Journal of rural medicine : JRM最新文献

{"title":"How can we help doctors stay in rural areas of Japan? A comparison in medical students' attitudes toward general practice and clinical research of a medical school in Japan and in Sweden.","authors":"Masahiro Hirose, Takashi Watari, Rie Sato, Patrik Midlöv, Masanobu Okayama, Hiroo Yoshikawa, Yuichi Imanaka","doi":"10.2185/jrm.2023-011","DOIUrl":"10.2185/jrm.2023-011","url":null,"abstract":"<p><strong>Objective: </strong>In Sweden, primary healthcare centers play an important role in the performance of general practice, education, and clinical research. In Japan, general physicians or general practitioners are expected to be more active in the small-scale hospitals and clinics in rural areas. This study aimed to explore the differences in attitudes toward general practice and clinical research among medical students in Japan and Sweden to present solutions to help doctors stay in rural areas of Japan.</p><p><strong>Materials and methods: </strong>This cross-sectional study was conducted at two medical schools in Japan and Sweden in 2018, using an anonymous and self-administered questionnaire survey that comprised 16 items including 9 items on clinical research.</p><p><strong>Results: </strong>Participants were 154 medical students (response rate: 69.4% for 222 students) in Japan and 56 (27.1% for 201 students) in Sweden. The proportion of medical students who wanted to become general physicians was greater in Japan than in Sweden (Japan:Sweden=36.4%:17.9%; <i>P</i>=0.012). Although fewer Japanese students wanted to conduct research in rural areas than Swedish students (43.5%:57.1%; <i>P</i><0.001), the positive proportion of Japanese students working in clinical research and/or taking an academic degree in rural areas was greater than that of Swedish students (52.0%:23.2%; <i>P</i>=0.032).</p><p><strong>Conclusion: </strong>As Swedish medical students and young doctors learn considerably from primary healthcare centers, their attitudes toward clinical research are more developed than those of their Japanese counterparts. However, more Japanese medical students than Swedish students wish to become general practitioners, and they are likely to strive to conduct clinical research at small-scale hospitals/clinics in rural areas. Therefore, the improvement of the clinical research environment in small-scale hospitals and clinics in rural areas is needed at the earliest in Japan.</p>","PeriodicalId":73939,"journal":{"name":"Journal of rural medicine : JRM","volume":"19 4","pages":"264-272"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11442082/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142360742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dispatch of replacement doctors from core hospitals to rural clinics in Japan.","authors":"Kazuhiko Kotani","doi":"10.2185/jrm.2024-019","DOIUrl":"10.2185/jrm.2024-019","url":null,"abstract":"<p><strong>Objectives: </strong>Core hospitals play an important role in rural healthcare, and the dispatch of replacement doctors (DRD) from core hospitals to rural clinics is included in medical care plans at the prefectural level in Japan.</p><p><strong>Material and methods: </strong>The conditions of DRD implementation in core hospitals (n=345) were observed using national data from 2022.</p><p><strong>Results: </strong>DRD was present in 101 (29.3%) core hospitals. A greater number of doctors per 100 beds (median: 16.7) was observed when DRD was present than when it was absent (median: 11.0; <i>P</i><0.05).</p><p><strong>Conclusion: </strong>More studies are warranted regarding the number of doctors and their functions in core hospitals to ensure DRD.</p>","PeriodicalId":73939,"journal":{"name":"Journal of rural medicine : JRM","volume":"19 4","pages":"310-311"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11442086/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142360741","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The mediating roles of psychological resilience and psychological well-being of caregivers for the older adults.","authors":"Hiroko Kukihara, Michiyo Ando, Kayoko Koga, Midori Nishio, Fumiko Nakashima, Niwako Yamawaki","doi":"10.2185/jrm.2023-037","DOIUrl":"10.2185/jrm.2023-037","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to investigate the mediating effects of psychological resilience and psychological well-being for caregivers at nursing homes on the relationship between insomnia and elder maltreatment. As the world is aging quickly and the number of older individuals cared for by formal caregivers has been increasing, this study's results could help create intervention programs to minimize the occurrence of older people's maltreatment.