Journal of rural medicine : JRM最新文献

Objective: Adnexal torsion is a common gynecological emergency whose prompt diagnosis is essential because a delay may lead to ovarian dysfunction. Although the whirlpool sign is reliable for diagnosing ovarian cyst torsion, technical difficulties hinder its use by sonographers. Here we developed a systematic approach to visualizing this sign by focusing on the fact that torsion arises from the space between the uterus and the pelvic wall. One must determine the origin of the torsion via transverse imaging of the uterus and follow the twisted ligaments to the ovarian cyst. Patients and Methods: Two women aged 56 (Case 1) and 28 years (Case 2) visited our hospital with lower abdominal pain. Transvaginal ultrasonography showed a 7-cm right ovarian cyst in Case 1 and a 5-cm cyst in the Douglas pouch in Case 2; normal bilateral ovaries and the whirlpool sign were detected in both cases. Under laparoscopic guidance in Cases 1 and 2, an ovarian cyst and a paraovarian cyst were confirmed and removed. Results: Our step-by-step method allowed us to identify the whirlpool sign and confirm adnexal torsion, leading to prompt surgery in both cases. Conclusion: Using a systematic procedure helps less experienced practitioners detect the whirlpool sign.

Objective: To identify the prevalence of risk factors for pulmonary non-tuberculous mycobacterial (NTM) disease in a Japanese population. Patients and Methods: We reviewed 337 consecutive Japanese patients (210 women) with pulmonary NTM disease, including 225 patients with Mycobacterium avium complex (MAC) disease (95.8%) at our hospital during 2006-2017. We calculated the prevalence of risk factors reported in Western countries among mycobacterial species. Results: Pulmonary MAC disease cases comprised 78.2% of pulmonary NTM patients in their 40s, increasing to 100% at age ≥80 years. Body mass index (BMI) was <18.5 in approximately 40% of patients, which was significantly higher than the prevalence of underweight in the Japanese population. The percentage of male heavy smokers (Brinkman index ≥600) was 58.2% of pulmonary NTM disease and was high for all mycobacterial species. In pulmonary MAC disease, systemic factors were observed in the order of malignant tumors (other than lung cancer), diabetes, rheumatoid arthritis, and tuberculosis. Local factors were observed in the order of bronchiectasis, chronic obstructive pulmonary disease, lung cancer, and bronchial asthma. Conclusion: The risk factors reported in Western countries were relatively highly prevalent among Japanese pulmonary NTM disease patients. This observation may help elucidate disease onset mechanisms.

Objective: The COVID-19 pandemic placed the Philippines' food and nutrition issues front and center. In this paper, we discuss the response of its government in addressing food and nutrition security at the beginning of the COVID-19 pandemic and describe its implications on nutritional status. We also cite initiatives that address food accessibility and availability in the communities. Lastly, we explore the importance of nutrition security dimension in food security. Methods: We analyze food and nutrition security issues in the Philippines during the COVID-19 pandemic through online reports and news articles. Results: The distribution of food and financial assistance in the country was extensive, albeit insufficient, considering the prolonged lockdown restrictions. Constantly changing community quarantine guidelines have affected the movement of food supply, delivery of health services, and household economic security. Nutrition programs, such as vitamin A supplementation, feeding for children, and micronutrient supplementation for pregnant women, had lower coverage rates, and by the latter half of 2020, the country had reached its highest recorded hunger rate. Cases of both undernutrition and overnutrition are predicted to rise because of dietary imbalances and a variety of factors. Conversely, community members and some local government units took it upon themselves to improve the food situation in their areas. The provision of food packs containing fresh fruits and vegetables was lauded, as it exemplified a conscious effort to deal with nutrition security. Conclusion: Efforts to address food security have always focused on increasing accessibility, availability, and affordability, often neglecting the nutritional components of foods. Strategies that incorporate nutrition security into food security are much needed in the country, especially during emergencies like the COVID-19 pandemic.

