Objective: The traits of the inhabitants of rural areas could affect clinical improvements. In the rural areas of Japan, a feeling of competitiveness often exists between the members of a community; this competitiveness could prompt patients to exert efforts in improving their health. This study aimed to assess the effects of competitiveness on the clinical outcomes of patients with diabetes.Patients and Methods: Between December 2014 and December 2015, a pilot study was conducted among patients with diabetes to assess the effects of an intervention on improvements in self-care, quality of life (QOL), and hemoglobin A1c (HbA1c) values. The intervention included showing each participant a histogram of the HbA1c levels of all patients visiting a clinic in the remote island as well as the location of their own HbA1c level on the histogram. Once every 4 months, the patient’s HbA1c level was assessed by conducting a blood test, and the self-care agency questionnaire 30 (SCAQ30) was administered by a community health nurse. After 12 months, changes in HbA1c values, SCAQ30 score, and MOS 36-item short-form health survey score were evaluated.Results: Sixty-four participants (mean age: 63.6 years; male-to-female ratio: 35:29) were included in the final analysis (follow-up rate: 71.1%). In participants with HbA1c values ≥ 8% and < 8% at baseline, the HbA1c value decreased by 1.39 (p < 0.001) and 0.12 (p = 0.137), respectively, and the mean SCAQ30 score increased by 14.94 and 6.39 points (p < 0.001), respectively. Furthermore, in participants with an HbA1c value ≥ 8%, the mean mental component summary score increased by 5.64 points (p = 0.019), and the mean role/social component summary score decreased by 6.04 points (p = 0.022).Conclusion: The continuous stimulation of competitiveness may help improve the health conditions of patients with diabetes. Moreover, collaboration between rural clinics and community health nurses may also be important.

Objectives: This study aimed at identifying the differences in the vegetable intake frequency among rural, suburban, and urban residents. It also intended to estimate the effects of vegetable cultivation, receiving vegetables, and purchasing vegetables at farmers’ markets on the differences in vegetable intake frequency. Based on the results, to promote vegetable intake, we discuss the value of supporting vegetable cultivation in the rural areas.Materials and Methods: We conducted a cross-sectional study targeting residents aged between 20 and 74, living in three parts of a city within the Gunma prefecture in Japan. The three locations were selected to represent the rural, suburban, and urban areas. We mailed two sets of anonymous self-administered questionnaires to all households in the three areas (a total of 2,260 households, comprising about 1,000 people aged between 20 and 74 in each area). The survey requested information on the vegetable intake frequency, vegetable cultivation, frequency of receiving vegetables, frequency of vegetable purchase at farmers’ markets, the subjective difficulty in food-store access, economic circumstances, health attitudes, and demographic characteristics. We used the analysis of covariance (ANCOVA) to examine the data obtained.Results: We received 873 responses (from 586 households), of which 90 were irrelevant, thus leaving a sample of 783 residents (257 rural, 259 suburban, 267 urban) available for statistical analysis. The results revealed that the rural residents had significantly greater vegetable intake frequency than the urban and suburban residents did. These regional differences became smaller after the adjustment of the following variables: vegetable cultivation, receiving vegetables, and vegetable purchase at farmers’ markets. No significant difference was observed in the vegetable intake frequency between the rural and urban respondents after this adjustment was made.Conclusions: Vegetable intake frequency was higher in the rural area than in the suburban and urban areas. Vegetable cultivation, receiving vegetables, and vegetable purchase at farmers’ markets were strongly linked to these regional differences.

Objective: For nursing students, career maturity –an individual’s readiness to cope with career development tasks and make age-appropriate career decisions– is an essential factor influencing their desire to continue the job after qualifying as a nurse. Although job security as motivation to become a nurse might influence the career maturity of nursing students, it has not been demonstrated. In this study I aimed to elucidate the correlation between job security as motivation and career maturity among Japanese nursing students.Patients and Methods: This study was conducted in 2012, through an anonymous, self-administered questionnaire, on 237 Japanese nursing students. Data on career maturity, job security as motivation, and personal characteristics were collected followed by data analysis using multiple regression.Results: Job security as motivation (“A nursing job is not affected by the economic climate”) was significantly correlated with career maturity (β = −0.29; p < 0.001).Conclusion: This study demonstrated that being motivated by job security negatively affects career maturity. Hence, at an early stage, basic nursing educators should identify nursing students with low career maturity by assessing whether they are motivated by job security, and if so, efficiently providing support to improve their career maturity.

