Introduction : In Japan, there are over 300,000 hemodialysis (HD) patients and 6,000 new patients are introduced yearly, a figure which is increasing. It is estimated that 12,000 specialists are needed to provide care for these patients, but there are currently only 4,000 to 7,000 such specialists. There is very little literature regarding the role of generalists in the care of HD patients. In our facility, family physicians provide care for HD patients including managing end stage renal disease (ESRD) with backup support from nephrologists.
Aims : To explore the possibility of expanding the generalist's role in the care of HD patients by critically reviewing our care using several quality indicators and demographics compared with available literature data.
Methods : Retrospective chart review.
Outcome measures : patient demographics, quality indicators including Kt/Vdp, hemoglobin, serum albumin, serum calculated calcium, serum phosphorus, intact-PTH, rates of hospitalization, transfer of care, and death.
Results : Fifty-two patients were cared for in 2011. The average target achievement rate was 80.0% for Kt/Vdp, 69.9% for hemoglobin, 63.7% for serum albumin, 85.4% for corrected serum calcium, 78.3% for serum phosphorus, and 56.8% for intact-PTH.
Conclusion : Generalists can contribute to the care of HD/ESRD patients by utilizing appropriate quality assurance training and support, and in turn reduce the work burden of specialists without compromising quality of care.

View full abstract

Background : With the recent progression of the aging society in Japan, what is now seen as important is not simply treatment of disease alone, but also increased quality of life. We have investigated the correlation between the feeling of subjective health and mortality after mean 3.8 year among local residents.
Methods : In fiscal 2008, a self-recording questionnaire survey was conducted by mailing the questionnaire to 2,657 local residents. Correlation with deaths after mean 3.8 years was investigated based on the Resident Register. With regard to the evaluation items, as background factors related to death, social life conditions (gender·age), health conditions (history of cardiovascular disease, state of depression, subjective happiness, subjective health)and basic activities of daily living (BADL : walking, diet, excretion, bathing, dressing, and ambulation)were evaluated using a 4-point scale ranging from total assistance to completely independent. The Tokyo Metropolitan Institute of Gerontology (TMIG : instrumental independence, intellectual activity, and social role)was used to evaluate the lifestyle factors.
Results : Of 1825 subjects, 767 males (mean age : 67±13 years)and 1058 females (mean age : 68±11 years), could be analyzed. There were 91 deaths from 2008 to 2012. Investigation of factors that increased subjective health revealed that age, cardiovascular disease, state of depression, intellectual activities, and subjective happiness were items that showed significant correlation. Multivariate logistic regression analysis revealed that subjective health was a significant explanatory variable of death.
Conclusion : How one personally feels about one's state of health and how one recognizes that, are important. Though not seen physically, they can be considered as important parameters that predict prognosis.

View full abstract

[in Japanese]

View full abstract

[in Japanese]

View full abstract

It has been reported that the prevalence of sleep disturbances increases with advancing age. Elderly patients, while being the main candidates for hypnotic therapy, are also pharmacologically susceptible to potential adverse effects. In today's busy practices, however, hypnotics tend to be readily initiated without adequate communication of their risks and benefits. We therefore investigated the relationship between hypnotic use, predominantly benzodiazepines, and health problems of community-dwelling elderly through a PubMed database search in order to obtain evidence on the risks and benefits of these drugs and contribute to their appropriate use. The results indicated that although short-term hypnotic use can improve sleep quality, the magnitude of the effect is small, and hypnotic use can increase the risk of developing dementia and fractures or injuries due to accidental falls. In addition, there is little evidence about long-term effectiveness of hypnotics. Clinicians should weigh the risks and short-term benefits of hypnotic use to appropriately manage sleep problems in the elderly.

View full abstract

A rural medicine experience camp is held every year for medical students of Sapporo Medical University who are obligated to work in rural area after graduation. We organized two method in our camp : 1. the lecture about rural medicine by senior medical students, 2. setting up the learning content in camp by participant before camp. We investigated how these methods make an impact on the participant's motivation about rural medicine. The results suggested that a method 1 enhanced the understanding of rural medicine and method 2 raised an a warenss about rural medicine. We thought that it was important to try various education about rural medicine for increasing the motivation to rural medicine for medical student.

View full abstract

This research clarifies what issues local government personnel faced in their response to the Great East Japan Earthquake and if they intend to use the knowledge gained from such issues in the future.
The research conducts oral interviews with Tagajo city personnel. The questions primarily concern issues in the disaster response, future disaster response initiatives.
Respondents report that “the scale of the disaster was unimaginable, and as they were conducting relief activities without an established manual, there are some things that were codified as rules or placed into a manual based on failures of their effort. The intention is that in the future, thorough care be provided for victims unable to enter public housing.
Since the time immediately following the disaster until today, there have been efforts to record these lessons.

View full abstract

Objective : To interview related government officials in charge of public health and listen to their opinions about the initial response of the local government to a norovirus outbreak and the challenges faced by them with respect to an increase in the number of affected individuals and school children and students absent from school likely due to bread infected with norovirus served during school lunch.
Methods : An interview survey was conducted on February 24, 2014 at the Hamamatsu City Hall involving officials at the Health and General Affairs Division and the Environmental Hygiene Division.
Results : In order to reduce the future incidence of norovirus infections caused by school lunches, it is important to strengthen the food safety inspection by appointing persons in charge of the school lunch program and by other means. Without sufficient data in hand, it is difficult to respond properly to the mass media
Conclusion : School lunch suppliers must strictly adhere to conducting personal health management. Refresher workshops should be provided specifically for personnel with cooking duties to improve the level of their hygiene management. Challenges and troubles experienced thus far with respect to dealing with the media were not negligible, but in cooperation with the public relations department, efforts have been made to facilitate timely information disclosure, keeping the number of claims received to the minimum.

View full abstract

Introduction : The purpose of this study was to clarify the antimicrobial susceptibility of Haemophilus influenzae in central Tokyo over a ten-year period.
Methods : We investigated the susceptibility of Haemophilus influenzae isolated in Tokyo Saiseikai Central Hospital for 10 years from 2004 through 2013.
Results : Significant increases in the proportion of strains resistant to ampicillin, ampicillin / sulbactam and cefditoren pivoxil were noted for some years in comparison to the first year studied. There were no significant changes in the susceptibility to levofloxacin and clarithromycin. The proportion of strains resistant to ampicillin and cefditoren pivoxil showed statistically significant increases during the study period. The proportion of the strains resistant to ampicillin / sulbactam isolated from children was greater than from adults for every year studied. Levofloxacin resistant strains were isolated only from adults. The proportion of strains resistant to clarithromycin were about 1% in Japanese national surveillance data, but the proportions in this study were over 9%.
Conclusion : Over a ten-year period in central Tokyo, Haemophilus influenzae strains resistant to ampicillin and cefditoren pivoxil increased. Strains resistant to clarithromycin occurred at a higher rate than nationally.

View full abstract

[in Japanese]

View full abstract