Journal of rural medicine : JRM最新文献

{"title":"Asymptomatic intestinal tuberculosis of the terminal ileum diagnosed on colonoscopy: a case report and literature review","authors":"Hiroyasu Sakai, Hironao Ichikawa, Jun Takada, Masaya Kubota, T. Ibuka, Y. Shirakami, Masahito Shimizu","doi":"10.2185/jrm.2023-045","DOIUrl":"https://doi.org/10.2185/jrm.2023-045","url":null,"abstract":"Objective Colonoscopy is useful in diagnosing intestinal tuberculosis. However, the terminal ileum is generally not examined during routine colonoscopy. Therefore, even with colonoscopy, the diagnosis can be missed in patients with lesions confined to the terminal ileum. Herein, we report the case of an asymptomatic patient with intestinal tuberculosis, in whom a colonoscope insertion into the terminal ileum led to the diagnosis. Patient An asymptomatic 71-year-old man visited our hospital for a colonoscopy after a positive fecal occult blood test. Results Colonoscopy revealed diffuse edematous and erosive mucosa in the terminal ileum. Mycobacterium tuberculosis was detected by polymerase chain reaction and culture of biopsy specimens from the erosions, leading to the diagnosis of intestinal tuberculosis. The patient was treated with antitubercular agents for 6 months, and a follow-up colonoscopy revealed healing of the lesions. Conclusion Asymptomatic intestinal tuberculosis may occasionally be detected on colonoscopy following a positive fecal occult blood test and is sometimes confined to the terminal ileum. Therefore, clinicians should consider intestinal tuberculosis in the differential diagnosis of the causes of positive fecal occult blood test results and perform colonoscopies, including observation of the terminal ileum.","PeriodicalId":73939,"journal":{"name":"Journal of rural medicine : JRM","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140772570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between multimorbidity and utilization of medical and long-term care among older adults in a rural mountainous area in Japan","authors":"Yuki Kuwabara, Toshihiro Hamada, Tsubasa Nakai, Maya Fujii, Aya Kinjo, Y. Osaki","doi":"10.2185/jrm.2023-049","DOIUrl":"https://doi.org/10.2185/jrm.2023-049","url":null,"abstract":"Objective With the accelerated population aging, multimorbidity has become an important healthcare issue. However, few studies have examined multimorbidity and its impact on the use of medical and long-term care services in Japan. Therefore, this study aimed to examine the association between multimorbidity and the use of medical and long-term care services among older adults living in the depopulated mountainous areas of Japan. Patients and Methods A cross-sectional study was conducted using insurance claims data from late-stage medical insurance and long-term care insurance (April 2017 to March 2018) for older adults ≥75 years residing in a mountainous area in the Tottori prefecture. In addition to the descriptive analysis, multiple generalized linear regressions with family gamma and log-link functions were used to examine the association between the number of morbidities and total annual medical and long-term care expenditures. Results A total of 970 participants ≥75 years were included in the analysis. Participants who had two or more morbidities constituted 86.5% of the total sample. Furthermore, participants with mental disorders were found to have more comorbidities. The number of comorbidities is associated with higher medical and long-term care expenditures. Conclusion Multimorbidity was dominant among late-stage older adults living in depopulated mountainous areas of Japan, and the number of morbidities was associated with higher economic costs of medical and long-term care services. Mitigating the impact of multimorbidity among older adults in depopulated regions of Japan is an urgent challenge. Future research should investigate the degree and effectiveness of social protections for vulnerable older adults living in remote areas.","PeriodicalId":73939,"journal":{"name":"Journal of rural medicine : JRM","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140795956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Care needs of caregivers of the elderly with early-stage dementia","authors":"Hiromi Kimura, Kayoko Koga, Midori Nishio","doi":"10.2185/jrm.2023-023","DOIUrl":"https://doi.org/10.2185/jrm.2023-023","url":null,"abstract":"Objective This study aimed to identify the care needs of family caregivers of elderly patients with early-stage dementia and examine support measures. Materials and Methods We conducted a self-administered questionnaire survey with 115 primary caregivers of outpatients who visited A City Community General Support Center or B University Hospital Department of Neurology for memory loss consultation. The questionnaire content included demographic characteristics, the care needs scale for caregivers of the elderly with early-stage dementia (Care Needs Scale), and the Japanese short version of the Zarit Burden Interview. The Medical Ethics Committee of Fukuoka University approved this study (approval number: M047). Of the 115 participants, 104 were included in the analysis