著者

Akihiro Karube Fumiko Saito Enami Nakamura Akihiro Shitara Natsuki Ono Megumi Konno Daisuke Tamura Daisuke Nagao

出版者

THE JAPANESE ASSOCIATION OF RURAL MEDICINE

雑誌

Journal of Rural Medicine (ISSN:1880487X)

巻号頁・発行日

vol.14, no.1, pp.48-57, 2019 (Released:2019-05-30)

参考文献数

34

被引用文献数

9 15

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Objective: Human papillomavirus (HPV) vaccination was introduced in Japan in April 2013, as a national immunization program for girls aged 12–16 years, after an initial introduction in 2010 as a public-aid program for girls aged 13–16 years. The Yuri-Honjo district had the highest vaccine coverage among women aged 17–51 years in 2017, due to the original public-aid program. The aim of this study was to evaluate the differences in the vaccine types of HPV16/18 infections between 2008–2012 (pre-vaccine era) and 2013–2017 (vaccine era).Materials and Methods: We evaluated whether HPV vaccination was associated with a decrease in the prevalence of HPV16/18 and high-risk HPV and the incidence of HPV-associated cervical lesions. A total of 1,342 women aged 18–49 years, covering both the pre-vaccine and vaccine eras, who visited Yuri Kumiai General Hospital and underwent HPV genotype tests from June 2008 to December 2017 were compared.Results: Among women aged 18–24 years with higher vaccine coverage (68.2%), the prevalence of HPV16/18 and high-risk HPV decreased from 36.7% and 69.4%, respectively, in the pre-vaccine era to 5.8% and 50.0%, respectively, in the vaccine era (p=0.00013 and p=0.047, respectively). Among those with cervical intraepithelial neoplasia grade 2− and grade 2+, HPV16/18 prevalence decreased from 30.0% to 2.7% (p=0.0018) and from 81.8% to 36.4% (p=0.030), respectively. In this age group, the rate of HPV16/18 positivity decreased significantly. Among age groups with lower vaccine coverage, HPV prevalence did not significantly differ between the two eras.Conclusion: The prevalence of HPV16/18 and high-risk HPV significantly decreased in women aged 18–24 years, most of whom were vaccinated. HPV vaccination effectively reduced the prevalence of HPV16/18 infections in the Yuri-Honjo district.

著者

Daichi Watanabe Keiichi Uranaka Kyoko Asazawa Takako Akimoto Hironori Ohnuma

出版者

THE JAPANESE ASSOCIATION OF RURAL MEDICINE

雑誌

Journal of Rural Medicine (ISSN:1880487X)

巻号頁・発行日

vol.18, no.2, pp.133-142, 2023 (Released:2023-04-05)

参考文献数

28

被引用文献数

1

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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.

著者

Yusuke Watanabe Shouta Mashimo Hiroyuki Ichige Hiroyuki Nagata Masayuki Kojima

出版者

THE JAPANESE ASSOCIATION OF RURAL MEDICINE

雑誌

Journal of Rural Medicine (ISSN:1880487X)

巻号頁・発行日

vol.16, no.1, pp.62-66, 2021 (Released:2021-01-05)

参考文献数

12

被引用文献数

3

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Objective: Scrub typhus is a relatively common life-threating disease; its symptoms are non-specific and similar to those of other viral infections. Therefore, scrub typhus might be underdiagnosed.Patient: Herein, we report a patient with scrub typhus whose clinical course mimicked that of infectious mononucleosis. A 63-year-old male patient with hypertension presented to our hospital complaining of symptoms including prolonged fever, pharyngeal discomfort, and a mild headache. He showed the appearance of a rash after amoxicillin administration. At the same time, he did not show a crusted rash on his body surface.Results: After a comprehensive examination, Epstein-Barr virus and cytomegalovirus infections were ruled out. We suspected that this patient suffered from scrub typhus on the basis of his usual lifestyle. Finally, polymerase chain reaction analysis showed a positive result for deoxyribonucleic acid of Orientia tsutsugamushi in his blood sample. Fortunately, he recovered naturally with only supportive treatment during his hospitalization.Conclusion: We should observe and monitor patients with infectious mononucleosis-like symptoms and emphasize the importance of a clinical interview.