Objectives: Gauze remnants form gauzeomas after surgery, if infection has not occurred. We present a case of gauzeoma diagnosed after surgery.Patient: A 72-year-old man noticed a mass in his lower abdomen. He had undergone surgery for left inguinal hernia 21 years ago. A retroperitoneal mass was found on computed tomography (CT) and magnetic resonance imaging (MRI), and he was then referred to our hospital. A detailed abdominal ultrasonography, CT, and MRI revealed a cystic mass with a bulkhead-like structure near the bladder. These findings indicated the possibility of a malignant cyst; hence, an open surgery was performed to excise the mass. Macroscopically, the specimen was clearly bound, covered with a capsule, and filled with pus and had a gauze inside.Results: Based on the patient history and position of the mass, it was diagnosed as gauzeoma, which had strayed into the retroperitoneal cavity during the surgery for inguinal hernia.Conclusion: The imaging findings of gauzeoma are diverse; hence, it is often difficult to diagnose without surgery. However, gauzeoma can be lethal if the cystic mass is infected; thus, it is important to diagnose it correctly.

Objective: This study aimed to evaluate the regular medications prescribed to elderly neurosurgical inpatients in community hospitals in Japan.Materials and Methods: Elderly patients (aged ≥ 65 years) who had been admitted to neurosurgery departments from April 2015 to March 2017 were enrolled in this study. We collected data on regular medications at the time of admission and discharge. Furthermore, we retrospectively analyzed factors associated with potentially inappropriate medications (PIMs). PIMs were defined as polypharmacy (≥ 6 medications used concurrently) or taking any of the unfavorable medications on the “list of drugs to be prescribed with special caution” in the “Guidelines for Medical Treatment and Its Safety in the Elderly 2015”.Results: We gathered data on over 1900 medications (mean number, 5.04) prescribed to 197 patients (mean age, 76.9 years). PIMs were observed in 51.3% of patients on admission. The most common prescriptions resulting in PIMs were benzodiazepine agents, followed by loop diuretics and H2 receptor antagonists. The multivariate analysis revealed that age (odds ratio, 1.08; p < 0.01) and the number of prescribers (odds ratio, 6.16; p < 0.01) were significantly related to PIMs on admission. PIM exposure at the time of discharge accounted for 39.1%, a 12.2% decrease.Conclusion: More than half of the elderly patients were prescribed PIMs on admission; however, this exposure decreased by 12.2% at the time of discharge. Hospitalization is an optimal opportunity for reconsidering the necessity of medications and for changing the prescriptions according to patients’ conditions.

Objective: Chemoradiation therapy is among the standard treatments for cancer, which often causes a decrease in appetite and subsequent weight loss. When weight loss occurs during treatment, the external body contour changes from that indicated during initial planning, causing changes in dose distribution to the target tumor regions and organs at risk (OARs). This study aimed to examine the dose changes to both the target regions and OARs, based on the dose-volume histogram (DVH).Methods: We established a 60 mm-diameter planning target volume (PTV) and a 30 mm-diameter rectum region of interest (OAR), using a phantom; this was followed by a 50 Gy/25 fraction irradiation to the target region that was measured using a two-dimensional-array ion chamber device. The measurement was conducted by varying the bolus thickness from 0 to −25 mm, in 5 mm decrements. In addition, the maximum dose for both PTV and OAR were evaluated based on the DVH, created using the Adaptive software.Results: The gamma analysis showed that the pass rate was less than 95% when the bolus thickness was altered by −25 mm for the helical delivery mode and by −10 mm for the direct delivery mode, resulting in a dose error greater than 3%. Results of the DVH evaluation revealed that the maximum dose of PTV increased by 5.18% when the bolus thickness was −25 mm for helical delivery, whereas a 9.95% increase was noted for the direct delivery mode compared with the dose at the reference level of 0 mm bolus thickness.Discussion: Our results suggest that it is necessary to formulate a new treatment plan owing to increased dose error, if the body thickness decreases by more than 20 mm and 10 mm for the helical and direct delivery modes, respectively. The results also demonstrate that helical delivery is less affected by changes in body thickness than direct delivery.

