Comprehensive Medicine
Online ISSN : 2434-687X
Print ISSN : 1341-7150
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Foreword
Original Paper
  • Takashi Tatsuse, Junko Fujimori, Yukiko Akasaki, Michikazu Sekine, Sad ...
    2020 Volume 18 Issue 1 Pages 2-13
    Published: January 25, 2020
    Released: July 02, 2020
    JOURNALS FREE ACCESS

    In order to realize a society where elderly people can flourish throughout their lifetime, quality of life (QOL) after retirement becomes more and more important in the future. It has not been fully recognized that the attitude towards one's work before retirement is important for one's retirement life. Therefore, this paper studies how attitude towards one's work before retirement affects the QOL in one's later life in light of psychosocial resources in old age.

    In this cross-sectional study, data were collected from attendees aged 60 years or older (85 men and 119 women) in continuing education classes in Toyama Prefecture in 2012. The QOL in old age was assessed with CASP-19 measurements (i.e., QOL measures comprising four domains:‘control’, ‘autonomy’, ‘pleasure’, and‘self-realization’). The measured psychosocial resources in old age include general self-efficacy, social self-efficacy, and sense of desolation. In this analysis, a structural equation modeling is used to verify whether the working attitude before retirement contributes to the QOL after retirement, based on the relationship with psychosocial resources.

    Mean CASP-19 score is 41.3 (SD=6.3) for men and 42.6 (SD=5.7) for women. The results of structural equation modeling indicate that the conformity index of the model including the variable about attitude towards one's work before retirement is high. The structural model shows that working attitude has an indirect effect on CASP-19 scores after retirement; however, no direct effect has been found. The conformity index of the model shows as GFI=0.990, AGFI=0.970, CFI=1.000, RMSEA=0.009, that indicates high level of conformity.

    This study has indicated that the way of working before retirement will contribute to QOL through latent psychosocial resources in old age such as efficacy and solitude, and clarified that the experience of working hard enables people to live a more fulfilling life after their retirement.

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Review Article
  • Tadahiro Sasajima, Taku Kokubo, Taishi Tamur, Naoya Kuriyama, Kumiko S ...
    2020 Volume 18 Issue 1 Pages 14-21
    Published: January 25, 2020
    Released: July 02, 2020
    JOURNALS FREE ACCESS

    Before 2000, incidence of arteriosclerosis obliterance (ASO) associated with diabetes mellitus (DM) was only about 30%. Currently, the main etiology of ischemic foot gangrene is ASO in 95%, and, with prevalence of DM, over 80% of ASO patients are diabetic, and 60% are dialysis-dependent (HD). ASO seen in DM patients is characterized by multi-segmental stenosis and occlusion in the infra-popliteal arteries, and commonly associated with disorder of microcirculation due to peripheral autonomic neuropathy, and extensive arterial calcification. The pathophysiology in DM foot may lead to extensive gangrene, which is nowadays the main cause of major amputation. Infection without ischemia due to arterial lesions may cause extensive foot gangrene, while, if the patients have mild ischemic foot with infection, both disorders produce a great combined effect, resulting in extensive tissue necrosis. In these situations, inadequate management of the foot gangrene may lead to major amputation.

    In this context of DM foot gangrene, our 5-year limb salvage rate after bypass surgery in DM patients with foot gangrene is 94%, and leading centers have achieved excellent outcomes. Our results demonstrated that if patients remain independent ambulatory function before onset of foot gangrene, most of the patients commonly retrieved physical functioning after limb salvage even in patients with extensive tissue loss. Therefore, ambulatory function before limb salvage treatment is important factor influencing outcomes of limb salvage treatment.

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  • Yukio Aoyama, Yuichi Maki, Tatsuo Yamamoto, Yasumasa Hirokado, Katsuta ...
    2020 Volume 18 Issue 1 Pages 22-28
    Published: January 25, 2020
    Released: July 02, 2020
    JOURNALS FREE ACCESS

    In comprehensive medicine, it is essential to comprehend patients on the biopsychosocial and existential level. In concrete methodology, it is required to take precise pathogenic and/or salutogenic approach and to provide such an approach timely. As to one of the main pillars of comprehensive medicine, namely “Finding of patient's resources and activation of them” is just the concept of salutogenesis. Here, “resources” are considered to be “patient's power” itself. In addition, to what degree the patient has SOC (sense of coherence: the attitude to manage his (or her) life or the sense of recognition of meaning of his (her) life) decides how well patient's resources can be utilized further to enhance patient's power. Having recognition of patient's power, both the therapist and the patient become aware of the resources (patient's power) in an inter-personal mutually independent relationship to activate them. In this respect, there is a great difference from the conventional approaches which are based on pathogenesis alone.

    In this paper, I would like to describe a case of a 45-year-old woman I encountered. She had been suffering both somatically and psychologically from adverse reactions of a drug since her withdrawal of an antidepressant for about 10 years. Even during such a time, with her inherent rich resources as the base, she could grow her patient's power owing to the warmhearted listening to, acceptance of, and support for what she tells. As a result, although slow in tempo, she is now making her way toward her dream.

