fatty liver disease, a higher BMI, and higher levels of AST and GGT, but lower levels of HDL-cholesterol and triglycerides. Conclusions: GBPs are more prevalent among JNs compared to JMs, with birthplace emerging as a novel independent risk factor. Fatty liver disease, BMI, and reduced HDL-cholesterol were associated with GBP risk. These findings hypothesize that dietary and metabolic health factors may be potential pathways for the higher GBP prevalence among JNs, though direct dietary assessment is required for confirmation. Full article

Smoking remains one of the leading preventable causes of chronic disease and premature workplace mortality worldwide. This study examined the association between smoking and nutritional status and hypertension and hematological disorders among hotel workers and occupational health nurses’ role in Indonesia. This cross-sectional study examined associations between smoking, nutritional status, and selected health outcomes among 366 hotel workers in Indonesia using routine medical check-up data. Logistic regression analyses were performed to assess the associations of smoking status and body mass index (BMI) categories with hypertension and hematological abnormalities (leukocytosis and anemia), after adjusting for age, gender, and job level. Older workers (40–69 years) and those categorized as overweight or obese had higher odds of hypertension than younger workers and those with normal BMI (ORs 2.63 and 1.37, respectively). Smoking was associated with a higher risk of leukocytosis (OR 0.395), reflecting increased risk among smokers due to variable coding. Older age and overweight status were strong predictors of hypertension, whereas smoking was associated with increased leukocytosis among hotel workers. These findings highlight the need for targeted OH interventions. Occupational health nurses should collaborate with management to strengthen WHP programs that encourage healthier lifestyles among employees. Full article

Objectives: This study aimed to prospectively investigate the associations among obesity, physical activity, and short-term high medical expenditures in Japanese employees and their dependents. Methods: Participants were 245,044 employees and their dependents aged 40–74 years who underwent the Specific Health Checkup in fiscal year 2008. Health checkup and medical expenditure data for 2008–2010 were provided by health insurers. They were divided into 12 groups according to the combination of body mass index categories (normal, overweight, and obesity) and engagement in exercise and/or daily physical activity (inactive, daily physical activity only, exercise only, and active). The multivariable-adjusted odds ratios of the groups for high total medical expenditures in the next year compared to the inactive normal body mass index group were estimated. High medical expenditures were defined as the top 5% of total annual expenditures, consistent with prior literature identifying high-cost users. Similar analyses were performed by sex and age (<65 years, ≥65 years). Results: Of the participants, 61.8% were men (mean age, 52.1 years). Multivariable-adjusted odds ratios were significantly high only in the inactive groups with overweight or obesity in men and younger individuals. In women and older individuals, the odds ratios were significantly high only in inactive women with obesity; however, the odds ratios were high in women who exercised only and in active older individuals, both with obesity. Conclusions: Exercise or daily physical activity might attenuate the possibility of incurring high short-term medical expenditures in men and younger individuals with overweight or obesity. These findings suggest that physical activity recommendations may need to be tailored for women and older individuals with obesity, and further longitudinal research is warranted. Full article

Background: Physical functional capacity plays a critical role in sports performance and changes markedly from adolescence to adulthood. This study aimed to compare the physical functional characteristics between adolescent and collegiate soccer athletes. Methods: Fifty elite male soccer athletes (30 adolescents, 20 college students) were assessed for joint range of motion, muscle flexibility, dynamic balance, and trunk functional capacity. Results: Adolescent athletes achieved significantly greater general joint laxity score than collegiate athletes (p = 0.01), with significantly greater hip range of motion across all planes (abduction, internal rotation, and external rotation; all p < 0.01). College athletes had significantly lower SLR degree (left: p < 0.01, right: p < 0.05) but significantly greater degrees on passive Ely’s test (p < 0.01) than adolescent athletes. Collegiate athletes delivered significantly superior dynamic balance performance in the Y-balance test, particularly in the posterolateral and posteromedial directions (all p < 0.05). Unexpectedly, trunk functional capacity was significantly lower in collegiate athletes compared with adolescents (p < 0.01). Limb asymmetry was observed in both groups: collegiate athletes showed asymmetry only in the anterior reach direction of the Y-balance test (p = 0.018), whereas adolescents exhibited asymmetry across multiple joints (ankle, hip, hamstrings, and quadriceps; all p < 0.05) and in the posterolateral direction of the Y-balance test (p < 0.01). Conclusions: Adolescent athletes demonstrated significantly superior joint range of motion and lower limb flexibility, whereas collegiate players exhibited better balance performance, indicating distinct functional profiles between the two cohorts, which may be associated with differences in training experience and developmental stages. Full article

