Journal of Rural Medicine
Online ISSN : 1880-4888
Print ISSN : 1880-487X
ISSN-L : 1880-487X
Current issue
Showing 1-8 articles out of 8 articles from the selected issue
Original Article
  • Masayuki Yamasaki, Shozo Yano, Miwako Takeda, Takafumi Abe, Minoru Iso ...
    2020 Volume 15 Issue 1 Pages 1-7
    Published: 2020
    Released: January 23, 2020

    Objective: Engaging in agriculture greatly affects workers’ lifestyles, particularly related to physical activity. This study aimed to clarify the prevalence of lifestyle-related chronic diseases among workers engaging and not engaging in agriculture in rural areas of Japan.

    Methods: A total of 4,666 consecutive participants aged ≥40 years (1,929 men and 2,737 women) were recruited during health examinations conducted from 2006 to 2014. For analysis, the participants were divided by sex and age into those engaging in agriculture and those not engaging in agriculture.

    Results: Engaging in agriculture may be contributing with a low prevalence of dyslipidemia, a constitutive factor of metabolic syndrome, in both sexes between the ages of 40 and 64 years. In the elderly aged ≥65 years, engaging in agriculture may influence the low prevalence of hypertension in men. Hypertension, a strong risk factor for stroke and cardiovascular disease, is very frequent among the Japanese elderly and, therefore, engaging in agriculture may have a significant impact on its prevention and control.

    Conclusion: In rural areas of Japan, engaging in agriculture may contribute to the control of lipid metabolism in middle-aged individuals and blood pressure in the elderly.

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  • Masahiro Ishikubo, Tohru Yoshida
    2020 Volume 15 Issue 1 Pages 8-15
    Published: 2020
    Released: January 23, 2020

    Objective: This study aimed to measure the physical activity (exercise and non-exercise) of community-dwelling elderly Japanese individuals and to investigate the relationships between physical activity and daily life behaviors.

    Methods: Community-dwelling elderly Japanese individuals who resided in town A, city B, Gunma Prefecture, Japan, and were not certified as requiring long-term care were included in this study. Physical activity in 1 week was measured using a triaxial accelerometer. A self-administered questionnaire was applied to assess daily life behaviors. Hierarchical multiple regression analysis was used to examine the factors affecting physical activity.

    Results: A total of 107 elderly Japanese (46 men and 61 women) individuals were included. The mean amount of physical activity in men was 37.9 Metabolic equivalents (METs)*h/wk, whereas that in women was 33.8 METs*h/wk. The proportion of exercise to physical activity for men and women was 43.2% and 26.0%, respectively. Men and women took an average of 47,393.7 and 35,305.6 steps/wk, respectively. Step counts and the presence or absence of plant cultivation were the factors associated with the amount of physical activity. The exercise component of physical activity was associated with step count, whereas the non-exercise component was associated with step count, plant cultivation, and frequent outings.

    Conclusion: Among community-dwelling elderly Japanese individuals, physical activity levels appear to be affected by step count and the presence or absence of certain factors, such as plant cultivation and frequent outings.

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  • Mika Harai, Hikaru Honda, Mariko Kawaharada
    2020 Volume 15 Issue 1 Pages 16-24
    Published: 2020
    Released: January 23, 2020

    Objective: To examine how doctors who work in outpatient clinics in depopulated areas in Hokkaido contribute to the provision of primary care to residents.

    Methods: The study adopted a qualitative research design. Six doctors, all of whom were men and in charge of medical clinics located in depopulated areas in Hokkaido, participated in a semi-structured interview. The interviews were recorded using a digital voice recorder. The data were transcribed and classified into codes, subcategories, and categories, and analyzed.

    Results: A qualitative analysis yielded the following five superordinate categories: (1) clinical praxis in accordance with residents’ lifestyles and life stages; (2) innovative care provision based on residents’ conditions; (3) provision of routine care in partnership with other healthcare providers and associated stakeholders; (4) beliefs and feelings of pride associated with working as doctors in clinics in depopulated areas; and (5) difficulties in guaranteeing reliable and continuous operation of clinics in depopulated areas.

    Conclusion: This study successfully identified the specific contributions of doctors working in outpatient clinics in depopulated areas to primary care, as well as the related challenges that they face. Moving forward, researchers should continue to examine how the issues faced by clinics in depopulated areas can be addressed using regional medical care plans.

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  • Ryosuke Chaya, Takehiko Okamura, Takahiro Yanase, Takashi Nagai, Yoshi ...
    2020 Volume 15 Issue 1 Pages 25-28
    Published: 2020
    Released: January 23, 2020

    Introduction: Cabazitaxel (CBZ) is used worldwide for castration-resistant prostate cancer after docetaxel treatment. In July 2014 the drug was approved in Japan with the same induction dose used for Caucasian patients. In this study, we examined and compared the results of an initial low-dose CBZ treatment in patients admitted to our hospital.

    Patients and Methods: Between July 2014 and August 2018, sixteen mCRPC patients were enrolled and underwent a low-dose CBZ treatment at our hospital. We compared the results with those of a Japanese metastatic docetaxel- and castration-resistant prostate cancer Phase I study.

