論文

BackgroundOvarian aging, characterized by declines in oocyte quantity and quality, results in reduced fertility, particularly in women over 38 years of age. Oxidative stress and endoplasmic reticulum (ER) stress are major contributors, necessitating strategies to support the developmental competence of aged oocytes. Holothuria lessoni, a sea cucumber species rich in bioactive compounds, offers antioxidant and cytoprotective potential that may help counteract these oxidative and ER stress-related declines.Material and methodsAged oocytes from BL6 hybrid female mice were fertilized in vitro and cultured with sea cucumber extract at concentrations of 0, 15, 20, and 25 ppm. Embryo development was evaluated at 24-, 48-, 72-, 96-, and 120-hours post-fertilization. Gas chromatography–mass spectrometry (GC–MS) was used to characterize extract composition, while quantitative reverse transcription polymerase chain reaction (qRT-PCR) of blastocyst expression of HSP90, and GPX1. In silico protein–protein interaction and pathway analyses were performed using bioinformatics databases.ResultsGC–MS revealed multiple bioactive constituents, including fatty acids, esters, squalene, and siloxane derivatives. A concentration of 20 ppm yielded the best developmental outcomes, with 100% of embryos reaching the two-cell stage and 29% forming blastocysts, along with superior blastocyst morphology, while 25 ppm reduced embryo quality. At 20 ppm, HSP90 and GPX1 were upregulated 20-fold and 6.58-fold, respectively, whereas 25 ppm further increased GPX1 but decreased HSP90 expression. Network analysis identified TP53, TNF, and IL1B as central regulators in oxidative stress-related pathways.ConclusionsHolothuria lessoni extract at 20 ppm enhanced early embryonic development of aged murine oocytes, likely by modulating oxidative stress and proteostasis via HSF1–HSP90 and Nrf2–GPX1 pathways. Further studies are required to optimize dosing and confirm downstream molecular targets for later developmental stages.

Background: Refugee, immigrant, and migrant (RIM) populations experienced unique obstacles to healthcare during the COVID-19 pandemic. Already facing displacement, insecure legal status, and economic instability, RIM populations were further affected by service disruptions, discrimination, and systemic weaknesses. The objective of this overview of reviews was to synthesize evidence on barriers and facilitators to healthcare access for RIM populations during the COVID-19 pandemic. Methods: This review followed the PRISMA 2020 guidelines and the protocol was registered in PROSPERO (CRD42024552590). Systematic searches of Embase, CINAHL, MEDLINE, PubMed, CENTRAL, Web of Science, and Google Scholar (January 2020 onward) identified systematic reviews addressing healthcare access for RIM during COVID-19. Two reviewers independently screened studies, extracted data, and assessed methodological quality using AMSTAR 2. Narrative synthesis was used to categorize barriers and facilitators into cross-cutting domains following a socio-ecological model framework. Results: Nine systematic reviews (published 2021–2024) met inclusion criteria, encompassing 14–256 primary studies each, and spanning low-, middle-, and high-income settings across the Americas, Europe, Africa, the Middle East, and Asia. Nine interacting domains of barriers and facilitators emerged involving legal constraints, economic concerns, service provision, physical and digital access, trust and confidence, information and communication, cultural and social influences, psychological and perceptual factors, and structural/systemic weaknesses. Common barriers included fear of deportation, exclusion from national health or social protection systems, job and income loss, high direct and indirect costs, service closures, overcrowded housing, discrimination, and misinformation. Facilitators included suspension of exclusionary policies, telemedicine and digital tools, mobile clinics, multilingual and culturally appropriate communication, messaging from trusted clinicians and community leaders, and civil society engagement. Conclusions: This overview shows that the pandemic both intensified long-standing barriers and prompted innovative solutions for RIM healthcare access. Lessons from the pandemic can help guide future sustainable, inclusive health systems for displaced populations.

The COVID-19 pandemic caused major disruption to healthcare education worldwide, forcing rapid transitions to online learning, interruptions to clinical placements, and heightened uncertainty that profoundly influenced student experiences. Given that academic motivation is a key determinant of learning quality, persistence, and professional identity, this review sought to consolidate global evidence on how the pandemic affected healthcare students’ motivation to study. A systematic search of peer-reviewed literature was conducted following PRISMA-ScR guidelines, identifying studies across medicine, nursing, and allied health programs that reported on changes in motivation and the factors shaping these trajectories. Extracted data were synthesized narratively, with attention to emerging themes such as stress, anxiety, burnout, resilience, gender differences, and the role of professional identity formation. Findings revealed substantial variability: while many students reported reduced motivation due to social isolation, technological barriers, and limited clinical exposure, others described increased drive linked to professional responsibility, adaptability, and resilience. Evidence also indicated gendered differences in motivational patterns, with female students more likely to report stress-related declines. Overall, the pandemic exposed both vulnerabilities and strengths in healthcare student motivation, pointing to the value of educational strategies that promote motivation, resilience, and professional identity development among future practitioners.

