Background and Objective: Since the early 2000s, the incidence of methicillin-resistant Staphylococcus aureus (MRSA) infections among the community of people lacking known healthcare risk factors has increased. This MRSA infection is referred to as community-associated MRSA (CA-MRSA) infection and is distinct from hospital-associated MRSA (HA-MRSA) infection, which occurs among people with known healthcare risk factors. Understanding the epidemiology of CA-MRSA infections is critical; however, this has not been investigated in detail in Japan. Our objective was to investigate the incidence of CA-MRSA infections in a regional hospital. Patients and Methods: We investigated CA-MRSA isolates and infections in a rural regional hospital by reviewing medical records of one year. Infections were classified as CA-MRSA if no established risk factors were identified. Results: During 2008, 31 Staphylococcus aureus (S. aureus) isolates were detected in 29 unique patients, with 1 methicillin-sensitive S. aureus (MSSA) isolates obtained from 19 patients (66%) and MRSA obtained from 10 patients (34%). In the 10 patients with MRSA, the number of HA-MRSA and CA-MRSA cases were nine (32% of patients with S. aureus isolates) and one (3%), respectively. The patient with CA-MRSA was diagnosed with cellulitis due to CA-MRSA. All nine patients with HA-MRSA exhibited colonization. Conclusion: We observed a CA-MRSA case in a regional hospital in Japan, suggesting that incidence trends of CA-MRSA should be considered in future research and treatment.

Introduction : The purpose of this study was to review studies on consultation length in Japan.
Methods : We used Ichushi-Web, CiNii, JMEDPlus, Google Scholar, and MEDLINE, and selected and reviewed papers in which researchers have measured consultation length.
Results : We identified 26 studies, 6 of which focused on consultation length in terms of associated factors such as the differences between specialty departments. Seven studies performed in outpatient clinics focused on waiting time as the main topic of investigation and secondarily measured consultation length. In addition, consultation length was used as an indicator for introducing interventions. Three studies discussed appropriate consultation length. Two studies investigated patient satisfaction. The definition of consultation length varied among studies.
Conclusion : Few studies investigated patient outcomes. Further studies are required to monitor consultation length and patient outcomes as well as to clarify the definition of consultation length.

There is systematic evidence that community-based education is effective in the recruitment of rural physicians to remote communities. However, various obstacles may exist that prevent rural physicians from sustaining their mentoring activities. The aim of this study was to explore ways for rural physicians to overcome such adversities and continue their mentoring activities. We interviewed four nominated physicians (all male, mean age 48 years) based in Hokkaido, Japan, who practiced in an area with less than 10,000 inhabitants. Semi-structured interviews of approximately 60 minutes were performed and focused on topics rural physicians’ found necessary for their teaching activities. All interviews were tape-recorded and transcribed, the verbatim transcripts were analyzed and repeated themes were identified. Three themes that emerged as needs were 1. sustained significant human relationship, including the formation of a network between students and university faculty, as well as developing partnerships with many community relationships, or other medical professions; 2. intrinsic motivations and satisfaction, including pleasure in mentoring the younger generations; and 3. rewards, including financial compensation. Rural physicians as preceptors require nonremunerative, intrinsic motivational factors, such as a sense of satisfaction regarding the education of medical students and being able to relate to residents and others health-care professions, when pursuing their educational activities. To support them, focusing only on monetary facets may be unsuccessful in encouraging them to continue their educational work.

Background: This study aimed to evaluate the relationship between disease type and healthcare-seeking behavior in patients in order to assess the role of primary care in rural areas of Japan.
Methods: National Health Insurance receipt data were collected for outpatients from four towns in Hokkaido, Japan. Disease names were encoded using the International Classification of Primary Care-2 (ICPC-2) coding system. Patient data were divided into two categories: those visiting medical facilities in their own towns and those visiting medical facilities in other towns.
Results: The percentage of patients who visited medical facilities outside their own town ranged from 42.9% to 72.7%; the mean value for all four towns was 54.6%. The three most frequent ICPC-2 codes according to the reimbursement receipts were K86 (hypertension, uncomplicated), T93 (lipid disorder), and T90 (diabetes, noninsulin dependent), and patients with T90 visited facilities in other towns more than those with K86 and T93. Patients with diseases of the eye, such as F91 (refractive error), F92 (cataract), and F71 (allergic conjunctivitis), and those with psychological disorders, such as P76 (depressive disorder), tended to visit facilities outside their towns rather than in their own towns.
Conclusions: Data regarding patients who visit medical facilities in their own towns may provide information on the role of primary care in that particular town. The analysis of medical reimbursement receipts from a particular area provides useful information about disease distribution in addition to an overview of the healthcare needs of the entire community in that area.

A 31-year-old Japanese female came to our outpatient clinic because of a 15-year history of recurrent episodic chest pain accompanied by fever, each lasting for three days. The patient was diagnosed with familial Mediterranean fever (FMF) because of the following: 1) short attacks of fever recurring at varying intervals; 2) pleuritic chest pain accompanied by fever; 3) the patient's sisters had similar episodes of fever accompanied by abdominal or chest pain; and 4) absence of any other causative factors responsible for her symptoms or pathologic findings. Although FMF has been described primarily in several limited ethnic groups, only a few cases have been reported in Japan. No diagnostic tests are commercially available for FMF so identifying the characteristic clinical picture of FMF is important.

