日本農村医学会雑誌
Online ISSN : 1349-7421
Print ISSN : 0468-2513
ISSN-L : 0468-2513
57 巻 , 6 号
選択された号の論文の19件中1~19を表示しています
――第57回日本農村医学会総会特集――
学会長講演
  • 椎貝 達夫
    2009 年 57 巻 6 号 p. 809-814
    発行日: 2009/03/30
    公開日: 2009/05/21
    ジャーナル フリー
     2007年度末の日本透析患者数は27万5,199人に達しました。透析患者の高齢化に伴い,患者の増加の勢いは弱まり,やがて減少に転じるという説がありますが,最近の増加率は4~5%で低下する傾向にありません。透析医療費は患者1人年に600万円と高額で,ほとんどすべて国の負担ですから,国の財政負担が増え続けることがまず問題です。
     次に問題となるのが透析患者の生活の質 (QOL) です。日本の腎臓移植は低迷しており,心臓死下,脳死下の提供を含めて年間に160~200腎が透析患者に提供されるに過ぎず,移植希望者に比べ提供数があまりに少ないので,移植を希望する透析患者が減りつつあります。ところが欧米では腎提供者が多く,透析患者の3分の1は腎移植下の生活を送っています。日本ではほとんどの透析患者が一生透析から離れられないのに比べ,欧米の患者のQOLははるかに良質です。
     このQOLの低さから,透析に入るのを極力遅くし,望むらくは一生透析に入らないような治療を行なう必要が,日本にはあると考えます。
     1987年11月から,私を中心とした当病院の腎臓スタッフは慢性腎臓病 (CKD) 保存療法を本格的に始めました。
     「本格的に」の内容は表1,表2に記してあります。
特別講演1
特別講演2
教育講演
公開講演
  • 宮脇 昭
    2009 年 57 巻 6 号 p. 827-832
    発行日: 2009/03/30
    公開日: 2009/05/21
    ジャーナル フリー
      We now enjoy an affluent, comfortable and efficient lifestyle that human beings have long dreamt of. And yet we feel lurking anxiety about the present and the future. Some youths do not have any definite aim in life or foresight, and some people are alarmed by nature destruction, environmental pollution, erratic climate change, global warming and so on.
      When it comes to medical care, there are serious shortages of physicians in rural areas and in specific departments such as obstetrics and gynecology and pediatrics. The average life expectancy of Japanese has increased, but various forms of disease including cancer and dementia debase the quality of life.
      Affluent urban life today is supported by the countryside, which undertakes foodproduction and preserves the natural environment. The government should make more efforts to correct disparities between urban and rural areas in population, economics, culture, and medical care.
      We live now at a crossroads in the 4-billion-year long history of life on the earth. The thread of genes has continued to the pressent. It must be handed down to posterity. Advances in medical technology have contribute greatly to the protection of our life and genes. Indigenous forests have unsophisticatedly fostered our health, physical and mental, soul, and have protected our genes.
      We humans and other animals alike are consumers in the ecosystems on the earth. Greenplants are the only producers, and bacteria and fungi are decomposers. Green plants, especially multi-layered native forests that enrich green plants, are the very foundation of human existence.
      Japanese were particularly zealous in protecting and bequeathing native forests in each community, and reforesting after destroying forests to construct paddy fields, roads and villages just as other peoples did in other partsof the world.
      Native forests in most areas of Japan are laurel forests. Main tree species of laurel forests have evergreen thick watery leaves and deep taproots grabbing thesoil. So, multi-layered native forests have the function of environmental protection including noise insulation, windbreaking, air and water purification, and water retention, as well as the function of disaster mitigation, minimizing damage from storms, earthquakes, fires and tsunamis.
      Forests absorb CO2 in the air through photosynthesis and fix carbon as an organic compound in the tree body. This helps curb global warming. In the age of deteriorating biodiversity, it is worthy of special mention that there are so many tree species and so many species of birds, insects and small animals in an indigenous forest as well as bacteria and fungi living in the soil. Thus, indigenous forests maintain rich biodiversity, and are the real green environments that protect our life, heart and genes.
      However, indigenous forests are rapidly vanishing from almost all the areas of the world. Where native forests still remain, they should be preserved. Where native forests are destroyed, they should be restored and regenerated by all possible mean. We conduct phytosociological field surveys to determine main tree species of a given district, nurse their potted seedlings until theroot system fully develops in the containers, and plant them mixed and densely with local citizens. In this ecological plantation survival rate is good, and seedlings grow steadily to form a quasi-natural forest in 10-15 years.
      Every one of us should plant seedlings for ecological reforestation here and now, especially around hospitals and clinics, and spread the reforestation movement to the whole world to protect our own life, heart and genes.