Background/Objectives: The Charlson Comorbidity Index (CCI), which focuses on 19 comorbid diseases and conditions, has been widely used as a valid predictor of mortality. This study aimed to comprehensively examine the prevalence of nearly all comorbidities and concomitant medications according to CCI classification (CCI = 0 and CCI ≥ 4) and age group (aged 40–44 and 70–74 years) in middle-aged Japanese adults. Methods: The present study included 9,182,226 individuals who underwent health checkups from April 2018 to March 2019. A total of 15,916 cases of diagnosed diseases and conditions, including communicable diseases; diseases of the eye, ear, skin, and musculoskeletal system; and psychiatric disorders, were investigated alongside 16,886 prescribed medications. Results: The prevalence of allergic rhinitis was ranked among the leading comorbidities in all age groups and CCI categories. Individuals with a CCI ≥ 4 in the 40–44 age group showed a higher prevalence of cardiometabolic diseases such as hypertension, diabetes, and dyslipidemia compared with individuals with a CCI = 0 in the 70–74 age group. Furthermore, individuals with a CCI ≥ 4 in the 40–44 age group also had a higher prevalence of communicable diseases, gastrointestinal symptoms, iron deficiency anemia, and psychiatric disorders compared with individuals with a CCI = 0 in the 70–74 age group. The ranking for prescribed medications was essentially the same between age groups, but was found to differ between CCI categories. Conclusions: This study identified overlooked comorbidities and concomitant medications that are not accounted for in the 19 conditions included in the CCI, which may be important prognostic factors in determining mortality. Although patients with more comorbidities were found to be more frequently diagnosed with cardiometabolic diseases regardless of their age, the presence of pharmacotherapy may be dependent on age. Full article

Grassroots recyclers play a fundamental role in solid waste management in Ecuador; however, they often work under precarious conditions that may compromise their health. This study aimed to identify factors associated with nutritional status, operationalized as the presence or absence of nutritional alterations, among grassroots recyclers through supervised machine learning approaches. Data from 303 recyclers from three Ecuadorian cities (Cuenca, Macas, and La Libertad) were analyzed, incorporating sociodemographic, occupational, and health-related variables. Nutritional alterations were defined based on anthropometric and biochemical indicators, specifically, excess body weight and/or elevated total lipid levels. The results showed that 71% presented nutritional alterations, evidencing an important public health problem in this vulnerable population. Significant associations were observed with sex, age, canton of residence, ability to ride a bicycle, bicycle use for work, and attendance at medical check-ups. Among the evaluated models, CatBoost trained with SMOTE achieved the highest ROC-AUC value and the most balanced performance between classes, although sensitivity for individuals without nutritional alterations remained limited. Feature importance analysis highlighted sociodemographic, occupational, economic, and healthcare access factors, underscoring the multidimensional nature of nutritional risk and supporting the use of machine learning as a support tool for public health planning and targeted interventions. Full article

Background: Specific health checkups in Japan aim to prevent and detect non-communicable diseases (NCDs). Lifestyle information and non-invasive measurements obtained during these checkups are valuable for population health monitoring. This study aimed to develop a predictive model for type 2 diabetes mellitus (T2DM) using only non-invasive measurements and to identify key predictors. Methods: A retrospective observational study was conducted using linked health checkup records and medical claims from a city in Japan. Logistic regression was performed to predict a T2DM diagnosis. Results: A total of 409 of the 1363 participants were diagnosed with T2DM, including 285 of the 950 participants aged 40–74 years and 124 of the 413 participants aged ≥75 years. The model achieved an area under the receiver operating characteristic curve of 0.680 for those aged 40–74 years and 0.665 for those aged ≥75 years, indicating moderate discrimination. Key predictors included male sex, use of antihypertensive drugs, walking speed, and eating habits within 2 h before bedtime. In particular, male sex, having a slower walking speed, and not eating within 2 h before bedtime were positively associated with T2DM diagnosis. Conversely, the absence of antihypertensive or lipid-lowering medications was negatively associated with T2DM diagnosis. Conclusion: A model based solely on non-invasive measurements moderately identified individuals at risk for T2DM in this community-based Japanese population. Routinely collected health checkup data may support early identification and targeted preventive strategies. Full article