after excluding 11 respondents with missing data. We divided the participants into a young group (under 65 years of age) and an old group (65 years of age or older) and compared the variables and each scale score using the Mann–Whitney U test. We also compared the correlations between the total score and subscale scores of the Care Needs Scale and each variable, in addition, we performed multiple regression analyses using the total score of the Care Needs Scale as the dependent variable. Results The young caregivers wanted to know how to take care, prevent deterioration, and deal with symptoms of early-stage dementia. They were trying to balance caregiving with work and housekeeping and reduce the stress and burden of long-term care. Older caregivers were confused about caregiving and wanted someone to talk about their situations. Conclusion Both groups shared that the family’s lack of understanding about caregiving and personal and role strains were associated with the care needs of caregivers of the elderly with early-stage dementia.","PeriodicalId":73939,"journal":{"name":"Journal of rural medicine : JRM","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140785975","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Applicability of the Self-Evaluation Scale of nursing practices for improving sleep quality among patients with dementia taking sleeping pills to general nurses","authors":"Yuichi Iwamoto, Narumi Fujino, Takaomi Furuno, Yuji Fujimoto, Yukiyo Kamada","doi":"10.2185/jrm.2023-046","DOIUrl":"https://doi.org/10.2185/jrm.2023-046","url":null,"abstract":"Objective Many patients with dementia experience sleep-related problems. However, there is a lack of clarity regarding nursing practices that can address these issues. Thus, we developed a self-assessment scale for nursing practices to improve sleep quality among patients with dementia taking sleep medication and confirmed its validity and reliability. This study aimed to test the validity and reliability of this scale for adaptability to general nurses and test its applicability. Participants and Methods The survey included basic attributes and questionnaire items related to nursing practices to improve sleep quality in patients with dementia taking sleeping pills. Data from 477 participants with no missing values in the survey items were used in the analysis. The self-evaluation scale of nursing practices for improving sleep quality among patients with dementia taking sleeping pills was based on a three-factor model, and confirmatory factor analysis was performed using structural equation modeling. Results Goodness-of-fit indices were satisfactory, supporting the construct validity of the scale. Cronbach’s α coefficients for the total score and the three factors of the self-evaluation scale of nursing practices for improving sleep quality among patients with dementia taking sleeping pills exceeded 0.7. Conclusion The development of this scale can improve the quality of nursing practice for patients with dementia who take sleeping pills. Moreover, it can serve as evidence for general nurses to participate in drug treatment and can be considered as basic research for appropriate drug treatment in nursing practice.","PeriodicalId":73939,"journal":{"name":"Journal of rural medicine : JRM","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140765627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anemia-related subjective symptoms in the general adult population in Japan.","authors":"Shinya Ito, Satoko Okabe, Niro Ujiie, Mina Watanabe, Norihiko Watanabe, Kenji Ishida, Aya Goto","doi":"10.2185/jrm.2023-014","DOIUrl":"10.2185/jrm.2023-014","url":null,"abstract":"<p><p><b>Objectives:</b> Approximately 17% of Japanese women have hemoglobin concentrations less than 12 g/dL. Therefore, anemia prevention and early intervention are crucial public health issues in Japan. This study aimed to identify the symptoms and characteristics of anemic individuals in the general adult population by comparing survey responses of individuals with anemia and without anemia visiting blood donation centers. <b>Materials and Methods:</b> This cross-sectional study used self-administered questionnaires. Individuals who visited two Japanese Red Cross Society blood donation centers in Fukushima Prefecture, Japan were included. Hemoglobin levels were measured at blood donation, and the levels of 13 g/dL for men and 12 g/dL for women were defined as anemia. <b>Results:</b> Of the 857 individuals analyzed, 530 were men and 327 were women, of whom 19 (3.6%) and 12 (3.7%) had low hemoglobin levels, respectively. Logistic regression analysis was performed in men, and the results showed that \"lightheadedness\" (odds ratio [OR]=8.4) and \"depressive symptoms\" (OR=3.6) were significantly associated with hemoglobin levels. None of the evaluated items were significantly associated with hemoglobin levels in women. <b>Conclusion:</b> Among healthy Japanese men, those who exhibit lightheadedness and depressive symptoms have an increased risk of anemia. Lightheadedness and depressive symptoms may be indicative of undiagnosed anemia in men, which necessitates greater clinical attention.