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 68, Issue 6
Displaying 1-22 of 22 articles from this issue
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Special Issue on the 68th Annual Meeting of the Japanese Association of Rural Medicine
LECTURE BY CONGRESS PRESIDENT
  • Community Healthcare, Functions of Healthcare, and Hospital Design
    Hideaki KIKUCHI
    2020 Volume 68 Issue 6 Pages 677-
    Published: 2020
    Released on J-STAGE: May 17, 2020
    DOIhttps://doi.org/10.2185/jjrm.68.677
    JOURNAL FREE ACCESS
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    　　The direction of healthcare in each community is determined by fiscal and healthcare policy at the national level, while concrete details are determined by the needs of each community. The role of medical institutions as public institutions is to continuously provide stable, high-quality healthcare for the community. In other words, what is expected of each medical institution is to accurately recognize its role in the community and to remain functional without collapsing. Before the relocation of Obihiro Kosei Hospital, the functions of the hospital were evaluated and ways that the hospital could sustainably contribute to the community were discussed. The outcomes of these discussions were taken into account when designing the new Obihiro Kosei Hospital.
    　　Tokachi Subprefecture, where Obihiro Kosei Hospital is located, covers a wide area (10,831 km2, equivalent to the entire area of Gifu Prefecture) and is surrounded by mountains and ocean. “Complete healthcare within the mountain boundaries” remains our main task. Based on an analysis of DPC data and bed reports, we outline our future vision of the hospital─to become an “acute phase specialist hospital” that protects healthcare in the community. Accordingly, the new hospital was designed to achieve the following goals:
    　　　1. Provide advanced emergency care
    　　　2. Adapt practice to provide advanced medical care (e.g., cancer treatment)
    　　　3. Provide a safe and secure healthcare environment
    　　　4. Provide an efficient working environment
    　　　5. Be resilient to disasters
    　　To meet these goals, some elements of the hospital, if unlikely to be needed, had to be eliminated.
    　　This lecture focused on the design of the hospital, but the hospital’s operations and equipment are also important. Further, more accurately understanding the hospital’s position makes clear the importance of cooperation (and beyond cooperation) with other medical institutions. For every medical institution, the most important point is to have a keen awareness of its own “responsibility to protect healthcare in the community” and to avoid misjudging its position.
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SPECIAL LECTURE 1
SPECIAL LECTURE 2
SPECIAL LECTURE 3
SPECIAL LECTURE 4
EDUCATIONAL LECTURE 1
EDUCATIONAL LECTURE 2
CULTURAL LECTURE
KANAI PRIZE WINNER'S LECTURE
SYMPOSIUM
WORKSHOP 1
WORKSHOP 2
PUBLIC OPEN LECTURE
ORIGINALS
  • Characteristics of Socially Isolated Elderly People in a Rural Area According to a New Classification System Based on Intentionality in Social Choices
    Results of a Questionnaire Survey and Correspondence Analysis
    Mai TANAKA, Toshiki KATSURA, Shinji ISHIKAWA, Akiko HOSHINO, Miho SHIZ ...
    2020 Volume 68 Issue 6 Pages 773-
    Published: 2020
    Released on J-STAGE: May 17, 2020
    DOIhttps://doi.org/10.2185/jjrm.68.773
    JOURNAL FREE ACCESS
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    　　The aim of this study was to analyze the relationships among various characteristics such as personal attributes, health status, and social functioning in socially isolated elderly people according to a new classification based on intentionality in social choices, and to clarify the characteristics and issues of these individuals living in the community. We conducted a questionnaire survey of all healthy elderly people in Town A, which is located in a rural area. We classified respondents as non-socially isolated, intentionally socially isolated, or accidentally socially isolated. We then compared the three groups. Correspondence analysis was used to examine relationships among personal attributes and physical, mental, social functioning in the three groups. Valid responses were received from 1,284 respondents. Results showed that intentional social isolation was associated with living alone and poor physical functioning but not with medical history. Thus, intentional social isolation requires interventions for improving lifestyle, physical activity, nutrition, and oral care to prevent frailty among elderly people living in the community. Accidental social isolation was associated with depression and cognitive decline, and therefore requires mental health intervention. In addition, the accidentally socially isolated elderly tended to have low socioeconomic status, so it is necessary to create a mechanism for the early identification of high-risk individuals during monitoring and intervention provided by health and welfare professionals in various fields.
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  • Relationship Between Physical Activity and Mild Cognitive Impairment in Community-Dwelling Elderly Adults Sampled Randomly From a Cohort
    Atsushi ODAGAWA, Toshiki KATSURA, Akiko HOSHINO, Miho SHIZAWA, Kanae U ...
