Objective: Despite the high prevalence of mental disorders in rural areas, mental health services are lacking because of shortages of resources and difficulty in accessing such services. Telemental health services can be beneficial for these patients. This study summarizes the efficacy of telemental health in managing mental disorders in rural areas.

Materials and Methods: The MEDLINE and Cochrane Central Register of Controlled Trials databases were searched to identify randomized controlled trials on telemental health for mental disorders in rural areas until June 2022. The reviewers independently screened, extracted, and assessed study quality using the Risk of Bias 2 tool.

Results: Six eligible studies were identified on mental health symptoms, insomnia, depression, and schizophrenia. The quality of all the studies was moderate, and they all reported that telemental health effectively improved the symptoms of mental disorders. One study reported a reduction in relapse and rehospitalization rates in young individuals. Another study reported that it was effective in improving the symptoms of depression and anxiety in older individuals.

Conclusions: Although further studies are warranted, telemental health services could effectively improve the symptoms of mental disorders in rural areas.

Objective: To determine if distance from our Neonatal Intensive Care Unit (NICU) follow-up clinic exacerbated risk of clinic non-attendance in high-risk groups defined by socioeconomic status or medical complexity, as geographical distance from the hospital can affect attendance rates at NICU follow-up clinics.

Patients and Methods: We retrospectively identified infants born between January 2014 and June 2018, and subsequently discharged from our 50-bed level IV NICU, which serves a predominantly rural population. Patients were included in our study if they had at least one NICU clinic follow-up visit scheduled at discharge. Distance to the clinic was calculated based on family ZIP code. Mixed-effects logistic regression analysis of attendance at each scheduled visit was used to identify independent associations and interactions with distance among study covariates.

Results: We included 576 patients in our study, with 74% missing at least one clinic appointment, and 30% not attending any of the three appointments. Median distance between our hospital and families was 53 km. On multivariable analysis, neither distance nor other infant or family characteristics were associated with clinic non-attendance. Only interfacility transfer had a statistically significant interaction with distance and this association only reached statistical significance for patients living furthest from our center.

Conclusions: NICU follow-up is important, but clinic attendance is poor. For families living furthest away, transfers of care during the infant’s hospitalization may be associated with lower completion of recommended post-discharge follow-up. Further research is needed to understand how clinics can mitigate barriers to attendance.

Objective: Aspiration pneumonia is a challenge in Japan, with many elderly citizens; however, there are insufficient experts on swallowing. Non-expert doctors may suspend oral intake for an overly long period because of the fear of further aspiration. We devised and modified an assessment protocol for swallowing function with reference to the Japanese and American practical guidelines for dysphagia. This study aimed to demonstrate clinical decision-making using the protocol by reporting the results of decisions on the safe and timely restart of adequate food intake for patients with aspiration pneumonia.

Patients and Methods: This comparative retrospective study included 101 patients hospitalized with aspiration pneumonia between April 2015 and November 2017. We compared the parameters of patients for whom decisions on resumption of oral intake were aided by our protocol against those of patients from the previous year when the protocol was not used. We counted the days until either resumption of oral intake or events of aspiration/choking.

Results: The duration of days until oral intake in the two groups was 1.64 ± 2.34 days in the protocol group (56 patients) and 2.09 ± 2.30 days in the control group (45 patients) (P=0.52). The adverse events of aspiration/choking were less frequent in the protocol group (5 vs. 15, odds ratio (OR) 0.32, P<0.001) as compared to the control group. The protocol group showed a significant reduction in aspiration/choking (OR 0.19, P<0.01).

Conclusion: Clinical decision-making based on the protocol seems to help non-expert doctors make informed decisions regarding resuming oral intake after aspiration pneumonia.

Objective: Loneliness is an important health problem in rural areas of Japan because of its ageing and declining population. Therefore, we investigated the association between loneliness and health.

Materials and Methods: Self-administered questionnaires were distributed to rural adult residents. The Japanese 3-item versions of the UCLA Loneliness Scale, self-rated health (SRH), and objective health status (whether the respondents had a physical and/or mental illness) were used. We defined a UCLA score of four points or more as loneliness, an SRH of four points or more as a subjective healthy state, and no physical or mental illness as an objective healthy state. The association was adjusted for sociodemographic data, lifestyle habits, and isolation risk using logistic regression analysis.

