Journal of rural medicine : JRM最新文献

Objective: This study aimed to identify the events perceived by support staff as affecting older adults' ability to live at home. It also explored the factors contributing to the perceptions of increasing overtime requirements among staff members supporting these individuals.

Materials and methods: An anonymous online survey was conducted among staff members at community general support centers nationwide. The survey examined the content of decision-making support provided to older adults living alone and the factors that led to the interruption of home-based living.

Results: The most common events leading to interruption of home-based care were deteriorating health, emergency hospitalization, and reduced willingness to continue living at home. Factors associated with staff perceptions of increased overtime were greater anxiety about being responsible for supporting older adults living alone (odds ratio: 4.83, 95% confidence interval: 1.72-13.59, P=0.003) and the perception that being responsible for older adults living alone increases work outside regular duties (odds ratio: 22.0, 95% CI: 6.95-69.79, P<0.001).

Conclusion: As increased overtime may lead to higher turnover rates among staff, administrators should monitor staff anxiety about being assigned to older adults living alone and the increased workload involved, and take appropriate measures to address these issues.

Objective: The Glasgow Prognostic Score (GPS), Prognostic Nutritional Index (PNI), and Neutrophil-to-Lymphocyte Ratio (NLR) have been shown to predict the prognosis of various cancer types. However, the prognostic roles of GPS, PNI, and NLR in patients with extensive-stage small cell lung cancer (ES-SCLC) remain controversial. This study aimed to assess the prognostic value of these three immunonutritional indicators in patients with ES-SCLC.

Patients and methods: We retrospectively analyzed 102 ES-SCLC patients who received first-line platinum-doublet chemotherapy. The GPS, PNI, and NLR were assessed before the initiation of first-line chemotherapy. Based on previous reports, the optimal cut-off levels were 40 for PNI and 3 for NLR. The Kaplan-Meier method and Cox proportional hazards models were used to evaluate progression-free survival (PFS) and overall survival (OS).

Results: Of the total participants, 102 had ES-SCLC. Patients with a GPS of 0/1 showed significantly longer PFS than those with a GPS of 2 (133 vs. 63 days, P<0.001), and a high PNI was also associated with longer PFS (133 vs. 80 days, P=0.007). No significant difference in PFS was observed between the low and high NLR groups (P=0.471). Similarly, OS was significantly longer in patients with a GPS of 0/1 than in those with a GPS of 2 (300 vs. 117 days, P<0.001) and in those with a high PNI than in those with a low PNI (296 vs. 136 days, P<0.001). The OS did not differ significantly in the NLR group (P=0.303). Multivariate analyses revealed that the GPS and PNI were independently associated with worse PFS and OS.

Conclusion: Our study demonstrated that both the GPS and PNI were significantly associated with PFS and OS in patients with ES-SCLC. The GPS may be a simple and reliable immunonutritional marker for predicting outcomes in patients with ES-SCLC treated with platinum doublet chemotherapy.

Objective: Salmonella enterica subsp. enterica serovar Poona (S. Poona) is a zoonotic pathogen commonly associated with reptiles, particularly turtles. We report a pediatric case of S. Poona bacteremia in which a pet turtle was microbiologically confirmed as the source of infection.

Patients: A 17-month-old Asian girl with fever and transient diarrhea was hospitalized. The patient had direct contact with the family's pet turtle shortly before symptom onset. The turtle's tank was routinely cleaned in the household kitchen sink.

Results: S. Poona was isolated from the patient's blood and stool, as well as from swabs taken from the turtle's limbs, shell, and feces. Macrorestriction analysis revealed that the isolates from the patient and the turtle shared identical genomic fragment patterns, indicating transmission through direct contact or environmental contamination. The patient made a full recovery following a 14-day course of intravenous cefotaxime and ampicillin.

Conclusion: To our knowledge, this is the first reported case in Japan of S. Poona infection with microbiological confirmation of the source animal. This case highlights the importance of strict hygiene practices when handling reptiles and cleaning their habitats, particularly in homes with young children or other vulnerable individuals.

Objective: To report a rare case of a solitary juvenile polyp in the transverse colon causing hematochezia in an older patient.

Patients and methods: A 78-year-old woman presented with hematochezia. She denied experiencing abdominal pain and had no history of colonoscopy. Colonoscopy performed at a local hospital revealed a 12 mm pedunculated lesion in the transverse colon covered with fresh blood. The patient was then referred for further evaluation. After confirming the cessation of bleeding, the lesion was removed via endoscopic mucosal resection. Histopathological analysis was performed on the resected specimen.

