A survey on palliative home care in rural Japan

<b>Purpose</b>: Palliative care is an essential part of integrated cancer treatment. This study aimed to identify general practitioner (GPs)' perceptions of palliative care and the difficulties they encounter in providing care to terminally ill cancer patients. <b>Methods</b>: Japanese GPs in a rural area where palliative care resources were inadequate were surveyed by questionnaire. Using the questionnaire, researchers visited 62 clinics in the area and carried out semi-structured interviews to identify problems and to investigate possible ways to promote the provision of palliative care by GPs. The transcripts were manually coded into descriptive and interpretive categories. <b>Results</b>: Seventy seven out of 95 responded to the questionnaire (effective response rate: 81%). Experience of pain control was inversely related to the extent of the GPs' perceived difficulties in providing palliative care. Lack of hospital support and understanding of patients and their families were also barriers to the provision by the GPs of palliative care to terminally ill cancer patients at home. The suggested solutions were: to provide seminars for doctors in the area to improve their pain control and other clinical skills; to build up good relations between the doctors in hospitals and clinics in the area; and to educate patients, families and the community at large in the necessity of palliative care. <b>Conclusion</b>: Our study indicated that building up good inter-organizational relations among physicians and educating the community were important in order to promote GPs' participation in palliative care. Palliat Care Res 2009; 4(2): 112-122

Mass Survey for Diabetes Mellitus by a Glucose Tolerance Test (GTT) as the First Screening / 日本農村医学会雑誌

We have carried out the mass survey for diabetes mellitus by a 50 g GTT as the first screening since 1971. Average incidences of diabetic pattern, IGT pattern, borderline pattern and normal pattern in a Glucose Tolerance Test (GTT) were 2.3±1.8%, 6.6±1.7%, 19.8±6.6% and 71.4 ±7.8%, respectively. 21 males and 6 females were found to be diabetic by this survey for 11 years. Insulinogenic indices (I. Is.) of diabetic, IGT, borderline and normal patterns were 0.13±0.07, 0.70±0.37, 0.58±0.40 and 1.05±0.30, respectively, and the values of I. I. in diabetics and borderline diabetics were significantly lower than that in the normal pattern. A I. I. in the subjects who have revealed the normal glucose tolerance every year for 11 year, 2.62±1.28, was high in the normal range. On the other hand, a I. I. in the subjects who became overtly diabetic from the IGT, borderline or normal pattern, 0.36±0.31, was significantly lower. Therefore, taking into consideration that one of the characteristics of NIDDM is low insulin response to glucose, the mass survey for diabetes mellitus should be carried out by a Glucose Tolerance Test (GTT) as the first screening with the measurement of plasma insulin concentrations. A follow-up study for the low insulin responder is considered to be one of the most preferable investigations for the detection of the early stage of diabetes mellitus.

Occurrence of Child Peptic Ulcer in A Rural Community / 日本農村医学会雑誌

During the 18-month period from January 1, 1981 to June 30, 1082, we encountered a total of 11 cases of child peptic ulcer-three gastric ulcer and eight duodenal ulcer casen.<BR>There is every indication that the incidence of child peptic ulcer will increase in a rural area like Yuri, which is situated in Japan's northeastern prefecture of Akita.<BR>To be noted is the fact that 10 cases out of 11 of peptic ulcer were found in three-year lower secondary schoolchildren and the remaining one was found in a sixth grader of six-year elementary school. The incidence as well as the number of visits to our clinics went up as the age advances and reached a peak in third graders of lower secondary school.<BR>The reason why third graders of lower secondary school were attacked most by peptic ulcer is probably that they, at puberty, are under psychic or psychogenic stress with anxiety over high school entrance examinations, mental strain from forced attendance at a cramming school, trouble in getting along with friends, and dissatisfaction with parents.<BR>Therefore, child peptic ulcer should not be treated as a disease of the digestive organ alone but as a disorder in the autonomic nervous system with an aid of psychosomatic medicine and psychiatry. For the prevention of the disease, it would also be necessary to take account of socio-cultural factors.