Results: The five-year population decline rate in the target areas was 10.2 to 12.3%. Of the 2,700 participants, there were 1,211 male and 1,489 female respondents, with an average age of 65.4 years. Moreover, 358 (13.6%) were living alone, and 829 (31.5%) were living in couple-only households. Among the participants, 1,395 (53.2%) experienced loneliness, 1,751 (65.7%) had good self-rated health, and 1,587 (60.8%) had objective health status. Loneliness was negatively associated with good SRH (OR=0.56, CI=0.45–0.70) and objective health status (OR=0.57, CI=0.46–0.71) after adjusting for sociodemographic data, lifestyle habits, and the risk of isolation. Statistically significant confounding factors for subjective and/or objective health status were employment, not smoking, obesity, exercise, having a family doctor, having an above-average number of teeth, and the ability to leave home.

Conclusion: In an ageing and declining population, loneliness is an independent factor affecting the health status of rural residents and is not limited to older adults. Therefore, measures to reduce it are needed.

Objectives: Correct diagnosis of iron deficiency remains challenging due to the cost of ferritin tests. Physicians, especially those in resource-limited settings, may resort to a complete blood count (CBC) when considering iron deficiency and anemia due to its accessibility. Although this has been practiced, it is still beneficial to assess whether CBC parameters exhibit the diagnostic capability of discriminating such medical conditions.

Materials and Methods: Serum ferritin and CBC were performed on venous blood samples of 170 Filipino women aged 18–44 years. The diagnostic ability of the CBC parameters to detect iron deficiency and iron deficiency anemia was analyzed using receiver operating characteristic (ROC) curves. Iron deficiency was defined as a ferritin level <30 µg/L, while iron deficiency anemia was defined as a ferritin level <30 µg/L with hemoglobin level <120 g/L.

Results: Ferritin levels correlated with red blood cell (RBC) count and hematocrit levels. With an area under the ROC curve (AUC) of 0.60, a hematocrit cutoff value of 38.5% was found to have low discriminating power in diagnosing iron deficiency only. Five parameters were observed to have higher discriminating powers for iron deficiency anemia: RBC count cutoff at 4.04 × 10¹²/L with AUC of 0.73, mean corpuscular volume (MCV) at 84.10 fL with AUC of 0.77, mean corpuscular hemoglobin concentration (MCHC) at 337.5 g/L with AUC of 0.80, mean corpuscular hemoglobin (MCH) at 29.15 pg with AUC of 0.81, and hematocrit at 35.5% with AUC of 0.96.

Conclusion: CBC parameters can be a satisfactory discriminator for iron deficiency anemia among the women studied. However, further studies are needed to elucidate its utility in discriminating iron deficiency. With further investigations in this field, the potential use of CBC as a diagnostic tool for iron deficiency and iron deficiency anemia is promising, particularly in rural areas.

Objective: To determine the proportion of women having four or more antenatal care (ANC) visits and to assess associated factors (utilization of ANC services) in poor urban settlements in Rishikesh, Uttarakhand.

Material and Methods: This was a community-based cross-sectional study. The study population included females who delivered during the last year residing in the target location. The data were collected through the house-to-house method in the four selected areas using a structured pre-tested expert-validated questionnaire. Data analysis was performed using SPSS version 23 using descriptive and multivariate statistical techniques.

Results: There was a 59.66% prevalence of four or more antenatal visits (52.01%–66.97%). Only 26.44% of the participants confirmed their husbands’ company during their antenatal visits. Socioeconomic status, type of family, mother’s educational status, parity, husband’s company during the visit, and mother’s autonomy were significant factors (P<0.005) associated with the number of ANC visits. In logistic regression, after adjusting for other covariates, the autonomy of the participants and the husband’s involvement during the visit were found to be significantly associated with four or more ANC visits.