Results: The lesion was successfully resected without complications. Histological examination revealed the typical features of juvenile polyps, including stromal expansion, edema, inflammatory cell infiltration, and crypt dilation without cytological atypia. The surgical margins were negative. The patient remained asymptomatic after the procedure and experienced no recurrence of bleeding.

Conclusion: Juvenile polyps are typically found in children but can occasionally occur in older patients. This case underscores the importance of considering juvenile polyps in the differential diagnosis of lower gastrointestinal bleeding, regardless of patient age. Complete endoscopic and histopathological evaluation is essential for accurate diagnosis and appropriate management.

Objective: Efforts have been made in Japan to transition individuals with mental disorders from inpatient medical care to community life. To promote the development of a community-based comprehensive care system that effectively addresses mental disorders, it is essential to clarify the issues from an individual's perspective. This study aimed to examine the perspectives of individuals with mental disorders who have experienced long-term hospitalization to support their continued life in the community from the viewpoint of personal recovery.

Materials and methods: A descriptive, qualitative study was conducted. Nine individuals with mental disabilities living in Japan were interviewed. The interviews were conducted between September 2021 and December 2023 using a semi-structured format guided by the interview protocol. The interview transcripts were analyzed using reflexive thematic analysis.

Results: Seven themes regarding future life were identified: "desire to live in one's own way", "realizing hopes and goals", "desire to connect with the society and others", "positive attitude toward the future", "concerns and preparations for one's own later life and that of one's family", "an uncertain future", and "improvement of physical symptoms". Eight themes associated with issues in community living were identified: "difficulty in controlling symptoms and self-management of medication", "impact of deteriorating health on daily life, employment, and studies", "social withdrawal and loss of connection with others", "excessive interference from family members and deterioration of relationships", "caring for elderly parents and their health issues", "lack of understanding and support from others", "difficulty in utilizing public support", and "sustainable housing and financial issues".

Conclusion: Professionals must believe in the ability of individuals with mental disorders to achieve personal recovery and persistently support their choices and decisions. It is necessary to build a recovery-oriented and comprehensive community care system that responds to mental disorders based on the needs of community-dwelling patients.

Objective: This study examined the relationships among lower limb skeletal muscle characteristics, walking function, and daily physical activity in community-dwelling, independently living older women. This serves as a fundamental study for the prevention and early detection of sarcopenia, using ultrasonography-based muscle mass and quality assessment.

Patients and methods: The participants were 53 community-dwelling women aged 66-89 years, who were independent in activities of daily living (ADL). Age, physical characteristics (height, weight, body fat percentage, skeletal muscle mass, and skeletal muscle index [SMI]), walking function, physical activity level, fall occurrence in the past month, and gastrocnemius muscle parameters (muscle thickness, fascial thickness, and muscle echo intensity) were assessed. Correlation analyses were conducted and intra-examiner reliability was confirmed using the intraclass correlation coefficient.

Results: The participants' median age was 77.0 years, height was 150.3 cm, weight was 51.0 kg, body fat percentage was 30.6%, and SMI was 6.5 kg/m². Overall, 11.3% of participants had an SMI below the sarcopenia threshold. The gastrocnemius muscle parameters showed the strongest correlations; muscle thickness had weak positive correlations with SMI, walking function, and physical activity, but negative correlations with age and total movement time. Fascial thickness correlated positively with weight and body fat percentage but negatively with walking function. Muscle echo intensity was positively correlated with age and negatively correlated with SMI, walking speed, step count, and housework time.

Conclusion: Although all the participants lived independently, 11.3% had an SMI below the sarcopenia threshold, highlighting the need for early prevention. Gastrocnemius muscle parameters were significantly associated with age, physical characteristics, walking function, and activity level. Reduced physical activity may contribute to muscle degeneration and impaired walking even in independent individuals. Combining muscle echo intensity and fascial thickness may enhance muscle quality assessment, aiding in the prevention and early detection of sarcopenia.

Objective: Venous malformations (VMs) are low-flow blood reservoir mass lesions with spongy or cystic venous lumens caused by dilation of the venous system vasculature. A VM is a congenital lesion that presents at birth and enlarges during childhood as the host grows. Subcutaneous lesions due to VMs are rarely diagnosed at an advanced age. We report a case of axillary VM in an older patient.

