Journal of rural medicine : JRM最新文献

Objective: Fabry disease is rarely reported in South Asian countries, except India. Here, we report a case of Fabry disease incidentally discovered in a Bangladeshi male.

Case report: A 31-year-old Bangladeshi male presented to our hospital in Japan for the evaluation of potential male infertility, during which hypospermia and asthenozoospermia were identified. No structural or endocrine abnormalities were observed; however, mulberry bodies were incidentally detected during urine microscopy. Reduced α-galactosidase activity and a known genetic mutation confirmed the diagnosis of Fabry disease. The patient was provided with information regarding Japan's subsidy program for rare diseases, through which he could access enzyme replacement therapy.

Conclusion: Fabry disease is likely to be underdiagnosed in developing countries because of limited medical resources and awareness. Although early detection has improved in developed countries, high treatment costs remain a challenge. This case highlights the need to balance equitable access to treatment for rare disorders, such as Fabry disease, with the maintenance of a sustainable healthcare system, regardless of the patient's nationality or socioeconomic status.

Objective: The purpose of this study was to clarify the meaning of the use of type-B continuous employment support facilities by individuals with mental disabilities and to examine the factors that make their transition to general employment difficult based on previous studies. This study sought to obtain insight into the role of nurses in employment-related disability welfare services.

Materials and methods: A literature search was conducted using the web version of the Igaku Chuo Zasshi (Index Medicus of Japan) and Medical Online search system. Sentences describing the meaning of Type B continuous employment support facilities were extracted, and the resulting data were collected and categorized. Factors that made the transition to regular employment difficult were summarized descriptively based on the extracted data.

Results: The use of type-B continuous employment support facilities by those with mental disabilities meant the following: [awareness as a member of society], [increased sense of self-efficacy], [attempts to stabilize psychiatric symptoms], and [independence in daily living]. The following factors complicated the transition of individuals with mental disabilities to regular employment: they found illness management challenging because of their psychiatric symptoms, which caused difficulties in continuing to work. They also perceived their workplace environment negatively, complaining that their coworkers did not understand their psychiatric symptoms.

Conclusions: Individuals with mental disabilities found meaning in utilizing B-type continuous employment support facilities beyond simply aiming for a transition to general employment. However, numerous factors complicate the transition to full employment. One is that individuals with mental disabilities find it challenging to manage their psychiatric symptoms. Hence, our findings suggest an increasing need for collaboration with nursing professionals and for providing high-level nursing care.

Severe fever thrombocytopenia syndrome (SFTS) is a tick-borne viral hemorrhagic fever prevalent throughout Asia. In 2024, our hospital in eastern Shizuoka reported three consecutive cases of SFTS, the first such cluster identified in this region. Since April 2013, the confirmed area of infection has expanded from Kyushu to Shizuoka, which currently marks the easternmost limit. As global warming progresses, the spread of SFTS is projected to increase.

Objective: This study aimed to determine the prevalence and risk factors of intimate partner violence during pregnancy in rural Tanzania.

Method: An analytical cross-sectional study was conducted among 360 randomly selected postnatal mothers in rural Tanzania between March and April 2024 to determine the prevalence and risk factors of intimate partner violence during pregnancy. Data were collected using a pre-tested, semi-structured questionnaire. Bivariate and multivariable logistic regression analyses were performed using Statistical Package for Social Sciences (SPSS) version 25 to identify risk factors. Statistical significance was assessed at a 95% confidence interval (CI), with associations reported as Adjusted Odds Ratios (AOR).

Results: During pregnancy, 70.3% of women experienced at least one form of violence, with 45.6% suffering from two or more forms. Overall, 112 postnatal mothers (31.1%, 95% CI=26.4%-36.2%) experienced intimate partner violence during pregnancy. Significant factors included the health facility attended; Kondoa (AOR=0.262, P=0.017), Mpwapwa (AOR=0.197, P=0.001), Manyoni (AOR=0.086, P<0.001), and Sokoine (AOR=0.122, P<0.001) compared to Makole Health Center; rural residence (AOR=3.653, P=0.001), woman's autonomy in choosing partner (AOR=2.757, P=0.046); dowry payment (AOR=2.809, P=0.013); male partner's alcohol use (AOR=2.125, P=0.025), and a history of abortion (AOR=2.910, P=0.005).

