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Volume 47 (1998 - 199･･･
- Issue 6 Pages 796-
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Volume 47, Issue 6
Displaying 1-15 of 15 articles from this issue
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Yoshitomo KASHIKI1999 Volume 47 Issue 6 Pages 796-804
Published: March 30, 1999
Released on J-STAGE: August 11, 2011
JOURNAL FREE ACCESSAt the 47th General Meeting of the Japanese Association of Rural Medicine, I had the opportunity to present my experiences in rural medicine together with the philosophy developed through these settlement activities.
My involvement in rural medicine started at the end of the 1950s after working as a medical student in a farming village in Gifu prefecture, Japan. Also, during my internship I worked with people living on the boart in the Sumida river, Tokyo.
Through these settlement activities I found my mission as a physician.
That is, the physician must learn the patterns of human living and the circumstances surrounding them to find the key to medical philosophy.
At the meeting, I also presented additional experiences and opinions based on practicing medicine at the front-lines of community health care. Even if social circumstances change, the philosophy of medicine based on my rural medical activities will not. I believe we should create more balanced farming areas (with safe foods, pure natural resources, and a symbiosis between urban and rural areas) and should support these ideas by establishing a rural community health care program.View full abstractDownload PDF (5977K) -
Hiroyuki SHIMIZU1999 Volume 47 Issue 6 Pages 805-806
Published: March 30, 1999
Released on J-STAGE: August 11, 2011
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[in Japanese]1999 Volume 47 Issue 6 Pages 807-812
Published: March 30, 1999
Released on J-STAGE: August 11, 2011
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Mitsuo KANEKO1999 Volume 47 Issue 6 Pages 813-818
Published: March 30, 1999
Released on J-STAGE: August 11, 2011
JOURNAL FREE ACCESSSince we developed the new neuropsychological test batteries to diagnose the early dementia 20 years ago, we have accumulated the data of the regional investigation on the incidence of dementia and their severity covering almost all Japan.
In most towns and villages, the whole incidence of dementia was from 25% to 30% to those of more than 65 years old, of which the ratio of the mild, the moderate and the severe dementia were mostly 2 to 2 to 1.
In our criteria, the patients of the mild dementia has solely the disturbance of the highest brain function or the prefrontal function ; therefore they can not manage the social business because they have the trouble in wit, imagination, planning or attention distribution and so on. On the tests, they fail only on the prefrontal function tests, for example on Kana pick-out test.
Those of the moderate dementia have the trouble even in house-keeping jobs ; cooking, cleaning or washing. On the tests, they also fail on the prefrontal function tests and get MMS from 23 to 15 points. Those of severe dementia have the difficulty to take self-care. They get MMS of less than 14 points. Once advanced into this level the recovery becomes almost impossible.
As for the cause of dementia, more than 90% of the whole dementia was thought to be derived from the bad life habbits (circumferential). They are characteristically workaholic without any hobby or any favorite arts since young. Soon after the retirement they become tedious and loose volition and interest for anything.The dementia starts 2-3 years thereafter. We called this type as the dementia of senility and disuse atrophy (DSD).
The vascular dementia accounted 5% at most by the several examinations in details. The Alzheimer disease of the genetic mutation accounted for only 1.2% which showed the early onset in 40th or 50th of age and became ill in bed within 2 or 3 years. This type was resistent for any treatment, even for the brain rehabilitation.
As the treatment for the type of DSD, we made diagnosis as early as possible, at least in the level of mild or moderate and gave them the brain activation therapy or the brain rehabilitation using several games, music, painting and sports.