著者

竹増 まゆみ 梶谷 真也 徳本 和哉 要田 芳代 川上 恵子 只佐 宣子 堀川 俊二 福原 和秀

出版者

THE JAPANESE ASSOCIATION OF RURAL MEDICINE

雑誌

日本農村医学会雑誌 (ISSN:04682513)

巻号頁・発行日

vol.61, no.6, pp.904-908, 2013-03-31

被引用文献数

1

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急性薬物中毒患者が搬入された際には,薬剤師が中毒原因物質に関する情報を迅速に収集し,個々の症例にあった適切な情報と治療方法を医師,看護師に提案する必要がある。 今回,ジフェンヒドラミン(以下,DPH)含有軟膏を大量に誤飲した99歳女性の救命治療に対して,胃洗浄を含めた治療方法と,患者の血中DPH濃度を経時的に測定することを提案した。その結果,血中DPH濃度の低下とともに臨床症状の改善が認められ,DPH含有軟膏誤飲例に対して胃洗浄を施行したこと,および血中濃度測定の臨床における有用性が示唆された。

著者

Takako Nagai Hidetaka Wakabayashi Shinta Nishioka Ryo Momosaki

出版者

THE JAPANESE ASSOCIATION OF RURAL MEDICINE

雑誌

Journal of Rural Medicine (ISSN:1880487X)

巻号頁・発行日

vol.18, no.1, pp.21-27, 2023 (Released:2023-01-06)

参考文献数

33

被引用文献数

1

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Objective: Dysphagia rehabilitation is an important area in geriatric nutrition due to the commonality of sarcopenic dysphagia in older adults. However, there have been no reports on the efficacy of treatment by board-certified physiatrists (BCP) in patients with sarcopenic dysphagia. This study therefore aimed to investigate whether intervention by board-certified physiatrists affects the functional prognosis of patients with sarcopenic dysphagia.Materials and Methods: Of 467 patients enrolled in the Japanese Sarcopenic Dysphagia database between November 2019 and March 2021, 433 met the study eligibility criteria. The patients were divided into two groups based on whether or not they received intervention by a BCP. The clinical characteristics and outcomes of the two groups were compared. Statistical analyses were performed by inverse probability weighting (IPW).Results: BCPs were involved in the management of 57.0% of patients with sarcopenic dysphagia. These patients had a significantly higher increase in the Barthel index both before and after IPW correction than those not managed by a BCP (P=0.001 and P=0.016, respectively). However, sarcopenic dysphagia significantly improved in the non-BCP group before IPW correction (P<0.001), although there was no significant difference after IPW correction (P=0.301).Conclusion: BCP management was significantly associated with higher activities of daily living (ADL), but not with an improvement in sarcopenic dysphagia. To provide and manage effective rehabilitation, it is necessary to familiarize patients with the management and training of sarcopenic dysphagia rehabilitation for BCP in order to cope in regions with few rehabilitation units.

著者

Toshikazu Ito Issei Kameda Naoki Fujimoto Ryo Momosaki

出版者

THE JAPANESE ASSOCIATION OF RURAL MEDICINE

雑誌

Journal of Rural Medicine (ISSN:1880487X)

巻号頁・発行日

vol.17, no.4, pp.221-227, 2022 (Released:2022-10-22)

