As the president of this congress of the Japanese Association of Rural Medicine, I would like to address you on some aspects of my contribution to the community from the viewpoint of agricultural medicine and rural health in the Tokachi district. The aspects of my contribution could be divided into three parts; one is relating to Farmer's lung, the next is to fatty liver, one of the important problems found by our physical check-up center, and the third is relating to reforms of the hospital management so as to meet the needs of the community with regard to medical care.
Farmer's lung is in my line since I have made a specialty of respiratory medicine. When I came to Obihiro 18 years ago, farmer's lung was prevailing. Farmers were in fear of the lung disease. I took it upon myself to cope with the epidemic. Group examinations for farmer's lung were initiated. We learned what state farmers were in and what should be done by way of prevention. Nowadays, farmer's lung is rare in this district.
As regards fatty liver, we have analyzed this pathophysiological aspect of steatosis of the liver with relation to obesity and hyperinsulinemia. In persons with fatty liver, significantly high blood levels of insulin after the glucose tolerance test was recognized. Hyperinsulinemia is well known as a risk factor for morbidity leading death. Fatty liver should be considered to be among high-risk factors for deadly diseases.
Thirdly about our hospital. Obihiro Kousei Hospital has been contributing so much to the Tokachi district. As the director of the hospital responsible for regional health care, I have encouraged our staff members to take good care of patients who visited our hospital. I have also endeavored to ameliorate our system to provide quick emergency care. The number of patients rushed to our emergency ward has been increasing as a result.
Finally, we would like to thank all the participants in the 51st Congress of the Japanese Association of Rural Medicine in Obihiro city.

抄録全体を表示

1) Japan made a remarkable recovery from ashes in the aftermath of World War II due to the people's effort to rebuild their lives and policy markers strong leadership. Moreover, great progress in medicine improved the quality of life.
2) A sweeping change in the living environment brought about a salient change in “disease structure.” There is no major difference between diseases endemic in the rural area and those in urban area.
3) Services provided by hospitals affiliated Koseiren (the Agricultural Cooperation for Health and Welfare) include internal medicine, pediatrics, surgery, orthopedics and obstetrics and gynecology. Medical services are provided by expert doctors in each department, and their mission is to improve the quality of rural medicine.
4) Apart from department-wise treatment, there is an interdisciplinary system making it easier for clinicians in different departments to cooperate. More attention should therefore be given to medical practices by these clinicians. Clinical medicine needs not be considered a particular type of practice in a rural setting. Rural medicine should be included in the category of general medicine.
5) Unlike teaching hospitals affiliated with a university, Koseiren hospitals have an extensive range of services including treatment of common diseases (eg, common cold or diarrhea, etc.), primary care, prevention of the three most common causes of death, treatment of lifestyle-related diseases, emergency treatment, a routine health checkup, home-visit nursing care services and home care. Given the present status surrounding a rural hospital which offers extensive services, young clinicians should no longer be equally encouraged to embrace the traditional idea of rural medicine. They should rather make better use of their expertise in the management of community-based medical services.
6) Studies on clinical medicine have gradually outnumberd those on rural medicine in the collection of lectures given at the general meeting of the Japanese Association of Rural Medicine (JARM) since its establishment indicating a change in the trend of rural medicine.
7) A course in rural medicine is not offered by the faculty of medicine in Japanese universities, which indicates that Japanese Ministry of Education, Culture, Sports, Science and Technology underestimates the importance of rural medicine.
8) Rural medicine dedicated to maintaining and improving the health of the rural populace is not related to the declining tendency of agriculture and rural population as a result of irresponsible Japanese agricultural administration. Rural clinicians are not responsible for that.
9) There is no point in discussing a definition of rural medicine usually influeneced by the thought, career and religious idea of those who govern. From my standpoint as a director of a community general hospital, I think clinical medicine should cover a broad range of areas.
10) Last but not least, my strongest hope is that an increasing number of young researchers will be interested in rural medicine besides pursuing their interests im their own area of expertise, and will be enrolled a members of the JARM. With a reduced number of members, the society's idea will die. I will follow the way that the JARM changes over time hoping for its further develpoment.

