Journal of rural medicine : JRM最新文献

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.

Fanconi syndrome is a disorder of the proximal renal tubules characterized by metabolic acidosis, renal glycosuria, and aminoaciduria. Recently, Fanconi syndrome caused by red yeast rice supplements has been reported. We encountered a 60-year-old woman with acute kidney injury and Fanconi syndrome caused by a red yeast rice supplement. The patient discontinued the supplements, leading to an improvement in her serum creatinine and urinary protein levels. Early detection and discontinuation of the suspected drugs are important for the treatment of drug-induced Fanconi syndrome.

Objective: Although pain is one of the most common symptoms experienced by people with dementia in long-term care, there have been few studies on the actionable knowledge of pain assessment and management in dementia care from a multidisciplinary perspective. This study aimed to identify practical tips for pain management of patients with advanced dementia using a multidisciplinary approach.

Patients and methods: Individual in-depth interviews were conducted between January and March 2022 with 24 healthcare professionals who had ample experience in primary palliative care for dementia. The qualitative data were analyzed using a qualitative content analysis.

Results: Three main themes and nine subthemes capturing advice in pain assessment and management for advanced dementia were identified: patient assessment (early detection, multidisciplinary comprehensive assessment, drowsiness and inactivity, diagnostic therapy), assessment of family understanding of pain in dementia (willingness to accept guidance from experts, understanding and acceptance of dementia), and intervention (distraction, resistance and nonadherence to care, care-related pain).

Conclusion: These findings identified dementia-specific practical advice for pain management. First, multidisciplinary teams are required to better understand slight behavioral changes of people with advanced dementia. Second, they must be equipped with the necessary knowledge to differentiate symptoms of advanced dementia from those of other conditions. Third, pain medicine administration, along with a diagnostic procedure, is recommended. Fourth, distraction from chronic pain, reduced resistance and nonadherence to care were offered as pain management strategies for advanced dementia. Finally, family members must be educated about pain in those with advanced dementia because pain management was the most identified burden faced by family caregivers.

Objective: Japan has the highest aging rate globally, with 29.1% of its population aged ≥65 years; however, the concepts of do-not-attempt-resuscitation (DNAR) and advance care planning (ACP) are less prevalent than in other countries. We aimed to survey DNAR orders in out-of-hospital cardiac arrest (OHCA) and compare them with previous surveys to examine changes in end-of-life care.

Methods: This prospective study examined all OHCA cases attended to by the Sagamihara City Fire Department between May 30, 2023, and February 15, 2024. Data were collected through emergency services and compared with those of a similar 2019 survey.

Results: The 2023 OHCA survey included 513 patients, a 25.9% increase from 2019. The mean age was 75.9 ± 15.1 years, similar to 2019 (74.9±17.7 years, P=0.986). A subgroup analysis of patients with DNAR orders revealed a significant decrease in DNAR orders, from 45 patients (11.4%) in 2019 to 27 patients (5.3%) (P=0.000). No significant differences were found in ambulance treatment services (airway security, peripheral intravenous route security, and drug administration) (7.4% vs. 8.9%, P=1.000). Emergency transport differed significantly (P=0.001), with non-transport cases (death confirmed by a house-call doctor on site) increasing from 2.2% to 33.3% in 2019.

Conclusion: This study revealed a decrease in OHCA cases involving DNAR declarations during the COVID-19 pandemic, reflecting a positive shift toward respecting individual dignity owing to increased ACP. However, certain DNAR cases still undergo resuscitation and transport, highlighting the need for legal DNAR protocol implementation to reduce emergency-setting challenges.

Objectives: This study explored the relationship between receiving healthy lifestyle advice from healthcare providers and hypertension among undiagnosed individuals in Afghanistan, defined as adults with no previous hypertension diagnosis or treatment history.

Materials and methods: Data were extracted from the 2018-19 Afghanistan National Non-Communicable Diseases Risk Factors Survey, comprising 2,838 participants. Outcomes included hypertension (systolic blood pressure ≥130 mmHg or diastolic blood pressure ≥80 mmHg) and elevated blood pressure (systolic blood pressure 120-129 mmHg and diastolic blood pressure <80 mmHg). Bivariate and multivariable multinomial logistic regression analyses were conducted to assess associated factors.

Results: Among the 2,838 participants, 1,344 (47.4%) had hypertension and 344 (12.1%) had elevated blood pressure. Most participants were aged <40 years (63.8%), male (55.8%), and ever-married (80.2%). Multivariable analysis revealed that not receiving healthy lifestyle advice was significantly associated with hypertension (adjusted relative risk ratio [aRRR]=1.24; 95% confidence interval [CI]: 1.04-1.47) and elevated blood pressure (aRRR=1.40; 95% CI: 1.08-1.81). Sociodemographic and behavioral factors such as age, sex, marital status, education, occupation, fruit consumption, physical activity, and excess weight were significantly associated with hypertension, whereas only sex and excess weight were significantly associated with elevated blood pressure.

Conclusion: Our findings underscore the association between receiving healthy lifestyle advice from healthcare providers and a lower prevalence of hypertension among undiagnosed Afghan adults. Accordingly, healthcare providers should recommend lifestyle changes to help manage hypertension among adults.

Hypersensitivity Pneumonitis (HP) is an allergic interstitial lung disease that arises from type III and IV allergic reactions. During the COVID-19 outbreak, HP was established as having similar manifestations to COVID-19. In remote rural regions of Japan, where respiratory specialists are not readily accessible, HP is not always easy to differentiate, and establishing a definitive diagnosis can be challenging due to insufficient laboratory examinations. Herein, we present a case of a moderately definite diagnosis of acute non-fibrosing HP. The foundation of treatment included antigen avoidance, which necessitates a comprehensive analysis of the patient's medical history. In instances where anomalous chest imaging outcomes are observed, it is imperative to conduct a comprehensive review of the patient's medical history, and to consider the possibility of HP.

Objective: Providing emergency care to serious patients in rural areas remains challenging. Intentional transit practice involves transporting a serious patient to a nearby hospital while requesting the Helicopter Emergency Medical Services (HEMS). This study aims to evaluate its effectiveness on earlier primary medical interventions and the decision of the destination hospital.

Patient and methods: We conducted a single-center, retrospective observational study at a HEMS base hospital in a rural area of Japan. The study participants included patients who underwent the intentional transit practice between April 2012 and March 2019. We compared actual times to estimated times for each case treated with the HEMS alone (HEMS-alone model). Outcomes were the time from ambulance call to reaching the physician (physician reaching time), arrival at the final destination facility (destination hospital arrival time), and helicopter waiting time at the landing zone (helicopter waiting time). Subgroup analyses by region and an analysis of the relationship between diagnostic tests performed at the transit hospital and the type of destination facility were performed.

Results: Eighty-seven patients were eligible for analysis. Compared to the HEMS-alone model, the intentional transit practice reduced the physician reaching time (median [interquartile] min) (26 [21-32] vs. 37 [29-47], P<0.0001) while increasing the destination hospital arrival time and the helicopter waiting time (71 [58-93] vs. 65 [59-80], P=0.03; 24 [18-34] vs. 19 [18-21], P<0.0001; respectively). Subgroup analysis showed a consistent result for physician reaching time but heterogeneity in the other time courses by region. Diagnostic tests were related to transportation to facilities other than the HEMS base hospital.

Conclusion: The intentional transit practice is beneficial for providing primary care earlier than the HEMS alone and for transport to more specific facilities. However, it delays arrival at the destination facility and increases helicopter waiting time.