参考文献数

19

被引用文献数

1

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Objective: This study assessed the regional disparities and the associated factors in the implementation of cardiac rehabilitation in Japan.Materials and Methods: Regional disparities were investigated by comparing the number of cardiac rehabilitation units in each of 47 prefectures in Japan based on the National Database of Health Insurance Claims Open Data published by the Ministry of Health, Labour, and Welfare. The relationships between the numbers of inpatient and outpatient cardiac rehabilitation units and the numbers of registered instructors of cardiac rehabilitation, board-certified physiatrists, and board-certified cardiologists were examined.Results: The region with the highest and lowest numbers of inpatient units showed 11,620.5 and 1,650.2 population-adjusted cardiac rehabilitation units adjusted per 100,000 population, respectively, corresponding to a 7.0-fold difference. Meanwhile, 4,865.3 and 238.6 units were present in the regions with the highest and lowest numbers of outpatient units, respectively, corresponding to a 20.4-fold regional disparity. Our analysis showed that the population-adjusted number of inpatient cardiac rehabilitation units was significantly associated with the population-adjusted numbers of registered instructors of cardiac rehabilitation (r=0.647, P<0.001) and board-certified cardiologists (r=0.445, P=0.002) but only marginally associated with the population-adjusted number of board-certified physiatrists (r=0.329, P=0.024). Moreover, the population-adjusted number of outpatient cardiac rehabilitation units was significantly associated with the population-adjusted numbers of registered instructors of cardiac rehabilitation (r=0.406, P=0.005) and board-certified cardiologists (r=0.450, P=0.002) but not with the population-adjusted number of board-certified physiatrists (r=0.078, P=0.603).Conclusion: Large regional disparities were observed during the implementation of cardiac rehabilitation. Increased numbers of cardiac rehabilitation instructors and cardiac rehabilitation practices are expected to eliminate these regional differences in cardiac rehabilitation practices.

著者

Kenta Hirai Kei Nagai Takashi Ono Masayuki Nakajima Tomohiro Hayakawa Yoshinori Sakata Yoshiharu Nakamura

出版者

THE JAPANESE ASSOCIATION OF RURAL MEDICINE

雑誌

Journal of Rural Medicine (ISSN:1880487X)

巻号頁・発行日

vol.16, no.1, pp.47-51, 2021 (Released:2021-01-05)

参考文献数

14

被引用文献数

1

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Objective: Most cases of severe metabolic alkalosis have many causes that may result in renal failure and death. Therefore, these should be treated promptly for successful recovery.Patient: A 61-year-old man was hospitalized due to an acute kidney injury (creatinine level of 4.36 mg/dL) after a 3-month history of anorexia and recurrent vomiting. He had been treated for tuberculosis in the past.Results: Blood gas analysis revealed severe metabolic alkalosis with pH=7.66, HCO3=94 mmol/L, and pCO2=82.0 mmHg. Routine biochemical examination revealed severe hypokalemia (K 2.9 mEq/L) that was associated with prolonged QTc interval (0.52 seconds) on the electrocardiogram. Gastrofiberscopic examination also revealed severe stenosis and ulcerated scarring of the gastric pylorus and severe esophagitis. Intravenous hydration and correction of hypokalemia improved renal function and resolved metabolic alkalosis. An investigation that was repeated after 6 days revealed a creatinine level of 1.58 mg/dL, pH=7.47, HCO3=23.4 mmol/L, K=3.6 mEq/L, and QTc of 0.45 seconds. The patient underwent gastrectomy and adenocarcinoma was observed.Conclusion: We described a resolved case of severe metabolic alkalosis and acute kidney injury in a rural medical setting following conservative management.

著者

尾崎 米厚 福島 哲仁 阿部 顕治 中川 昭生 岡本 傳男 山根 洋右

出版者

THE JAPANESE ASSOCIATION OF RURAL MEDICINE

雑誌

日本農村医学会雑誌 (ISSN:04682513)

巻号頁・発行日

vol.36, no.4, pp.937-941, 1987

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島根県農村部における輸入赤痢アメーバ症の2例について報告した。2例とも中華人民共和国のツアー中に, 北京にてスイカを食べており, これが感染経路と考えられた。<BR>症例1は, 帰路上海にて発症し, 患者は, 悪心・嘔吐・下痢・意識消失を来し, 上海病院に緊急入院し, 脱水症状に対する治療を受けた。帰国後, 糞便検査にて<I>Entamoeba histolytica</I>の栄養型が認められ, 赤痢アメーバ症と診断された。メトロニダゾールにて治療を行なったが, 高令で激症アメーバ性大腸炎を呈した本例においては, 効果があまりなく, チニダゾールの方が効果を示した。<BR>症例2では, 自覚症状が認められなかったが, 糞便検査にて, <I>Entamoeba histolytica</I>の嚢子型が認められ, キャリアと診断され治療を受けた。<BR>近年は, 都市部のみならず農村部においても海外渡航者が増えており, 旅行者における輸入赤痢アメーバ症の多発, およびその集団発生に, 今後注意を払う必要があるものと考える。

