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Development of a nursing care problems coping scale for male caregivers forpeople with dementia living at home

Journal of Rural Medicine.2015;10(1):34-42. doi:10.2185/jrm.2896

Objective: The number of male caregivers has increased, but male caregiversface several problems that reduce their quality of life and psychological condition. Thisstudy focused on the coping problems of men who care for people with dementia at home. Itaimed to develop a coping scale for male caregivers so that they can continue caring forpeople with dementia at home and improve their own quality of life. The study also aimedto verify the reliability and validity of the scale.
Patients/Material and Methods: The subjects were 759 men who care for peoplewith dementia at home. The Care Problems Coping Scale consists of 21 questions based onelements of questions extracted from a pilot study. Additionally, subjects completed threeself-administered questionnaires: the Japanese version of the Zarit Caregiver BurdenScale, the Depressive Symptoms and the Self-esteem Emotional Scale, and RosenbergSelf-Esteem Scale.
Results: There were 274 valid responses (36.1% response rate). Regarding theanswer distribution, each average value of the 21 items ranged from 1.56 to 2.68. Themedian answer distribution of the 21 items was 39 (SD = 6.6). Five items had a ceilingeffect, and two items had a floor effect. The scale stability was about 50%, andCronbach’s α was 0.49. There were significant correlations between the Care ProblemsCoping Scale and total scores of the Japanese version of the Zarit Caregiver Burden Scale,the Depressive Symptoms and Self-esteem Emotional Scale, and the Rosenberg Self-EsteemScale.
Conclusion: The answers provided on the Care Problems Coping Scalequestionnaire indicated that male caregivers experience care problems. In terms ofvalidity, there were significant correlations between the external questionnaires and 19of the 21 items in this scale. This scale can therefore be used to measure problems withcoping for male caregivers who care for people with dementia at home.

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Nontraumatic central fracture dislocation of the hip in a patient with chronic kidney disease and post gastrectomy

Ken Shimizu ; Hisanori Kameda ; Haruo Kawamura ; Takeshi Makihara ; Yukiyo Shimizu

Journal of Rural Medicine.2015;10(1):43-47. doi:10.2185/jrm.2894

Objective: Patients with secondary hyperparathyroidism caused by chronic kidney disease (CKD) develop secondary osteoporosis, which increases fracture risk. We report a case of insufficiency fractures complicated by secondary osteoporosis caused by chronic renal failure and gastrectomy.
Patient: A 78-year-old man with a medical history of nephrotic syndrome and gastric cancer experienced an occult intertrochanteric fracture of his left femur after falling.
Results: Ten days after the first fracture, the patient was treated with hemodialysis for acute uremic symptoms. Eight weeks after this fracture, he sustained a right insufficiency acetabular fracture and was treated with total hip arthroplasty (THA).
Conclusion: For patients with CKD, effective fracture prevention is difficult. THA with reconstruction of the acetabulum was an effective therapy in a patient with nontraumatic central fracture dislocation of the hip.

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Perspectives concerning living wills in medical staff of a main regional hospital in Japan

Yoshitaka Maeda ; Shuzo Shintani

Journal of Rural Medicine.2015;10(1):29-33. doi:10.2185/jrm.2893

Objective: Living wills, written types of advanced directives, are now widespread in western countries, but in Japan, their recognition still remains restricted to a small part of the population. As an initial step to introduction of such patient-oriented medicine, we surveyed present recognition and acceptance patterns concerning living wills in a main regional hospital located in a suburban area of Tokyo.
Methods: Without any preceding guidance on living wills, the questionnaire on living wills was distributed to all the staff working at JA Toride Medical Center in September 2013, and their responses were collected for analysis within one month.
Results: Questionnaires were distributed to all hospital staff, 843 in total, and 674 responses (80.0% of distributed) were obtained. The term of living will was known by 304 (45.1%) of the respondents, and introduction of living wills to patients was accepted in 373 (55.3%) of the respondents, meanwhile, 286 (42.4%) respondents did not indicate their attitude toward living wills. As to styles of document form, 332 respondents (49.3%) supported selection of wanted or unwanted medical treatments and care from a prepared list, and 102 respondents (15.1%) supported description of living wills in free form. As preferred treatment options that should be provided as a checklist, cardiac massage (chest compression) and a ventilator were selected by more than half of the respondents. Based on their responses, we developed an original type of living wills available to patients visiting the hospital.
Conclusions: Although not all the respondents were aware of living wills even in this main regional hospital, introduction of living wills to patients was accepted by many of the hospital staff. Awareness programs or information campaigns are needed to introduce living wills to support patient-centered medicine.

