Journal of rural medicine : JRM最新文献

Objective: Loneliness is an important health problem in rural areas of Japan because of its ageing and declining population. Therefore, we investigated the association between loneliness and health. Materials and Methods: Self-administered questionnaires were distributed to rural adult residents. The Japanese 3-item versions of the UCLA Loneliness Scale, self-rated health (SRH), and objective health status (whether the respondents had a physical and/or mental illness) were used. We defined a UCLA score of four points or more as loneliness, an SRH of four points or more as a subjective healthy state, and no physical or mental illness as an objective healthy state. The association was adjusted for sociodemographic data, lifestyle habits, and isolation risk using logistic regression analysis. Results: The five-year population decline rate in the target areas was 10.2 to 12.3%. Of the 2,700 participants, there were 1,211 male and 1,489 female respondents, with an average age of 65.4 years. Moreover, 358 (13.6%) were living alone, and 829 (31.5%) were living in couple-only households. Among the participants, 1,395 (53.2%) experienced loneliness, 1,751 (65.7%) had good self-rated health, and 1,587 (60.8%) had objective health status. Loneliness was negatively associated with good SRH (OR=0.56, CI=0.45-0.70) and objective health status (OR=0.57, CI=0.46-0.71) after adjusting for sociodemographic data, lifestyle habits, and the risk of isolation. Statistically significant confounding factors for subjective and/or objective health status were employment, not smoking, obesity, exercise, having a family doctor, having an above-average number of teeth, and the ability to leave home. Conclusion: In an ageing and declining population, loneliness is an independent factor affecting the health status of rural residents and is not limited to older adults. Therefore, measures to reduce it are needed.

Objective: This study evaluated the effects of interprofessional conferences on intensive care units (ICUs) by comparing related outcomes before and after their introduction. Patients and Methods: This study was conducted at a single center and included ICU patients admitted between April 2017 and March 2019. Interprofessional conferences include physicians, nurses, physical therapists, nutritionists, and pharmacists. Data were extracted from the available medical records. The primary outcome measure was ICU length of stay (LOS). The secondary outcome measures were hospital LOS and any rehabilitation and nutrition begun within 48 hours of ICU admission. Outcomes before and after the introduction of the interprofessional conferences were compared. The adjusted variables were sex, age, body mass index, ICU readmission, health outcomes, Barthel index at admission, and disease (classified according to the International Statistical Classification of Diseases and Related Health Problems 10th edition). Results: We included 1,765 ICU patients admitted between April 2017 and March 2019. There were 898 patients in the "pre-interprofessional conference introduction" group (before group) and 867 in the "post-interprofessional conference introduction" group (after group). The ICU LOS (regression coefficient: -0.08; 95% confidence interval [CI]: -0.13 to -0.04) and hospital LOS (regression coefficient: -2.96; 95% CI: -5.20 to -0.72) were significantly shorter in the after group. Moreover, the proportion of patients who commenced nutrition (odds ratio [OR]: 1.45; 95% CI: 1.14 to 1.84) and rehabilitation (OR: 0.77; 95% CI: 0.51 to 1.17) within 48 hours of ICU admission was significantly higher in the after group. Conclusions: Introduction of interprofessional conferences effectively reduced ICU and hospital LOSs and improved likelihood of commencing nutrition and rehabilitation within 48 hours of ICU admission.

Objective: Aspiration pneumonia is a challenge in Japan, with many elderly citizens; however, there are insufficient experts on swallowing. Non-expert doctors may suspend oral intake for an overly long period because of the fear of further aspiration. We devised and modified an assessment protocol for swallowing function with reference to the Japanese and American practical guidelines for dysphagia. This study aimed to demonstrate clinical decision-making using the protocol by reporting the results of decisions on the safe and timely restart of adequate food intake for patients with aspiration pneumonia. Patients and Methods: This comparative retrospective study included 101 patients hospitalized with aspiration pneumonia between April 2015 and November 2017. We compared the parameters of patients for whom decisions on resumption of oral intake were aided by our protocol against those of patients from the previous year when the protocol was not used. We counted the days until either resumption of oral intake or events of aspiration/choking. Results: The duration of days until oral intake in the two groups was 1.64 ± 2.34 days in the protocol group (56 patients) and 2.09 ± 2.30 days in the control group (45 patients) (P=0.52). The adverse events of aspiration/choking were less frequent in the protocol group (5 vs. 15, odds ratio (OR) 0.32, P<0.001) as compared to the control group. The protocol group showed a significant reduction in aspiration/choking (OR 0.19, P<0.01). Conclusion: Clinical decision-making based on the protocol seems to help non-expert doctors make informed decisions regarding resuming oral intake after aspiration pneumonia.