著者

Yohei Tomaru Hiroshi Kamada Yuta Tsukagoshi Shogo Nakagawa Mio Onishi Kenta Tanaka Ryoko Takeuchi Yuki Mataki Shumpei Miyakawa Masashi Yamazaki

出版者

THE JAPANESE ASSOCIATION OF RURAL MEDICINE

雑誌

Journal of Rural Medicine (ISSN:1880487X)

巻号頁・発行日

vol.14, no.2, pp.176-180, 2019 (Released:2019-11-20)

参考文献数

10

被引用文献数

2

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Objectives: The purpose of this study was to evaluate the relationship between exercise time and musculoskeletal problems and to determine the appropriate amount of exercise for children in both lower- and higher-grade levels of elementary and junior high schools.Materials and Methods: Mark-sheet-type questionnaires were distributed to and collected from all elementary and junior high schools in two cities. We collected 22,494 questionnaires in total. The relationship between exercise time and musculoskeletal problems was analyzed. The χ2 test and multivariate logistic regression analysis were used for statistical analyses.Results: The mean exercise time in school, in addition to physical education time, was 3.1 hours per week. In 56% of the children, the exercise time was less than 2 hours per week, and in 13% of the children, the exercise time was more than 10 hours per week. Although the rate of sports injury increased with an increase in exercise time, the duration of one-leg stand (a test of balance and muscle strength) also increased with an increase in exercise time. The cut-off values for sports injuries in boys/girls were 2.9/2.9 hours, 4.0/2.9 hours, and 7.5/4.2 hours in lower grade elementary school, higher grade elementary school, and junior high school, respectively.Conclusions: Although an appropriate amount of exercise improves one’s physical health and ability, excessive exercise leads to musculoskeletal problems. Approximately 7 hours/week of exercise is recommended for junior high school students. In elementary school, the exercise time should be carefully decided as the musculoskeletal system of the students is still immature.

著者

前原 和平

出版者

THE JAPANESE ASSOCIATION OF RURAL MEDICINE

雑誌

日本農村医学会雑誌 (ISSN:04682513)

巻号頁・発行日

vol.62, no.6, pp.853-858, 2014

被引用文献数

1

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東日本大震災ならびに福島第一原子力発電所事故から2年8か月が経とうとする現在,30km圏内をはじめとする避難区域はもとより,その周辺の地域コミュニテイの復旧・復興の見通しは杳として立っていない。昨年の学会では,東日本大震災とそれに引き続く東京電力福島第一原子力発電所事故によりその日現場で何が起きたのか,そして福島県下病院の被災状況について報告をさせていただいた。大震災より2年8か月が経過した本学会開催時には福島県の復興の確かな足取りをお話しするつもりであった。しかし,住民の帰還どころか,仮の町計画すら具体化せず,最大16万6,000人に上った避難住民は8月現在,未だおよそ15万人(県内に約9万6,000人,県外へ約5万4,000人)が避難生活を送っている。第一原発から20km以内の旧警戒区域にある双葉郡4町(浪江,双葉,大熊,富岡)は5年間帰還しないことを決めた。避難生活が6年以上に渡る人は5万4,000人に上ると推定されている。また,旧緊急時避難準備区域は解除されて1年5か月が経過したが帰還したのは避難した住民の1~2割に止まり復旧は進んでいない。 震災二周年の3月11日に報道されたNHK特集では避難区域から8万5,000人,区域外から7万人の避難生活者のなかで,転居を4~5回以上した人が76.7%,もといた家族と暮らせていない人が59.6%に上ると報道された。避難住民は,生活基盤を根こそぎ奪われ,地域コミュニティから隔絶された中で,経済的にも精神的にも困難な状況に置かれている。さらに,この状況が次第に見えづらくなってきつつあることが憂慮される。福島第一原発事故も本年8月に入って汚染地下水の海への流出や貯蔵タンクからの汚染水漏れが明らかとなり収束にはほど遠い状況にある。病院を含む双葉郡地域社会の復興・再生はようやくとば口に立ったに過ぎない。 地域コミュニテイの復旧なしには病院の復旧・復興も進まない。旧警戒区域の7病院は未だ休止中であり再開の目処は立っていない。また,診療を再開した旧緊急時避難準備区域の6病院は病院スタッフの減少により厳しい医業経営を強いられている。放射線低線量被爆への不安から避難している住民のなかには,子供のいる若い世代の医療スタッフも多く含まれ,県下病院において医療スタッフの不足が深刻化している。これからの福島県医療の復興・再生には遠い道のりが待ち構えている。