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Are eating habits effective screening indicators for anemia in elderly Japanese people? The Kyushu-Asakura Project (KAP)

Yoshihisa Hirakawa

Journal of Rural Medicine.2015;10(1):48-50. doi:10.2185/jrm.2892

Objective: The aim of the present study was to explore whether the presence of unhealthy eating habits is an effective indicator of anemia among older people or not.
Methods: We used data from a prospective observational cohort study of all users who underwent an annual health checkup at a public clinic in a rural area. The subjects of the present study were 150 users aged 75 years and older who underwent the checkup between January and September 2010. The subjects were first divided by gender and further separated into anemic and non-anemic subgroups according to their estimated anemia prevalences: Hb < 130 g/L for males and Hb < 120 g/L for females. For each category, we compared the subjects’ lifestyles including eating habits between the anemic and non-anemic groups.
Results: Both among the women and the men aged 75 and over, there were no significant differences in any items including eating habits between the two anemic subgroups.
Conclusion: Our results suggest that the presence of unhealthy eating habits is not an effective indicator of anemia among older people.

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The effects of coaching on salivary cortisol stress marker in mothers with young children, a randomized controlled trial

Junko Ohashi ; Toshiki Katsura

Journal of Rural Medicine.2015;10(1):20-28. doi:10.2185/jrm.2891r

Objectives: The purpose of this study was to evaluate the effects of a coaching program on saliva cortisol sensitivity in normal healthy mothers with young children.
Methods: A randomized controlled trial (RCT) was conducted with objective and subjective outcome measurements of the stress indicator. A postal survey to assess emotional intelligence (EI) was administered by random sampling to mothers of young children aged 3 months to 6 years in Japan. A total of 74 mothers with median EI scores or lower were enrolled in a RCT involving the coaching program. The intervention group received a 3-month coaching program. The control group was given the coaching program at follow-up. Stress state outcomes (saliva cortisol level, EI score, and Profile of Mood States (POMS)) were measured at baseline and immediate follow-up, with salivary cortisol measured again at a one-month follow-up.
Results: Significant differences were found for saliva cortisol level and the EI score within and between the intervention and control groups. Some POMS subscale scores were significantly different within the intervention and control groups.
Conclusion: The participants in the coaching program had significantly reduced saliva cortisol levels and better secondary outcomes than those in the control group.

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Reactions of community members regarding community health workers’ activities as a measure of the impact of a training program in Amazonas, Brazil

Ryoko Kawasaki ; Toru Sadamori ; Terezinha Ferreira de Almeida ; Megumi Akiyoshi ; Mika Nishihara ; Toshiro Yoshimura ; Mayumi Ohnishi

Journal of Rural Medicine.2015;10(1):7-19. doi:10.2185/jrm.2890

Objectives: The aim of this study was to evaluate the impact of community health worker (CHW) training on recognition and satisfaction regarding the performance of CHWs among members of the community in Amazonas, Brazil, which is a resource-poor area underserved with regard to medical health-care accessibility.
Methods: Baseline and endline surveys concerning recognition and satisfaction with respect to CHW performance among members of the community were conducted by interview using a questionnaire before and after implementation of a program to strengthen community health projects in Manicoré, Amazonas, Brazil. One of the components of the project was CHW refresher training, which focused on facilitating adequate use of health-care services and providing primary health care, including health guidance. The baseline survey was performed in February 2004 at the beginning of the project, and the endline survey was performed in February 2006 at the end of the project. There were 82 and 120 CHWs working in Manicoré at the times of the baseline and endline surveys, respectively. Statistical analysis was performed to determine the significance of changes in experience with CHW activities, expected functions of CHWs, and satisfaction regarding the performance of CHWs between the baseline and endline surveys. In addition, qualitative analysis was conducted to evaluate the acceptability, feasibility, and sustainability of CHW refresher training.
Results: Overall recognition and level of satisfaction regarding CHW performance among members of the community were improved from the baseline to the endline survey, regardless of type of residential area, such as town and/or remote area. Members of the community came to not expect CHWs to “provide strong medicine” (P < 0.001) and “provide injections” (P < 0.001), and came to appreciate “go to hospital with a sick person” (P = 0.031) as a function and role of CHWs.
Conclusions: The results of the present study indicated that steady approaches to motivate and support CHWs in resource-limited settings could improve performance of CHWs and satisfaction of people in the community regarding the activities of CHWs to sustain their health.