Conclusion: A high proportion of women experienced intimate partner violence during pregnancy. Residing in rural areas, autonomy in partner selection, bride price payment, male partner alcohol use, prior experience of abortion exacerbated the prevalence. The study advocates for widespread educational campaigns to raise awareness about the detrimental impact of intimate partner violence, especially during the vulnerable period of pregnancy.

Objective: This report describes a rare case of a dural arteriovenous fistula of the falcine sinus associated with a flow-related aneurysm.

Patient and methods: A 68-year-old man presented with severe headache secondary to an intracranial hemorrhage. The bleeding was caused by a dural arteriovenous fistula (dAVF) of the falcine sinus with a flow-related aneurysm of the dural branch of the right posterior cerebral artery.

Results: Trans arterial obliteration of the aneurysm and its feeder using glue and trans venous embolization of the draining portions using a coil were successfully performed.

Conclusion: The unusual coexistence of a flow-related aneurysm on the feeder of the dAVF resulted in a unique hemorrhage.

Objective: Standard treatment modalities, including surgery, are desirable, even in older adults with breast cancer. However, frailty and comorbidities may limit surgery. This study aimed to evaluate whether endocrine therapy (ET) is associated with a lower survival rate than a standard surgical regimen.

Patients and methods: In this retrospective observational study, older adults (aged ≥75 years) diagnosed with nonmetastatic hormone receptor-positive, HER2-negative, primary breast cancer who were treated between 2006 and 2022 were evaluated in the ET (n=33) and surgery (n=95) groups. Survival status and cause of death were analyzed by estimating the overall survival (OS) and breast cancer-specific survival (BCSS) rates. Univariate and multivariate analyses were performed to identify survival-associated factors. Propensity score matching (PSM) was used to reduce the effect of selection bias.

Results: The median ages of the ET and surgery groups were 84.6 and 80.4 years, respectively, and their mortality rates were 12.5% and 17.2%, respectively. OS and BCSS were significantly higher in the surgery group than in the ET group (hazard ratio [HR] 0.27, P=0.0014 and HR 0.66, P=0.029, respectively). Age, performance status, and treatment regimen proved to have a significant effect on OS and BCSS in univariate analysis. Only age and treatment affected OS; however, no factors were shown to affect BCSS in multivariate analysis. After PSM, the OS rates were higher in the surgery group than in the ET group (HR 0.23, P<0.001); however, no differences in BCSS rates were found.

Conclusion: ET may be an appropriate treatment option for older adults with breast cancer without sufficient life expectancies.

Objective: This study aimed to investigate factors influencing fatigue, its relationship with turnover or transfer intention (TTI), and its impact on the mental health of intensive care unit (ICU) nurses in rural Okinawa, Japan. In this region, career options are limited, and many female nurses struggle with balancing work and household responsibilities, potentially contributing to fatigue and mental health challenges.

Patients and methods: A retrospective observational study was conducted with 28 ICU nurses from an acute care hospital in Okinawa. Fatigue and depressive symptoms were assessed using the Japanese Workers' Accumulated Fatigue Self-Diagnosis Checklist and Patient Health Questionnaire-9 (PHQ-9). Participants were categorized according to fatigue levels (Low-High and Highest) and TTI status. Univariate analysis was used to examine the relationships between fatigue, TTI, and variables including gender, marital status, interpersonal issues, and nursing experience.

Results: The Highest fatigue group accounted for 67.9% of the participants, and 42.9% were classified as having mild depression. The Highest fatigue group showed significantly higher PHQ-9 scores, longer nursing experience, and higher proportions of married nurses compared to the Low-High fatigue group (P<0.05). Fatigue and PHQ-9 scores were positively correlated (r=0.657, P<0.001). TTI was reported by 46.4% of participants, with significantly higher rates observed among female nurses experiencing interpersonal issues and those in the Highest fatigue group (P<0.05).