Conclusions: Approximately 60% of participants in poor urban settlements had four or more ANC visits. The findings of our study affirm the involvement of husbands in antenatal visits and women’s autonomy as significant determinants of antenatal care utilization.

Objective: This study aimed to understand the structure of a self-assessment for evaluating the care management skills of individuals in the care management process.

Materials and Methods: A survey was distributed to 964 care managers in home care management hailing from each committee in Japanese municipalities in Ibaraki, Chiba, Saitama, Kanagawa, and Tokyo. The process implementation degree of care management in 46 care management process evaluation items was assessed using a five-point method. Cronbach’s alpha coefficients were derived for the items, and an exploratory factor analysis was conducted to ascertain the factor structure. We also verified the relationship between the factor scores, presence or absence of a chief care manager, and years of experience.

Results: We received 385 responses (response rate: 39.9%), of which 372 were included in the analysis (valid response rate: 96.6%). Six factors were extracted, and 29 items were retained because of the exploratory factor analysis. Three of the six factors did not exist in the existing scales and had a unique structure. The cumulative contribution rate of the six factors was 64.9%, and Cronbach’s alpha coefficient for all items was α=0.95, with Factor 1 being 0.88; Factor 2 being 0.83; Factor 3 being 0.86; Factor 4 being 0.85; Factor 5 being 0.80; and Factor 6 being 0.87. The total score for Factors 1, 2, 4, and 5 was significantly higher among chief care managers. Pearson’s correlation coefficients were calculated to determine the correlation between scale scores and years of experience. Factor 1 (r=0.22) and Factor 2 (r=0.21) showed a modest positive correlation between the scale scores and years of experience.

Conclusion: We retained 29 items and extracted six factors for the care manager self-assessment items that had a unique factor structure while following existing scales’ factor structure.

Objectives: Japan has implemented a policy to facilitate the employment of people aged 65 and older. It should be common practice for hospitals to employ older nursing assistants. We investigated factors associated with the acceptance of employing older nursing assistants among those younger than 65.

Materials and Methods: The subjects were female nursing assistants younger than 65 working in 30 hospitals. A questionnaire-based survey was conducted. We performed factor analyses of both respondents’ opinions on the employment of “Nursing assistants aged 65–69” and “Nursing assistants aged 70–74”. To examine the associations between the “Acceptance of employing nursing assistants aged 65–69” and the “Opinions on the employment of nursing assistants aged 65–69”, we conducted multiple regression analysis (Statistical Model 1). To examine the associations between the “Acceptance of employing nursing assistants aged 70–74” and the “Opinions on the employment of nursing assistants aged 70–74”, we also conducted multiple regression analysis (Statistical Model 2).

Results: By factor analyses of the opinions on the employment of both “Nursing assistants aged 65–69” and “Nursing assistants aged 70–74”, the same factors were extracted. These factors were: “Health and job performance”, “Utilization of the knowledge and experience of older nursing assistants”, “Reducing the workload of nursing assistants”, and “Manners of older nursing assistants”. By multiple regression analyses in both “Statistical Models 1 and 2”, “Health and job performance”, “Utilization of the knowledge and experience of older nursing assistants”, and “Reducing the workload of nursing assistants” were significant variables. Moreover, only in “Statistical Model 1”, full-time nursing assistants were more accepting of employing nursing assistants aged 65–69 compared to part-time nursing assistants.

Conclusion: To facilitate the acceptance of employing older nursing assistants, hospital managers should pay careful attention to these findings.

Objective: To investigate the etiology of cardiac arrest in patients living in depopulated rural areas with a high elderly population in the Kamo region.

Patients and Methods: We investigated patients with cardiac arrest who were transported by the Shimoda Fire Department between January 2019 and December 2021. The following patients’ details were collected: circumstance, age, sex, cause of cardiac arrest, witnessed collapse, chest compression performed by bystanders, oral instruction, use of an automated external defibrillator (AED), initial rhythm, advanced cardiac life support provided by emergency medical technicians, and neurological outcomes. The patients were divided into two groups based on the return of consciousness (RC). We compared the variables above between the two groups.