抄録全体を表示

農村における検診活動及び健康増進・生活改善を含む健康教育活動の費用効果について研究を行った。県の全市町村における国保医療費の分析では, 人口当たり保健師数と基本健康診査受診率が多いところほど, 老人及び一般の療養諸費が少なかった。また検診活動と健康教育活動が充実している市町村では, 一人当たり国保医療費が少なく, とくに老人医療費においてそれが著明であり, 経費に比べ医療費の軽減額が多かった。逆に, 一人当たり国保医療費の少ない町村では, 検診受診率, 在宅死亡率, 学習会参加率が高かった。国保レセプトの分析では, 検診を積極的に受診しているものほど, 国保医療費, とくに入院医療費が少ないという結果が得られた。胃検診は胃がん死亡率減少に効果があり, 逸失利益を含めれば, 費用効果が認められた。検診受診は, 有病率低下にはすぐには結びつかなかったが, 日常生活習慣の改善に効果が認められた。

抄録全体を表示

It took more than one century after modernization started in Japan for rural residents, in contrast with urban residents, to come to enjoy modern medicine. The delay was caused by the geographic distance from medical institutions and the extreme shortage of medical doctors in countryside even after the national health insurance system for all the people started in 1961. Through the difficult period the residents have maintained a reciprocal aid system in each community and their traditional medicine, and local governments have developed their own systems of medical aid.
The recent financial difficulties both at national and local levels would inevitably arouse dissatisfaction with the current public health care system. The medical aid systems which have been developed among residents and local governments in countryside could be a new model of medical care if the dissatisfaction caused by the financial difficulties increases in the future.
From the viewpoint of medical anthropology, the traditional health care system was the complex and compound system which consisted of not only medical professionals, medical institutions and medical facilities but also a vast network of ordinary people. The financial difficulties in medical administration could provide a good opportunity to change the current health care system which will cost a greater deal and ultimately collapse.

抄録全体を表示

Bioethics has raised many questions in the field of contemporary medicine, and successfully contributed to the reconstruction of medical ethics. Bioethics is in its character controversial and accusatory on the basis of its own principles. It is now seen to stand in confrontation with environmental ethics, which has a radically different perspective from the former. The practice of medicine in rural communities offers an opportunity to weigh and evaluate both branches of ethics for gainig a new perspective for a better and higer life.

抄録全体を表示

慢性腎疾患 (CKD) の進行抑制に低たんぱく食 (LPD) は不要という説がある。しかしCKDのうちの非糖尿病性腎症 (NDN) を対象としたLPDのランダム化比較試, 験 (RCT) についてのメタアナリシス (MA) 3篇では, いずれのMAでもLPDは「進行抑制に有用」と結論されている。他領域でも行われているような, RCT一つ一つの質を評価し, 質の高いものだけのMAを行えば, LPDの有用性はさらに高まると思われる。
一歩退いて進行抑制にLPDが無効の場合を考えてみよう。WHO/FAOが疾病予防の観点から30年前に発表した一般人の食事についての勧告では, 推奨される1日たんぱく摂取量 (DPI) はたんぱく0.8g/kg/dayであった。しかし先進国では国民のDPIはどの国でも1.1～1.3g/kg/dayである。CKDに対し食生活に何の規制も加えなければ, この一般人のたんぱく摂取量になってしまうだろう。
一般人より心血管系リスクがはるかに高いNDN・CKD例がたんぱく制限なしで良いとは到底考えられない。つまりどのような立場であってもDPIのモニタリングをキチンと行い, DPIO.89/kg/day, あるいはDPI0.6g/kg/dayになるような指導を行い, その条件下に降圧療法, レニン・アンジオテンシン系抑制, アシドーシス補正, 腎性貧血の治療などの総合的な進行抑制療法を行うべきだろう。

抄録全体を表示

現在, 肝炎ウイルスのなかではC型肝炎ウイルス (HCV) が重要な問題となってきている。以前我々は, 血液中にHCVを認めた血液透析患者において, 各種ダイアライザーの前後で血液中HCV-RNA量を測定したところ, 特にポリメチルメタクリレート (PMMA) 膜ダイアライザーでは血液中HCV-RNA量が有意に低下することを報告した。今回, PMMA膜ダイアライザーに変更後血液中HCV-RNAが陰性化した症例を経験したので報告する。症例は72歳女性。透析歴21年7か月。輸血歴あり。血液生化学的データに関しては, 血清AL, P, TTTのみ高値であった。血液中HCV-RNA量は, 以前より減少傾向が認められていた。ダイアライザー変更時は32KIU/mlであった。ダイアライザー変更後12ケ月で陰性化 (0.5KIU/ml未満) した。このことから, HCV陽性血液透析患者でのダイアライザーの選択に, 膜のHCV除去能も考慮すべきであると考えられた。

抄録全体を表示

福島県県南地域を診療圏とする白河厚生総合病院外科における胃癌手術例の臨床的検討を行った。
昭和56年 (1981年) 1月から, 平成12年 (2000年) 12月までの20年間に1,132例の胃癌の手術を施行した。切除数は1,023例 (切除率90.4%), 治癒切除数894例 (治癒切除率79.0%) であり, 切除例の5年生存率は68.3%, 治癒切除例は75.6%であった。
20年間の症例の前期10年間と, 最近の10年間での比較では, 切除数は減少しているが, 切除率は上昇した。進行程度, 組織分類, 深達度, リンパ節転移などで早期のものが増え, 5年生存率も次第に向上してきた。

抄録全体を表示