</p><p><strong>Materials and methods: </strong>A total of 431 care workers who met all criteria, from 21 care service centers for older adults in Fukuoka, Japan, completed the Conditions of Maltreatment Scale, Caregivers' Belief in Ideal Care, Insomnia Severity Index, WHO-5 Well-Being Index, and Connor-Davidson Resilience Scale-10.</p><p><strong>Results: </strong>A multivariate analysis of variance revealed that participants with no insomnia had greater resilience, higher psychological well-being, and greater belief in ideal care and to treated older clients less roughly compared to participants with insomnia. Psychological resilience and well-being were significant mediators in the relationship between insomnia, rough care, and beliefs in ideal care.</p><p><strong>Conclusion: </strong>As formal caregivers are in urgent demand, society should take care of them. The most effective and successful intervention for improving their physical and psychological well-being should be initiated at the individual and organizational levels.</p>","PeriodicalId":73939,"journal":{"name":"Journal of rural medicine : JRM","volume":"19 4","pages":"241-249"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11442087/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142362529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and effectiveness of exercise rehabilitation system for dysphagia using information and communication technology systems.","authors":"Takako Nagai, Hiroshi Uei, Kazuyoshi Nakanishi","doi":"10.2185/jrm.2024-008","DOIUrl":"10.2185/jrm.2024-008","url":null,"abstract":"<p><strong>Objective: </strong>In older patients, dysphagia is a major risk factor for aspiration pneumonia and choking as it progresses slowly and recurs repeatedly without awareness. Information and communication technology (ICT) is used in various medical fields. However, no feeding or swallowing disorder prevention program has been developed to date and no reports have verified its effectiveness and safety. This study aimed to develop a dysphagia rehabilitation system using ICT and verify its effectiveness.</p><p><strong>Methods: </strong>Changes in swallowing function and functional prognosis were examined in 120 patients with aspiration pneumonia: 60 in the control and 60 in the ICT group. Physical therapists performed pulmonary rehabilitation in the control group. There were additional activities within the ICT rehabilitation system, such as motor and swallowing function evaluations, training sessions, and provision of dietary instructions, in addition to the rehabilitation content of the control group.</p><p><strong>Results: </strong>The Functional Oral Intake Scale (FOIS) score, a measure of swallowing function, significantly improved in the ICT group (<i>P</i><0.001). ICT use was considered an influencing factor of FOIS change (β=0.49, 95% confidence interval, 1.47 to 2.97 <i>P</i><0.001). ICT use positively affected the Barthel index gain (β=0.49, 95% confidence interval, 14.73 to 32.72 <i>P</i><0.001).</p><p><strong>Conclusion: </strong>A rehabilitation program using ICT improved swallowing function and the Barthel index. The system can also be used in sparsely populated and rural areas where there are few rehabilitation professionals, and high ripple effects are expected.</p>","PeriodicalId":73939,"journal":{"name":"Journal of rural medicine : JRM","volume":"19 4","pages":"291-299"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11442085/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142360739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers to the implementation of sexual and reproductive health programs for adolescents in Eastern Visayas, Philippines: a thematic synthesis of national policies using a qualitative study.","authors":"Kim Leonard G Dela Luna, Alvin Duke R Sy, Rowel C Malimban, John Oliver H Estadilla, Jasper M Maglinab, Heyeon Ji, Jihwan Jeon, Carl Mark Vincent B Babasoro","doi":"10.2185/jrm.2023-040","DOIUrl":"10.2185/jrm.2023-040","url":null,"abstract":"<p><strong>Objective: </strong>To review the implementation of essential reproductive health services in Eastern Visayas, Philippines.</p><p><strong>Materials and methods: </strong>We reviewed four national policies through a qualitative research design using a series of key informant interviews conducted with service providers and focus group discussions with service beneficiaries.</p><p><strong>Results: </strong>There was a gap between the policies and the implementation of reproductive health services in the Eastern Visayas region. This gap is mainly due to the refusal of service providers to cater to teenagers' needs regarding reproductive health services. This has resulted in teenagers hesitating to seek reproductive health services and related support from primary healthcare facilities. Service beneficiaries have also reported on the unavailability of several reproductive health services in primary healthcare facilities.