Objective: Despite the high prevalence of mental disorders in rural areas, mental health services are lacking because of shortages of resources and difficulty in accessing such services. Telemental health services can be beneficial for these patients. This study summarizes the efficacy of telemental health in managing mental disorders in rural areas. Materials and Methods: The MEDLINE and Cochrane Central Register of Controlled Trials databases were searched to identify randomized controlled trials on telemental health for mental disorders in rural areas until June 2022. The reviewers independently screened, extracted, and assessed study quality using the Risk of Bias 2 tool. Results: Six eligible studies were identified on mental health symptoms, insomnia, depression, and schizophrenia. The quality of all the studies was moderate, and they all reported that telemental health effectively improved the symptoms of mental disorders. One study reported a reduction in relapse and rehospitalization rates in young individuals. Another study reported that it was effective in improving the symptoms of depression and anxiety in older individuals. Conclusions: Although further studies are warranted, telemental health services could effectively improve the symptoms of mental disorders in rural areas.

Objective: To investigate the etiology of cardiac arrest in patients living in depopulated rural areas with a high elderly population in the Kamo region. Patients and Methods: We investigated patients with cardiac arrest who were transported by the Shimoda Fire Department between January 2019 and December 2021. The following patients' details were collected: circumstance, age, sex, cause of cardiac arrest, witnessed collapse, chest compression performed by bystanders, oral instruction, use of an automated external defibrillator (AED), initial rhythm, advanced cardiac life support provided by emergency medical technicians, and neurological outcomes. The patients were divided into two groups based on the return of consciousness (RC). We compared the variables above between the two groups. Results: A total of 281 patients with cardiac arrest were included in this study. The participants were predominantly men (59.7%), and the average age was 76 years. AED was applied to eight patients at the scene; however, all eight did not have an initial shockable rhythm. RC was achieved in eight (2.8%) patients. The precise cause of cardiac arrest among the participants who achieved RC was cardiogenic, drowning, and suffocation in three, three, and two cases, respectively. The patients were significantly younger, and the ratio of securing a venous route and airway was significantly lower in the RC (+) group than in the RC (-) group. The ratio of helicopter emergency medical services (HEMS) in the RC (+) group was significantly greater than that in the RC (-) group. Conclusion: This study reported the etiology of cardiac arrest in patients living in a depopulated rural area of Japan with a high elderly population. The usefulness of an AED could not be proven; the cardiogenic cardiac arrest was not dominant among patients who achieved RC, and HEMS transport might be useful for obtaining RC.

Objective: Intersectin 2 (ITSN2) is reported to cause hereditary nephrotic syndrome, but the number of cases remains quite small. We observed a case of progressive renal dysfunction and family history for end-stage kidney disease with a known single heterozygous ITSN2 variant. This study aimed to reveal the novel pathological significance of altered ITSN2 expression via a detailed examination. Patient and Methods: A 52-year-old Japanese woman with mild proteinuria and hematuria visited our center. The patient did not opt for a detailed examination but was instead followed up with conservative treatment consisting of low-dose angiotensin receptor blockers. Serum Cr worsened from 1.15 to 1.79 mg/dL after 7 years when precise diagnosis was performed by renal biopsy and genetic testing. Results: Kidney biopsy showed a thin basement membrane (TBM) and global glomerulosclerosis in 37.5% (6 out of 16) glomeruli examined. Comprehensive gene panel testing of 121 genes revealed a known ITSN2 variant, assumed to be involved in pathogenesis. No variants in the Alport syndrome genes, which are typically responsible for TBM, were detected. Conclusion: A possible novel phenotype of the heterozygous ITSN2 variant was identified as a cause of hereditary renal failure. Further investigation of similar cases is required for a better understanding.

Objective: To determine the proportion of women having four or more antenatal care (ANC) visits and to assess associated factors (utilization of ANC services) in poor urban settlements in Rishikesh, Uttarakhand. Material and Methods: This was a community-based cross-sectional study. The study population included females who delivered during the last year residing in the target location. The data were collected through the house-to-house method in the four selected areas using a structured pre-tested expert-validated questionnaire. Data analysis was performed using SPSS version 23 using descriptive and multivariate statistical techniques. Results: There was a 59.66% prevalence of four or more antenatal visits (52.01%-66.97%). Only 26.44% of the participants confirmed their husbands' company during their antenatal visits. Socioeconomic status, type of family, mother's educational status, parity, husband's company during the visit, and mother's autonomy were significant factors (P<0.005) associated with the number of ANC visits. In logistic regression, after adjusting for other covariates, the autonomy of the participants and the husband's involvement during the visit were found to be significantly associated with four or more ANC visits. Conclusions: Approximately 60% of participants in poor urban settlements had four or more ANC visits. The findings of our study affirm the involvement of husbands in antenatal visits and women's autonomy as significant determinants of antenatal care utilization.