Objective: This quick literature review aimed to organize information on the detailed components of total pain in older people with advanced dementia in a holistic manner. Materials and Methods: The authors analyzed qualitative data from relevant clinical guidelines or textbooks, focusing on certain types of pain and distress in older people with advanced dementia, followed by an expert panel review by research team members. In the search, the authors defined a person with advanced dementia as having a functional assessment staging tool scale score greater than or equal to six. Results: The model covered a wide variety of pain, from physical pain to dementia-related psychological and spiritual aspects of total pain, including living environment change, stigma, discrimination, lack of communication and understanding, loss of sense of control and dignity, and cultural distress. It also identified physical appearance as an important factor in dying with dignity, as established by existing research on individuals with incurable cancers. Conclusion: The conceptual model of total pain in people with advanced dementia is expected to help turn healthcare professionals' attention to physical, psychological, social, and spiritual contributors to total pain in advanced dementia.

Arsenic cannot be tasted, seen or smelled and can vary in concentration between water wells even in condensed areas. American domestic well water is not regulated to meet the same drinking water standards as other types of water supplies and often contains arsenic. If arsenic is not detected in a well water sample, it is unlikely to be found later. Conversely, if it is detected in a new well, it is recommended to retest six months later as levels may fluctuate in the first months following well construction. It is up to the well owner to test their water and remove arsenic through commercially available water filters. If it is not detected and removed via filtration, a variety of serious, yet common, medical conditions may arise from chronic arsenic exposure, some of which are life-threatening. These include diabetes mellitus, hypertension, skin cancer, renal, bladder and lung cancers, polyneuropathy and cardiac QTc prolongation. Testing is best done through urine speciation if an initial total urine arsenic concentration is elevated. Consider a complete blood count, renal and liver function tests, an electrocardiogram as well as a urinalysis assessing for evidence of hematuria when examining patients with histories concerning for chronic arsenic exposure.

Objective: To determine if distance from our Neonatal Intensive Care Unit (NICU) follow-up clinic exacerbated risk of clinic non-attendance in high-risk groups defined by socioeconomic status or medical complexity, as geographical distance from the hospital can affect attendance rates at NICU follow-up clinics. Patients and Methods: We retrospectively identified infants born between January 2014 and June 2018, and subsequently discharged from our 50-bed level IV NICU, which serves a predominantly rural population. Patients were included in our study if they had at least one NICU clinic follow-up visit scheduled at discharge. Distance to the clinic was calculated based on family ZIP code. Mixed-effects logistic regression analysis of attendance at each scheduled visit was used to identify independent associations and interactions with distance among study covariates. Results: We included 576 patients in our study, with 74% missing at least one clinic appointment, and 30% not attending any of the three appointments. Median distance between our hospital and families was 53 km. On multivariable analysis, neither distance nor other infant or family characteristics were associated with clinic non-attendance. Only interfacility transfer had a statistically significant interaction with distance and this association only reached statistical significance for patients living furthest from our center. Conclusions: NICU follow-up is important, but clinic attendance is poor. For families living furthest away, transfers of care during the infant's hospitalization may be associated with lower completion of recommended post-discharge follow-up. Further research is needed to understand how clinics can mitigate barriers to attendance.

Objectives: Japan has implemented a policy to facilitate the employment of people aged 65 and older. It should be common practice for hospitals to employ older nursing assistants. We investigated factors associated with the acceptance of employing older nursing assistants among those younger than 65. Materials and Methods: The subjects were female nursing assistants younger than 65 working in 30 hospitals. A questionnaire-based survey was conducted. We performed factor analyses of both respondents' opinions on the employment of "Nursing assistants aged 65-69" and "Nursing assistants aged 70-74". To examine the associations between the "Acceptance of employing nursing assistants aged 65-69" and the "Opinions on the employment of nursing assistants aged 65-69", we conducted multiple regression analysis (Statistical Model 1). To examine the associations between the "Acceptance of employing nursing assistants aged 70-74" and the "Opinions on the employment of nursing assistants aged 70-74", we also conducted multiple regression analysis (Statistical Model 2). Results: By factor analyses of the opinions on the employment of both "Nursing assistants aged 65-69" and "Nursing assistants aged 70-74", the same factors were extracted. These factors were: "Health and job performance", "Utilization of the knowledge and experience of older nursing assistants", "Reducing the workload of nursing assistants", and "Manners of older nursing assistants". By multiple regression analyses in both "Statistical Models 1 and 2", "Health and job performance", "Utilization of the knowledge and experience of older nursing assistants", and "Reducing the workload of nursing assistants" were significant variables. Moreover, only in "Statistical Model 1", full-time nursing assistants were more accepting of employing nursing assistants aged 65-69 compared to part-time nursing assistants. Conclusion: To facilitate the acceptance of employing older nursing assistants, hospital managers should pay careful attention to these findings.