</p><p><strong>Conclusion: </strong>The gap between national policies and program implementation must be bridged. This can be achieved by creating culturally-specific policies that can improve the implementation of reproductive health programs in the study areas.</p>","PeriodicalId":73939,"journal":{"name":"Journal of rural medicine : JRM","volume":"19 4","pages":"250-263"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11442089/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142360737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute pancreatitis complicated with diabetic ketoacidosis following COVID-19 mRNA vaccination: a case report.","authors":"Yusuke Watanabe, Eisei Akaike, Yuki Tokunaga, Kozue Murayama, Mari Segawa","doi":"10.2185/jrm.2024-003","DOIUrl":"10.2185/jrm.2024-003","url":null,"abstract":"<p><p><b>Objective:</b> Since the onset of the coronavirus disease 2019 (COVID-19) pandemic, COVID-19 vaccination has substantially reduced mortality and hospitalization rates worldwide, with rare adverse events reported in clinical settings. Herein, we present a case of acute pancreatitis complicated by diabetic ketoacidosis (DKA) following the third COVID-19 vaccination dose. <b>Patient:</b> A 72-year-old male with a history of diabetes mellitus developed generalized fatigue, mild epigastric pain, nausea, and frequent vomiting after receiving the COVID-19 vaccine. <b>Results:</b> Blood analysis revealed elevated levels of pancreatic enzymes, hyperglycemia, and acidemia. Computed tomography revealed evidence of acute pancreatitis, leading to a diagnosis of both DKA and acute pancreatitis. Treatment with a large volume of saline and intravenous insulin improved both DKA and acute pancreatitis. After a thorough examination, no other factors capable of causing acute pancreatitis were identified. Hence, we concluded that acute pancreatitis was induced by COVID-19 vaccination. <b>Conclusion:</b> Acute pancreatitis is a rare but potentially life-threatening adverse event associated with COVID-19 vaccination. Delaying the treatment or diagnosis of acute pancreatitis can increase mortality risk in patients with both acute pancreatitis and DKA. Hence, it is crucial for healthcare professionals to consider the potential occurrence of acute pancreatitis and DKA following COVID-19 vaccination.</p>","PeriodicalId":73939,"journal":{"name":"Journal of rural medicine : JRM","volume":"19 3","pages":"199-203"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11222627/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141556125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Labor shortage of physicians in rural areas and surgical specialties caused by Work Style Reform Policies of the Japanese government: a quantitative simulation analysis.","authors":"Yoshiki Numata, Masatoshi Matsumoto","doi":"10.2185/jrm.2023-047","DOIUrl":"https://doi.org/10.2185/jrm.2023-047","url":null,"abstract":"<p><p><b>Objective:</b> The Japanese government's physician workforce reform, which commenced in April 2024, introduced regulations on physicians' working hours. However, in areas facing physician shortages such as rural regions and surgical medical specialties, healthcare provision relies heavily on the extended working hours of each physician. The anticipated impact of this reform, when implemented, was significant. <b>Materials and Methods:</b> Using publicly available government data, we estimated the current working hours of physicians in various medical specialties in each prefecture across Japan. Subsequently, we calculated the ratio of surplus or deficit physicians when hypothetically assuming that all physicians adhered to the regulatory upper limit of 58.4 working hours per week nationwide. <b>Results:</b> Assuming that all physicians work to the regulated maximum, there would be a shortage of doctors in various medical specialties across Japan, such as surgery, neurosurgery, orthopedic surgery, obstetrics and gynecology, and emergency medicine. Geographically, shortages of doctors are observed in rural prefectures such as those in the Tohoku region, particularly in emergency- and surgery-related specialties, indicating a critical shortage of physicians in rural areas. Additionally, it has become evident that even in medical specialties with a calculated surplus of physicians nationwide, the margin of surplus is generally only a few percentage points. <b>Conclusion:</b> Currently, rural areas and surgical medical specialties in Japan have limited leeway in the physician workforce, and the strict application of workforce reform may lead to a severe shortage of physicians in these areas. It is noteworthy that as similar reforms may subsequently be implemented in other countries, analogous challenges would arise. Thus, the implementation of workforce reform requires a flexible approach to minimize its negative effects, which widen the existing disparity in the workforce.