1.Influence of the HPV16/18 Infection on the Age Distribution of Cervical Cancer Patients
Akihiro KARUBE ; Fumiko SAITO ; Daisuke NAGAO ; Megumi OTOMO ; Daisuke TAMURA ; Naoko KIMURA
Journal of the Japanese Association of Rural Medicine 2014;63(2):87-92
This study was conducted to document a correlation between the age distribution of patients with cervical cancers and their genotype patterns of human papilloma virus (HPV). Retrospective analysis was performed on 53 patients in the clinical stage of CIN 3 and above. The patients were treated in our hospital during the period between January 2008 and May 2011. The age distribution showed that the patients in their twenties accounted for 28.0%, those in their thirties 34.0%, those in their forties 24.0%, those in their fifties 4.0%, and those in their sixties and older 10.0%, the average of the subjects was 39.5 years. This distribution pattern also indicated that the women aged 49 and younger are prone to cervical cancer. The overall detection rate of positive HPV in the high risk group was 97.1%. The detection rates varied according to the HPV genotypes, being 41.2% in HPV16, 17.6% in HPV52, 13.2% in HPV58, and 5.9% in HPV18. The average ages of patients at the stage of CIN3 and above who demonstrated the positive and negative results for HPV16/18 were 35.4 years and 44.7 years, respectively. During the follow-up period of 40 months, 27 of 179 patients with positive HPV of the high risk group showed development of grades from below CIN2 to those CIN3 and above. Of the patients positive for HPV16/18, 30.9% demonstrated a further development of the lesions, whereas there were only 8.1% in the patients negative for HPV16/18. These studies suggested a significant connection between the viral infection of HPV16/18 and the development of cervical cancer in young women.
2.Difficulties and Countermeasures in Nursing Practice for Non-English-Speaking Foreign Patients with COVID-19
Risa HAMANO ; Megumi NAGAO ; Takiko MATSUNO ; Ritsuko KUBOE ; Yasuyo WATANABE ; Junichi MATSUDA ; Mari HANASHIMA ; Nobuyuki MITANI ; Takayuki KUGA
Journal of the Japanese Association of Rural Medicine 2022;70(5):535-542
The purpose of this study was to clarify difficulties and countermeasures in nursing practice for foreign patients with COVID-19 who were non-English native speakers. A questionnaire was collected from 16 nurses in a COVID-19 ward. They cared for 13 non-English-speaking foreign patients from admission to discharge in the ward between May 2021 and June 2021. All nurses reported difficulties in communication related to collecting information from patients and explaining hospital care. For example, they could have simple conversations using a two-way translation device (POKETALK®) but could not understand detailed symptoms or complaints without an interpreter. Not much meaning could be inferred from a patient’s response of “OK”. The nurses reported that it was difficult to explain details of treatments, Japanese customs, and hospital rules. With the help of interpreters, they made hospital manuals and question cards in the patients’ native languages. In nursing care for foreign patients with COVID-19, it was helpful to provide explanations of Japanese customs and hospital rules before admission and to prepare hospital manuals and question cards in patients’ native languages.
3.Trial of Seamless Regional Cooperation in Palliative Care of Cancer Patients Using Communication Tools of Cooperation
Yuko TOMOMATSU ; Tomoko IDO ; Megumi KABEYA ; Syuu YUASA ; Chiaki KOGA ; Seiji NAGAO ; Nobuyoshi OHTA ; Kenji INA
Palliative Care Research 2018;13(2):163-167
Regional cooperation in palliative medicine involves multidisciplinary team care. It is very important for cancer patients to choose an appropriate place of stay during their end-of-life period. As the Nagoya Memorial Hospital does not have a palliative care ward, collaborating with other facilities offering palliative care and home care becomes pivotal. Therefore the Higashi-Nagoya home care social gathering was organized to improve communication and cooperation among regional health care professionals. Through discussions during this social gathering, the communication tools for cooperation in palliative care were outlined in November, 2015. We reviewed the outcome of 35 patients referred from our hospital using the communication tools for cooperation in palliative care: 25 patients were referred to chronic care hospitals including palliative care facilities, and 10 patients received palliative care at home; 23 died in the palliative care ward, 6 died at home, and 4 died at our hospital. A questionnaire survey conducted among the community health care professionals revealed that the introduction of this tool would be useful in providing accurate information on the prognosis of patients, level of understanding between the patients and their family, and patients’ views on life and death. Using the communication tool for communication would contribute to realizing seamless palliative care in the region surrounding our hospital, which would in turn lead to local team work and shared responsibilities to provide optimal palliative care.