In Japan, non-farmers and people living in urban areas have not been greatly affected by environmental changes. In contrast, primary producers living in rural areas increasingly suffering from declining crop yields and drastically reduced catches of wild animals and seafood because of recent environmental changes. Studies, mainly from overseas, have reported that farming is an especially stressful occupation associated with high rates of depression and suicide, and the relationship between climate change and depression, as well as between climate change and suicide, is almost certain in rural communities. Particularly striking examples include the impact on the mental health of farmers in rural Australia and the Inuit in the Canadian Arctic, who are losing their livelihoods because of ecological collapse; this mental distress is known as "ecological grief". Such mental distress may be a major cause of depression and suicide among people in rural areas and Japan is no exception. I hoped that the concept of mental distress due to environmental changes will be recognized in Japan, leading to more eco-friendly attitudes that can promote the health of people living in rural areas and protect the surrounding ecosystem.

Objective: Examined literature on coping behaviors of women with menopausal symptoms and/or menopausal disorders to clarify their current situation and to get advice for future undertakings. Methods: The subjects of the survey were from documents on coping behaviors of women with menopausal symptoms and menopausal disorders published in Japan during the period from 2000 to July 2022. The investigations were acquired from Japan Medical Abstracts Society, CiNii, PubMed, by mixing the keywords "menopausal symptoms" or "menopausal disorders" and "measures" or "self-care" or "self-administration" in Japanese. Ultimately, we obtained 10 cases from Japan Medical Abstracts Society and 5 cases from CiNii. We focused on 13 cases for this analysis. Results: As a result of analyzing the contents of coping behaviors of women with menopausal symptoms and menopausal disorders, 6 categories [Adjusting daily life behaviors], [Taking measures for the symptoms], [Adjusting in my own way], [Connecting to others], [Thinking optimistically] and [Doing nothing] consisting of 18 subcategories were obtained. Conclusion: Women reconciled positively with menopause by themselves, even though they had menopausal symptoms and menopausal disorders. In future endeavors, psychology education will be obtained by clarifying the process of reaching it, and the possibility of raising the well-being of menopausal women will be enhanced. It has been revealed that there are women adopting coping behaviors suitable for themselves, while there are women who are tolerant even if the symptoms are severe, or those who do not consult specialists for menopausal symptoms. We believe that the findings are useful for promoting the coping behaviors of women with menopausal symptoms and menopausal disorders and educating them to prevent aggravation and prolongation of symptoms by clarifying the reasons why they do not take action to relieve their menopausal symptoms.

Objective: In recent years, an association between serum soluble immune checkpoint molecules (sICMs) and malignant tumors has been reported, which may become important biomarkers in the future. Although several reports have suggested a correlation between sICMs and prognosis, their origin is unclear. In this study, changes in serum soluble PD-L1 (sPD-L1) during the perioperative period and its origin were analyzed in patients with lung cancer. Patients and Methods: Patients with lung tumors (n=39) were included. Samples for sPD-L1 measurements were collected at five time points before and after surgery, and their changes over time were analyzed. ELISA was used to measure sPD-L1 levels. Results: Thirty-nine patients with lung tumors (31, males; 8, females; age, 74 (years) ± 7.7 (range: 51-89) years; malignancy/benign, 33/6) were enrolled. Eight cases of driver gene mutation-positive tumors were included. Twenty-eight (72%) patients were smokers, and their performance status was 0-1 in all 39 patients. PD-L1 TPS was ≥50%/1-49%/<1% in 8/10/14 patients. Stage I/II/III/IV/postoperative recurrence of lung cancer was observed in 21/0/6/5/1 patients, respectively. There were no significant correlations between sPD-L1 levels and clinicopathological features and no correlation with PD-L1 TPS. Comparing localized lesions (stages I-III) with advanced lesions (stage IV and postoperative recurrence), the distribution of sPD-L1 was slightly higher in advanced lesions, although the difference was not significant. No obvious changes in sPD-L1 expression were observed before and after surgery. Conclusion: sPD-L1 levels tended to be high in stage III and above lung cancer. There was no change in sPD-L1 levels before and after surgery. sPD-L1 levels did not correlate with the PD-L1 TPS.