著者

亀谷 富夫 森田 達志 田中 功 越田 英夫 五十嵐 豊 堀上 健幸 永井 忠之 加藤 正義

出版者

THE JAPANESE ASSOCIATION OF RURAL MEDICINE

雑誌

日本農村医学会雑誌 (ISSN:04682513)

巻号頁・発行日

vol.43, no.1, pp.41-44, 1994

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症例は56歳の男性。1975年頃よりアルコール依存症 (酒1升/日) 有り。1978年より糖尿病を指摘され, 1985年よりインスリン治療を受けたがHbA<SUB>1c</SUB>は9.2~12.8%とコントロール不良であった。1990年11月までに6回の低血糖昏睡をおこした。内因性インスリン分泌は著明に低下し, 糖尿病3徴を認めた。はっきりとした歩行障害, 痴呆, 尿失禁は認めなかったが, 頭部CTスキャンとMRIでは脳萎縮を伴わない著明な脳室拡大を認めた。しかし脳脊髄圧は正常であった。RI cisternographyにて48時間後にも脳室内停留を認めたことより, 特発性正常圧水頭症と診断された。本邦での報告例はなく, 低血糖と正常圧水頭症との関連性を示唆する興味深い症例と思われた。

著者

若月 俊一 菅野 二郎 林 茂樹 松島 松翠 北出 公俊 有馬 和雄

出版者

THE JAPANESE ASSOCIATION OF RURAL MEDICINE

雑誌

日本農村医学会雑誌 (ISSN:04682513)

巻号頁・発行日

vol.24, no.4, pp.571-594, 1975

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1. 昭和48年と昭和49年の2年にわたり, 全国の5つの病院において, 罹病調査と有病調査を実施した。登録し得た疾病件数は, 前者では160, 309件, 後者では33, 549件である。<BR>2. 罹病調査では, 呼吸器系疾患, 消化器系疾患, 神経系・感覚器疾患, 等が多く, 有病調査では, 循環器系疾患, 消化器系疾患, 呼吸器系疾患等が多かった。すなわち, 感冒, 急性咽頭炎など比較的経過の短いものは前者に多く, 高血圧など経過の長いものは後者に多かった。<BR>3. 性別にみると, 消化器系疾患, 呼吸器系疾患, 不慮の事故, 外傷などは男子に多く, 性尿器系疾患 (膀胱炎等) は女子に多かった。<BR>4. 年代別では20~29才の「お嫁さん」年令の罹患がもっとも多かった。また一般に乳幼児, 小児では, 呼吸器系疾患, 青年・中年層では消化器系疾患, 高年層では循環器系疾患が多くみられた。<BR>5. 職業別では, とくに農家や「農業を主」としているものに, 循環器系疾患, 筋骨格系・結合織疾患, 新生物が多くみられた。とくに筋骨格系・結合織疾患は, 専農女子に多く, 不慮の事故は兼農男子に多くみられた。また非農に多いものは呼吸器系疾患, 皮膚疾患であった。<BR>6. 20年前の罹患調査と比較して, 著しく減少しているのは, 伝染病・寄生虫疾患であり, 増加しているのは, 循環器系疾患, 呼吸器系疾患, 消化器系疾患, 性尿器系疾患, 精神病, 不慮の事故・外傷等であった。すなわち, 感染性の疾患は少くなり, 慢性の成人病を中心とする疾患がふえつつあるといえる。

著者

Hidenobu Kawabata Yuya Kimura Kengo Kisa Manabu Murakami Masaji Maezawa

出版者

THE JAPANESE ASSOCIATION OF RURAL MEDICINE

雑誌

Journal of Rural Medicine (ISSN:1880487X)

