Journal of rural medicine : JRM最新文献

Objective: This study investigated the association between rurality and healthcare employees' income in Japan's secondary medical areas (SMAs), specifically focusing on whether hospital beds, particularly in public hospitals, contribute more to employee income in rural areas than in urban areas at the SMA level. To our knowledge, this is the first study to examine these associations using a validated rurality index for healthcare research in Japan (RIJ).

Materials and methods: This ecological cross-sectional study analyzed all the SMAs in Japan using publicly available data. SMAs were categorized into urban and rural areas using the RIJ cutoff values. Multiple linear regression analyses were conducted to examine the association between the proportion of employee income in healthcare (dependent variable) and number of hospital beds by type and ownership (explanatory variables). All variables were treated as continuous variables and the forced entry method was used. Hospital bed types included general and long-term care beds in both public and private hospitals, high-acuity hospital beds, and clinic beds per 100,000 population.

Results: Of the 334 SMAs, 158 were classified as urban (low RIJ score) and 176 as rural (high RIJ score). In urban areas, general beds in private hospitals had the strongest association with healthcare employee income (β=0.396, P<0.001). In rural areas, general beds in public hospitals showed the strongest association (β=0.452, P<0.001), followed by general beds in private hospitals (β=0.342, P<0.001).

Conclusion: This study demonstrated that the contribution of hospital bed type to healthcare employee income differs substantially between urban and rural areas. Rural areas depend more on general beds in public hospitals, whereas urban areas rely primarily on general beds in private hospitals. This study suggests that public hospitals, particularly their general bed numbers, play a critical role in sustaining essential healthcare services and supporting employee incomes in rural areas.

Objective: This study aimed to investigate the relation among farming activities, muscle strength, and body composition in middle-aged and older adults.

Patients and methods: Participants aged ≥40 years were recruited from three health-related events in Nagoya City, Japan. A questionnaire was used to collect information on basic characteristics and daily activities, and grip strength, body weight, and body composition were assessed.

Results: The study included 126 participants (42 in the farming activity group and 84 in the nonfarming activity group) with a mean age of 60.4 ± 12.5 years, of whom 65.9% were women. A decline in skeletal muscle percentage was significantly associated with aging, regardless of farming activities. Lower grip strength was significantly associated with aging in the nonfarming group but not in the farming group.

Conclusion: The findings of this study suggest that farming activities may be associated with the maintenance and improvement of muscle strength.

Objective: Clinical empathy is a vital aspect of medical practice that enhances patient care and strengthens the doctor-patient relationship. This cross-sectional study aimed to investigate innovative teaching methods for clinical empathy by exploring the use of a virtual patient model in medical education.

Materials and methods: Medical students were allocated into two groups according to their roll numbers (odd or even): the virtual patient (VP) group, which was exposed to Virtual People Factory (VPF) simulations, and the standard patient (SP) group, which interacted with volunteers role-playing as patients. Pre- and post-interaction changes in empathy levels were assessed using the Toronto Empathy Questionnaire. Empathetic communication was evaluated during the interactions using the Empathetic Communication Coding System (ECCS) by the research team.

Results: Empathy scores were similar between the VP and SP groups in both pre- and post-intervention assessments.

Conclusion: The findings indicate that virtual patient models can be effective in enhancing clinical empathy, highlighting their potential as a teaching tool in medical education.

Objective: This study aimed to assess and compare the readability, understandability, and actionability of radiation-related health information targeting fetuses and children, as provided by Japanese-language web-based sources and AI chatbot-generated content. Furthermore, this study aimed to explore the potential of AI tools to improve access to health information in rural and underserved regions.

Materials and methods: We analyzed 40 publicly accessible Japanese webpages and 30 AI-generated texts produced by ChatGPT (paid and free versions), Copilot, and Gemini. Two prompt types were used: one at the standard reading level and the other at the 6th-grade reading level. Texts were evaluated using the Japanese version of the Patient Education Materials Assessment Tool for Printable Materials (PEMAT-P) to assess understandability and actionability, and jReadability to evaluate text complexity.