As the results, it was confirmed that about 60% of them could come back to the level of independent home life and other 35% was not worsened. The effect could be continued more than 6 or 7 years.View full abstractDownload PDF (696K) -
Reiko KISHI, Eri TSUKISHIMA1999 Volume 47 Issue 6 Pages 819-827
Published: March 30, 1999
Released on J-STAGE: August 11, 2011
JOURNAL FREE ACCESSWe reviewed recent concepts of social support networks and results of epidemiological studies on the relationship between the social relationships and health status of the elderly. Recent scientific researches have established strong empirical evidences for a causal impact of social relationship on the health status of the elderly. We showed our community-based longitudinal comparative epidemiological study data. From 1991, in Hokkaido prefecture, the health and the social relationship in the elderly living in three areas included a large city “Sapporo”, an ex-coal-mining town, and a rural area “Takasu”, were studied. Lumbar pain and arthritis were main symptoms that the elderly living in the rural town complained more frequently than in other areas. Number of persons with declined activities of daily living (ADL) or with dementia, who might need serious care and support from others, was not significantly different in three cohorts. However, availability of social supports and social participations of the elderly in the rural area was the best and highest among the three areas. From our prospective cohort data in men living in the rural area, Cox proportional hazard analysis showed emotional supports and social participations had protective effects to mortality after adjusting age, health behaviors and the subjective and objective health status. Such effects were not found in women. These findings suggests that the community care system in each town should pay attention to social relationship, especially participation of the elderly themselves. In addition, we discussed some future issues on the community health-care and welfare systems for the elderly and related policies in Japan.View full abstractDownload PDF (1099K) -
Seiryo TAKASHINA1999 Volume 47 Issue 6 Pages 828-837
Published: March 30, 1999
Released on J-STAGE: August 11, 2011
JOURNAL FREE ACCESSMany of lifestyle-induced, or diseases of the sort which progressively becomes degenerative with an advance in senility, have something to do significantly with the everyday life-style. Their secondary prevention is extensively in effect, having brought about considerablesuccesses. But studies on the primary prevention can hardly be described as adequate. It is a fact that, of people in whom no specific abnormalities were detected in a conventional mass health screening, or those for whom no significant signs of degeneration were declared latent, 25 percent were found to have some systemic abnormality or the other a few years later. For more successful achievements from the primary prevention of lifestyle-induced, it will presumably be of more effect to select from among the persons in whom no specific abnormalities were detected in a conventional health screening the highly risky persons for whom the possibility is high for a drop in the status of their health several years later and to enthusiastically provide education and guidance for improvements in the everyday life-style. For a study on the selection parameters (risk parameters), the criteria for selection of subjects were so arranged as to include the ages at 20 to 69, the systolic blood pressure level at less than 160mmHg, diastolic blood pressure level at downwards of 95mmHg, BMI level at 18.1-25.9kg/m2, serum cholesterol level at 120-220mg/dl, fasting plasma glucose level at downwards of 120mg/dI and casual plasma glucose level at 160mg/d1 or under. Retrospective cohort studies were perfomed on 6, 771 subjects who met those conditions and could be observed year after year. As a result, it was concluded that the systolic blood pressure level at 130mmHg, diastolic blood pressure level at 85mmHg, BMI at 24.Okg/m2, serum cholesterol level at 200mg/dl, fasting plasma glucose level at llOmg/dl and casual plasma glucose level at 180mg/d1 should be appropriate as selection parameters (risk parameters).View full abstractDownload PDF (1281K) -
Analysis of Factors That Makes Life Worth LivingMasao WATANABE, Eiji OURA, Kenji KOSHIYAMA1999 Volume 47 Issue 6 Pages 838-845
Published: March 30, 1999
Released on J-STAGE: August 11, 2011
JOURNAL FREE ACCESSWe performed a statistical analysis to find characteristic elements or moments which may make old people feel life worth living in rural areas in Japan, using the results of a questionnaire survey we reported in 1996 wiht the title “Aging of the Rural Population and Effective Measures to Respond to the Trend.”
In the analytical procedure, we used a multiple regression analysis with a logistic model. The dependent variable was the question “Is your present life worth your while to live?” As the independent variables, 168 questions were used covering various aspects of everyday life-farm work, activity in the community, environment, health, medication, aging, death, etc.