</p>","PeriodicalId":73939,"journal":{"name":"Journal of rural medicine : JRM","volume":"19 3","pages":"166-173"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11222621/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141556129","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Consideration points in the decision making in chronic respiratory diseases.","authors":"Wakae Maeda, K M Saif-Ur-Rahman, Tsukasa Muraya, Yoshihisa Hirakawa","doi":"10.2185/jrm.2023-044","DOIUrl":"10.2185/jrm.2023-044","url":null,"abstract":"<p><p><b>Objective:</b> Even though dynamic multidisciplinary team discussions are crucial for end-of-life care management and decisions concerning chronic obstructive pulmonary disease (COPD), the details of the discussion contents remain poorly understood. This study aimed to identify essential considerations in decision-making for patients with chronic respiratory diseases to enhance a consensus-based approach. <b>Materials and Methods:</b> A qualitative content analysis of focus group conversations on published clinical case reports in the Japanese community about end-of-life care for patients with chronic respiratory disorders was conducted. The cases were searched through Igaku Chuo Zasshi (ICHUSHI) and Google in February 2021, using the keywords: \"COPD\", \"chronic respiratory diseases\", and \"end-of-life care\". A total of 41 healthcare professionals participated in the focus group discussions. <b>Results:</b> Four major themes evolved from the qualitative content analysis: unpredictable disease prognosis and stages, low awareness of patients on disease severity, acute exacerbations, and home oxygen therapy (HOT). The participants perceived that assessment of severity and prognosis in chronic respiratory diseases such as COPD was a core discussion point to enhance patients' decision-making. The study's findings also indicated that healthcare providers evaluate the influence of acute aggravation of the condition on patients' perceived health status and decision-making. <b>Conclusion:</b> The study reaffirms the significance of informed consent in patients with chronic respiratory disease. It details how, after a thorough assessment of disease severity, patients are given personalized explanations of standardized HOT. This approach ensures they fully understand the unpredictable nature and various stages of their condition resulting from acute exacerbations.</p>","PeriodicalId":73939,"journal":{"name":"Journal of rural medicine : JRM","volume":"19 3","pages":"158-165"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11222620/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141556127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spontaneous migration of a dedicated plastic stent after endoscopic ultrasound-guided hepaticogastrostomy in a patient with surgically altered anatomy: a case report.","authors":"Kei Yane, Takayuki Imagawa, Masahiro Yoshida","doi":"10.2185/jrm.2023-050","DOIUrl":"10.2185/jrm.2023-050","url":null,"abstract":"<p><p><b>Objective:</b> We report a case of spontaneous migration of a dedicated plastic stent after endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) in a patient with surgically altered anatomy. <b>Patient:</b> The patient was a male in his 70s. He underwent EUS-HGS with the successful insertion of a dedicated plastic stent and had no obvious postprocedural complications. However, nine days after the procedure, the patient visited our hospital because of abdominal pain, fever, and stent excretion. We performed EUS-HGS with antegrade stenting, after which the patient had no further complications. <b>Conclusion:</b> Stent migration is considered a complication requiring caution when performing EUS-HGS in patients with surgically altered anatomy.</p>","PeriodicalId":73939,"journal":{"name":"Journal of rural medicine : JRM","volume":"19 3","pages":"196-198"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11222626/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141556081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Congress of the International Association of Rural Medicine (IARM 2023).","authors":"","doi":"10.2185/jrm.CR19-204","DOIUrl":"https://doi.org/10.2185/jrm.CR19-204","url":null,"abstract":"","PeriodicalId":73939,"journal":{"name":"Journal of rural medicine : JRM","volume":"19 3","pages":"204-214"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11222618/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141556083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}