ABSTRACT
<p><b>Objective:</b> To clarify the scope of practice on rural islands of Okinawa.</p><p><b>Patient:</b> A 59-year-old man presented to our clinic with shortness of breath. He was intubated due to acute respiratory failure caused by severe pneumonia. We could not transfer him owing to bad weather, and had to continue patient care in the clinic for more than 24 hours.</p><p><b>Discussion:</b> In remote regions, rural physicians may require a broad scope of practice from primary to tertiary care, in addition to preventive and end-of-life care.</p><p><b>Conclusion:</b> This case illustrates the current state of emergency care and unique scope of practice on rural islands of Okinawa.</p>
ABSTRACT
<p><b>Objective</b>: To explore how rural physicians practicing in the remote islands of Okinawa, Japan experience and manage their negative emotions.</p><p><b>Materials and Methods</b>: We conducted semi-structured interviews with doctors who had worked in a clinic on a remote island in Okinawa prefecture for 2 years. The interviews were conducted using an Internet video conferencing system, and were recorded and transcribed. The transcribed data were then analyzed using the Steps Coding and Theorization method as a framework.</p><p><b>Results:</b> All four participants were male. The mean interview time was 61 minutes. In the category of induction of negative emotions, we extracted five themes: differences in recognition between rural physicians and patients, invasion of professionalism, suppression by one’s role as a rural physician, discordance with multiple occupations, and relationships with unfamiliar hospital physicians. In the category of controlling negative emotions, we also extracted five themes: time flow, reflection, acceptance of islanders’ characteristics, and growth through their role.</p><p><b>Conclusion:</b> Rural physicians in the remote islands of Okinawa experienced negative emotions in relation to patients, other islanders, and medical staff. They deepened their understanding of the islanders, including the cultural background, over time and through discussion and reflection with other medical professionals. In this way, they realized their potential for growth and how to control negative emotions. Thus, rural physicians may be able to effectively control their negative emotions through recognizing temporal changes in human relations and their own adaptation to the remote island life.</p>
ABSTRACT
<p><b>Introduction: </b>Currently, there are no studies on changes in health problems due to population aging in Japan. This study was conducted to estimate the changes by comparing the present health problems using the International Classification of Primary care second edition (ICPC-2) with a previous study.</p><p><b>Methods: </b>We conducted a retrospective open cohort study on a rural island in Okinawa. We classified health problems of all patients using ICPC-2, and compared the data with a previous study using the International Classification of Health problems in Primary care-2 defined (ICHPPC-2 defined) from 1990.</p><p><b>Result: </b>The total number of visits to the clinic was 4660 per year (age 0-14 years, n=828; age 15-64, n=2146; age 65 or older, n=1688). In 2015, the frequency of musculoskeletal, skin and general, and unspecified problems was higher. The number of health problems contained within the top 50% of all health problems, which is an indicator of the comprehensiveness of practice, was higher in the previous study.</p><p><b>Conclusion: </b>The present study suggested that orthopedic and dermatological disorders increased, and greater comprehensiveness of practice is needed.</p>
ABSTRACT
<b>Objectives: </b>First steps to promote the proper use of medicines in remote islands and rural areas are as follows: (1) recognition of the profession of “pharmacist” from secondary-remote-island residents who do not have a pharmacy or drugstore or the opportunity for pharmacist contact and (2) an understanding by remote-island residents of the advantages of having a “family pharmacist.”<br><b>Methods: </b>Repeated “medicine information and consultation sessions” for secondary-remote-island residents of Japan’s Nagasaki Prefecture were held. Residents were then surveyed for changes in awareness of or demand for pharmacists and the nature of such changes.<br><b>Results: </b>Before the information sessions, 29.7% of residents did not recognize the profession of pharmacy, but the extent of their recognition increased after information sessions were concluded. They were asked “Who explains medicines in a way that is easy to understand ?”; more than half responded “doctors” before the information session, but after information sessions were concluded, those who said “pharmacists” increased.<br><b>Conclusion: </b>Conducting “medicine information and consultation sessions” for residents of secondary-remote islands and rural areas enabled them to understand the profession of pharmacy. The initiatives in the present study are first steps toward promoting proper use of medicines by residents of remote islands and rural areas who use “family pharmacies/pharmacists.”