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Effect of Rosuvastatin 2.5mg on Achieving Lipid Goals Defined by the 2007 Japan Atherosclerosis Society Guidelines

Hiroyuki Ohbayashi

Journal of Rural Medicine.2007;3(1):10-14. doi:10.2185/jrm.3.10

Objective: The aim of the study was to assess the effect of rosuvastatin 2.5 mg, an inhibitor of HMG-CoA reductase, on achieving lipid goals defined by the 2007 Japan Atherosclerosis Society guidelines.
Subjects and Methods: Thirty-seven patients with moderate to high risk hypercholesterolemia (Mean age: 64.8 ± 8.4) were treated with 2.5 mg/day of rosuvastatin and their lipid and hepatic function parameters were measured at the baseline and at Weeks 4 and 8.
Results: At 4 and 8 weeks after start of treatment, 74.1% and 92.6% of moderate risk patients, as well as 70% and 80% of high risk patients, achieved their LDL-C goals, respectively. In both moderate and high risk patients, the mean LDL-C/HDL-C ratio, which is considered as a prospective index for plaque regression, was significantly reduced (p<0.001 for both the moderate and high risk groups), and the mean LDL-C/HDL-C ratio decreased to less than 2 in moderate risk patients. No abnormal changes were observed in hepatic function tests during the study.
Conclusion: More than 80% of moderate to high risk patients with hypercholesterolemia achieved their lipid goals and the mean LDL-C/HDL-C ratio was significantly reduced after the 8-week short treatment of rosuvastatin 2.5 mg, suggesting the clinical possibility of continuous use of rosuvastatin for plaque regression.

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A Case of Community-Associated Methicillin-Resistant Staphylococcus Aureus Infections in a Community Hospital

Hidenobu Kawabata ; Manabu Murakami ; Kengo Kisa ; Yuya Kimura ; Masaji Maezawa

Journal of Rural Medicine.2010;5(1):140-143. doi:10.2185/jrm.5.140

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.

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Open-label, Randomized Crossover Study Between Telmisartan and Valsartan on Improving Insulin Resistance and Adipocytokines in Nondiabetic Patients with Mild Hypertension

Hiroyuki Ohbayashi ; Shinya Minatoguchi ; Takuma Aoyama ; Hisayoshi Fujiwara

Journal of Rural Medicine.2010;5(2):165-174. doi:10.2185/jrm.5.165

Objective: The comparative effect of telmisartan and valsartan upon insulin resistance and adipocytokines in nondiabetic patients with mild hypertension is unclear.
Methods: Fifty nondiabetic patients with untreated mild hypertension were randomly assigned to telmisartan (40 mg/day) and valsartan (80 mg/day) groups and were switched in a crossover manner at 3-month intervals. Serum leptin, adiponectin, hsCRP and the HOMA-R were measured before and at 3 months during each treatment period.
Results: The HOMA-R significantly improved over the 3 months in the high insulin resistance group (HOMA-R>/=2.5) during the telmisartan treatment period (p=0.042), but not during the valsartan period. Both telmisartan and valsartan significantly decreased serum leptin levels in each female group during each treatment period (p<0.001 and p<0.001, respectively), but not in the male groups. Serum adiponectin did not increase in either treatment group. Serum hsCRP levels also significantly decreased in the high hsCRP subjects (>/=0.1) of both treatment groups (p=0.044 and p=0.015, respectively).
Conclusions: Telmisartan significantly improved insulin resistance, possibly through the effect on PPAR-gamma, while both telmisartan and valsartan significantly decreased serum leptin levels in female groups and hsCRP in both genders, suggesting no significantly different effects on adipocytokines by either drug in nondiabetic patients with mild hypertension.

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Psychosocial Factors That Have an Influence on the Effects of Obesity Improvement Programs

Hideaki Hanaoka ; Hitoshi Okamura ; Mamiko Iwamoto ; Chiaki Yagura ; Isao Kihara ; Akiko Nogi ; Hajime Shimizu ; Kuninori Shiwaku

Journal of Rural Medicine.2010;5(2):175-183. doi:10.2185/jrm.5.175

Objective: The objective of the present study was to clarify the relationship between factors having an influence on obesity improvement programs and psychosocial factors from a more comprehensive point of view.
Methods: We studied a total of 43 subjects with a body mass index (BMI) of 25 kg/m2 or higher who wished to take part in an obesity improvement program and agreed to participate in the study. We conducted an obesity improvement program based on behavior change theories for three months and evaluated physical composition, mental health, social support, stress-coping and the like before intervention and immediately after completion of the program.
Results: The average weight showed a significant decrease from 69.0 } 8.8 kg to 65.7 } 8.7 kg before and after intervention (p<0.001), respectively. It was also shown that the presence or absence of chronic diseases, social support from a spouse and the decrease of avoidance stress coping were related to weight loss.
Conclusion: The findings suggest that it will be further necessary to continue working on the need to enhance awareness about stress with a view to preventing occurrence of rebound after the end of weight loss programs and acquisition coping techniques, apart from the cooperation of attending doctors, strengthening of social support from family and friends and managing stress for the duration of the program.

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