Patient: A 92-year-old man was suspected of having left axillary lymphadenopathy (single nodule, 23 mm long) on chest computed tomography (CT) scan. Seven years earlier, a chest CT scan showed a small, 13 mm nodule in the same area.

Results: On ultrasound elastography, the lesion did not appear hard, however, color Doppler imaging revealed abundant blood flow, suggesting a malignant lesion. Histologically, the lesions were consistent with VM.

Conclusion: VMs should be considered a differential diagnosis for superficial lymphadenopathy, even in older patients.

Purpose: This study aimed to investigate the efficacy of the keyword method in improving outcomes for patients with unstable circulation.

Methods: Patients with unstable circulation were selected from the Japan Doctor Helicopter (DH) Registry System (JDRS) database. Unstable circulation was defined as systolic blood pressure of less than 90 mmHg when emergency medical technicians (EMTs) contacted the patients. The following details of the dispatch activity were collected from the JDRS database: whether the request for the DH dispatch was made before (Keyword) or after (Control) the EMTs contacted the patient, time from first call to DH contact, age, sex, initial vitals, DH intervention, disease classification, and outcome.

Results: There were 650 subjects in the Keyword group and 1,085 patients in the Control group. All the participants were evacuated from the scene. The duration from the first call to contact, respiratory rate, and the ratio of tracheal intubation to transfusion were significantly smaller in the Keyword group than in the Control group. The average systolic blood pressure and survival ratio in the Keyword group were significantly higher than those in the Control group. After matching the analysis to align with the patients' backgrounds, the observed tendencies persisted.

Conclusion: This is the first report to describe the keyword method as a prognostic factor in patients with unstable circulation who were evacuated by the DH using the JDRS. Future prospective studies are required to determine the accuracy of these results.

Objective: As artificial intelligence (AI) technologies advance rapidly, their integration into healthcare is transforming the clinical practice landscape. This study aimed to evaluate how second-year medical students perceive their professional mission in an AI-integrated medical future, through a structured essay task, using text-mining analysis to identify emerging themes and attitudes.

Methods: A total of 105 second-year medical students at Kagawa university in Japan completed an essay titled "What is your mission in the AI-driven medical world?". Responses were analyzed using KH Coder for frequency analysis, multidimensional scaling, and co-occurrence network mapping. Participants provided verbal informed consent and student anonymity was ensured.

Results: The most frequently used terms were medical, consider, think, doctor, AI, human, and patient. Three thematic clusters emerged: (1) career design, (2) AI and medicine, and (3) AI and human. Co-occurrence analysis revealed strong associations between "medical" and both "consider" and "patient", while "patient" was linked to both "AI" and "human", indicating thoughtful reflection on technology's impact on patient care.

Conclusion: Second-year medical students in Japan demonstrated critical engagement with the concept of mission formation in the context of AI in healthcare. Their essays reflected a balance between optimism for technological advancement and concern for preserving human-centered care. These findings highlight the importance of implementing systematic career education and future-oriented thinking that is aligned with the characteristics of Generation Z learners.

Objective: This study aimed to clarify the current status of collaboration between type-B continuous employment-support facilities and psychiatric care in Japan and determine the intention of these facilities toward medical collaboration.

Methods: A self-administered anonymous questionnaire survey was conducted by mail. Basic descriptive statistics were calculated for the questions with multiple-choice responses. For the free descriptions of medical collaborations, we grouped sentences with similar meanings and generated categories.

Result: Of type-B employment continuation support offices, 76% collaborated with psychiatrists. However, only 6% incurred an additional fee for the medical collaboration system. They attempted to collaborate with medical care by contacting doctors and nurses and accompanying them during medical examinations. Some respondents stated that they did not need to collaborate with medical care. Type-B facilities often require support from doctors and nurses regarding support for psychiatric symptoms, guidance on medication, and other problems related to illnesses and treatment. Other opinions suggested that persons with mental disabilities should solve their problems themselves without intervention by doctors or nurses and that the support they want is absent. Among type-B continuous employment-support facilities that do not hire nurses, 25% would be unable to hire them, although desired, because of financial difficulties or other reasons, and 72% did not consider doing so.

Conclusion: Among the type-B continuous employment-support facilities, 76% collaborated with the psychiatric department. Some respondents indicated that medical collaboration was "Not required". Among the types of support expected from doctors and nurses, those related to illness and treatment were the most commonly requested. But opinions emerged, including "No support is sought". Many type-B continuous employment-support facilities that do not employ nurses, do not consider hiring nurses, and the most common reason is "Economically difficult to hire".