Conclusion: This study found a correlation between ICU nurses' subjective fatigue and mental health, suggesting that severe fatigue, particularly due to interpersonal challenges, may be linked to TTI, highlighting the need for early interventions. However, no direct link was found between fatigue, depressive symptoms, and TTI. Further longitudinal research is required to clarify causality and enhance interventions. In rural areas such as Okinawa, where career options are limited, tailored interventions targeting fatigue and interpersonal challenges are essential.

Objective: In this study, we investigated the status of polypharmacy among community-dwelling older adults and comprehensively examined background factors, including social frailty and Kihon Checklist (KCL) scores, based on the presence or absence of polypharmacy.

Materials and methods: We conducted a survey using self-administered questionnaires distributed via mail to 319 participants. Information on demographics, comorbidities, highest educational attainment, medication status, social frailty, and KCL scores was collected.

Results: Using propensity score matching, 75 and 71 patients with and without polypharmacy, respectively, were selected for analysis. A comparison between the two groups indicated no differences in social frailty; however, significant differences were observed in the total KCL scores (P=0.002), motor dysfunction (P=0.045), oral hypofunction (P=0.023), social withdrawal (P=0.032), and depression (P=0.034).

Conclusion: Among community-dwelling older adults with polypharmacy, attention should be paid to the potential for decreased motor and oral functions, social withdrawal, and depression.

Objective: We report a case of L. monocytogenes bacteremia accompanied by skin lesions, a rare manifestation of adult listeriosis.

Patient: A Japanese woman in her 80s was hospitalized due to pain in the left leg and difficulty walking. Physical examination revealed diffuse erythema, warmth, swelling, and tenderness in the left thigh and lower leg.

Results: Administration of cefazolin was initiated based on a clinical diagnosis of cellulitis. However, similar erythema appeared on the opposite thigh the following day. Blood cultures obtained on admission yielded L. monocytogenes, prompting a change in antibiotic therapy to meropenem on day 4, followed by ampicillin on day 6. The symptoms in both legs subsequently improved and had nearly resolved by approximately 2 weeks after admission. Antibiotic treatment was continued until day 26. Although the patient died of hepatic dysfunction due to intrahepatic portosystemic venous shunts on day 31, the skin manifestations did not recur during hospitalization.

Conclusion: Even in cases of cellulitis, L. monocytogenes should be considered when blood cultures from older adults yield Gram-positive bacilli, as cephalosporins, often used for the treatment of cellulitis, are inactive against this organism.

Objective: To elucidate the trends in stroke and myocardial infarction (MI) over 24 years in O City, Ehime Prefecture, Japan.

Materials and methods: We conducted an annual survey of hospital-based disease registrations to determine the incidence and type of stroke (hemorrhagic stroke (HS) and ischemic stroke (IS)) and MI from 1996 to 2022. The numbers of deaths due to stroke and MI were determined using the electronic death certificate dataset provided by the Ministry of Health, Labour and Welfare. The number of deaths and incidences of stroke and MI in O City over 24 years were classified into four six-year periods: 1999-2004 (Period 1), 2005-2010 (Period 2), 2011-2016 (Period 3), and 2017-2022 (Period 4).

Results: Age-adjusted death rates from stroke and IS decreased in both men and women, while those from HS remained unchanged. However, the age-adjusted incidence of stroke and IS in men and women decreased from Periods 1 to 2 but increased from Periods 2 to 4. In women, the age-adjusted incidence of HS increased from Periods 2 to 4, whereas in men, the incidence of HS remained unchanged. In both men and women, the age-adjusted death rate of MI decreased. In women, the age-adjusted incidence of MI decreased from Periods 1 to 4. The age-adjusted incidence of MI in men did not change over time.

Conclusion: For both men and women during the 24 years of follow-up, the age-adjusted death rates from stroke and MI decreased from Periods 1 to 4; however, the age-adjusted incidences of stroke and IS increased from Periods 2 to 4.