</p>","PeriodicalId":73939,"journal":{"name":"Journal of rural medicine : JRM","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10774000/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139405468","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":"Peroral cholangioscopy for the evaluation of bile duct stricture in hepatocellular carcinoma on a preoperative examination.","authors":"Mitsuru Chiba, Masaki Aokawa, Takashi Goto, Wataru Sato, Kenichi Takahashi, Shinichiro Minami, Katsunori Iijima","doi":"10.2185/jrm.2023-022","DOIUrl":"10.2185/jrm.2023-022","url":null,"abstract":"<p><p><b>Objective:</b> Bile duct tumor thrombosis in hepatocellular carcinoma (HCC) is a relatively rare event with a poor prognosis. Furthermore, bile duct tumor thrombus in HCC may be misdiagnosed when only imaging modalities are used. The efficiency of peroral cholangioscopy (POCS) in evaluating bile duct lesions has been reported. <b>Patients:</b> We present three cases of HCC with bile duct strictures in which POCS was performed as a preoperative evaluation. <b>Results:</b> In these three cases, diagnosing whether the lesion was a bile duct tumor thrombus on CT and endoscopic retrograde cholangiopancreatography was difficult. We performed POCS in three cases and were able to diagnose the presence of bile duct tumor thrombus of HCC, including differentiation from extrinsic compression of the bile duct. <b>Conclusion:</b> POCS for HCC with bile duct features is useful for the preoperative diagnosis of bile duct tumor thrombus, especially in cases where the surgical procedure depends on the presence of bile duct tumor thrombus.</p>","PeriodicalId":73939,"journal":{"name":"Journal of rural medicine : JRM","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10773999/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139405524","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":"Impact of functional independence and sociodemographic factors on post-stroke discharge destination in a super-aged rural community in Japan.","authors":"Saya Iwasa, Yuki Uchiyama, Yuta Tauchi, Tetsuo Koyama, Kazuhisa Domen","doi":"10.2185/jrm.2023-033","DOIUrl":"10.2185/jrm.2023-033","url":null,"abstract":"<p><p><b>Objective:</b> This study aimed to clarify the factors influencing the discharge destination of stroke patients in a super-aged rural community in Japan, focusing on functional independence and sociodemographic factors. <b>Patients and Methods:</b> We enrolled patients recovering from stroke with supratentorial lesions who were admitted to our convalescent rehabilitation hospital. The motor components of the Functional Independence Measure (FIM-motor) were assessed for each patient at admission and discharge as explanatory variables. An increase in the FIM-motor scores during hospitalization was also recorded. Additionally, sociodemographic data such as sex, age, and clinical characteristics, such as type of stroke, history of stroke, days from stroke onset to transfer to our convalescent rehabilitation hospital, total duration of hospital stay including acute care, number of co-resident household members, living with a spouse, and number of children were collected. As target values, discharge outcomes were categorized into two groups: returning home and going to a nursing home. Logistic regression analysis was performed. <b>Results:</b> The study sample comprised 160 patients (mean age ± standard deviation, 74.80 ± 12.19 years). Of these, 114 were discharged to their homes, and 46 were transferred to nursing homes. The results of multivariate logistic regression analysis indicated that higher FIM-motor scores at discharge, greater number of co-resident household members, and living with one's spouse were the most powerful predictors of a higher probability of returning home. <b>Conclusion:</b> This study demonstrated that functional independence levels and the number of co-resident household members were crucial factors in predicting the discharge destination of patients after stroke in a super-aged rural community in Japan. These findings imply that for older patients with lower functional independence, supportive social networks are essential for home discharge, offering clues for providing long-term healthcare in super-aged rural communities worldwide.</p>","PeriodicalId":73939,"journal":{"name":"Journal of rural medicine : JRM","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10774001/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139405494","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":"Tele-education by an orthopedic specialist increased the confidence in orthopedics of a general practitioner at a rural solo-practice clinic.","authors":"Takashi Akimoto, Tadashi Kobayashi, Hiroki Maita, Takahiro Hirano","doi":"10.2185/jrm.2023-025","DOIUrl":"10.2185/jrm.2023-025","url":null,"abstract":"<p><p><b>Objective:</b> General practitioners in rural clinics are required to deal with musculoskeletal problems, but they often lack the confidence. We aim to confirm changes in their confidence in orthopedic practices after using tele-education. <b>Materials and Methods:</b> We conducted tele-education in orthopedic