    Results: The median patient age was 77 years (range, 53–84 years). Of the 16 patients, eight (50%) had a lymph node metastasis and 11 (68.8%) had a distant metastasis, 10 of whom had only a bone metastasis. The median dose of CBZ was 30 mg (range, 20–32 mg) and the median number of CBZ cycles was 2.5 (range, 1–18). The PSA level of 9 (56.3%) patients decreased after CBZ treatment, including 4 (25%) who showed a decrease to <50%. The median time interval in which the PSA level decreased was 2 months (range, 1–18 months). The observed adverse events (AE) were neutropenia (31.3%), febrile neutropenia (6.3%), fatigue (43.8%), nausea (18.8%), diarrhea (12.5%), decreased appetite (25%), dysgeusia (6.3%), white blood cell count decrease (43.8%), platelet count decrease (12.3%), and anemia (75%). However, no patient listed an AE as the reason for discontinuing the treatment.

    Conclusions: Even at a low dose, CBZ could improve the PSA value in patients with CRPC previously treated with docetaxel. Dose reduction and prophylactic administration of sustained G-CSF were also safe treatment options. Further studies involving an introduction period including a modulation of duration and dose are necessary, especially in Japanese patients.

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  • Hirohito Nanbu, Mihoko Uebayashi, Mayumi Miura
    2020 Volume 15 Issue 1 Pages 29-37
    Published: 2020
    Released: January 23, 2020

    Objective: This study aimed to clarify the association between social mutual aid and psychological stress among residents in a rural district.

    Materials and Methods: A cross-sectional study based on Andersen’s Behavioral Model of Health Care Utilization was conducted on 2,500 residents of City A in Akita Prefecture who were aged 65 years or older. The study was conducted from April 8 to May 15, 2017. Participants were administered a questionnaire containing items on individual characteristics (predisposing, enabling, and need) and contextual characteristics (physical factors).

    Results: Responses were obtained from 1,236 participants, and data from 974 valid questionnaires were analyzed. Factors related to the high level of psychological stress were “maintenance of confidential relationships that could only be formed in the rural district (low)” and “social support (low)”, which are forms of social mutual aid. Use of health services had no association with psychological stress, whereas when psychological stress was high (5 points or higher), the rate of “not participating in community groups (no)” was also high.

    Conclusion: The findings of this study indicate the need for the objective evaluation of the roles of self-help and mutual help among elderly adults living in a rural district and the mutual help and public help functions represented by health services. It is also important to develop districts that promote the enhancement of social mutual aid so that such help can be fully utilized.

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Field Report
  • Kanako Yamauchi, Tadahiro Kato, Isao Saito, Masamitsu Yamaizumi
    2020 Volume 15 Issue 1 Pages 38-43
    Published: 2020
    Released: January 23, 2020

    Objective: This study aimed to examine the relationship between mortality risk and health-related factors and sense of coherence (SOC) in a cohort study of residents from a rural area of Japan.

    Materials and Methods: We followed-up with 3,416 baseline respondents over 3.76 years. Residents were subdivided into three groups based on SOC score: low, middle, and high. We used the total SOC score of the low-level SOC group as the standard, and calculated the standardized mortality ratio (SMR) for the middle- and high-level SOC groups. For all three SOC groups, health-related factors were analyzed by one-way analysis of variance, and lifestyle and history were analyzed using the χ2 test. Results were also analyzed by gender and age.

    Results: For men in the low-level SOC group, the SMR value was defined as 1, and for men in the high-level SOC group (0.44; 95% confidence interval: 0.11–0.77), the SMR value was significantly lower. There was a statistically significant reduction in the percentage of smokers in the men in the high-level SOC group.

    Conclusion: In this study, high-level SOC was associated with low mortality risk. This finding was particularly pronounced in the men.

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Case Report
  • Yoshiaki Sasaki, Hiroki Kajino
    2020 Volume 15 Issue 1 Pages 44-46
    Published: 2020
    Released: January 23, 2020

    Two months ago, a 9-year-old boy experienced intermittent abdominal pain regardless of food intake, without diarrhea, bloody stool, or nausea. Blood test results revealed a peripheral blood eosinophil count of 660 cells /µL, which was marginally elevated, without inflammatory reaction, occult blood, or enteric pathogens. The intestinal mucosa from the terminal ileum to the rectum was endoscopically normal, but mucosal biopsy revealed eosinophilic infiltration of the terminal ileum and whole colon with ≥20 eosinophils/high power field (HPF). Subsequent upper gastrointestinal endoscopy revealed normal endoscopic mucosa from the esophagus to the second part of the duodenum, but mucosal biopsy showed an eosinophil infiltration of ≥20 eosinophils/HPF. Based on the above findings, he was diagnosed with eosinophilic gastroenteritis (EGE). The cause of EGE and mechanisms of eosinophil infiltration have yet to be fully elucidated. For these nonspecific abdominal symptoms, evidence of eosinophilic infiltration of the gastrointestinal mucosa, specifically 20 eosinophils/HPF in each intestinal mucosa, is required for the definitive diagnosis of EGE. Even if only persistent abdominal pain develops, EGE diagnosis should be confirmed with the analysis of mucosal biopsy in addition to the review of allergic disease history and peripheral blood eosinophil counts.

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  • Masafumi Tanaka, Yasuyuki Shimada, Yasushi Terada
    2020 Volume 15 Issue 1 Pages 47-49
    Published: 2020
    Released: January 23, 2020

    Cystic adventitial disease (CAD), a rare arterial disorder, can cause localized arterial stenosis or obstruction. A 55-year-old man presented with a 2-month history of left lower leg pain and paleness when bending the left knee. The patient was diagnosed with CAD of the left popliteal artery based on imaging examinations. Surgery was performed with the patient placed in the prone position using an S-shaped skin incision, and the left popliteal artery was exposed. A simple incision of the cyst wall was made. There was no sign of recurrence at 1 year postoperatively.

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