Online ISSN : 1349-7421
Print ISSN : 0468-2513
ISSN-L : 0468-2513
66 巻 , 6 号
  • 青木 一雄
    2018 年 66 巻 6 号 p. 621-
    発行日: 2018年
    公開日: 2018/05/02
    ジャーナル フリー
      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.
  • 田村 直子, 牛久保 美津子
    2018 年 66 巻 6 号 p. 703-
    発行日: 2018年
    公開日: 2018/05/02
    ジャーナル フリー
  • 北方 悠太, 水野 吉雅, 小林 一博, 森 良雄, 勝村 直樹, 安田 憲生, 鷹津 久登
    2018 年 66 巻 6 号 p. 713-
    発行日: 2018年
    公開日: 2018/05/02
    ジャーナル フリー
     近年,胸膜癒着療法に50%ブドウ糖液を用いた報告があり,当院でも施行している。症例は63歳女性,関節リウマチで通院中に胸部X線で異常陰影を指摘された。胸部CTで右肺下葉(S 6 )に結節影を認めた。術前に確定診断に至らなかったが画像上原発性肺癌が疑われた。またCT上,両肺下葉背側優位に蜂巣肺所見を認め,KL-6の上昇と合わせ,間質性肺炎合併が疑われた。右下葉切除術を施行したが,術後に気漏の遷延を認め,6日目に50%ブドウ糖液を用いた胸膜癒着療法を施行した。発熱や疼痛,間質性肺炎の急性増悪は認めず,気漏が改善し,7日目にドレーン抜去が可能であった。病理診断は原発性肺癌(扁平上皮癌,pT2aN0M0 Stage I B)だった。背景肺は病理学的にも間質性肺炎(UIP)と診断された。間質性肺炎合併肺癌の術後の気漏に,50%ブドウ糖液を用いた胸膜癒着療法によって気漏の軽快を得た症例を経験した。
  • 高木 理光, 橋本 英久, 中村 有美, 三輪 正治, 今井 信輔
    2018 年 66 巻 6 号 p. 718-
    発行日: 2018年
    公開日: 2018/05/02
    ジャーナル フリー