巻号頁・発行日

vol.4, no.2, pp.87-90, 2009 (Released:2009-11-20)

参考文献数

19

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Intestinal anisakiasis is rarely diagnosed because it is thought to be uncommon and is poorly recognized. It produces severe abdominal pain and an inflammatory reaction often resulting in reactive intestinal obstruction, which is sometimes treated with an unnecessary laparotomy as acute abdomen or intestinal obstruction. We reported a 58-year-old female with acute intestinal obstruction caused by intestinal anisakiasis, which resulted in a self-limiting clinical course. The diagnosis was based on a history of recent ingestion of raw fish and abdominal computed tomographic findings of partial thickening of the intestinal wall accompanied by focal luminal narrowing with ascites. In spite of the severity of the abdominal pain, the bowel obstruction induced by inflammation and edema was resolved with conservative treatment after three weeks. Accordingly, intestinal anisakiasis was considered in the differential diagnosis of intestinal obstruction, which can be treated with conservative therapy.

著者

Yurie Kobashi Hong Chhay Thyryfong Savat Manabu Okawada Masaharu Tsubokura Yushifumi Hayashi

出版者

THE JAPANESE ASSOCIATION OF RURAL MEDICINE

雑誌

Journal of Rural Medicine (ISSN:1880487X)

巻号頁・発行日

vol.15, no.4, pp.212-216, 2020 (Released:2020-10-01)

参考文献数

10

被引用文献数

3 4

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Objective: Regional disparities in health services is a crucial problem in Cambodia. Particularly, a number of NCD risk factors are more common among the rural poor. Fortunately, 80% of NCDs are preventable and cost-effective interventions exist. Therefore, health care needs assessments regarding NCDs in poor rural areas are vital. The object of this pilot study was to identify health care needs regarding NCDs among residents in poor rural areas in Cambodia.Materials and Methods: A medical health check-up and questionnaire survey were conducted with 208 rural residents who participated in a free health check-up and doctor consultation in Kaoh Peam Reang.Results: One hundred sixteen (55.8%) females were included in the total sample size of 208 participants; the majority (52.9%) were between 35 and 65 years of age. Twenty-five participants (12%) were current smokers, and 44 (21%) were current alcohol drinkers. Eighty (38.5%) participants had hypertension and 44 participants (21.2%) had a body mass index over 25. Alcohol drinking and smoking habits were more common among men. The five most frequent medical complaints were headache (18.3%), lower back pain (14.4%), foot and hand pain (13.9%), joint pain (10.1%), and difficulty breathing (10.1%).Conclusions: The medical need for doctor consultations regarding chronic disease and chronic pain might be higher in poor rural areas in Cambodia.

著者

Hirotaka Mutsuzaki Ryoko Takeuchi Yuki Mataki Yasuyoshi Wadano

出版者

THE JAPANESE ASSOCIATION OF RURAL MEDICINE

雑誌

Journal of Rural Medicine (ISSN:1880487X)

巻号頁・発行日

vol.12, no.1, pp.33-37, 2017 (Released:2017-05-24)

参考文献数

24

被引用文献数

23 33

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Objective: Postoperative knee range of motion (ROM) is among the most important factors influencing patient satisfaction after total knee arthroplasty (TKA). The purpose of this study was to clarify the time course of improvement in knee ROM up to 12 months after TKA, including intraoperative knee ROM after implantation, and to clarify a target ROM for rehabilitation after TKA.Patients and Methods: In total, 39 knee joints in 26 patients with osteoarthritis who underwent TKA (retaining the posterior cruciate ligament) were evaluated. Goniometry was used to measure the knee range of extension and flexion preoperatively; intraoperatively; at 1 and 2 weeks after TKA; and then at 1, 3, 6, and 12 months after TKA.Results: The postoperative extension range gradually improved up to a maximum at 6 months after TKA; there were no significant differences in the extension range between intraoperative and 6 months after TKA, intraoperative and 12 months after TKA, or 6 and 12 months after TKA. The postoperative flexion range gradually improved, with the maximum improvement observed at 3 months after TKA; there were no significant differences in the flexion range before TKA and 3, 6, and 12 months after TKA. There were no significant differences between flexion ROM measured at 3, 6, and 12 months after TKA.Conclusions: The changes in the knee range of extension plateaued 6 months after TKA, and those in the knee range of flexion plateaued 3 months after TKA. The target range of extension for rehabilitation from 6 months to 12 months after TKA was the intraoperative range, and the target range of flexion for rehabilitation from 3 months to 12 months after TKA was the preoperative range.