    2020 Volume 68 Issue 6 Pages 781-
    Published: 2020
    Released on J-STAGE: May 17, 2020
    DOIhttps://doi.org/10.2185/jjrm.68.781
    JOURNAL FREE ACCESS
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    　　The increase in dementia is becoming a serious health-related issue in Japan. The Ministry of Health, Labour and Welfare has indicated that the most effective method for preventing dementia is to detect and manage mild cognitive impairment (MCI). Accordingly, this study focused on “low physical activity”, which is a risk factor for dementia, and aimed to clarify the correlation between physical activity and MCI by analyzing the amount of physical activity among community-dwelling elderly adults sampled randomly from a cohort. A door-to-door survey was conducted of 26 physically housebound elderly adults and 26 physically nonhousebound elderly adults matched for sex, age, and living quarters who were randomly sampled from a 2013 cohort. Housebound status was assessed using a basic checklist. The survey was conducted at the participants’ homes. Components of the survey included basic attributes, basic checklists, the International Physical Activity Questionnaire, Japanese version of the Montreal Cognitive Assessment (MoCA-J), Kohs Block Design Test (Kohs), Revised Hasegawa’s Dementia Scale, Geriatric Depression Scale─Short Version-Japanese, Instrumental Activities of Daily Living Scale, and grip strength. The chi-squared or Mann─Whitney U test was used for comparisons between the elderly adults with low physical activity and those with high physical activity. The chi-squared test was used to compare the relationships between physical activity and MCI assessments (MoCA-J, Kohs). Statistical analysis was performed using SPSS for Windows, with significance established at p < 0.05. Physically inactive elderly adults were engaged in significantly physical activities and had significantly more inactive periods compared with physically active elderly adults. The inactive elderly adults did not fulfill the level of physical activity needed to maintain fitness. In addition, a significantly higher percentage of inactive elderly adults had MCI compared with active elderly adults according to MoCA-J score. When MCI was assessed using the Kohs, on the other hand, there was no significant difference between the active and inactive elderly adults. Inactive elderly adults were not able to fulfill the level of physical activity necessary to maintain fitness and prevent MCI. There is a need to urgently consider ways to identify inactive community-dwelling elderly adults and to detect and manage MCI at an early stage.
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CASE REPORTS
  • Renal Prognosis and Pregnancy Management in 4 Pregnancies Complicated by Renal Disease
    Momoko SEKI, Rie KITANO, Shiori KOHRI, Maiko ICHIKAWA, Seiichi ENDO, M ...
    2020 Volume 68 Issue 6 Pages 790-
    Published: 2020
    Released on J-STAGE: May 17, 2020
    DOIhttps://doi.org/10.2185/jjrm.68.790
    JOURNAL FREE ACCESS
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    　　Pregnant women with renal disease are at high risk of perinatal complications and renal impairment. Here, we report the outcomes of 4 pregnancies complicated by renal disease diagnosed during pregnancy and the puerperal period. Case 1: Urine test had been positive for protein from 8 weeks of pregnancy, and chronic kidney disease stage G4 was diagnosed at 25 weeks of pregnancy. Renal impairment worsened over time, and cesarean section was performed due to non-reassuring fetal status at 32 weeks of pregnancy. Case 2: Urine test had been positive for protein since before pregnancy, and chronic glomerulonephritis was diagnosed at 15 weeks of pregnancy. Gradual impairment of renal function started at 31 weeks of pregnancy, and the patient had a vaginal delivery at 37 weeks of pregnancy. Case 3: Urine test had been positive for protein since before pregnancy, and hypertension and urine protein were observed since around 26 weeks of pregnancy. Cesarean section was performed due to acute renal failure at 36 weeks of pregnancy. Chronic glomerulonephritis was suspected after childbirth. Case 4: Blood pressure became uncontrollable beginning around 28 weeks of pregnancy, and cesarean section was performed due to sudden worsening of hepatic and renal functions at 31 weeks of pregnancy. Autosomal dominant polycystic kidney disease was diagnosed after childbirth. Pregnancies complicated by renal disease need to be managed carefully with monitoring of blood pressure and renal function. Cooperation with a renal specialist is crucial throughout the perinatal and puerperal periods.
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  • Long-Term Response in PD-L1-Negative Advanced Non-Small Cell Lung Carcinoma With Discontinued and Restarted Nivolumab Therapy Due to Immune-Related Adverse Event
    Tomoshige CHIAKI, Soichi MARUYAMA, Shinya FUJII
    2020 Volume 68 Issue 6 Pages 797-
    Published: 2020
    Released on J-STAGE: May 17, 2020
    DOIhttps://doi.org/10.2185/jjrm.68.797
    JOURNAL FREE ACCESS
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    　　The patient was 67-year-old woman with non-small cell lung carcinoma (squamous cell carcinoma, T2bN2M1a, Stage IVA) who was started on fifth-line therapy with nivolumab, an immune checkpoint inhibitor. Although tumor biopsy was negative for programmed cell death ligand 1 (PD-L1), the tumor size decreased. Nivolumab had to be discontinued due to suspected immune-related adverse events (i.e., skin rash and enteritis symptoms), but the tumor size reduction persisted after discontinuation and complete response was maintained for ≥ 8 months. After disease recurrence, nivolumab therapy was restarted. The tumor size decreased, and partial response was achieved and maintained. The disease was successfully controlled for ≥ 2 years (27 courses of nivolumab), when nivolumab therapy was again discontinued due to skin rash. Despite the PD-L1-negative status, the patient achieved long-term response to nivolumab therapy. The immune-related adverse events in this case were comparable between the initial and reintroduced nivolumab therapy, suggesting that nivolumab is safe to administer over the long term.
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