Taiwan is widely recognized as a leading destination for medical tourism and serves as a useful model for countries seeking to develop this sector. This study aimed to delineate the roles and competencies of Taiwanese nurse medical tourism facilitators (NMTFs) across the international patient pathway and to derive managerial, educational, and policy implications for this industry. A qualitative descriptive study was conducted using semi-structured interviews with five registered nurses employed as NMTFs in four Taiwanese hospitals (September–October 2019). Data were analysed using a (theoretical) reflexive thematic analysis following Braun and Clarke’s six phases. Four interrelated NMTF roles emerged along the pathway from pre-arrival to post-return: Gatekeeper (eligibility/risk triage and protection of clinicians’ time), Advocate (relationship-based communication across linguistic/cultural boundaries), Coordinator (logistical and clinical scheduling aligned to hospital workflows), and Cultural care leader (transforming experiential insights into organization-level cultural competence). Together, these roles integrate access control, person-centred support, and operational coordination within international medical services. The findings of this study suggest the utility of an integrated nurse-facilitator model embedded in medical tourism provider organizations. Recognizing NMTFs as core team members, formalizing standard operating procedures, and investing in cultural-communication education can improve service quality and patient experience. Key points Nurses employed as medical tourism facilitators (NMTFs) coordinated almost all medical tourism arrangements before clients’ arrival in Taiwan. Because of their clinical background, NMTFs can effectively utilize hospital resources. NMTFs helped to develop the cultural competence of medical professionals.

Background/Objectives: Volunteering has been widely recognized as beneficial to the well-being of older adults, providing health benefits, increased social engagement, and a sense of purpose. This study aimed to explore the associations between volunteering and physical and mental health measures among older adults in Japan. Methods: Using an online survey conducted during the COVID-19 pandemic, 500 participants aged 65 and older were divided into volunteer and non-volunteer groups. Demographic, lifestyle, and health characteristics were comprehensively assessed using a series of reliable and validated instruments. Logistic regression analysis was used to explore the associations between volunteering and health outcomes. Results: The findings revealed that while there were no significant differences in physical health indicators and undertreatment of most diseases (with the exception of cataracts), volunteers reported significantly lower levels of depression and loneliness compared to non-volunteers. The volunteer group also showed greater engagement in social activities and hobbies, which may have contributed to their improved mental health outcomes. Conclusions: The results of this study add to the growing body of evidence suggesting that volunteering may be an effective, low-cost intervention for promoting mental health and social engagement among older adults.

Objective Home independence is an important issue for the elderly in many countries and cultures. The aim of this study was to examine the effect of short-stay service use on stay-at-home duration for elderly people by level of care need under the Japanese long-term care insurance system. Methods We analyzed anonymous, Ministry of Health, Labour and Welfare of Japan Long-Term Care Insurance claims data from Ibaraki Prefecture. All participants were certified as eligible for long-term care insurance and had moved into a facility under long-term care insurance after certification between April 2006 and March 2012. Data was analyzed for 2,454 participants aged 65 years or older who entered residential care at least 1 month after initial use of care services. The participants were divided into 2 groups (low- and high-care need), depending on their required level of care. Cox proportional hazard modeling was used to calculate the adjusted hazard ratio (HR) of residential care admission after initial use of care services. Results Use of short-stay services was positively correlated to delay of residential care admission compared to non-use in the low-care need group (HR; 0.834, 95% confidence interval (CI); 0.740–0.939). In the high-care need group, however, use of short-stay services was somewhat correlated with earlier admission (HR; 1.254, 95% CI; 1.084–1.451). Conclusions The results of this study show that appropriate timing short-stay service use is necessary for the elderly to stay at home longer.

Recently, Japanese medical students are expected to acquire a high degree of English proficiency with the tacit understanding that it will feature in their future profession through interactions with non-Japanese patients and/or engagement with medical research. However, to the best of our knowledge, the motivation of Japanese medical students to learn English as a second language (L2) has not been studied. Using quantitative and qualitative questionnaires, we investigated the L2 learning motivation of second-year Japanese medical students and the degree to which the students have international posture, i.e., their awareness and openness to internationalization. The results revealed that the students were primarily instrumentally and vocationally motivated; in other words, their chief motivation for L2 learning came from an understanding of the usefulness of L2 proficiency for their future profession. The results also showed that the students had strong international posture, as evidenced by a deep desire to communicate internationally and an understanding of the role of English as a tool for global communication. The findings suggest that, to sustain or improve L2 learning motivation, educators should employ study materials that are pertinent to students’ future needs and professions.