JOURNAL OF THE JAPANESE ASSOCIATION OF RURAL MEDICINE
Online ISSN : 1349-7421
Print ISSN : 0468-2513
ISSN-L : 0468-2513
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Volume 58, Issue 5
Displaying 1-10 of 10 articles from this issue
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SERIES “Rural Medicine: As I See it”
ORIGINALS
  • Changes of Care Levels of Frail Elderly Individuals After Introduction of Long-Term Nursing Care Insurance System
    Miki FUKUMA, Kuninori SHIWAKU
    2010 Volume 58 Issue 5 Pages 516-525
    Published: January 30, 2010
    Released on J-STAGE: April 01, 2010
    DOIhttps://doi.org/10.2185/jjrm.58.516
    JOURNAL FREE ACCESS
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      A long-term care insurance law was enacted in 2000 for the purpose of socializing elderly care. Since then, the Japanese government has come to shoulder an unexpected financial burden because of a large increase in the number of the slightly frail elderly. Based on the need of frail elderly individuals, five care levels were established by the insurance law. Predictive factors for changes of the care level of such individuals are not yet clear. We conducted an analysis of the relationship between changes of care levels of frail elderly people residing in Izumo City, Shimane, and such factors as gender, age, activity of daily life (ADL) and care services utilization, in a cohort study of 1,965 certified elderly individuals in 2000, and of 2,547 such individuals in 2002. We arbitrarily set the care levels into three categories:maintenance/improvement, deterioration, and death; we then tracked the care levels of each cohort over a two-year period. At the end of 2-year tracking, 39.9% of the 2000 cohort were in the maintenance/improvement level, 37.7% in deterioration and 22.4% had died; for the 2002 cohort, the results were 51.8%, 25.8% and 22.5%, respectively. The elderly in all care levels in the 2002 cohort, especially those with the higher ADL (support necessary and care level 1), improved their ADL but showed no significant differences in death rate, compared with the 2000 cohort. The certification method of care level for long-term care did not substantially change between 2000 and 2004. The improvement of care level change in the 2002 cohort was not related to either level of care or dementia, or to utilization rates of services at home. Therefore, the attitude of the users of services and the quality of home care may have contributed to the improvement of care levels from 2000 to 2002.
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  • Creating Flowcharts of Eating and Swallowing
    Hirotaka SHOJI, Taizo YAMAMOTO, Tomoko INOUE, Chizuru OIKAWA, Natsumi ...
    2010 Volume 58 Issue 5 Pages 526-532
    Published: January 30, 2010
    Released on J-STAGE: April 01, 2010
    DOIhttps://doi.org/10.2185/jjrm.58.526
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    Purpose: To create flow charts of eating and swallowing that make it easy to identify the cases requiring professional treatment including dysphagia rehabilitation during oral intake.
    Subjects: 28 patients (mean age: 78.7±11.3 years) with dysphagia who underwent videofluorography (hereinafter “VF”).
    Methods: We conducted various tests such as Repetitive Salvia Swallowing Test (RSST), Modified Water Swallowing Test (MWST) and Food Test (FT), and studied relationships between VF findings and Fujishima's grade of eating and swallowing capability.
    Results: After the examination of th results of RSST (sensitivity: 0.83, specificity: 0.22), MWST (sensitivity: 0.56, specificity: 0.72), FT (sensitivity: 0.33, specificity: 0.75), VF and grade of eating and swallowing capability of Fujishima, the use of MWST and FT was appropriate. However, four cases in which the results of MWST and FT were over the cut-off value had misswallowed water and food. We created the flowcharts considering that all of those 4 cases are also the cases that suffered from the consequences of cerebral strokes.
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  • Habit of Eating Quickly Is Independently Related With Overweight Among Japanese Rural Residents Aged 40-79 Years.
    Yoshito MOMOSE, Hiroshi UNE, Masato HAYASHI, Naoharu TAKEYAMA, Kiyoshi ...
    2010 Volume 58 Issue 5 Pages 533-540
    Published: January 30, 2010
    Released on J-STAGE: April 01, 2010
    DOIhttps://doi.org/10.2185/jjrm.58.533
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    Objective: To examine relationships between fast eating habit and overweight. Design: Cross-sectional study. Setting: Four rural areas in Japan. Subjects: A total of 2,239 adults (782 men and 1,457 women) who participated in a health check-up program. Measurements: Body mass index (overweight 25.0) and the habit of eating quickly (validated brief-type self-administered diet history questionnaire). Statistical analysis: A covariance analysis was used to examine an independent relationship between the habit of eating quickly and overweight. Results: 21.1% of males and 21.4% of females were found overweight. 40.3% of males and 34.7% of females reported that they were in the habit of eating quickly. The multivariable adjustment included age, total energy intake, fat energy balance, alcohol intake, smoking status, physical activity level, and survey area. After adjusting for these variables, the habit of eating quickly was positively related with overweight in both males and females.
    Conclusion: The habit of eating quickly was independently related with overweight, and to control of the eating behavior would thus be essential for Japanese rural residents in order to reduce their body weight.