The number of subjects responded to the survey totaled 1, 373 men and women at age 55 and over living in 7 prefectures in Japan. The purpose of the analysis was to obtain items of questions with statistically significant coefficients in the logistic regression equation for the dependent variable. A total of 28 items of questions of statistic significance were obtained and most of the answers to these questions had a positively directed nature in order. Some of the items are as follows:
“Principles in life, ”“High hopes on agriculture, ”“Family with plural generations, ”“Satisfaction with domestic conditions, ”“Positive (healthy) ADL-markers, ”“Liking for harmony, ”“Participation in neighborhood activity, ”“Medication up to the terminal stage, ”“Willingness to leave one's body to medicine or donate for organ transplantation, ” etc.
Further, we discussed the comparison of items of unique characteristics between prefectures, healthy and unhealthy groups, sexes, age groups, and farmers and non-farmers.View full abstractDownload PDF (939K) -
1999 Volume 47 Issue 6 Pages 846-850
Published: March 30, 1999
Released on J-STAGE: August 11, 2011
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1999 Volume 47 Issue 6 Pages 851-853
Published: March 30, 1999
Released on J-STAGE: August 11, 2011
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1999 Volume 47 Issue 6 Pages 854-856
Published: March 30, 1999
Released on J-STAGE: August 11, 2011
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Hideomi FUJIWARA, Chihiro TANAKA, Shoukei GOTO, Masahiko GOYA, Hiroshi ...1999 Volume 47 Issue 6 Pages 857-863
Published: March 30, 1999
Released on J-STAGE: August 11, 2011
JOURNAL FREE ACCESSThere are many acquired and hereditary coronary risk factors, and the gender is known as a factor influencing the development of acute myocardial infarction (AMI). To evaluate the role of the gender in the occurrence of AMI, we compared patient backgrounds, their clinical manifestations, outcomes, and coronary angiographic findings between 390 male and 110 female AMI patients, who had been admitted to the coronary care unit (CCU) of the Tsuchiura Kyodo General Hospital and undergone coronary angiography on an emergency basis. The incidence of AMI was the highest in the age group of 60s for males, while for females in the age group of 70s. As coronary risk factors, smoking habit was more common in males, while hypertension, hyperlipidemia and diabetes meritus were more common in females. Coronary angiograms revealed no differences in the number of diseased vessels and location of infarction. Frequencies of urgent PTCA were also identical between the two groups. In clinical outcomes, elder females had poorer prognosis mainly due to a higher incidence of death caused by cardiac rupture. It has been reported that definite increase of AMI after menopause is attributable to disturbed lipid metabolism due to a reduced estrogen level. Our study showed that aged female AMI patients had poorer prognosis possibly due to associated multiple risk factors, mutiple organ disorders and delayed admission to hospital and higher risk of cardiac rupture. Therefore, in the treatment of aged female AMI patients, these tendencies must be taken into account.View full abstractDownload PDF (832K) -
Akiko KONDOH, Kazuko ISHIZUKA, Gen KURAMOCHI, Shin HASEGAWA1999 Volume 47 Issue 6 Pages 864-871
Published: March 30, 1999
Released on J-STAGE: August 11, 2011
JOURNAL FREE ACCESSIt is known that lactic acid bacteria preparations suppress the intestinal putrefaction and improves defecation, and that lactulose acidifies the intestinal contents and stimulates the proliferationof lactic acid bacteria in the intestines and further inhibits the absorption of ammonia from the intestine, resulting in the decrease in the synthesis of urea in the liver. For this clinical study, 15 patients receiving maintenance hemodialysis were selected and were divided into two groups. They received orally either lactic acid bacteria preparations or lactulose earlier for 6 weeks, followed by administration of their combination for 6 weeks. We examined the effects of each administration on the changes in peripheral blood counts, blood chemistries, intestinal bacterial flora in a lower portion of the rectum and bowel habits. Administration of lactulose combined with lactic acid bacteria preparations following the intake of lactulose alone induced a significant decrease in the serum triglyceride levels and a significant increase in serum phosphate levels. However, administration of lactic acid