In the United States, although the gaps in health insurance coverage by sexual orientation have been closing since the implementation of the Affordable Care Act and legalization of same-sex marriage, the LGB group (i.e., lesbian, gay, bisexual) continues to report healthcare utilization and access inequities such as more delayed or unmet care. The extant research has often examined healthcare utilization and access inequities due to affordability (e.g., out-of-pocket costs). However, healthcare utilization and access inequities are only partially explained by cost reasons; there are non-cost reasons that have not been adequately empirically examined. The present study innovatively includes discrimination structural variables to understand how social structure is associated with healthcare utilization and access inequities of LGB people. It focuses on two routine health services—regular check-ups and prescription medications—for LGB people who have chronic diseases. Additionally, sexual orientation may intersect with sex assigned at birth (sex, hereafter, i.e., male, female) to impact healthcare utilization and access inequities. The current study applies quantitative intersectional analysis to understand healthcare utilization and access inequities from a sexual orientation and sex intersectional lens and for easier and clearer interpretations of intersectional results and more actionable policy implications for inter-categorical groups. Using the 2023 National Health Interview Survey (weighted N = 136,231,053), we conducted quantitative intersectional analysis for logistic regression using complex survey data. First, we fit a series of logistic regression models with sexual orientation–sex interactions for routine healthcare utilization and access outcomes, adjusting for covariates. Second, we calculated average marginal predictions for inter-categorical groups by interacting sexual orientation and sex and other covariates. Third, we computed risk ratios of average marginal predictions for all the covariates. Lastly, we examined the interaction of inter-categorical groups/sexual orientation and structural variables. Our results show that experiencing a higher level of discrimination is positively associated with underutilization of regular check-ups and lower access to prescription medications, and this effect is stronger for LGB people. Further, LGB women are least likely to utilize regular check-ups and LGB men are least likely to access prescription medications among the inter-categorical groups. Highlighting structural issues of healthcare utilization and access offers new evidence on healthcare utilization and access inequities that can inform policies for raising awareness of and addressing structural issues. The intersectional analyses suggest that relevant policies target LGB women and LGB men. Full article

Background: Cognitive impairment is a major health problem, so several studies worldwide have studied its aggravating and protective factors. However, few studies have looked into the prediction of better or worsening cognitive status based on the presence of the most relevant biopsychosocial factors. Thus, the aim of this study is to predict cognitive status classification, specifically into normal cognitive status, mild cognitive impairment, and severe cognitive impairment, based on the most studied risk and protective factors in the context of the Survey of Health, Ageing and Retirement in Europe and Harmonized Cognitive Assessment Protocol association (SHARE-HCAP) project. Methods: Participants were from five European countries, and measures included their cognitive status classification from SHARE-HCAP and several associated factors previously measured in the eighth wave of SHARE. Results: A multinomial logistic regression was performed, with normal cognition as the reference category. Most individuals were correctly classified. Conclusions: Frequent participation in social activities and good cognitive task performance were associated with a lower likelihood of mild cognitive impairment compared to normal cognitive status. In turn, higher scores in depression and social network were associated with an increased likelihood of being classified as MCI in contrast to normal cognition. Additionally, being a woman and having worse cognitive performance were predictors of severe cognitive impairment classification over normal cognition status. Depression also contributed to a higher likelihood of being classified as mild and severe cognitive impairment, in contrast to a normal cognitive status. These findings highlight the importance of preventive medical check-ups and interventions before the onset of the first cognitive decline symptoms. Full article

Objectives: The purpose of this study is to evaluate the trend of anthropometric and cardiometabolic risk (CMRs) changes among health professionals over a three-year period at a medical center in Taiwan. Study Design: A 3-year follow-up cohort study design. Methods: This cohort study was conducted from 2019 to 2022 in a single healthcare center. The participants underwent annual physical check-ups for three consecutive years. CMRs were measured using standard methods and weight status change was measured using BMI. We used McNemar test and Wilcoxon Sign Rank test to evaluate the differences within and between subgroups. We used logistic regression to examine the risk of increased CMRs among subgroups of different weight status changes. Results: A total of 2217 participants (1641 females and 576 males) were included in this study, with a mean age of 40.2 ± 10.2 years. During this period, 72 (4.4%) female participants’ weight status changed from normal weight to overweight or obese and 530 (32.3%) remained overweight or obese. Among males, the proportion was 6.8% and 61.1%, respectively (p < 0.01). Participants who remained overweight or obese have more adverse CMRs. Compared to remained normal weight male subjects, the mean systolic blood pressure (131.0 ± 18.1 mmHg) and fasting blood glucose (94.4 ± 13.5 mg/dL) were higher in remained overweight or obese subjects (p < 0.001). Among females, those who remained overweight or obese have 4.01 (95% CI 2.92–5.51) times higher risk for abnormal diastolic blood pressure and 2.98 (95% CI 2.05–4.32) times higher risk for abnormal blood glucose compared to those with remained normal weight. Conclusions: Participants who remained overweight or became obese had more adverse CMRs such as high blood pressure, hyperglycemia, and dyslipidemia during the 3-year follow-up period. Full article