4.Reduction in HPV 16/18 prevalence among young women following HPV vaccine introduction in a highly vaccinated district, Japan, 2008–2017
Akihiro KARUBE ; Fumiko SAITO ; Enami NAKAMURA ; Akihiro SHITARA ; Natsuki ONO ; Megumi KONNO ; Daisuke TAMURA ; Daisuke NAGAO
Journal of Rural Medicine 2019;14(1):48-57
Objective: Human papillomavirus (HPV) vaccination was introduced in Japan in April 2013, as a national immunization program for girls aged 12–16 years, after an initial introduction in 2010 as a public-aid program for girls aged 13–16 years. The Yuri-Honjo district had the highest vaccine coverage among women aged 17–51 years in 2017, due to the original public-aid program. The aim of this study was to evaluate the differences in the vaccine types of HPV16/18 infections between 2008–2012 (pre-vaccine era) and 2013–2017 (vaccine era).Materials and Methods: We evaluated whether HPV vaccination was associated with a decrease in the prevalence of HPV16/18 and high-risk HPV and the incidence of HPV-associated cervical lesions. A total of 1,342 women aged 18–49 years, covering both the pre-vaccine and vaccine eras, who visited Yuri Kumiai General Hospital and underwent HPV genotype tests from June 2008 to December 2017 were compared.Results: Among women aged 18–24 years with higher vaccine coverage (68.2%), the prevalence of HPV16/18 and high-risk HPV decreased from 36.7% and 69.4%, respectively, in the pre-vaccine era to 5.8% and 50.0%, respectively, in the vaccine era (p=0.00013 and p=0.047, respectively). Among those with cervical intraepithelial neoplasia grade 2− and grade 2+, HPV16/18 prevalence decreased from 30.0% to 2.7% (p=0.0018) and from 81.8% to 36.4% (p=0.030), respectively. In this age group, the rate of HPV16/18 positivity decreased significantly. Among age groups with lower vaccine coverage, HPV prevalence did not significantly differ between the two eras.Conclusion: The prevalence of HPV16/18 and high-risk HPV significantly decreased in women aged 18–24 years, most of whom were vaccinated. HPV vaccination effectively reduced the prevalence of HPV16/18 infections in the Yuri-Honjo district.
5.Clinical Experience and Lessons of Coronavirus Disease 2019 (COVID-19) Treatment Early in the Pandemic at a Public Regional Core Hospital
Takayuki KUGA ; Yuka YANO ; Masatoshi SHIGETA ; Ryunosuke SAKAMOTO ; Mayu TAKEHARA ; Rie NAGAI ; Takiko MATSUNO ; Megumi NAGAO ; Yasuyo WATANABE ; Jyunichi MATSUDA ; Ritsuko KUBOE ; Mari HANASHIMA
Journal of the Japanese Association of Rural Medicine 2021;70(1):22-31
Coronavirus disease 2019 (COVID-19) has spread rapidly in Japan. The purpose of this study was to report the clinical experience of our COVID-19 patients early in the pandemic and lessons from our experience. An outpatient fever clinic was established on April 7. Admission of COVID-19 patients was started on July 23. Between April 7 and September 30, there were 364 walk-in outpatients and emergency patients with fever. Polymerase chain reaction test for SARS-CoV-2 RNA or COVID-19 antigen test were performed in all patients, and all results were negative. Twenty patients with COVID-19 were admitted to a newly established dedicated COVID-19 ward. They were discharged well. There were no cases of nosocomial infection at our hospital. Length of hospitalization was correlated with serum ferritin level at admission, serum CRP level at admission, and age. More than half the patients experienced psychological stress, and COVID-19 specialized nurses experienced some stress. It is essential to set up the medical system for COVID-19 according to the trends of the disease. Creation of our original database and our “problem notebook” were useful for treatment and care of COVID-19 patients as well as for mental care of nurses.