Chiaki Sano

Introduction: Isolation and loneliness among older adults in rural communities pose significant risks to physical and mental health, leading to higher rates of morbidity and mortality. This study investigates the impact of continual rural health dialogues facilitated by family physicians on reducing loneliness and enhancing community health in Unnan City, Shimane Prefecture, Japan.Method: Using a constructivist grounded theory approach, we conducted a qualitative study involving 165 participants over 65 from five rural communities between April 2022 and March 2024. Monthly health dialogues covered chronic diseases, exercise, and polypharmacy. Data were collected through ethnographic observations, focus group interviews, and field notes, with iterative coding and analysis to identify themes and concepts.Results: Three primary themes emerged: the existence of loneliness and its impact on health, motivation to address loneliness through a sense of security, and recognition of the importance of community engagement in reducing loneliness. Participants reported increased health awareness, enhanced community interaction, and recognition of loneliness's prevalence and health impacts. Regular dialogues fostered trust with healthcare professionals, encouraged proactive health management, and facilitated supportive community connections. These interactions significantly reduced feelings of loneliness and improved health outcomes.Conclusion: Continual rural health dialogues effectively mitigate loneliness and enhance health outcomes in rural communities by fostering regular interactions and building supportive networks. These findings underscore the importance of community engagement and continuous relationships with healthcare professionals in addressing loneliness. Policymakers and healthcare providers should consider integrating such dialogues into rural health strategies to promote healthier, more connected communities. Future research should explore these interventions' long-term sustainability and broader applicability across diverse rural settings.

IntroductionRheumatic diseases, such as rheumatoid arthritis (RA) and psoriatic arthritis, significantly affect quality of life and require comprehensive management, especially where rheumatologists are scarce. Family physicians in rural settings play a crucial role in providing this care. This study aims to elucidate the educational process for family physicians in managing RA within rural hospitals.MethodsUsing a qualitative autoethnographic approach, we explored the learning experiences of family physicians at Unnan City Hospital in rural Japan. Data were collected through semi-structured interviews, direct observation, reflective field notes, and informal conversations with participants. The study focused on the practical education of RA management facilitated by a family physician with expertise in rheumatology.ResultsThree main themes emerged: (1) comprehending arthritis as a systemic disease, (2) managing dynamic conditions with prudence, and (3) providing comprehensive and continuous care amid uncertainty. Participants initially viewed arthritis as a localized condition but learned to approach it as part of systemic inflammation. They recognized the fluctuating nature of autoimmune diseases, emphasizing the need for cautious and flexible management. Continuous monitoring and a comprehensive approach to patient care with enduring uncertainty were identified as essential for effective RA management.ConclusionThe study highlights the importance of experiential learning and mentorship in educating family physicians about RA in rural settings. Understanding arthritis as a systemic condition, exercising prudence in treatment, and maintaining comprehensive care amid uncertainty are crucial components of effective management. These findings inform the development of targeted educational programs for family medicine residents, ultimately enhancing patient care in rural areas. Future research should include multiple rural settings and quantitative data to validate and expand upon these insights.

Prostate cancer is highly prevalent among older men and poses significant health challenges, particularly in rural areas where access to specialized care is limited. This narrative review aims to evaluate the quality of prostate cancer care in rural primary care settings, identify gaps, and suggest strategies for improvement. A comprehensive narrative review was conducted using PubMed to identify relevant studies published between April 2000 and August 2024. The search focused on articles discussing prostate cancer management in rural primary care, including challenges, outcomes, and collaborative practices. Thirteen studies met the inclusion criteria and were analyzed to assess the quality of care and potential areas for enhancement. The review highlighted significant disparities in prostate cancer care in rural areas, including limited access to urologists, variability in PSA testing practices, and socioeconomic and geographic barriers. Innovative models like telehealth and 'One Stop' Prostate Clinics (OSPCs) showed promise in addressing these challenges. However, gaps in long-term symptom management and follow-up care persist, emphasizing the need for comprehensive survivorship plans and targeted educational interventions for primary care physicians. Rural primary care settings face unique challenges in managing prostate cancer, necessitating tailored strategies to improve care quality. Enhancing collaboration between primary care physicians and urologists, expanding access to innovative care models, and addressing socioeconomic and geographic disparities are critical to improving outcomes for prostate cancer patients in rural areas. Future research should focus on developing and evaluating these strategies to ensure equitable care for all patients.