bacteria preparations in combination with lactulose following the intake of lactic acid bacteria preparations alone induced no significant changes. Plasma levels of ammonia and glycohemoglobin remained unchanged. Administration of lactic acid bacteria preparation and lactulose and their combination induced the increase in the percentages of Streptococcus, Enterococcus and Staphylococcus groups in the lower portion of the rectum, whereas Candida albicans was not detected. The improvement of bowel habits was observed after administration of their combination rather than administration of lactic acid bacteria preparations and lactulose alone. These results suggest that the environmental changes of the intestine produced by administration of lactulose earlier than of the combination with lactic acid bacteria preparations are effective in changing blood chemistries, and that administration of their combination has advantages in improving the bowel habits.View full abstractDownload PDF (939K) -
Toshiko TADA, Akiyoshi BANDO1999 Volume 47 Issue 6 Pages 872-878
Published: March 30, 1999
Released on J-STAGE: August 11, 2011
JOURNAL FREE ACCESSWe conducted a questionnaire survey of the state of health and daily living of the people over 65 years of age who live in a commercial district and an adjoining rural area. In this survey, subjects were asked to select answers to multiple-choice questions by themselves. The survey revealed various facts. Among them, our attention was riveted on the fact that loss of bladder control is a serious problem for many of the people of advanced age, especially women. So, we worked toward gaining an insight into the lifestyle of the aged with urinary incontinence.
In both commercial and agricultural communities, predominantly more women than men complained of incontinence. Over 50% of them replied that the frequency of incontinence is once every day, more or less. There also were indications that the inability to control urination indubitably threatens the physical and mental well-being of the old people irrespective of sex. However, as far as women are concerned, problems associated with incontinence are more serious for inhabitants in the farming area than in the commercial district. Our analysis also found notable declines in ADL (activities of daily living) and physical functions among incontinent women in the farming area. We deem it important to reach out a helping hand to them.View full abstractDownload PDF (775K) -
Shinji MIYAHARA, Hiroe HITOMI1999 Volume 47 Issue 6 Pages 879-893
Published: March 30, 1999
Released on J-STAGE: August 11, 2011
JOURNAL FREE ACCESSThis study was conducted to clarify the actual status of deaths at home in rural communities and factors that enable patients to die at home. From all over Japan, 123 towns and villages were selected and a questionnaire survey was conducted by mail. The response ratio was 31.7% and the number of respondents 767. The ratio of deaths at home during the three-year period from 1994 through 1996 was 29.0% on an average, ranging from 6.8% to 63.0%. In most of the areas with higher ratios of deaths at home, there were doctors willing to provide care to patients in their homes and well-organized nurse stations for home visits.
Heart diseases and cerebrovascular diseases each accounted for more than 20% of all deaths at home, and cancer 14.0% for men and 9.0% for women. As for the length of stay at home from the onset until death, 19.3% was within 24 hours (sudden death), 27.5% more than one year, 18.4% more three years, and 7.3% more than 5 years. The length of care at home rarely extended over a very long period.
Those who had access to more than three types of home medical care and welfare services (home visits by nurses, homemaking services by home health aides, etc.) accounted for a mere 32.0%, indicating that home care still means hardly anything more than care by family members.
Medical treatment had been received by 73.1% of the patients before death, and it was assumed that the minimum medical care to remove pains and sufferings such as oxygen inhalation (15.5%) and use of narcotics (7.2%) was being dispensed.
Care or dying at home is based on five basic elements of primary care Accessibility, Comprehensiveness, Coordination, Continuity and Accountability, and implementing those five elements will realize a desirable form of home care.View full abstractDownload PDF (1853K) -
1999 Volume 47 Issue 6 Pages 894-902
Published: March 30, 1999
Released on J-STAGE: August 11, 2011
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