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Case Report
  • Katsuhiko Kiyama, Tomotsugu Okayama, Naoki Shida, Yukari Uchiyama, Kat ...
    2020 Volume 18 Issue 1 Pages 29-40
    Published: January 25, 2020
    Released: July 02, 2020
    JOURNALS FREE ACCESS

    Myalgic Encephalopathy/Chronic Fatigue Syndrome (ME/CFS) is a syndrome of unexplained severe chronic fatigue, and is accompanied by a variety of symptoms, including widespread pain and sleep disorders. Case: A 14-year-old girl with ME/CFS had systemic allodynia and flexion contracture of fingers and toes. Her ADL (activities of daily living) scores were 51 out of 126 in functional independence measure (FIM). Clinical course: We not only applied tonifying method, but prescribed rehabilitation exercises that were supervised by a physical therapist (PT). Results: Her symptoms of ME/CFS and ADL scores improved (FIM: 110 out of 126). Conclusion: ME/CFS leads to more than 50%reduction in the ability to perform daily activities. Some patients even become housebound or bedridden. Although post-exertional fatigue is a hallmark of ME/CFS and is a symptom required for diagnosis, patients are often prescribed inappropriate exercises. We consider that the patient's ADLs improved through a combination of tonifying method, her resources, and appropriate physical therapy interventions.

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  • Satoko Shiwa, Katsutaro Nagata, Chika Otsuki, Risa Otsuka, Chizuru Ito ...
    2020 Volume 18 Issue 1 Pages 41-48
    Published: January 25, 2020
    Released: July 02, 2020
    JOURNALS FREE ACCESS

    [Objective] At our clinic, we conduct an intake interview, in which questions asked are set in the context of comprehensive medicine. Patients with fibromyalgia (FMS) often shed tears when their existential problems as well as psycho-social issues are touched upon. This study considers the meaning of life of FMS patients by analyzing their answers to medical questionnaires.

    [Methods] Based on the questionnaires from 58 FMS patients, the author assessed the answers to questions on their existential aspect. Their answers were compared with those of 30 patients who had local pain (e.g. trigeminal neuralgia and diabetic neuropathy) and 32 healthy people with occupation. The questionnaire consists of the following 4 sections: (1) What do you think is truly significant in your life? (2) What brings you joy and happiness? (3) Why do you desire health? (4) What would you like to do when you are restored to health? “Patient-centered medicine” adopted in the United States was used as a model to develop questions in this study.

    [Results] In section 1, most FMS patients answered that family mattered most to them, followed by health. In section 2, family came in first with relationships in the second. Section 3 revealed that 50% of FMS patients wanted to be healthy for their own sake while 47% for someone they cared about. (3% did not answer.) On the other hand, 73% of patients with local pain wanted to be healthy for their own sake and 27% for someone they cared about. Section 4 showed that 59% of FMS patients desired ordinary experiences while 19% wanted extraordinary experiences such as travel. In contrast, 30% of local pain patients wished for ordinary experiences and 40% for extraordinary experiences.

    [Conclusions] It was thought that many FMS patients deepened their insights into themselves while struggling against widespread pain every day. This experience was considered to finally lead them to the awareness of their longing to be useful to someone, or the meaning of their lives. FMS patients perhaps had a real sense how irreplaceable a normal life was. They also seemed to know intuitively that they were suffering from a functional disorder, and have hope that they could return to a normal life. It is crucial that therapists should respect the very hope of patients' and assist patients throughout treatment.

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  • Yoshinobu Nakano
    2020 Volume 18 Issue 1 Pages 49-56
    Published: January 25, 2020
    Released: July 02, 2020
    JOURNALS FREE ACCESS

    Oral psychosomatic disorders can be managed using psychosomatic treatment methods such as oral care, drug therapy, pathology explanation technique, general psychotherapy, outpatient Morita therapy and logotherapy in most patients. However, some patients show inadequate remission of symptoms, and require other psychosomatic treatment methods. In such patients, active muscle relaxation can immediately reduce oral complaints in oral psychosomatic disorders and neck/shoulder complaints, and can be used for more effective psychosomatic treatment. Active muscle relaxation in combination with outpatient Morita therapy or logotherapy may be useful for oral psychosomatic disorders.

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W.H.O. Lecture series
  • Mahito Kiyoshi
    2020 Volume 18 Issue 1 Pages 57-65
    Published: January 25, 2020
    Released: July 02, 2020
    JOURNALS FREE ACCESS

    Fromm and Frankl, both have a point of deep sameness. Both stand on the same viewpoint, that man must elucidate the psychopathy in the relationship with “the fundamental desire for sense of life”, which results from “the existential specific character” of human being. Both insistence equally, that man can get the passion to live only by grasping the sense of life, and man can feel the sense of life only by binding together “the deep cords of love” (loving and being loved) with others, that is, “the deep cords of call & response”. When we turn now to the mentality of Japanese youth today from that viewpoint of both, we must feel the deep anxiety. The psychopathy, which is called recently “the expanded suicide”, the increase of suicide-intending youth, the cruel treatment for own child, IJIME (rag), etc. these are the keywords, which indicate today's mental desolation. So, now, Fromm and Frankl must be re-found by the youth! Really they are waiting for their encounter with both!

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