Objective: This study aimed to understand the structure of a self-assessment for evaluating the care management skills of individuals in the care management process. Materials and Methods: A survey was distributed to 964 care managers in home care management hailing from each committee in Japanese municipalities in Ibaraki, Chiba, Saitama, Kanagawa, and Tokyo. The process implementation degree of care management in 46 care management process evaluation items was assessed using a five-point method. Cronbach's alpha coefficients were derived for the items, and an exploratory factor analysis was conducted to ascertain the factor structure. We also verified the relationship between the factor scores, presence or absence of a chief care manager, and years of experience. Results: We received 385 responses (response rate: 39.9%), of which 372 were included in the analysis (valid response rate: 96.6%). Six factors were extracted, and 29 items were retained because of the exploratory factor analysis. Three of the six factors did not exist in the existing scales and had a unique structure. The cumulative contribution rate of the six factors was 64.9%, and Cronbach's alpha coefficient for all items was α=0.95, with Factor 1 being 0.88; Factor 2 being 0.83; Factor 3 being 0.86; Factor 4 being 0.85; Factor 5 being 0.80; and Factor 6 being 0.87. The total score for Factors 1, 2, 4, and 5 was significantly higher among chief care managers. Pearson's correlation coefficients were calculated to determine the correlation between scale scores and years of experience. Factor 1 (r=0.22) and Factor 2 (r=0.21) showed a modest positive correlation between the scale scores and years of experience. Conclusion: We retained 29 items and extracted six factors for the care manager self-assessment items that had a unique factor structure while following existing scales' factor structure.

Objectives: Correct diagnosis of iron deficiency remains challenging due to the cost of ferritin tests. Physicians, especially those in resource-limited settings, may resort to a complete blood count (CBC) when considering iron deficiency and anemia due to its accessibility. Although this has been practiced, it is still beneficial to assess whether CBC parameters exhibit the diagnostic capability of discriminating such medical conditions. Materials and Methods: Serum ferritin and CBC were performed on venous blood samples of 170 Filipino women aged 18-44 years. The diagnostic ability of the CBC parameters to detect iron deficiency and iron deficiency anemia was analyzed using receiver operating characteristic (ROC) curves. Iron deficiency was defined as a ferritin level <30 µg/L, while iron deficiency anemia was defined as a ferritin level <30 µg/L with hemoglobin level <120 g/L. Results: Ferritin levels correlated with red blood cell (RBC) count and hematocrit levels. With an area under the ROC curve (AUC) of 0.60, a hematocrit cutoff value of 38.5% was found to have low discriminating power in diagnosing iron deficiency only. Five parameters were observed to have higher discriminating powers for iron deficiency anemia: RBC count cutoff at 4.04 × 10¹²/L with AUC of 0.73, mean corpuscular volume (MCV) at 84.10 fL with AUC of 0.77, mean corpuscular hemoglobin concentration (MCHC) at 337.5 g/L with AUC of 0.80, mean corpuscular hemoglobin (MCH) at 29.15 pg with AUC of 0.81, and hematocrit at 35.5% with AUC of 0.96. Conclusion: CBC parameters can be a satisfactory discriminator for iron deficiency anemia among the women studied. However, further studies are needed to elucidate its utility in discriminating iron deficiency. With further investigations in this field, the potential use of CBC as a diagnostic tool for iron deficiency and iron deficiency anemia is promising, particularly in rural areas.

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.