Results: At the standard level, 46.7% of the ChatGPT-4o texts and 78.6% of the Gemini texts achieved PEMAT-P scores ≥70. At the 6th-grade level, all AI-generated texts exceeded this threshold. The AI texts were consistently easier to read than the web-based materials. The paid version of ChatGPT-4o generated slightly more comprehensible text than its free counterpart. However, both AI and web content lack sufficient actionable elements and visual support. Among chatbots, Gemini produced the most user-friendly content, whereas Copilot exhibited notable limitations in terms of coherence and clarity.

Conclusion: Even free AI chatbots can generate health information that is easy to read and understand when guided by well-designed prompts. These tools have the potential to reduce health information disparities, especially in rural areas or during disasters where access to professional medical consultations may be limited. Future studies should address the accuracy, reliability, and practical implementation of AI-generated content in real-world health communications.

Objectives: This report examined the challenges of providing health support to residents evacuated after the Fukushima nuclear accident.

Materials and methods: We reviewed municipal administrative records and observed health examinations and exercise classes to describe Namie Town's health support programs for dispersed residents.

Results: Although evacuation orders were lifted in most areas by 2017, only 15% of registered residents have returned to Namie town, while the majority continue to live as evacuees. The town's responsibility to provide health services to geographically dispersed registered residents has created significant administrative and logistical challenges, raising questions about the sustainability of current municipal-based health support systems. Meanwhile, resident-initiated exercise groups have emerged in evacuation locations, demonstrating a potential alternative approach to health promotion and community rebuilding.

Conclusion: This case study highlights the need to reconsider both administrative frameworks and community-based solutions for long-term disaster recovery.

Objective: This study aimed to assess the proportion of long-term care settings that deliver palliative care services to older clients with advanced dementia and identify trends across different facility types in Japan.

Participants and methods: A nationwide cross-sectional facility-based survey was conducted between November 2022 and January 2023. The survey targeted 3,000 long-term care facilities, including 1,000 geriatric hospitals, 1,000 geriatric health service facilities, and 1,000 home nursing care stations. Palliative care practices were assessed using an eight-item scale covering pain assessment, symptom management, spiritual care, and family support.

Results: Less than half of the geriatric hospitals supported family participation or addressed the spiritual needs of older clients with dementia, although most conducted pain assessments and prescribed analgesics. In the geriatric health service facilities, fewer than half used pain assessment tools or supported family caregivers' distress and involvement. In contrast, more than 80% of the home nursing care stations reported implementing most of the listed palliative care practices.

Conclusion: Palliative care provisions for older adults with advanced dementia vary considerably across long-term care settings in Japan. These findings highlight the need to develop specific strategies to enhance palliative care delivery in institutional and community-based settings.

Objective: This study aimed to examine whether vegetable supply sources and production areas are associated with the quantity and variety of vegetable intake.

Materials and methods: The setting of this cross-sectional study was one agricultural district (114 households) in Japan. Respondents were asked about their use of 10 vegetable supply sources (e.g., home-grown, receiving from others) and their vegetable intake frequency from five production areas (e.g., home-grown, district-grown). Vegetable intake quantity and variety were assessed using validated scales.

Results: Among the 163 included participants (73 men and 90 women), the quantity of vegetable intake was significantly greater among men who were home-grown vegetable consumers than among non-consumers. The variety of vegetable intake was significantly greater among men who received vegetables than among non-receivers, among supermarket non-users than among users, and among women who used farmers' markets outside the district than among non-users. For vegetable production areas, the variety was significantly greater among men with high district-grown vegetable intake than among those with low intake and among women with high city-grown vegetable intake than among those with low intake.

Conclusion: Both vegetable supply sources and production areas were associated with the quantity and variety of vegetable intake, which may provide insights into potential environmental factors influencing eating behaviors. Specifically, home-grown, received, and farmers' market vegetable sources were positively associated with a greater quantity and variety of vegetable intake, whereas supermarket use was negatively associated with variety. Vegetable production areas, such as district- or city-grown areas, were also positively associated with variety.