IntroductionSigmoid volvulus is a gastrointestinal condition characterized by twisting the sigmoid colon, leading to obstruction and potentially severe complications. It is associated with factors such as advanced age, constipation, and the use of certain medications. Despite treatment, recurrence is common and significantly impacts patients' quality of life. This study aimed to identify factors influencing the recurrence of sigmoid volvulus to develop effective preventive strategies.MethodsA retrospective cohort study was conducted at Fuchu Hospital, Osaka, including 44 patients diagnosed with sigmoid volvulus between May 2013 and May 2023. Data on variables such as age, gender, constipation, cardiac and neuropsychiatric diseases, hypertension, diabetes mellitus, sigmoid colon overgrowth, and BMI were collected from electronic medical records. Recurrence was defined as two or more diagnoses of sigmoid volvulus during the study period. Logistic regression analysis was used to identify significant predictors of recurrence.ResultsOf the 44 patients, 20 experienced recurrences. Single regression analysis identified constipation, neuropsychiatric disorders, and sigmoid colon overgrowth as significant factors. Logistic regression analysis confirmed constipation as an important predictor of recurrence (OR: 8.84, 95% CI: 2.05-38.1, p=0.0034). The area under the receiver operating characteristic (ROC) curve for the model was 0.804 (95% CI: 0.67-0.938), indicating good predictive accuracy.ConclusionConstipation is a significant risk factor for the recurrence of sigmoid volvulus, likely due to chronic fecal overload leading to elongation and dilation of the sigmoid colon. Effective management of constipation is crucial in preventing recurrence. Future prospective studies with larger sample sizes are needed to validate these findings and explore additional preventive measures.

This case report discusses a 69-year-old immunocompromised woman who presented with dyspnea and lower back pain, later diagnosed with an external dental fistula following the observation of a mass and pus discharge on her right cheek. The patient’s medical history included idiopathic thrombocytopenic purpura (ITP) and long-term use of immunosuppressive medications, complicating her condition. The fistula was linked to chronic inflammation that had progressed to maxillary bone destruction, requiring both antibiotic therapy and oral surgical intervention. Despite the initial challenge of diagnosing this rare and atypical presentation in elderly, immunosuppressed patients, comprehensive treatment improved her inflammatory markers and overall condition. This case highlights the importance of early detection and multidisciplinary management in preventing severe complications in patients with complex medical histories. It also emphasizes the need for heightened awareness of dental infections in patients with systemic conditions, mainly when presenting atypical symptoms.

IntroductionStaphylococcus aureus bacteremia (SAB) poses a significant health risk, particularly among adults over 65 years old, due to age-related vulnerabilities and comorbidities. Recurrent SAB is associated with increased morbidity, prolonged hospitalizations, and higher healthcare costs, necessitating the identification of risk factors that contribute to these recurrent infections.MethodsA retrospective cohort study was conducted at a rural community hospital to identify factors associated with recurrent SAB in older patients. Data were extracted from electronic medical records of patients diagnosed with SAB between April 2016 and December 2023. Multivariate logistic regression was employed to analyze the relationship between recurrent SAB and potential risk factors, including age, sex, BMI, dependency on Japanese long-term health insurance, and comorbidities.ResultsAmong 99 patients with SAB, 36 (36.4%) experienced recurrence. Higher BMI was significantly associated with recurrent SAB (OR: 1.15, 95% CI: 1.01-1.31, p = 0.036), while dependency on long-term care was associated with a lower risk of recurrence (OR: 0.20, 95% CI: 0.06-0.64, p = 0.007). Age and sex did not show significant associations with recurrence.ConclusionThis study identified higher BMI as a risk factor for recurrent SAB in older patients, while dependency on long-term care was protective. These findings highlight the need for targeted management strategies for patients with higher BMI to prevent recurrent SAB. Further research is needed to explore these associations and confirm their relevance in other clinical settings.

