日本農村医学会雑誌
Online ISSN : 1349-7421
Print ISSN : 0468-2513
ISSN-L : 0468-2513
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59 巻, 6 号
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——第59回日本農村医学会総会特集——
学会長講演
  • 衛生学から見た岩手の農業
    立身 政信
    2011 年 59 巻 6 号 p. 660-666
    発行日: 2011/03/30
    公開日: 2011/05/30
    DOIhttps://doi.org/10.2185/jjrm.59.660
    ジャーナル フリー
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      I started to study health problems in dairy farming in the Kitakami mountain district during the latter half of the1970's. Fields were located mostly in steep slopes and pastures were limited in area. In this district a survey of dairy farmers, time budget was carried out by the direct time-study method. And the energy consumption of farmers for their dairy farming activities was measured using the Douglas bag method.
      Working hours were prolonged because grass grew thick from early May to late October (the busy farming season). In this season, many farmers worked 13-14 hours per day. Grass harvesting that was done on the steep slope consumed a lot of energy. There was a close correlation between gradient and energy consumption for mowing.
      Various other kinds of agriculture were researched in Iwate Prefecture. And we pointed out some problems in each study.
      In recent years, the most serious problem in farm work is a high rate of accident occurence. About 400 farmers died in accidents every year for the past 40 years, and there is not a sign to decrease at all. This is the big problem that the Japanese Association of Rural Medicine should wrestle with.
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特別講演I
  • 〈われらはいっしょにこれから何を論ずるか〉
    ～宮澤賢治の〈挫折と甦りの生涯〉を辿りながら～
    望月 善次
    2011 年 59 巻 6 号 p. 667-677
    発行日: 2011/03/30
    公開日: 2011/05/30
    DOIhttps://doi.org/10.2185/jjrm.59.667
    ジャーナル フリー
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      The title of this lecture, ‘What should we discuss from now?’ is taken from the first paragraph in the introduction of “General Theory of Farmers' Arts” written by Miyazawa Kenji. It can be said the life of Miyazawa was marked by “failure and resurrection.” He suffered his setback five times in his life, and was not able to recover from the last frustration until he closed his life at the age of 37. From the fact that the manuscript fee was received only once throughout his whole life, it could be difficult to say that his life ‘in this world’ was successful. However, thousands of people have been touched by his awkward, but earnest, way of life, and it will give many suggestions to the prospect of JARM.
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特別講演II
教育講演I
教育講演II
教育講演III
シンポジウムI
シンポジウムII
ワークショップI
ワークショップII
  • 特定健康診査・特定保健指導への提言
    大淵 宏道, 前原 和平
    2011 年 59 巻 6 号 p. 710-713
    発行日: 2011/03/30
    公開日: 2011/05/30
    DOIhttps://doi.org/10.2185/jjrm.59.710
    ジャーナル フリー
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      Two years and six months have passed since the national health care system “Tokutei Kensin and Tokutei Hoken Sidoh”, which is a metabolic syndrome-specific health check up and counseling system, was enforced on April in 2008. It is high time for us to review it and make a proposal for a future improvement of the system. We would like to discuss the present problems and how we can increase the efficiency of the system in the workshop.
      Tokutei Hoken Sidoh, which is six month counseling and instruction for health-promoting lifestyle behavior, has significant effects not only on an improvement of lifestyle, i.e., physical activity and energy intake, but also on the reduction in body weight, waist circumference and blood pressure. Particularly, initial counseling and instruction after health check-up has a great importance for realization of future risks of cardiovascular diseases, and motivation for reducing abdominal obesity and other risk factors. However, the effects are lost in time after the accomplishment of the six-month program. Therefore, how to maintain the motivation and actual lifestyle change should be sought. At present, the cost effectiveness of Tokutei Hoken Sidoh appears to be low, because we tend to expend a lot of time in counseling. To increase efficiency, standardized group counseling would be needed. In addition, the stratification of individuals may be necessary for attending group counseling, because there are large differences in realization and motivation among subjects regarding metabolic syndrome.