Objective: Telemedicine is expected to be useful in rural areas owing to its advantages in improving patient access to medical care. In Japan, rural clinics and core hospitals are assigned to provide rural medical care according to the medical plans formulated for each prefecture. However, the relationship between telemedicine use in such medical facilities and the role of local governments remains unclear. Therefore, their relationship was investigated in this study.

Materials and methods: A nationwide survey was conducted in 2022. Questionnaires were sent to rural clinics (n=1,006) and core hospitals (n=334) via mail.

Results: The response rates for rural clinics and core hospitals were 51.2% and 50.6%, respectively. Telemedicine was used in 24.9% of the clinics and 24.9% of the core hospitals. Local government collaboration was significantly more prevalent in the telemedicine (+) group than in the telemedicine (-) group in rural clinics (44.5% vs. 5.2%, P<0.01) and core hospitals (35.7% vs. 19.4%, P<0.05). In the telemedicine (-) group, the first-ranked barrier to telemedicine use was hardware preparation (clinics, 34.0%; core hospitals, 26.4%), followed by financial issues (clinics, 22.4%; core hospitals, 22.0%). In the telemedicine (+) group in rural clinics, both doctor-to-patient (45.6% vs. 22.5%, P<0.01) and doctor-to-patient with nurse models (52.6% vs. 7.0%, P<0.01) were significantly more prevalent in collaboration with local governments.

Conclusion: The relationship between rural medical care facilities and local government collaborations may contribute to the development of rural telemedicine in Japan.

Objective: In modern society, where women's continued participation in the workforce is increasing, health issues associated with menopause require a multifaceted response owing to the complex interplay of physical, psychological, and social factors. We previously demonstrated that difficulties in self-acceptance of menopause created conflicts for women, indicating a need for support based on this understanding. This study aimed to clarify the internal process of self-acceptance using qualitative data from our prior work and to provide foundational knowledge for developing support systems.

Participants and methods: Based on previous research, we extracted descriptions related to self-acceptance from semi-structured interviews with 20 women, primarily in the medical and welfare professions, and conducted a secondary analysis using qualitative content analysis.

Results: The results confirmed the five-stage process of menopausal self-acceptance: 1. awareness (noticing physical changes) and 2. resistance (resisting ill health and social pressure), 3. exploration (access to medical care and information); 4. acceptance (acceptance and adjustment to changes), and 5. redefinition (reevaluating experiences and reconstructing the self). Individual differences were observed in that these stages did not progress in a linear fashion but rather involved fluctuations. The presence or absence of support from the environment and interpersonal relationships likely influences this transition.

Conclusion: Menopause is not merely a period of loss but can also be viewed as a turning point for reconstructing one's roles and self. The results of this study indicate that fostering proactive self-acceptance is crucial for women to continue working while maintaining their mental and physical health.

Objective: To elucidate the relationship between health-related quality of life (HRQOL) and all-cause mortality in O City, Ehime Prefecture, Japan, using the Basic Resident Registration data collected over a 13-year follow-up period.

Materials and methods: Using the Basic Resident Registration System, we analyzed data from 3,398 middle-aged Japanese participants (1,409 men and 1,989 women) who had completed a detailed lifestyle questionnaire and were followed until death, relocation, or survival between 2009 and 2022. HRQOL was measured using the Short Form-8 Health Survey (SF-8). Physical component summary (PCS) and mental component summary scores were derived from the eight SF-8 subscales. A Cox proportional hazards regression model was applied to examine the associations between HRQOL and all-cause mortality, adjusting for the following covariates: age, body mass index, elevated blood pressure/hypertension, dyslipidemia, prediabetes/diabetes, alcohol consumption, smoking, solitary living, and physical activity.

Results: A total of 317 deaths occurred during the 13-year follow-up period. After adjustment for nine covariates, a low PCS score (hazard ratio=1.51; 95% confidence interval: 1.05-2.15) in men was significantly associated with all-cause mortality.

Conclusion: Among men, a low PCS score was significantly associated with all-cause mortality.