著者

Jun Watanabe Kazuhiko Kotani

出版者

THE JAPANESE ASSOCIATION OF RURAL MEDICINE

雑誌

Journal of Rural Medicine (ISSN:1880487X)

巻号頁・発行日

vol.18, no.1, pp.1-7, 2023 (Released:2023-01-06)

参考文献数

57

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Objective: Rural surgical training for residents is expected to increase the number of general surgeons working in rural areas; however, the impact of rural training programs to ensure such surgeons remains to be determined. Therefore, we reviewed the relevance of rural surgical rotation to the increase of general surgeons in rural areas.Materials and Methods: Studies on the outcomes of rural surgical rotations during the residency period in comparison to non-rural surgical rotations were retrieved using electronic databases through April 2022.Results: Among the 514 articles, five were eligible for review. All studies were published in the United States. Four studies reported an increased number of general surgeons in rural areas owing to rural surgical rotations. A meta-analysis of all studies showed a positive impact on the number of general surgeons in rural areas (odds ratio=2.19, 95% confidence interval=1.23–3.91). The programs generally ranged from 2 to 12 months with extensive experience with minor surgery and subspecialties necessary for surgery.Conclusions: Rural surgical rotations during the residency period can increase the number of general surgeons working in rural areas. Further studies are needed to evaluate the placement of general surgeons in rural areas.

著者

Nobuhito Ishikawa Toshiki Katsura Mayumi Hara

出版者

THE JAPANESE ASSOCIATION OF RURAL MEDICINE

雑誌

Journal of Rural Medicine (ISSN:1880487X)

巻号頁・発行日

vol.16, no.4, pp.270-279, 2021 (Released:2021-10-01)

参考文献数

26

被引用文献数

2

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Objective: Physical frailty has been considered a risk factor for certification of long-term care needs (hereafter referred to as Certification) under Japan’s long-term care insurance (LTCI). Therefore, assessment of frailty in elders should be studied from multiple perspectives. The Kihon Checklist (KCL) is widely used to identify need for support/care among Japanese older adults. This study aims to examine the relationship between changes in KCL items and Certification among Japan’s young-old and old-old.Material and Methods: The KCL responses of 7,092 participants were assessed in April 2012 and March 2016, along with gender, age, and living environment. Deaths, Certifications, and relocations were tracked until March 2018. Changes in KCL items were categorized as bad, worse, improved, or good.Results: Between March 2016 and March 2018, about 7.3% of respondents obtained Certifications. KCL item changes increased the risk of new Certification for bad and worse groups, while improved cognitive function among the old-old possibly reduced the risk of new Certification.Conclusion: Therefore, rather than administering the KCL once, identifying KCL changes among people at risk could help prevent or delay their need for long-term care.

著者

Yoko Watanabe Isao Saito Ikuyo Henmi Kana Yoshimura Hirotatsu Maruyama Kanako Yamauchi Tatsuhiro Matsuo Tadahiro Kato Takeshi Tanigawa Taro Kishida Yasuhiko Asada

出版者

THE JAPANESE ASSOCIATION OF RURAL MEDICINE

雑誌

Journal of Rural Medicine (ISSN:1880487X)

巻号頁・発行日

pp.2887, (Released:2014-06-17)