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ワークショップIII
ワークショップIV
ワークショップV
  • 肥満と糖尿病
    川村 功, 大野 恒夫
    2011 年 59 巻 6 号 p. 722-725
    発行日: 2011/03/30
    公開日: 2011/05/30
    DOIhttps://doi.org/10.2185/jjrm.59.722
    ジャーナル フリー
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      Health education provided by a group of professionals from different disciplines, so-called “team medical care”, is considered essential for the treatment of diabetes. When each specialized professional educates diabetic patients on how to manage their condition, patient-centered medical care is realized, and it becomes possible to provide appropriate support to individual patients. The treatment of obesity is somewhat similar to that of diabetes. Diet therapy and exercise are the basic therapies, and diabetes in many obese patients can simply be improved by weight loss. Metabolic syndrome has been reported to be associated with visceral fat-type obesity. In order to prevent the development of atherosclerotic occlusive diseases due to weight loss, individual counseling after each medical checkup is provided by public health nurses or registered dietitians.
      Behavior modification is necessary to improve lifestyle. Helpful education and advice by various professionals help patients to modify their behavior, and thus patient-centered medical care can be achieved.
      Recently, for the treatment of diabetes, new oral hypoglycemic agents and insulin preparations as well as incretin preparations have become available, indicating that diabetes treatment strategies are increasing. This has allowed better glycemic control in diabetes than was possible before. Nonetheless, diet therapy and exercise remain the basic treatment methods, and they should not be made light of.
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金井賞受賞講演
原著
  • 当院における進行卵巣癌症例の検討
    ——予後不良因子の解析——
    川島 将彰, 近藤 肇
    2011 年 59 巻 6 号 p. 730-736
    発行日: 2011/03/30
    公開日: 2011/05/30
    DOIhttps://doi.org/10.2185/jjrm.59.730
    ジャーナル フリー
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    〔目的〕当院における進行卵巣癌症例を後方視的に解析し，進行卵巣癌における予後因子について検討を行なった。
    〔対象と方法〕2003年1月から2009年12月の7年間に当院で初回治療を行なった進行卵巣癌 (III期およびIV期) 15例につき診療録を後方視的に解析した。初回化学療法およびSLO/SDSの完遂群と未完遂群につき，両群間の比較検討を行ない，次いで多変量解析を用いて予後因子の解析を行なった。
    〔結果〕初回化学療法未完遂群では完遂群と比較し，年齢が有意に高かった。SLO/SDS完遂群では未完遂群と比較し，有意にCA125値の低下を認めた。予後因子の解析では，高齢，初回化学療法の未完遂およびCA125値の低下不良が予後不良因子として検出された。
    〔考察〕高齢者の治療では，慎重な説明を行ない十分な同意を得ておく必要がある。また術前化学療法の検討や緩和療法への移行も考慮すべきと考えられた。
    　また初回化学療法が完遂できなかった場合やCA125値の低下が不良な場合には治療困難となることが予想され，早期の二次化学療法への移行や緩和医療の導入も考慮すべきと考えられた。
    〔結論〕今回の解析から予後不良因子として高齢，初回化学療法の未完遂，CA125値の低下不良が挙げられた。予後不良因子を認める場合は，治療に難渋する可能性が高く十分な説明と慎重な対応が肝要と考えられた。
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症例報告
  • 救命可能であった仙骨部褥瘡に起因した壊死性筋膜炎の2例
    長谷川 毅, 三宅 孝
    2011 年 59 巻 6 号 p. 737-743
    発行日: 2011/03/30
    公開日: 2011/05/30
    DOIhttps://doi.org/10.2185/jjrm.59.737
    ジャーナル フリー
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    　壊死性筋膜炎は急速に進行する致死性の高い疾患で，基礎疾患として糖尿病が多い。今回，仙骨部褥瘡に起因した壊死性筋膜炎で，広範囲の切開排膿，洗浄ドレナージとデブリードマンを行ない救命できた症例を2例経験したので報告する。症例1は74歳男性で，既往歴に糖尿病とうつ病を認めた。症例2は82歳男性で，既往歴に糖尿病，脊椎損傷による対麻痺，仙骨部褥瘡を認めた。いずれも壊死性筋膜炎発症早期に臀部と背部の広範囲の切開排膿，洗浄ドレナージとデブリードマンを行ない，広域スペクトルの抗菌薬投与で救命できた。また術前の全身状態，糖尿病などの基礎疾患や術後の創部からの蛋白漏出により，術後に栄養状態が著明に悪化したため，糖尿病のコントロールとそれに伴う栄養管理で栄養状態は改善した。活動性低下に対しては，体圧分散寝具の使用，体位交換やリハビリテーションが創の早期改善のために必要であった。
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