Cross-cultural Study about Cancer and Palliative Care in the Okinawa, Tohoku, and Tokyo Metropolitan Area

Background: Consideration of cultural aspects is important in medical care. We explored regional differences in cancer and palliative care among Okinawa, Tohoku, and Tokyo metropolitan area. Methods: We conducted a questionnaire survey of physicians involved in cancer medicine from September to November 2020. A total of 11 items related to physician experiences were rated using a 5-point Likert-type scale. Results: Responses were received from 553 physicians (187 in Okinawa, 219 in Tohoku, 147 in the Tokyo metropolitan area). In Okinawa, “When patients die, it is important that all family members are present at the last moment,” “Patients/family members primarily consult the elders of the family about the medical treatments,” “Family members hope the patients die at home, because the soul will not return when they die at the hospital,” “Patients/family members get advice from religious advisors about the medical treatments,” and “Family members wish to take the patient home when he/she is about to die and to confirm death at home” were significantly more frequently observed. In Tohoku, “Patients wish to be hospitalized at a specific season” was significantly more frequently reported. In Tohoku and Okinawa, “Patients hide cancer from neighbors and relatives” and “Elderly patients do not want treatment, because they cover the living expenses and education expenses for their children and grandchildren.” were significantly more frequently experienced. Conclusion: There are regional differences in cancer and palliative care in Japan. Being sensitive to the culture of the region is needed.

A study of Cross-Cultural Care for the Foreign Elderlies in Okinawa / 国際保健医療

Introduction  The purpose of this study was to reveal the current conditions of the nursing care system for elderly and determine the problems concerning the cross-culture care practice. Methods  This study is a qualitative and descriptive research. We conducted a semistrustured interview study including six foreign sresidents in Okinawa who provided consent to participate in the study.  After recording verbatim and extracting the contents related to elderly nursing care, We coded these contents into each semantic unit to extract the themes by repeating the reorganization/integration while considering the similarity of the contents. Results  We extracted 126 codes as a narration related to nursing care and generated. 61 subcategories and 17 categories. Next,we extracted the following nine themes: 1） struggles overcoming the language barrier. 2） anxieties over symptom control or treatment of their illnesses. 3） a financial burden for receiving satisfactory medical treatment. 4） a sense of security with someone who understands their language, 5） affection by overcoming language barriers. 6） a cross-cultural environment in which they can choose their own living condition, 7） a sense of appreciation for care services that assist in achieving life stability. 8） adaptation to the cross-cultural life and attachment to Okinawa,and 9） life supported by religion, and the method of burial according to religion.Conclusion  The prpbrems should be resolved through 1） care service restructuring with the involvement of the recipients. 2） utilizing their community where they can share cultural connection, 3） fostering an interculture environment, 4） supporting caregivers, and 5） supporting an ideal end-of-life care with religion.

Effects of practicing in remote Japanese islands on physicians’ control of negative emotions: A qualitative study / Journal of Rural Medicine

<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>

Relationship between Pediatric Wheezing Attack Frequency and Sugarcane Harvest Work: Prospective Cohort Study / 日本プライマリ・ケア連合学会誌

<p><b>Introduction: </b>Our aim was to determine the relationship between pediatric wheezing attacks and sugarcane harvest work.</p><p><b>Methods: </b>We recorded daily symptoms, including wheezing attacks, from 167 children attending kindergarten, elementary and junior high school on Minamidaito Island, Okinawa. We calculated wheezing attack frequency every two months and checked the seasonal changes. Logistic regressions were performed to examine the relationship between wheezing attacks and background factors.</p><p><b>Result: </b>The collection rate of the check sheets was 62.5%. The median age was 7.5 years old, male-to-female ratio was 8:7 and the percentage of children with asthma was 36%. Wheezing attack frequency during sugarcane harvest work (January-March) had increased significantly compared with other periods. There was a number of wheezing attacks even in children without asthma.</p><p><b>Conclusion: </b>There is a possibility that sugarcane harvest work is related with pediatric wheezing attacks.</p>