practices from June 1, 2022, to November 30, 2022. Using a teleconference system, the first author, an orthopedic specialist, provided tele-education training to an independent general practitioner in a rural clinic. We adopted a 7-point Likert scale to assess the general practitioner's confidence levels. In pre- and post-research, the counts and confidence levels in the scale were assessed for 18 types of orthopedic practices each month. Furthermore, we interviewed the general practitioner to examine the factors influencing their confidence. <b>Results:</b> The confidence levels increased for all measurement items. The most experienced orthopedic practice was \"Advising on daily care for musculoskeletal problems\", with confidence levels increasing from 3 to 6. The least experienced orthopedic practice was \"Manipulative reduction of radial head subluxation\", with confidence levels increasing from 4 to 5. The factors that influenced the change in confidence levels were regular feedback and unrestricted availability of consultations. <b>Conclusion:</b> Tele-education in orthopedics may enhance general practitioners' confidence in orthopedic practices.</p>","PeriodicalId":73939,"journal":{"name":"Journal of rural medicine : JRM","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10773997/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139405525","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":"Experience of students who participated in psychiatric nursing educational program aiming at competency development.","authors":"Miwa Sasaki, Mie Kumachi","doi":"10.2185/jrm.2023-034","DOIUrl":"10.2185/jrm.2023-034","url":null,"abstract":"<p><p><b>Purpose:</b> To clarify experience of students who participated in psychiatric nursing educational program aiming at competency development. <b>Methods:</b> We conducted a semi-structured interview with five students who participated in a psychiatric nursing educational program and analyzed the results qualitatively and descriptively. <b>Results:</b> We generated 19 categories and 39 subcategories. The students reached [acquisition of diversity and multi-phase viewpoint] through team discussion and attempted to understand patients holistically, including [acquisition of patient's viewpoints]. Moreover, they formed supportive relationships while [repeating trial and error] and gained self-understanding based on [egocentrism awareness]. <b>Conclusion:</b> Participation in this program increased students' preparedness for psychiatric nursing practical training, believed to contribute to competency development. Some students had difficulty relating to patients and hesitated to express negative emotions while establishing supportive relationships. This indicates the need for an educational approach that encourages students to express negative emotions easily.</p>","PeriodicalId":73939,"journal":{"name":"Journal of rural medicine : JRM","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10774002/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139405470","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 lifestyle modification in patients with non-alcoholic fatty liver disease: a scoping review.","authors":"Kaoru Shibayama, Chie Furushima, Minako Saka, Takako Sakamoto, Hirokazu Takahashi","doi":"10.2185/jrm.2023-026","DOIUrl":"10.2185/jrm.2023-026","url":null,"abstract":"<p><p><b>Objective:</b> Non-alcoholic fatty liver disease is common worldwide, and lifestyle modifications are key to its treatment. This study aimed to identify the barriers to lifestyle modifications in patients with non-alcoholic fatty liver disease and to organize the results using the Capability Opportunity Motivation-Behavior (COM-B) model. <b>Materials and Methods:</b> The framework of Arksey and O' Malley was used in this scoping review. We searched PubMed, Scopus, and the Cochrane Library without language restrictions for reports published up to September 11, 2022, including peer-reviewed literature reporting barriers to lifestyle modifications in patients with non-alcoholic fatty liver disease. Patient-reported barriers were analyzed inductively and organized into the components (capability, opportunity, and motivation) of the COM-B model. <b>Results:</b> The literature search yielded 583 articles, of which seven qualitative studies, four quantitative studies, and one mixed-methods study met the inclusion criteria. Lack of time, lack of information on the diagnosis and management of non-alcoholic fatty liver disease, negative perceptions of the prescribed exercise and diet, physical symptoms interfering with the behavior, presence of comorbidities, and lack of family cooperation were frequently reported as barriers. <b>Conclusion:</b> The results of this study may contribute to the development of appropriate care and education strategies to promote behavioral changes in patients with non-alcoholic fatty liver disease.</p>","PeriodicalId":73939,"journal":{"name":"Journal of rural medicine : JRM","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10774003/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139405932","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}