Results: A total of 281 patients with cardiac arrest were included in this study. The participants were predominantly men (59.7%), and the average age was 76 years. AED was applied to eight patients at the scene; however, all eight did not have an initial shockable rhythm. RC was achieved in eight (2.8%) patients. The precise cause of cardiac arrest among the participants who achieved RC was cardiogenic, drowning, and suffocation in three, three, and two cases, respectively. The patients were significantly younger, and the ratio of securing a venous route and airway was significantly lower in the RC (+) group than in the RC (−) group. The ratio of helicopter emergency medical services (HEMS) in the RC (+) group was significantly greater than that in the RC (−) group.

Conclusion: This study reported the etiology of cardiac arrest in patients living in a depopulated rural area of Japan with a high elderly population. The usefulness of an AED could not be proven; the cardiogenic cardiac arrest was not dominant among patients who achieved RC, and HEMS transport might be useful for obtaining RC.

Objective: Examined literature on coping behaviors of women with menopausal symptoms and/or menopausal disorders to clarify their current situation and to get advice for future undertakings.

Methods: The subjects of the survey were from documents on coping behaviors of women with menopausal symptoms and menopausal disorders published in Japan during the period from 2000 to July 2022. The investigations were acquired from Japan Medical Abstracts Society, CiNii, PubMed, by mixing the keywords “menopausal symptoms” or “menopausal disorders” and “measures” or “self-care” or “self-administration” in Japanese. Ultimately, we obtained 10 cases from Japan Medical Abstracts Society and 5 cases from CiNii. We focused on 13 cases for this analysis.

Results: As a result of analyzing the contents of coping behaviors of women with menopausal symptoms and menopausal disorders, 6 categories [Adjusting daily life behaviors], [Taking measures for the symptoms], [Adjusting in my own way], [Connecting to others], [Thinking optimistically] and [Doing nothing] consisting of 18 subcategories were obtained.

Conclusion: Women reconciled positively with menopause by themselves, even though they had menopausal symptoms and menopausal disorders. In future endeavors, psychology education will be obtained by clarifying the process of reaching it, and the possibility of raising the well-being of menopausal women will be enhanced. It has been revealed that there are women adopting coping behaviors suitable for themselves, while there are women who are tolerant even if the symptoms are severe, or those who do not consult specialists for menopausal symptoms. We believe that the findings are useful for promoting the coping behaviors of women with menopausal symptoms and menopausal disorders and educating them to prevent aggravation and prolongation of symptoms by clarifying the reasons why they do not take action to relieve their menopausal symptoms.

Objective: This study evaluated the effects of interprofessional conferences on intensive care units (ICUs) by comparing related outcomes before and after their introduction.

Patients and Methods: This study was conducted at a single center and included ICU patients admitted between April 2017 and March 2019. Interprofessional conferences include physicians, nurses, physical therapists, nutritionists, and pharmacists. Data were extracted from the available medical records. The primary outcome measure was ICU length of stay (LOS). The secondary outcome measures were hospital LOS and any rehabilitation and nutrition begun within 48 hours of ICU admission. Outcomes before and after the introduction of the interprofessional conferences were compared. The adjusted variables were sex, age, body mass index, ICU readmission, health outcomes, Barthel index at admission, and disease (classified according to the International Statistical Classification of Diseases and Related Health Problems 10th edition).

Results: We included 1,765 ICU patients admitted between April 2017 and March 2019. There were 898 patients in the “pre-interprofessional conference introduction” group (before group) and 867 in the “post-interprofessional conference introduction” group (after group). The ICU LOS (regression coefficient: −0.08; 95% confidence interval [CI]: −0.13 to −0.04) and hospital LOS (regression coefficient: −2.96; 95% CI: −5.20 to −0.72) were significantly shorter in the after group. Moreover, the proportion of patients who commenced nutrition (odds ratio [OR]: 1.45; 95% CI: 1.14 to 1.84) and rehabilitation (OR: 0.77; 95% CI: 0.51 to 1.17) within 48 hours of ICU admission was significantly higher in the after group.

Conclusions: Introduction of interprofessional conferences effectively reduced ICU and hospital LOSs and improved likelihood of commencing nutrition and rehabilitation within 48 hours of ICU admission.