シンポジウム
ワークショップ1
ワークショップ2
ワークショップ3
  • 戸村 成男, 木澤 義之
    2009 年 57 巻 6 号 p. 851-854
    発行日: 2009/03/30
    公開日: 2009/05/21
    ジャーナル フリー
      The goal of palliative care is to soothe or relieve the patients with serious illness of their suffering and to improve the quality of their life. It integrates the physical, psychological, social and spiritual aspects of patient care into a comprehensive whole. Doctors and other medical workers talk with the patients by providing appropriate information and explanations and care should be carried out according to the patients' wishes. The care team should confirm their wishes at every opportunity since the patients' wishes can change with time. The presenters who were actually involved in medical care or nursing care discussed how to solve the problems of palliative care and end-of-life care.
ワークショップ4
ワークショップ5
  • 玉置 久雄, 谷畑 英一
    2009 年 57 巻 6 号 p. 859-861
    発行日: 2009/03/30
    公開日: 2009/05/21
    ジャーナル フリー
      The comprehensive daily payment system by DPC developed the standardization of medical care and cost-effectiveness. We can exchange intelligence of other hospitals through the benchmark. Clinical pathways were useful for both the standardization and cost-benefit analysis. The production of pathways improved the communication between hospital employees. The excessive shortening of the average length of hospital stay decreased the rate of bed usage. The DPC payment system leaves much room for improvement in the quality of medical treatment and care.
ワークショップ6
  • 石渡 勇, 染川 可明
    2009 年 57 巻 6 号 p. 862-866
    発行日: 2009/03/30
    公開日: 2009/05/21
    ジャーナル フリー
      We discussed the current state of the emergency care of pregnant women and better ways to solve the problems confronting obstetricians and hospitals in our country.
      The basis of this problem is that doctors specialized in obstetrics and gynecology are working hard at high risk of being sued, resulting in the rapid decrease in the number of obstetricians. It has become difficult for many hospitals to maintain the department of obstetrics and gynecology. In other arords, it boils down to how to increase, or at least not to decrease the number of obstetricians and how to use present working doctors efficiently. By so doing, we could take in more emergency patients. To incease the number of those who choose obstetrics and gynecology, we should emphasize attrctive aspects of obstetrics and gynecology to students in early grades of medical schools. To assist the women doctors' return after maternity leave in taking care of their child, 24-hour day nurseries are necessary. Construction of the systems of short time work to reduce their hard and long-time load is also needed.
      In addition, the effective regional hospital association and cooperation should be encouraged and prompt maternal transportation should be achieved as much as possible. Doctors of different clinics or hospitals are expected to join forces to replenish the work of a regional perinatal central hospital. There are many of the medical treatment lawsuit when the newborn baby with cerebral palsy is born. This is one reason why the doctors keep away from obstetrics. A new system of the nofault amends system may be established by which the load of medical providers and patients can be reduced. Increased salary for obstetrician may be effective to induce doctors to obstetrics. These points were discussed.
ワークショップ7
  • 原田 真由美, 前田 浩利
    2009 年 57 巻 6 号 p. 867-870
    発行日: 2009/03/30
    公開日: 2009/05/21
    ジャーナル フリー
      Recently, the Jepanese government have advanced home medical care services. They former health care system was reformed to place much emphasis on home care. But there are many problems:for instance, the difficulty of coordinating discharges from a hospital and cooperation between hospitals and regional clinics. Especially, the biggest problem was that medical staff in wards do not have knowledge of the realities of home medical care and visiting nursing services. In this session, we invite four persons who are actively involved in the front lines in the field of home medical care. We expect they will speak about realities of home care and make you understand the potential of home medical care.
金井賞受賞講演
症例報告
  • 村上 雅博, 井川 洋
    2009 年 57 巻 6 号 p. 873-877
    発行日: 2009/03/30
    公開日: 2009/05/21
    ジャーナル フリー
     抗腫瘍薬の開発により副作用の軽減や良好な治療成績の報告がなされており,卵巣癌において長期生存が可能となった。一方で長期投与による晩期有害事象としての骨髄異形成症候群 (MDS) や白血病が問題となっている。今回我々は抗腫瘍薬開始後30か月でMDSを発症した症例を経験した。症例は59歳,卵巣癌IIIcに対して,術前化学療法としてパクリタキセル/カルボプラチン (TC) を3コース実施後,根治手術実施した。術後weekly TC 16コース実施した (16コース目ではパクリタキセルの副作用のため途中で中止)。3か月の無病期間の後にCA 125の再上昇,PET-CTにて再発を認めた。ドセタキセル,ブリプラチン,ゲムシダビン,トポテシンを投与したが抗腫瘍効果を認めなかった。その後遷延する血小板の低下,貧血を認めた。骨髄検査にてMDSと診断された。以後は化学療法を行なわず対症療法のみであるが,幸い白血病化はしていない。
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