Journal of rural medicine : JRM最新文献

Objective: This study aimed to investigate the amount of physical activity, including daily movement, and the factors related to the amount of physical activity undertaken by patients with type 2 diabetes mellitus at an outpatient clinic.

Patients and methods: A self-administered questionnaire was distributed to 111 patients, aged 20 years or older, with type 2 diabetes mellitus, who visited a diabetes outpatient clinic. The amount of physical activity was investigated using the International Physical Activity Questionnaire-Long Version. Influencing factors were divided into individual attributes (age, sex, and employment status), disease-related factors (body mass index, treatment period, medication usage, insulin usage, symptoms of fatigue, and lethargy), and emotion-related factors (depression and optimism). These were tested using stepwise regression analysis.

Results: Daily physical activity was 288 metabolic equivalents of task/minute. The sub-scores by the time of day showed "physical activity within the household" and "physical activity during leisure time" as the highest, with 51 metabolic equivalent of tasks/minute. Employment status, medication usage, and depression status were found to have a significant influence and explained 17.9% of the distribution of the entire model.

Conclusion: The results suggest that the amount of daily physical activity among non-working patients should increase. Moreover, we highlight the need to provide diabetes education from the early treatment stages and the importance of early detection and care of patients' psychological needs.

Objective: Repeated guidance through specific health guidance (SHG), a service that provides health advice to high-risk individuals for specific health examinations, may be affected by examinees' mental health status. However, the association between repeated SHG sessions and mental health remains unclear.

Materials and methods: Data were collected from 123 men and women who underwent specific health checkups at Jiaikai Izuro Imamura Hospital between April 13, 2021 and April 13, 2022 after receiving SHG in the previous year. A questionnaire survey was conducted to assess burnout, resilience, and lifestyle-related factors such as weight change and the amount of alcohol consumed. Odds ratios (OR) and 95% confidence intervals (CI) for repeated SHG were estimated using stepwise multiple logistic and mediation analyses.

Results: The results showed that repeated SHG was significantly associated with weight gain ≥10 kg from the age of 20 years (OR=4.41, 95% CI 1.74-11.20) and burnout subscale of cynicism (OR=4.18, 95% CI 1.31-13.33).

Conclusion: Weight loss guidance could be an effective component of SHG. Additionally, individuals who are repeatedly provided with SHG experience a mental health burden. Furthermore, interventions to reduce cynicism may be necessary to prevent the need for repeated SHG.

Objective: This study aimed to elucidate the relationship between daily eating habits and stroke risk factors in O City, Ehime Prefecture, Japan, using stroke registry data collected over a 26-year follow-up period based on standardized national criteria.

Materials and methods: Overall, 1,793 middle-aged Japanese participants (446 men and 1,347 women) who completed a 33-item Food Frequency Questionnaire (FFQ) and had no history of stroke were matched to those from O City in a stroke registry from 1996 to 2022. Stroke diagnosis for each person was used to determine whether this was their first documented stroke, and we classified strokes as either a cerebral infarction (CI) or a hemorrhagic stroke (HS), the latter which included an intracerebral hemorrhage (ICH) or a subarachnoid hemorrhage (SAH). A Cox proportional hazard regression model was used to examine the association between habitual dietary intake and the occurrence of stroke, using the following covariates: age, body mass index, elevated blood pressure/hypertension, dyslipidemia, prediabetes/diabetes, alcohol consumption, and smoking.

Results: During the 26 years of follow-up, 45 men (10.1%) and 76 women (5.6%) had stroke. The CI rate was 70.2% (n=85; 38 men, 47 women). The HS rate was 29.8% (n=36; 7 men and 29 women); of these patients, 26 and 10 had ICH and SAH, respectively. In men, orange intake showed a significant inverse correlation with CI. In women, fresh fish intake showed a significant inverse correlation with CI, while yogurt intake showed a significant inverse correlation with HS.

Conclusion: Our results indicated that fresh fish intake was significantly associated with the prevention of CI among women in a Japanese cohort survey.

Objective: To determine the seasonal differences in instrumental activities of daily living (IADL) and objective physical activity among older adults residing in non-urban areas in snowy and cold regions according to sex.

Patients and methods: Fifty older adults aged ≥65 years were included in the present study. IADL was assessed using the revised Frenchay Activities Index (FAI), and physical activity was measured using a triaxial accelerometer. Comparisons were made between the snowy and non-snowy seasons based on sex.

Results: Compared to the non-snowy season, the female participants exhibited significantly lower scores for outdoor housework, outdoor activity, and overall scores on the FAI during the snowy season. In terms of physical activity, a decrease in the number of steps and light-intensity physical activity, accompanied by an increase in sedentary behavior, was observed in both sexes. High light-intensity physical activity decreased in the snowy season, especially in the female participants. In addition, the total moderate-to-vigorous physical activity (MVPA) and short-bout MVPA (intermittent and lasting <10 minutes) also decreased.

Conclusion: Considering the significant changes in lifestyle and physical activity during the cold snowy season, women should consider performing alternative physical activities other than indoor household chores. Furthermore, men should be encouraged to participate in indoor household chores they typically do not engage in, irrespective of the season.

Objective: The incidence of noncommunicable diseases (NCDs) is increasing in low- and middle-income countries and represents a major public health challenge. Herein, we present Japan's experience in training medical coordinators to combat NCDs, with a focus on hepatitis, early-onset dementia, and children with medical complexity. Coordinators play an important role in bridging the gap between patients and healthcare services.