Objective: To clarify the relationship between the proportion of severely insufficient vegetable intake frequency and 1) vegetable cultivation, 2) frequency of receiving vegetable among non-cultivators.Materials and Methods: Residents aged 20 to 74 years in three areas of a city in Gunma Prefecture, Japan, were invited to participate. In September 2016, two sets of self-administered questionnaires were mailed to all 2,260 households in the three areas. The survey items covered the frequency of vegetable intake, vegetable cultivation (as a farmer, as a non-farmer, or no-cultivation), frequency of receiving vegetable, and basic characteristics. For vegetable cultivators, we asked the proportion of cultivated vegetables for home consumption and for giving to neighbors. Binomial logistic regression models were used to analyze the data collected. The respondents were classified into two groups according to their vegetable intake frequency: fewer than three times per day (severely insufficient), and at least three times per day.Results: We had 796 valid responses. Using the no-cultivation group as reference, both of the other groups —vegetable cultivation as a farmer, and as a non-farmer— had a significantly smaller proportion of severely insufficient vegetable intake frequency. Among the no-cultivation group, using those who had never received vegetable in the past month as reference, those who rarely, sometimes, or often received vegetables had a significantly smaller proportion of severely insufficient vegetable intake frequency. These associations were similar in cases where vegetable juice was or was not included. The proportion of those who cultivated vegetables for home consumption was 96% among farmers and 100% among non-farmers, respectively, and for giving to neighbors was 84% among farmers and 62% among non-farmers, respectively.Conclusion: A negative association of the proportion of severely insufficient vegetable intake with vegetable cultivation, and with receiving vegetable among non-cultivators, was suggested.

Objective: The aim of this study was to determine the prevalence of curable and pseudoarthrosis stages of adolescent lumbar spondylolysis under high school students complaining of and seeking medical consultation for low back pain.Patients and Methods: We analyzed age, sex, morbidity, presence of spina bifida occulta (SBO), and competitive sport discipline of patients with lumbar spondylolysis. We then stratified their pathological stage using a modified classification system via magnetic resonance imaging and computed tomography.Results: Of 507 patients, 451 lesions in 268 patients were diagnosed with lumbar spondylolysis (average age, 14.7 years; sex ratio, 215:53 male/female). Morbidity levels were as follows: L1, 1 lesion in 1 patient; L2, 9 lesions in 5 patients; L3, 38 lesions in 25 patients; L4, 106 lesions in 74 patients; L5, 297 lesions in 189 patients, and SBO verified in 111 patients. A total of 264 patients played a specific sport: baseball, 93; soccer, 49; volleyball, 21; track and field, 21; basketball, 20; others, 164. The prevalence of curable- and pseudoarthrosis-stage lumbar spondylolysis was 206 lesions in 142 patients, and 141 lesions in 87 patients, respectively.Conclusion: With 59.3% of patients having curable-stage lumbar spondylolysis, adolescent athletes with low back pain are urged to seek consultation. Furthermore, clinicians should perform magnetic resonance imaging to avoid misdiagnosis.

Objective: Evidence from developing countries on the association between women’s endorsement of attitudes justifying partner abuse and their use of reproductive health services is suggestive but inconclusive. This study uses a nationally representative dataset from Lao PDR to provide strong evidence for the relationship between women’s endorsement of attitudes justifying partner abuse and use of reproductive health services.Methods: This study used data from the 2011–2012 Lao Social Indicator survey (LSIS). The analyses were performed on the responses of 4227 women. The exposure of interest in this study was endorsement of attitudes justifying partner abuse. Antenatal care (ANC) visits divided according to amount and quality, delivery care by type and place, and utilization of postnatal care (PNC) for mothers and newborn infants were used as representative outcome variables of reproductive health service utilization.Results: Approximately seven out of ten respondents (67.9%) believed that partner abuse was justified. Women who endorsed these attitudes were significantly less likely to receive any ANC, to seek institutional delivery, and to use trained medical personnel for delivery assistance. Endorsing attitudes were associated with reduced probability of receiving PNC services for mothers and newborn infants, reduced frequency of ANC visits, and receiving a fewer number of ANC components. Other sociodemographic factors likely to affect the increased utilization of several of the indicators of reproductive health care were living in the central region, belonging to the high bands of wealth, having higher level of education, being a young adult (20–34 years) or older (35–49 years), residing in urban areas, and being sexually empowered.Conclusions: In addition to a broad range of sociodemographic factors, our findings suggested that women’s endorsement of attitudes justifying partner abuse should be treated as an important psychosocial determinant of reproductive health care service utilization in Lao PDR.

Background: Older pacemaker systems, which are magnetic resonance imaging (MRI) incompatible, require replacement with compatible systems when patients are in need of MRI. Replacement involves extraction of the pacing lead, which is usually done with a laser sheath under general anesthesia.Case presentation: We report two cases of complete pacing system replacements allowing patient access to MRI. Both replacements were made under local anesthesia and without the use of special devices over 6 years after the initial surgery. Both replacements used retractable screw-in leads with a cut-down of cephalic or external jugular veins performed during the initial surgeries. Case 1 involved a 79-year-old man with cerebral ischemia, and case 2 involved a 70-year-old man with spinal canal stenosis.Conclusion: With careful management, it is possible to replace an entire pacing system under local anesthesia without additional devices.