Infections caused by methicillin-resistant Staphylococcus Aureus (MRSA) have recently occurred in communities in people lacking known healthcare risk factors. This MRSA infection is referred to as community-associated MRSA (CA-MRSA) infection, and is distinct from hospital-associated MRSA infection, which occurs in people with risk factors. We experienced a patient diagnosed with CA-MRSA cellulitis, as culture of pus revealed MRSA and he had not been exposed to healthcare environments for the past year. The patient was a previously healthy 38-year-old man with suppurative cellulitis in his right index finger following injury to the finger at his worksite. The cellulitis was successfully managed with incision and drainage (I&D), followed by cefazolin during a 10-day clinical course, although the patient’s MRSA strain was resistant to cefazolin. There are several reports that suggest that I&D followed by antibiotic treatment for CA-MRSA skin infection produces equivalent clinical outcomes, whether the antibiotic prescribed was effective or not. Given that MRSA emerged in an outpatient setting, CA-MRSA should be considered a possible etiology of skin infection in healthy individuals with no classical risk factors for acquisition of MRSA.

Background and Objective: Since the early 2000s, the incidence of methicillin-resistant Staphylococcus aureus (MRSA) infections among the community of people lacking known healthcare risk factors has increased. This MRSA infection is referred to as community-associated MRSA (CA-MRSA) infection and is distinct from hospital-associated MRSA (HA-MRSA) infection, which occurs among people with known healthcare risk factors. Understanding the epidemiology of CA-MRSA infections is critical; however, this has not been investigated in detail in Japan. Our objective was to investigate the incidence of CA-MRSA infections in a regional hospital.
Patients and Methods: We investigated CA-MRSA isolates and infections in a rural regional hospital by reviewing medical records of one year. Infections were classified as CA-MRSA if no established risk factors were identified.
Results: During 2008, 31 Staphylococcus aureus (S. aureus) isolates were detected in 29 unique patients, with 1 methicillin-sensitive S. aureus (MSSA) isolates obtained from 19 patients (66%) and MRSA obtained from 10 patients (34%). In the 10 patients with MRSA, the number of HA-MRSA and CA-MRSA cases were nine (32% of patients with S. aureus isolates) and one (3%), respectively. The patient with CA-MRSA was diagnosed with cellulitis due to CA-MRSA. All nine patients with HA-MRSA exhibited colonization.
Conclusion: We observed a CA-MRSA case in a regional hospital in Japan, suggesting that incidence trends of CA-MRSA should be considered in future research and treatment.

Intestinal anisakiasis is rarely diagnosed because it is thought to be uncommon and is poorly recognized. It produces severe abdominal pain and an inflammatory reaction often resulting in reactive intestinal obstruction, which is sometimes treated with an unnecessary laparotomy as acute abdomen or intestinal obstruction. We reported a 58-year-old female with acute intestinal obstruction caused by intestinal anisakiasis, which resulted in a self-limiting clinical course. The diagnosis was based on a history of recent ingestion of raw fish and abdominal computed tomographic findings of partial thickening of the intestinal wall accompanied by focal luminal narrowing with ascites. In spite of the severity of the abdominal pain, the bowel obstruction induced by inflammation and edema was resolved with conservative treatment after three weeks. Accordingly, intestinal anisakiasis was considered in the differential diagnosis of intestinal obstruction, which can be treated with conservative therapy.
Intestinal Obstruction ; Acute ; Intestinal ; Therapeutic procedure ; Due to

Infections caused by methicillin-resistant Staphylococcus Aureus (MRSA) have recently occurred in communities in people lacking known healthcare risk factors. This MRSA infection is referred to as community-associated MRSA (CA-MRSA) infection, and is distinct from hospital-associated MRSA infection, which occurs in people with risk factors. We experienced a patient diagnosed with CA-MRSA cellulitis, as culture of pus revealed MRSA and he had not been exposed to healthcare environments for the past year. The patient was a previously healthy 38-year-old man with suppurative cellulitis in his right index finger following injury to the finger at his worksite. The cellulitis was successfully managed with incision and drainage (I&D), followed by cefazolin during a 10-day clinical course, although the patient’s MRSA strain was resistant to cefazolin. There are several reports that suggest that I&D followed by antibiotic treatment for CA-MRSA skin infection produces equivalent clinical outcomes, whether the antibiotic prescribed was effective or not. Given that MRSA emerged in an outpatient setting, CA-MRSA should be considered a possible etiology of skin infection in healthy individuals with no classical risk factors for acquisition of MRSA.

Object : Through understanding feelings of residents in the face of the large-scale rationalization of medical resources and their views about the new system of community medicine, we clarify how we should streamline community medicine along the opinion of residents living in local areas.
Methods : We interviewed some residents in the face of the economic collapse in X city. Through the interviews, we qualitatively analyzed their feelings that they had concerning the large-scale rationalization of medical resources and their views about community medicine in the future.
Results : We found three common themes with regard to how to streamline community medicine along the residents' opinions : the way of the rationalization of medical resources, the state of community medicine, and the attitude of the municipal government and medical institutions.
Conclusion : To carry out streamlining community medicine, it is important for the municipal government and medical institutions to take account of residents' opinions more seriously in the process and the content of the rationalization of medical resources, and to understand the social background of the community and residents' feelings more deeply.