Objective: Intersectin 2 (ITSN2) is reported to cause hereditary nephrotic syndrome, but the number of cases remains quite small. We observed a case of progressive renal dysfunction and family history for end-stage kidney disease with a known single heterozygous ITSN2 variant. This study aimed to reveal the novel pathological significance of altered ITSN2 expression via a detailed examination.

Patient and Methods: A 52-year-old Japanese woman with mild proteinuria and hematuria visited our center. The patient did not opt for a detailed examination but was instead followed up with conservative treatment consisting of low-dose angiotensin receptor blockers. Serum Cr worsened from 1.15 to 1.79 mg/dL after 7 years when precise diagnosis was performed by renal biopsy and genetic testing.

Results: Kidney biopsy showed a thin basement membrane (TBM) and global glomerulosclerosis in 37.5% (6 out of 16) glomeruli examined. Comprehensive gene panel testing of 121 genes revealed a known ITSN2 variant, assumed to be involved in pathogenesis. No variants in the Alport syndrome genes, which are typically responsible for TBM, were detected.

Conclusion: A possible novel phenotype of the heterozygous ITSN2 variant was identified as a cause of hereditary renal failure. Further investigation of similar cases is required for a better understanding.

Arsenic cannot be tasted, seen or smelled and can vary in concentration between water wells even in condensed areas. American domestic well water is not regulated to meet the same drinking water standards as other types of water supplies and often contains arsenic. If arsenic is not detected in a well water sample, it is unlikely to be found later. Conversely, if it is detected in a new well, it is recommended to retest six months later as levels may fluctuate in the first months following well construction. It is up to the well owner to test their water and remove arsenic through commercially available water filters. If it is not detected and removed via filtration, a variety of serious, yet common, medical conditions may arise from chronic arsenic exposure, some of which are life-threatening. These include diabetes mellitus, hypertension, skin cancer, renal, bladder and lung cancers, polyneuropathy and cardiac QTc prolongation. Testing is best done through urine speciation if an initial total urine arsenic concentration is elevated. Consider a complete blood count, renal and liver function tests, an electrocardiogram as well as a urinalysis assessing for evidence of hematuria when examining patients with histories concerning for chronic arsenic exposure.

Objective: This quick literature review aimed to organize information on the detailed components of total pain in older people with advanced dementia in a holistic manner.

Materials and Methods: The authors analyzed qualitative data from relevant clinical guidelines or textbooks, focusing on certain types of pain and distress in older people with advanced dementia, followed by an expert panel review by research team members. In the search, the authors defined a person with advanced dementia as having a functional assessment staging tool scale score greater than or equal to six.

Results: The model covered a wide variety of pain, from physical pain to dementia-related psychological and spiritual aspects of total pain, including living environment change, stigma, discrimination, lack of communication and understanding, loss of sense of control and dignity, and cultural distress. It also identified physical appearance as an important factor in dying with dignity, as established by existing research on individuals with incurable cancers.

Conclusion: The conceptual model of total pain in people with advanced dementia is expected to help turn healthcare professionals’ attention to physical, psychological, social, and spiritual contributors to total pain in advanced dementia.

In Japan, non-farmers and people living in urban areas have not been greatly affected by environmental changes. In contrast, primary producers living in rural areas increasingly suffering from declining crop yields and drastically reduced catches of wild animals and seafood because of recent environmental changes. Studies, mainly from overseas, have reported that farming is an especially stressful occupation associated with high rates of depression and suicide, and the relationship between climate change and depression, as well as between climate change and suicide, is almost certain in rural communities. Particularly striking examples include the impact on the mental health of farmers in rural Australia and the Inuit in the Canadian Arctic, who are losing their livelihoods because of ecological collapse; this mental distress is known as “ecological grief”. Such mental distress may be a major cause of depression and suicide among people in rural areas and Japan is no exception. I hoped that the concept of mental distress due to environmental changes will be recognized in Japan, leading to more eco-friendly attitudes that can promote the health of people living in rural areas and protect the surrounding ecosystem.