Rural physicians’ scope of practice on remote islands: A case report of severe pneumonia that required overnight artificial airway management / Journal of Rural Medicine

<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>

Rheumatoid arthritis following ciguatera poisoning: A case report / Journal of Rural Medicine

<p><b>Objective:</b> To report the first case of ciguatera-associated rheumatoid arthritis in Japan.</p><p><b>Patient:</b> A 53-year-old man presented to our clinic with morning stiffness and pain in the fingers and wrists.</p><p><b>Results:</b> For six months, he had suffered from chronic pain in both hands and shoulders caused by ciguatera poisoning. He was referred to a local general hospital and diagnosed with RA.</p><p><b>Conclusion:</b> When synovitis becomes evident in chronic ciguatera poisoning, reevaluation is necessary, including investigation of chronic arthritis, which might be associated with the onset of RA.</p>

Analysis of antioxidant prenylflavonoids in different parts of Macaranga tanarius, the plant origin of Okinawan propolis

OBJECTIVE@#To analyze the antioxidant prenylflavonoids in different parts of Macaranga tanarius (M. tanarius) (Euphorbiaceae) including the leaf, petiole, stem, leaflet, flower and fruit (only in female plant), and to evaluate their antioxidant properties.@*METHODS@#Methanol extracts of each part of M. tanarius were prepared and five prenylflavonoids in them were quantitatively analyzed using HPLC. The fruits from female plant were further separated into seed, pericarp, and glandular trichome. After the quantitative analyses of prenylflavonoids in each part of M. tanarius, antioxidant activity of the extracts was evaluated by 2,2-diphenyl-1-picryl-hydrazyl (DPPH) radical scavenging assay.@*RESULTS@#The leaf of M. tanarius contained two prenylflavonoids as main components in both male and female plants. Both flowers (male and female) contained five kinds of prenylflavonoids. In the petiole, stem and leaflet of both male and female plants, the prenylflavonoids were not detected or their amounts were very low. Five kinds of prenylflavonoids were detected in the seed, pericarp and glandular trichome of female M. tanarius. In particular, the glandular trichome had the highest level of total prenylflavonoids (235 mg/g of fresh plant). DPPH radical scavenging activity of all parts was more than 30%.@*CONCLUSIONS@#We found that different parts of M. tanarius contained antioxidant prenylflavonoids. In particular, not only the glandular trichome but also the leaf contained prenylflavonoids, which indicated that M. tanarius may be developed as a functional plant, because the leaves of this plant can be easily collected.

Production of peach grafts under hydroponic conditions / Produção de mudas de pêssego enxertadas em sistema hidropônico

The objective of the present work was to study the feasibility of producing Okinawa rootstocks and peach grafts using a hydroponic system. The study was conducted in two phases. The growth and development of Okinawa rootstocks under hydroponic conditions were determined in the first phase, and in the second phase, the viability of grafting production of peach cultivars Aurora and Diamante associated with different types of rootstocks. The parameters analysed were the time required for 60 to 75 percent plants to reach the stages of transplanting (15 cm height) and grafting (4 to 6 cm stem diameter), the percentage of sprouting grafts determined 20 days after grafting, and the height of the shoots measured every 7 days until grafts were 40 cm high measured from the crown. Although 13 percent of the Okinawa rootstocks grown under hydroponic conditions presented undesirable genetic segregation characteristics, transplanting was reached at 30 days after transference (DAT) to hydroponic conditions and grafting at 61 DAT. Proximal pruning at 5 cm gave rise to grafts of 47.53 cm in height at 116 DAT, and both cultivar showed 100 percent graft sprouting with the cultivar Aurora presenting higher growth.

