I would like to begin our discussion of rural medicine by considering rural medicine from the perspective of public health and hygiene and discuss the role of rural medicine as social medicine in relation to public health, referring to the views and efforts of doctors who worked to support the Japanese Association of Rural Medicine from its early days. The Japanese Association of Rural Medicine was founded in 1952 and the first president, Dr. Toshikazu Wakatsuki, consistently argued the need to unify treatment and prevention if we truly want to improve health and medical care for farmers in rural areas, but that conventional medicine has become highly specialized and lacks a comprehensive perspective. Dr. Wakatsuki stressed that addressing these problems requires actions from a social point of view to achieve integration of medical practice and recognition that rural medicine should be social medicine by definition. Even in those days, his argument underscored the fact that rural medicine was essentially public health. Also, his thinking clearly complied with the World Health Organization’s definition of public health with minor modifications by, for example, replacing the original terms with more field-specific terms such as “communities” with “farming villages and rural areas”, “residents” with occupational fields, and “workers” with “farmers”. It has also been suggested that the essence of public health medicine is public health-minded professionals, as opposed to clinically-minded clinicians. Clinicians are primarily clinically and patient-oriented, while public health professionals are public health and population-oriented, focusing on communities and societies rather than on individual patients. These features of public health are also consistent with Dr. Wakatsuki’s view of rural medicine. I firmly believe that Dr. Wakatsuki rightly acknowledged public health and hygiene as the origin of rural medicine.
　　As a second major topic, next we discuss how, in the midst of rapidly changing infrastructure and socioeconomic environments, the research findings, knowledge, and skills developed and accumulated by the pioneers in rural medicine can be effectively applied to advance rural medicine further. For this, we need to take a broader perspective and discard today’s inter- and intra-regional disparities in health and medical care. We need to confirm the true purpose and fundamental role of rural medicine and apply information and communication technology (ICT) in the field of social welfare, including health, medical, and nursing care. It is expected that ICT will enable us take new quantum leaps forward, and it is not an overstatement that the use of ICT holds the key to addressing various problems simultaneously, such as the quantity of health, medical, and nursing care (e.g., regional disparities in medical resources including manpower and medical devices) and its quality (e.g., regional and inter-institutional disparities in medical technology). To address disparities in the quantity and quality of medical care, we need to overcome these various inter- and intra-organizational challenges through close co ordination between the government, companies, and medical institutions. As stated earlier, ICT is a major tool to more easily overcome these challenges, enabling data sharing between the government, hospitals and clinics, insurance providers, and individual healthcare professionals. The efficient and effective use of ICT in healthcare, medicine, and social welfare in farming villages and rural areas is expected to provide solutions to various problems associated with rural medicine in different fields, guiding us to the next chapter of rural medicine.

View full abstract

　　The objective of this study was to investigate the focus of interactions between highly experienced visiting nurses and their trainees during visiting-nurse practicums. These practicums are a part of the curriculum of senior students in nursing colleges. Semi-structured interviews were conducted with 10 experienced visiting nurses in rural areas of Japan and data were analyzed by using qualitative inductive methods. The following seven categories of the areas of focus of the home-based practicums were extracted from the data: “Easing trainee tensions,” “Making trainees observe the atmosphere/environment of patients in their homes,” “Quickly acclimating trainees to patients’ home life,” “Creating opportunities for trainees to understand patients during interactions based on their communication capacity,” “Linking home-based nursing to the general practice of nursing care,” “Verbalizing and reinforcing lessons learned from home visits for subsequent visits,” and “Having a supportive attitude to encourage trainees to relax and practice with ease.” The experienced visiting nurse instructors in this study appeared to interact with their trainees with multiple areas of focus in mind; the main goals were helping them understand how nursing services can support home living and simultaneously providing patients and their families with highly individualized and appropriate nursing care.

View full abstract

　　There are some recent reports of using 50% glucose for pleurodesis. Here, we report successful treatment of air leakage after lung resection using pleurodesis with 50% glucose. A 63-year-old woman with rheumatoid arthritis presented with an abnormal shadow on chest radiography and a pulmonary nodule in the right lower lobe on computed tomography. The lesion was strongly suspected to be primary lung cancer. However, pathological confirmation was not possible with bronchoscopy. Interstitial pneumonia was also diagnosed due to the honeycomb appearance on radiographic examination and elevated serum levels of KL-6. After resection of the right lower lobe, air leakage was prolonged for 6 days and we performed pleurodesis using 50% glucose. No side effects such as fever, pain, or acute exacerbation of interstitial pneumonia were observed. The air leakage disappeared the next day and the drainage tube was removed. Thereafter, primary lung cancer (squamous cell carcinoma, pT2aN0M0 Stage IB) and interstitial pneumonia were diagnosed pathologically.

View full abstract

　　A case of synchronous cancer of the transverse colon with associated cancer of the gastric angle detected preoperatively by systematic inspection of the gastrointestinal tract using abdominal ultrasound and upper gastrointestinal endoscopy. A man in his 60s visited the Department of Internal Medicine, Nishimino Kosei Hospital, with chief complaints of loss of appetite for about a year, weight loss, vomiting after ingestion of solids that started a month before presentation, and generalized malaise. He was hospitalized on the same day due to severe anemia. Gastric cancer was suspected on upper gastrointestinal endoscopy at admission, and so preoperative abdominal ultrasound was performed. Systematic inspection of the gastrointestinal tract revealed localized gastric wall thickening suggestive of cancer at the gastric angle and abnormal thickening of the wall of the transverse colon suggestive of colon cancer. Lower gastrointestinal endoscopy was performed, which confirmed a type II lesion of the transverse colon. The patient was diagnosed as having primary gastric cancer and synchronous primary colon cancer. Lesions were excised endoscopically, and pathological examination confirmed anaplastic adenocarcinoma of the gastric angle with moderately differentiated tubular adenocarcinoma of the transverse colon. We performed abdominal ultrasound and systematically inspected the gastrointestinal tract, enabling us to detect the second cancer. Systematic inspection of the gastrointestinal tract facilitates paying due attention to multiple lesions, instead of focusing on the lesion detected first, thus improving the accuracy of the examination.

View full abstract