Materials and methods: We examined the training and roles of the coordinators. In the Japanese model, medical coordinators, including both medical and non-medical personnel, have successfully strengthened the delivery of healthcare services for specific diseases. However, challenges persist, including the uneven distribution of coordinators, inconsistencies in training programs, the program's relatively recent establishment, and limited awareness of coordinators' roles and activities.

Results and conclusion: Training medical coordinators can strengthen comprehensive patient support in managing NCDs. Despite its limitations, this model provides valuable insights for developing interventional strategies in other Asian countries facing similar medical human resource shortages. Collaboration among governments, hospitals, and related organisations in training coordinators holds promise in addressing the growing prevalence of NCDs in these regions.

It is very important to cooperate with interprofessional personnel is in order to establish the community-based integrated care system, but this is very difficult. We have held comprehensive consultation services regarding medical, welfare, and legal problems to support the community.

Objectives: This study aimed to identify the associations between background factors (such as medical conditions, intractable diseases, welfare problems, disabilities, economic difficulties, legal problems, elderly adults, children, and foreign persons) and difficult cases to provide more thorough consultation services.

Patients and methods: A survey was conducted on people who participated in comprehensive consultation services on medical, welfare, and legal issues related to medical care, welfare, and legal matters held from April 2021 to March 2024. We analyzed risk factors that may be difficult to resolve using multivariate logistic regression.

Results: Multivariate analysis showed that the factor of "economic difficulty" was significantly more difficult to solve.

Conclusion: When treating patients, doctors must consider the possibility of multiple underlying issues. It is advisable for doctors to be aware of the need to consult with social workers and legal professionals when necessary.

Objective: To evaluate the performance of Genki, a computer-aided detection (CADe) software, in detecting tuberculosis (TB) using chest radiography in a mobile TB screening program in Chennai, India.

Materials and methods: Genki, an AI-based CADe software, was employed in four mobile diagnostic units in remote areas of Chennai, India for screening TB. Patients from remote areas of Chennai who visited the vans and registered in the screening program underwent chest radiography, and the acquired X-ray scans were analyzed using Genki, which provided an assessment of each scan as either "TB suggestive" or "TB not suggestive". Subsequently, sputum or swab from the patients with "TB suggestive" results was collected to confirm the diagnosis.

Results: In total, 25,598 patients were screened between January and December 2022. When the annotations from the expert radiologists were considered to be true, Genki demonstrated an aggregated sensitivity of 98%, specificity of 96.9%, and accuracy of 96.9% in detecting TB from chest X-ray scans of the screened population. Furthermore, it exhibited a sensitivity, specificity, and accuracy of >95%, >94%, and >94%, respectively, for both sexes (male and female) and all age groups (14-35, 36-60, and ≥61 years).

Conclusion: Genki demonstrated excellent value as a TB screening tool in remote locations in Chennai, India. Employing a CADe-based approach for systematic TB screening is cost-effective and reduces workload in high-burden and low-resource settings.

In mass casualty incidents, effective triage, treatment, and transport are critical for efficient management but often deviate from practices and ethical standards. In terms of resource allocation, decentralized transport is the predominant transport method; however, it is not standardized. This report retrospectively analyzed the response to a mass casualty incident at a university emergency center. By centralizing patient transport from the scene, the time to patient transport could be shortened, the burden on the scene related to transport could be reduced, and undertriage at the scene could be avoided. No trauma-related deaths occurred. This case provides a valuable contribution to the understanding of situations in which critical patients may concentrate in emergency centers during future mass-casualty incidents.

Objective: Primary care physicians on remote islands and specialists in mainland are expected to collaborate using telemedicine. This survey aimed to identify diseases for which primary care physicians on remote islands consider telemedicine necessary.

Materials and methods: A mail survey was conducted at rural public clinics on remote islands. Participants were asked to select diseases for which telemedicine with mainland specialists was necessary.

Results: A total of 23 physicians participated in this survey. The most common disease category for telemedicine was psychiatric/psychosomatic diseases, followed by neurological and endocrine/nutrition/metabolic diseases.

Conclusion: These data may be useful for the future development of telemedicine involving primary care physicians on remote islands and mainland specialists.

Objective: Academic stress is associated with mental health disorders, notably depression and anxiety among students. Mitigating stress can decrease the incidence of mental health disorders and improve student well-being. This study explored factors influencing academic stress among secondary school students in Vietnam.

Materials and methods: A three-year longitudinal study was conducted using a self-reported questionnaire with 611 students from four secondary schools in Hue City, Vietnam. Academic stress was evaluated using the Educational Stress Scale for Adolescents (ESSA). Family factors, including the number of siblings and parental educational levels; lifestyle factors, including physical activity and sleep; and academic factors, including grade point average and attending extra classes were evaluated. Linear regression models were used to analyze the associations between the ESSA scores at follow-up and family, lifestyle, and academic factors at baseline.

Results: A total of 341 students completed both the baseline and follow-up surveys and answered the questions required for this analysis. The mean ESSA score of 341 students increased from 46.4 ± 7.6 (mean ± SD) to 53.5 ± 10.8, from 2018 to 2021. The multivariate model revealed that the number of siblings, higher father's educational attainment level, female gender, lower academic scores, and attending extra classes were associated with overall academic stress. In contrast, no associations were observed between the variables of lifestyle, parental concentration, and parental acceptance and overall academic stress.

Conclusion: The findings highlight the impact of family factors and study workload on academic stress, emphasizing the need for proper care from family and school to reduce or prevent student academic stress and provide them with a comfortable and healthy learning environment.