Conduziu-se este trabalho, com o objetivo de estudar a viabilidade da produção de porta-enxerto 'Okinawa' e de mudas enxertadas em sistema hidropônico. O experimento foi conduzido em duas etapas. Na primeira etapa, pesquisaram-se o tempo de germinação e o desenvolvimento vegetativo das plantas do porta-enxerto 'Okinawa' e na segunda etapa a viabilidade de produção de mudas enxertadas de pêssego das cultivares 'Aurora' e 'Diamante', associada a diferentes tipos de desmama dos enxertos. As características avaliadas referiram-se ao tempo para que 60 a 75 por cento das plântulas atingissem o ponto de repicagem (15 cm de altura) e o ponto de enxertia (diâmetro de 4 a 6 mm) coletados semanalmente, a percentagem de pegamento da enxertia foi avaliada aos 20 dias após a enxertia e o crescimento em altura dos enxertos (brotos), tomadas semanalmente, até atingirem 40 cm de altura. Embora cerca de 13 por cento dos porta-enxerto de 'Okinawa' tenham se apresentado com aparência arbustiva e ananicante, características impróprias ao futuro desenvolvimento normal das mudas, o ponto de repicagem dos porta-enxertos foi atingido aos 30 dias após transferência para solução nutritiva (DAT) e o ponto de enxertia aos 61 DAT. A desbrota a 5 cm foi a mais apropriada à propagação de mudas de pessegueiro, estando as mesmas prontas para a comercialização aos com 47,53 centímetros de altura aos 116 DAT e ambas as cultivares apresentaram índice de pegamento de 100 por cento, sendo que a cultivar Aurora apresentou maior crescimento.

Effects of OHAP-1 on expression of bcl-2/bax mRNA and oxidative stress in rat C6 glioma cells / 吉林大学学报(医学版)

Objective To observe the effects of Okinawa Habu apoxin protein-1 (OHAP-1) on the proliferation inhibition of rat C6 glioma cells and its mechanisms. Methods MTT colorimetric analysis was used to measure the inhibitory effect of OHAP-1 with different doses(2.5,5.0,and 10.0 mg?L-1) on C6 glioma cells .RT-PCR was used to evaluate the mRNA expressions of bcl-2 and bax genes.The activity of superoxide dismutase (SOD) and the level of maleicdialdehyde (MDA) in the C6 glioma cells were also examined. Results The proliferation of C6 glioma cells was significantly inhibited by different doses of OHAP-1(2.5,5.0,and 10.0 mg?L-1).The inhibitory rate were 49.77%,67.65%,and 76.42%,respectively.The inhibitory rate in 2.5,5.0, and 10.0 mg?L-1 groups were higher than that in control group(P

CHANGES IN HTLV-I POSITIVE RATES AMONG PREGNANT WOMEN IN OKINAWA PRIOR TO THE EFFECTS OF MEASURES INTRODUCED TO PREVENT VERTICAL TRANSMISSION THROUGH BREAST MILK FEEDING

Objectives: Human T cell leukemia virus type-I (HTLV-I) is a causative agent of human T-cell leukemia and HTLV-I associated myelopathy (HAM/TSP). HTLV-I carriers are often infected vertically, especially via mother's milk. Since 1985, clinical measures have been adopted at a hospital in Okinawa to prevent vertical infections.<BR>Methods: We examined HTLV-I antibodies in all of the women (total 11, 506) who gave birth after 24 gestational weeks at a hospital on the Okinawa main island from January 1985 to December 1999.<BR>Results: The positive rate among all pregnant women was always higher than that among primipara alone. Both figures decreased over the period studied, but the primiparity rate (36-39%) did not change significantly. The percentage of HTLV-I positive primipara pregnant women among the HTLV-I positive total was close to the primiparity rate from 1985 to 1988, but it was considerably lower than the overall primiparity rate thereafter (22-26%).<BR>Conclusions: Preventive measures against HTLV-I infection did not contribute to the decrease in HTLV-I positive mothers before 1999 because these measures were adopted from 1985, and so there must be other reasons for the decrease in HTLV-I positive rate. Further studies on social factors and by year of birth are needed to identify factors influencing HTLV-carrier ratios among pregnant women.