This case report describes an 85-year-old woman with a history of aspiration pneumonia who was admitted to a rural hospital with fever, vomiting, and decreased oxygenation. Initially diagnosed with aspiration pneumonia and acute pyelonephritis, she was treated with antibiotics. Despite this, her fever persisted, and subsequent imaging suggested aspiration pneumonitis or organizing pneumonia. Her condition improved following fasting and corticosteroid therapy. This case highlights the challenges in differentiating aspiration pneumonia from aspiration pneumonitis, as both conditions may present similarly but require different treatment approaches. Persistent fever despite broad-spectrum antibiotics prompted a change in treatment strategy, leading to the introduction of corticosteroids, which improved her symptoms. This case underscores the importance of considering aspiration pneumonitis in older patients with recurrent or persistent respiratory symptoms and fever, especially when dysphagia is present and antibiotic therapy is ineffective. Early intervention with corticosteroids, particularly when imaging findings are suggestive of organizing pneumonia, can prevent further deterioration. Accurate diagnosis and timely treatment adjustments are crucial in managing aspiration-related pulmonary conditions in elderly patients.

ANCA-associated fasciitis is a rare manifestation of ANCA-associated vasculitis (AAV) that can mimic other conditions, such as pseudogout, especially in elderly patients. We present the case of a 93-year-old woman who initially developed polyarthralgia, muscle pain, and difficulty walking, symptoms suggestive of pseudogout. However, after further investigation, including elevated myeloperoxidase (MPO)-ANCA levels and MRI findings, she was diagnosed with ANCA-associated fasciitis. Treatment with high-dose prednisolone and rituximab led to significant clinical improvement. This case highlights the diagnostic challenges of ANCA-associated fasciitis and emphasizes the importance of a comprehensive approach for early diagnosis and management to prevent functional decline.

Castleman disease (CD) is a rare lymphoproliferative disorder that can present with nonspecific symptoms, making diagnosis challenging, particularly in elderly patients. This case report describes a 93-year-old woman who presented with intermittent abdominal pain, which was unresponsive to standard treatments and showed no systemic signs of infection or malignancy. Initial imaging revealed scattered lymphadenopathy, raising concern for a lymphoproliferative disorder. A laparoscopic lymph node biopsy was performed, leading to a diagnosis of unicentric CD (UCD). The patient was treated with corticosteroids, which resulted in a marked improvement in her symptoms, including the complete resolution of her abdominal pain. This case emphasizes the importance of considering CD in the differential diagnosis of unexplained abdominal pain in elderly patients, as early diagnosis and treatment can prevent complications and significantly improve outcomes. The successful use of corticosteroids in this patient highlights a nonsurgical treatment option for UCD in cases where surgical excision is not feasible.

Rheumatoid arthritis (RA) is a global autoimmune disease causing significant morbidity, particularly in rural areas with limited rheumatology care access. Primary care plays a crucial role in early RA detection and management. This systematic review evaluates RA management in rural primary care to identify ways to enhance quality of care. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a meta-ethnography synthesis was conducted on studies from PubMed, Web of Science, and Embase (April 1995-December 2023). Quality was assessed using the best evidence in medical education (BEME) scale, focusing on diagnosis, treatment barriers, and collaboration between general physicians (GPs) and specialists. Of 55 studies, 11 were included. Significant diagnostic delays were linked to patient, physician, and systemic factors. Barriers included limited GP rheumatology training, inefficient referrals, and poor patient-specialist communication. Successful strategies involved GP education, telehealth (e-consults), and collaborative care models. Thematic analysis highlighted patient behaviors, GP knowledge gaps, and the need for interdisciplinary collaboration. Rural RA management faces challenges such as diagnostic delays and limited resources. Key improvements include enhancing GP education, utilizing telehealth, and streamlining referral systems. A multifaceted approach emphasizing the role of primary care in early diagnosis and management is essential to improving RA care in underserved areas.