Medical Cooperation System for Acute-Sub Acute Care and Post-ICU as Long-Term Ventilation Unit in The Community Care System / 日本農村医学会雑誌

　　From 2008 to 2014, we experienced 40 respiratory failure cases which required long-term ventilation in the post-ICU in Kakeyu Hospital. They had been referred to our hospital from acute care hospitals and most of them had been transferred on our regional medical cooperation system. Initially, we used long-term care beds for them, but as the number of serious cases increased, we moved them to acute care beds. As regards main causes of respiratory failure, post cardiac arrest syndrome topped the list with 12 cases, followed by chronic obstructive pulmonary disease, intractable neurological diseases and cervical cord injury. All these cases combined, the number came to 30 cases, accounting for 75% of all. The shortest stay in hospital was made by a patient with brain stem lymphoma. It was only 12 days, but the longest was made by a patient with post meningoencephalitis 6 years. Our care consisted not only ventilation and medical care but also giving a bath, walking with a type of wheelchair, and sunbathing at the rooftop of our hospital. In May 2014, we renovated the post-ICU from an acute care division to a physical disability patient ward. As the elderly population will increase, it is expected that the need for acute care will augment in parallel with an increase to the number of post cardiac arrest syndrome and the demand of long-term ventilation. Therefore, the community care system will need the post-ICU for cooperation with acute care hospitals.

Grappling with the Problems of Training in Community Medicine / 日本農村医学会雑誌

　　Under the system of initial-phase clinical on-the-job training for newly accredited physicians, the part for community medicine became a compulsory subject in 2010. Then our hospital began to accept residents and trained them in community medicine in coordination with acute phase hospitals from 2011. The core of this training consists of “experience at places of livelihood” and “linkage of medical care with welfare,” and training is performed according to a program that centers on projects evolved outside the hospital and also on recovery phase rehabilitation wards. Our programs were designed to educate the need for coordination between medical care and welfare so that trainees could turn their attention to “living” as the endpoint beyond “life and organs.”　　With a “surge in the wave of population” just around the corner, it has become increasingly important to work for coordination (initial-phase and final-phase coordination) between acute phase hospitals and post-acute hospitals and also between medical institutions for chronic diseases and care at home and facilities. That said, it has now become an urgent task to train “physicians required for the society.” It is necessary for the Japanese Association of Rural Medicine to take in training for community medicine as one of its important tasks and strive for its improvement in the training and its standardization and to appeal its importance to the society.

Trends in Incidence of Myocardial Infarction in Saku District / 日本農村医学会雑誌

Using the method specified in the WHO-MONICA Project, we monitored the incidence of myocardial infarction (MI) in the Saku district. When it comes to the trends over a period of 10 years from 1989, we did not observe significant changes, nor did we witness an increase in the incidence, which is ascribable to the aging of population. The average age of women with MI remained unchanged, whereas there were signs of a slight rise for men. Sudden death is more likely to occur in patients with the severest case of MI, so that community based studies in which the local public health center takes the lead are required to come to grips with the full particulars. In the meantime, there is the need for studies in which whether farm workers are involved is spotlighted, and it would be significant if the trends in MI mortality and morbidity in the farming populace were taken up as a research theme for our Association.

A Study on Glucomannan's Function to Reduce Cholesterol / 日本農村医学会雑誌

We have checked into the function of <I>konjak</I>, or the devil's-tongue (<I>Hydrosme vivieri</I>) to reduce cholesterol in order to cast light on its significance as a health food. We processed chipped glucomannan into crackers (hereinafter referred to as “mannan crackers”) and examined its impacts on lipid metabolism. Enrolled for this study were hospital staff members whose total cholesterol exceeded 200mg/dl and students boarding in the hospital's nursing college.<BR>The findings attested to the fact that the intake of mannan crackers may serve to reduce the values of total cholesterol. The higher the value of total cholesterol before this study, the greater the drop. Since we could not detect any effect on either HDLcholesterol or triglyceride, the mannan crackers were considered capable of specifically reducing LDL-cholesterol. We observed no numerical changes in the complete blood cell count (CBCC) and blood chemistry, either. Some of the subjects had abdominal swelling, diarrhea and other digestive problems but theirs were not serious cases. Yet in another aspect, there was no difference in body weight between before and after this study, but the intake of energy and lipid dropped during the period, suggesting that the intake of mannan crackers would produce an effect on the dietary pattern. Having said that, <I>konjak</I> (mannan crackers) may be considered capable of directly or indirectly reducing cholesterol, particularly LDL-cholesterol, suggesting that mannan crackers are of significance as a health food.<BR>The significance of this study for agriculture and rural community must not go unmarked. This study will contribute to the development of agriculture as an industry, while the farm product by the name of <I>konjak</I> has something to do for health, and will be instrumental in protecting the rural environment, not to mention the lives of farm workers engaged in its production. It is a task for us to grapple with by associating itself with farm work and rural villages with the close collaboration of those farm producers.

The Circadian Variation of the Onset of Myocardial Infarction / 日本農村医学会雑誌

We have studied the circadian variation of the onset of myocardial infarction (MI). The subject were taken from the cases with MI, the onset of which was registered as the Saku Public Health Center, from April 1989 to March 1997, in accordance with the clinical criteria of the WHOMONICA Project. The number of subjects were 309 cases in which the onset time could be associated with circadian disturbance. We classified them into three groups, the <I>midnight and dawn</I> (00: 00-07: 59 hours), the <I>daytime</I> (08: 00-17: 59 hours) and the <I>nighttime</I> (18: 00-23: 59 hours), and the factors which had influenced the onset time were studied. The cases with sudden deaths (deaths out of hospitals and in the emergency room or deaths from post-resuscitation hypoxic encephalopathy) were also included, if autopsy found coronary occlusion or narrowing, and tissue signs suggestive of fresh MI. The t test was used to check the significant differences.<BR>From the circadian variation of 309 cases of MI, circadian rhythm was observed in a dual-peak pattern - morning and evening (morning < evening). As the sharpest peak had appeared in males at a relative young age (69 or under), it was suggested that there existed relations between the onset time of MI and the engagement in work. However, it was considered necessary to further study the impacts of farming work on the onset of ML In a study of deaths in acute phase, no difference was observed in mortality by onset time, but many deaths from cardiogenic shock were witnessed among cases at night. There is the need for the circulatory management of those cases.