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  • Validity of the Diagnostic Criteria and Effects of Epidural Blood Patch for Spontaneous and Traumatic Cerebrospinal Fluid Hypovolemia
    Yoshikatsu SHIMBO, Masaru TOMIKAWA, Kazuhiko TAKAKUWA
    2010 Volume 58 Issue 5 Pages 541-548
    Published: January 30, 2010
    Released on J-STAGE: April 01, 2010
    DOIhttps://doi.org/10.2185/jjrm.58.541
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      The diagnosis of spontaneous cerebrospinal fluid hypotension or hypovolemia (CSH) can be made with a set of characteristics of orthostatic headache and cranial MRI findings, and atypical cases without these characteristics can be diagnosed by CT-myelography or radionuclide cisternography, which visualizes the location of leakage of cerebrospinal fluid. It has been proposed in our country that the manifestation of a chronic whiplash syndrome may be similar to that of atypical spontaneous CSH and that a considerable number of patients may be relieved by epidural blood patching, an effective therapy for CSH. After that proposition, the definition of CSH became confused, although the guideline was presented in 2007 by the study group of CSH, which had agreed upon the presence of traumatic CSH including the chronic whiplash syndrome. We have made epidural blood patches in 14 patients since 2004 on the basis of the criteria comparable to that guideline. Among seven cases of spontaneous CSH, six cases showed both orthostatic headaches and typical cranial MR imaging, and in the remaining one, the location of the cerebrospinal fluid leakage was detected. Diagnosis was established in all of the cases of spontaneous CSH. Among the seven cases of traumatic CSH, none of which showed orthostatic headache or typical cranial MR imaging, two cases did not reveal any locations of leaks of cerebrospinal fluid, the one of which showed a good outcome of epidural blood patching. The criteria in that guideline seemed valid for the diagnosis of spontaneous and traumatic CSH. After epidural blood patches, improvement was shown in every case of the spontaneous CSH, and a good outcome was in three cases and partial improvement in two cases of the traumatic CSH. The patients of the traumatic SCH had much difficulty in keeping the daily life because of lassitude or fatigue. Epidural blood patching proved to be useful for them.
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  • A Trial Calculation of the Costs Incurred by the Absences of Agricultural Co-opEmployees in Aichi Prefecture due to Novel Influenza
    Hiroshi INAGAKI, Haruo YAMADA, Hiromichi MIWA, Kazuo KONDO, Yoshitaka ...
    2010 Volume 58 Issue 5 Pages 549-557
    Published: January 30, 2010
    Released on J-STAGE: April 01, 2010
    DOIhttps://doi.org/10.2185/jjrm.58.549
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      With the spread of a novel H1N1 strain of influenza A around the world, the World Health Organization declared that the situation had entered the pandemic phase. In Japan, it had a major social impact, causing a great hit to the national economy. And there is every likelihood that the H1N1 influenza is going to break out a lot of people on the staff of the agricultural cooperatives in Aichi Prefecture, seriously affecting the activities of agricultural cooperatives too. Based on the amount of damage from the flu presumed by the Japanese government and various kinds of statistical material, we worked out how much the flu would cost the agricultural co-ops in the prefecture by infecting their employees and involved their family. At an absence rate of 20%, the lowest rate presupposed by the government, our calculation showed that the extra costs would amount to 740 million yen altogether. If the rete of abscense from work was given 40%, the largest estimate by the government, the costs rocketed to highly 1.48 billion yen. A check on the situation of individual co-ops revealed that some of the co-ops would burden an extra cost of well over 100 million yen. From these findings, we concluded that to minimize the effects of the flu appropriate, effective countermeasures have to be taken after sufficient information about the novel influenza virus was collected and analyzed carefully.
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REPORTS
  • Readiness of Community-based Medical Facilities Liked up to Mainstay Cancer Treatment Hospitals in a Preparatory Stage of Critical Pathway Development: A Survey
    Toyohisa YAGUCHI, Shinya KATO, Toyomi MATSUURA
    2010 Volume 58 Issue 5 Pages 558-562
    Published: January 30, 2010
    Released on J-STAGE: April 01, 2010
    DOIhttps://doi.org/10.2185/jjrm.58.558
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      The Ministry of Health, Labor and Welfare on March 1, 2008, made public a guideline for putting in order hospitals expected to play central roles as strongholds in fighting cancer. The guideline called on these major hospitals to tabulate critical pathways in collaboration with community medical facilities and share the tables among them. In preparation for this collaborative project, we made a questionnaire survey to sound out the practitioners in the Ama area on this.
      The survey found that opinions of some respondents differed widely from what the hospitals thought should be. Those which replied that they were ready to accept cancer patients accounted for 52.6% of the respondents. Some facilities, which said they were going to take care of cancer patients in any stage, were not capable of palliative care. It was also found that there were many facilities who did not like to accept patients referred to them from hospitals. From these findings, we thought more efforts should bemade to establish closer cooperation between clinics and hospitals.
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  • Palliative Care and Cancer Notification
    Sayaka WATANABE, Eiichi YABATA, Haruko ITO, Masako TSURUMI, Mieko SUZU ...
    2010 Volume 58 Issue 5 Pages 563-568
    Published: January 30, 2010
    Released on J-STAGE: April 01, 2010
    DOIhttps://doi.org/10.2185/jjrm.58.563
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      In our hospital the palliative care committee has been held once a month since 2000. In 2007, a total of 1,583 cancer patients were admitted to our hospital orreceived medical care at home. The average length of hospital stay was 24 days. Of the total number of patients, 88.4% was informed that they had cancer. In the latter half of the year it increased to 92.6% because the palliative caretakers gave doctors accurate information on patients' psychology and social background. In October 2007 a questionnaire survey was conducted on those who visited our palliative care section on the occasion of the hospital festival. A total of 46 responded to our survey about the knowledge of palliative care, physician's precise explanation about the illness, image of opioids, desirable place of death and so on. Twenty-eight respondents (60.9%) did not know anything about palliative care. Forty-four (95.7%) wanted precise explanation of cancer. Thirty-four (73.9%) said they had had a night image of opioids after reading the panel. Twenty-eight (60.9%) responded they would rather stay at home until death. We should give healthy people more information about palliative care and opioids.
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REGIONAL MEETING
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