被引用文献数

47 68

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Objectives: Despite the fact that the total energy intake of Japanese people has decreased, the percentage of obese people has increased. This suggests that the timing of meals is related to obesity. The purpose of the study was to investigate the relationship between the timing of meals and obesity, based on analyses of physical measurements, serum biochemical markers, nutrient intake, and lifestyle factors in the context of Chrononutrition.Participants and Methods: We analyzed data derived from 766 residents of Toon City (286 males and 480 females) aged 30 to 79 years who underwent detailed medical examinations between 2011 and 2013. These medical examinations included. (1) physical measurements (waist circumference, blood pressure, etc.); (2) serum biochemical markers (total cholesterol, etc.); (3) a detailed questionnaire concerning lifestyle factors such as family structure and daily habits (22 issues), exercise and eating habits (28 issues), alcohol intake and smoking habits; (4) a food frequency questionnaire based on food groups (FFQg);and (5) a questionnaire concerning the times at which meals and snacks are consumed.Results: The values for body mass index (BMI) and waist circumference were higher for participants who ate dinner less than three hours before bedtime (<3-h group) than those who ate more than three hours before bedtime (>3-h group). The Chi-square test showed that there was a significant difference in eating habits, e.g., eating snacks, eating snacks at night, having dinner after 8 p.m., and having dinner after 9 p.m., between the <3-h group and the >3-h group. Multiple linear regression analysis showed that skipping breakfast significantly influenced both waist circumference (β = 5.271) and BMI (β = 1.440) and that eating dinner <3-h before going to bed only influenced BMI (β = 0.581).Conclusion: Skipping breakfast had a greater influence on both waist circumference and BMI than eating dinner <3-h before going to bed.

著者

Shinsuke Hori Kenta Ushida Ryo Momosaki

出版者

THE JAPANESE ASSOCIATION OF RURAL MEDICINE

雑誌

Journal of Rural Medicine (ISSN:1880487X)

巻号頁・発行日

vol.17, no.3, pp.125-130, 2022 (Released:2022-07-01)

参考文献数

27

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Objective: Many countries have recently established registration databases in the field of rehabilitation to clarify their current status. However, these databases are primarily created for inpatients, with only a few large-scale databases for outpatients. The present study aimed to clarify secular changes, age distribution, and regional disparities in the implementation of outpatient rehabilitation in Japan using the National Database of Health Insurance Claims.Materials and Methods: Using the National Database of Health Insurance Claims Open Data published by the Ministry of Health, Labor, and Welfare, the number of outpatient rehabilitation units from 2014 to 2018 were extracted and examined.Results: The total number of units for outpatient rehabilitation increased gradually from 2014 to 2018. Orthopedic rehabilitation accounted for more than 80% of the total number of units for outpatient rehabilitation in 2018. The total number of units for outpatient rehabilitation according to age was highest among those in their late 70s, while cerebrovascular and dysphagia rehabilitation had the highest number of units in children.Conclusion: The total number of units for outpatient rehabilitation gradually increased from 2014 to 2018; whereas the number of total units for outpatient rehabilitation according to age was the highest among those in their late 70s. However, cerebrovascular rehabilitation and dysphagia rehabilitation had the highest number of units in children. The implementation status of rehabilitation in each region varied greatly among prefectures, suggesting the need for policy planning to eliminate regional disparities.

著者

Mustafa Boğan Mustafa Sabak Mehmet Murat Oktay Hasan Gümüşboğa Tutku Tek Tufan Alatlı

出版者

THE JAPANESE ASSOCIATION OF RURAL MEDICINE

雑誌

Journal of Rural Medicine (ISSN:1880487X)

巻号頁・発行日

vol.15, no.3, pp.98-103, 2020 (Released:2020-07-17)

参考文献数

17

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Objective: This study is unique as it examines biological materials brought to the emergency department. The purpose of this study was to investigate the reasons behind the presence of nonhuman biological material in the emergency department.Methods: The materials brought were photographed and a pre-prepared survey form was filled in following examination.Results: A total of 46 biological materials were brought to the emergency department within a 12-month period. Ticks were the most frequently brought material, and the most common reason for bringing them was to get the creature removed from the body. Situations in which the physician did not have knowledge about the material were more frequent among those that were neutral about being satisfied with the attitude of the physician towards the material brought, and satisfaction was higher in cases when the physician was knowledgeable, although this was not statistically significant.Conclusion: Physicians should not condemn biological materials brought into the department after exposure. If possible, they should try to gain more knowledge about them. If the material is not to be stored, once it is made sure that it is not dangerous, it should be disposed of in a medical waste bin. Physicians should be knowledgeable toward the frequency and the types of such agents in their region.