Objective: To explore the value of multimodal molecular imaging in diagnosing and differentiating dementia with Lewy bodies (DLB). Methods: A retrospective analysis was conducted on clinical data and multimodal molecular imaging of 40 probable DLB patients treated at Peking Union Medical College Hospital (August 2017–December 2024). All 40 had ¹⁸F-FDG PET/CT; 15 had ¹³¹I-MIBG imaging; 11 had ¹⁸F-FP-CIT PET/CT. A total of 12 patients with poor cognition or atypical ¹⁸F-FDG PET/CT underwent ¹⁸F-AV45 PET/CT (2 also had ¹⁸F-PM-PBB3 imaging). A sex- and age-matched control group (cognitively normal, same-period health checkup ¹⁸F-FDG PET/CT) was included. ¹⁸F-FDG PET/CT images were visually and semi-quantitatively analyzed (ROI, SPM). ¹⁸F-AV45 PET/CT was assessed both visually and semi-quantitatively; ¹³¹I-MIBG imaging and ¹⁸F-FP-CIT PET/CT were visually evaluated. Results: The 40 DLB patients (29 males, 11 females; mean age 72 years) had distinct initial symptoms: 8 (20%) presented with cognitive decline as the first symptom, 23 (57.5%) with parkinsonian symptoms as the first symptom, and 9 (22.5%) with both symptoms occurring simultaneously. Mean intervals: 16.25 months from initial cognitive decline to parkinsonian symptoms, and 24.43 months from initial parkinsonian symptoms to cognitive decline. All had parkinsonian symptoms and cognitive impairment; 38 (95%) had visual hallucinations; and 26 (65%) had REM sleep behavior disorder. ¹⁸F-FDG PET/CT: 30(75%) showed typical occipital hypometabolism and posterior cingulate island sign; 10 (25%) had atypical findings. ¹³¹I-MIBG (15/15, 100%): cardiac sympathetic denervation. ¹⁸F-FP-CIT (10/11, 90.9%): basal ganglia dopaminergic damage. ¹⁸F-AV45 (9/12, 81.8%): positive. Semi-quantitative ¹⁸F-FDG analysis revealed parietal, occipital, and lateral temporal hypometabolism in DLB (left more severe than right). Conclusions: Dementia with Lewy bodies (DLB) presents with pre-onset parkinsonism and cognitive impairment, plus high rates of visual hallucinations and sleep disorders. Key imaging features—occipital hypometabolism/island sign on ¹⁸F-FDG PET/CT, cardiac sympathetic denervation on ¹³¹I-MIBG, and basal ganglia dopaminergic damage on ¹⁸F-FP-CIT—aid DLB diagnosis. ¹⁸F-AV45 PET/CT detects Aβ pathology in severely cognitively impaired patients, suggesting these DLB patients may have underlying AD pathology beyond DLB. Full article

Background/Objectives: Smoking is an established cofactor for cervical carcinogenesis, but evidence on how Smoking Pattern Changes around cohort entry relate to risk in Japan is limited. We quantified cervical cancer risk by baseline smoking status and by changes between two routine health checkups in a nationwide cohort. Methods: We used the Japan Medical Data Center claims–checkup database between January 2005 and July 2022. Women with ≥2 pre-index checkups were included; the index date was the second checkup. Self-reported smoking at each visit defined never, former (quit), new (initiated), and current (persistent) smokers; checkup pairs >36 months apart were excluded. Incident cervical cancer required ICD-10 C53 plus cancer-directed treatment (surgery, radiotherapy, or systemic antineoplastic therapy). Multivariable Cox models estimated hazard ratios (HRs) with 95% CIs, adjusting for age, BMI, alcohol, exercise, hypertension, diabetes, cerebrovascular and cardiovascular disease, and cholangitis. Results: Among 1,330,797 women, incidence rates (per 100,000 person-years) were 151.4 in never smokers and 244.9 in ever smokers. Ever versus never smoking was associated with higher risk (HR 1.53, 95% CI 1.43–1.62). A graded risk was observed across Smoking Pattern Change categories versus never: former HR 1.44 (1.15–1.79), new HR 1.51 (1.20–1.90), current HR 1.54 (1.44–1.64). By age, HRs were 1.58 (1.47–1.70) for <50 years and 1.35 (1.17–1.55) for 50–64 years; ≥65 years was not statistically significant (HR 0.69, 0.30–1.59). Conclusions: Smoking was associated with substantially higher cervical cancer risk, with a clear risk gradient from former to new to current smoking. The rapid elevation in new smokers and residual risk after quitting support integrating proactive cessation and initiation prevention into risk-stratified screening and routine health-check programs in Japan. Full article