Telemedicine is expected to be useful in rural areas owing to its advantages in improving patient access to medical care. In Japan, rural clinics and core hospitals are assigned to provide rural medical care according to the medical plans formulated for each prefecture. However, the relationship between telemedicine use in such medical facilities and the role of local governments remains unclear. Therefore, their relationship was investigated in this study. A nationwide survey was conducted in 2022. Questionnaires were sent to rural clinics (n=1,006) and core hospitals (n=334) via mail. The response rates for rural clinics and core hospitals were 51.2% and 50.6%, respectively. Telemedicine was used in 24.9% of the clinics and 24.9% of the core hospitals. Local government collaboration was significantly more prevalent in the telemedicine (+) group than in the telemedicine (-) group in rural clinics (44.5% vs. 5.2%, P<0.01) and core hospitals (35.7% vs. 19.4%, P<0.05). In the telemedicine (-) group, the first-ranked barrier to telemedicine use was hardware preparation (clinics, 34.0%; core hospitals, 26.4%), followed by financial issues (clinics, 22.4%; core hospitals, 22.0%). In the telemedicine (+) group in rural clinics, both doctor-to-patient (45.6% vs. 22.5%, P<0.01) and doctor-to-patient with nurse models (52.6% vs. 7.0%, P<0.01) were significantly more prevalent in collaboration with local governments. The relationship between rural medical care facilities and local government collaborations may contribute to the development of rural telemedicine in Japan.
Objective: This study aimed to identify factors that enhance or hinder job satisfaction among public health physicians in Nagoya City, Japan. Methods: We conducted semi-structured interviews with 20 public health physicians employed by local government agencies, representing various ages, sexes, years of experience, and departmental affiliations. The interviews were audio-recorded, transcribed verbatim, and analyzed using qualitative content analysis. Codes were generated inductively, grouped into categories, and synthesized into overarching themes. Member checking and triangulation among researchers were performed to enhance the study's credibility. Results: Three themes were identified as key promoters of job satisfaction: (1) contributing to public health policy through professional expertise, which allowed participants to apply knowledge gained through medical practice to preventive medicine and evidence-based policymaking; (2) a sense of contribution to the community, fostered by collaborative efforts with local organizations to improve residents' health and quality of life; and (3) work-life balance and career flexibility, enabling alignment between professional responsibilities and personal values. Conversely, two themes emerged as barriers: (1) limited opportunities for professional growth and self-efficacy due to the routine nature of tasks and a lack of specialized training, and (2) difficulty adapting to the organizational culture and decision-making processes of public administration, often accompanied by unclear role definitions. Conclusion: Enhancing the motivation and retention of public health physicians requires creating work environments that support the meaningful application of expertise, foster a strong sense of community impact, and facilitate adaptation to the administrative organizational culture. Additionally, providing structured opportunities for professional development and strengthening career pathways could reinforce physicians' professional identities and long-term engagement in public health practice.
This study aimed to determine the prevalence and risk factors of intimate partner violence during pregnancy in rural Tanzania. An analytical cross-sectional study was conducted among 360 randomly selected postnatal mothers in rural Tanzania between March and April 2024 to determine the prevalence and risk factors of intimate partner violence during pregnancy. Data were collected using a pre-tested, semi-structured questionnaire. Bivariate and multivariable logistic regression analyses were performed using Statistical Package for Social Sciences (SPSS) version 25 to identify risk factors. Statistical significance was assessed at a 95% confidence interval (CI), with associations reported as Adjusted Odds Ratios (AOR). During pregnancy, 70.3% of women experienced at least one form of violence, with 45.6% suffering from two or more forms. Overall, 112 postnatal mothers (31.1%, 95% CI=26.4%-36.2%) experienced intimate partner violence during pregnancy. Significant factors included the health facility attended; Kondoa (AOR=0.262, P=0.017), Mpwapwa (AOR=0.197, P=0.001), Manyoni (AOR=0.086, P<0.001), and Sokoine (AOR=0.122, P<0.001) compared to Makole Health Center; rural residence (AOR=3.653, P=0.001), woman's autonomy in choosing partner (AOR=2.757, P=0.046); dowry payment (AOR=2.809, P=0.013); male partner's alcohol use (AOR=2.125, P=0.025), and a history of abortion (AOR=2.910, P=0.005). A high proportion of women experienced intimate partner violence during pregnancy. Residing in rural areas, autonomy in partner selection, bride price payment, male partner alcohol use, prior experience of abortion exacerbated the prevalence. The study advocates for widespread educational campaigns to raise awareness about the detrimental impact of intimate partner violence, especially during the vulnerable period of pregnancy.
Objective: This study aimed to identify the characteristics of non-cohabiting family caregivers who preferred to share or delegate the responsibility of accompanying cancer survivors to outpatient chemotherapy appointments in rural settings. The analysis was based on the hypothesis that greater transport-related burdens would be associated with stronger preferences for delegation. Materials and Methods: A cross-sectional survey was conducted among caregivers of patients undergoing outpatient chemotherapy. Data on caregiver demographics, employment status, income, scheduling flexibility, and support preferences were collected. Geographic information systems (GIS) were used to visualize spatial relationships between caregivers and medical facilities. Descriptive and inferential statistical analyses were performed to examine caregiver characteristics and support preferences. Fisher's exact test was used for categorical comparisons, and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated to assess effect sizes. Statistical analysis of geographic factors was not conducted because of the wide variation in travel distances and the limited sample size. Results: Of the 40 individuals approached, 27 responded (67.5%), and 26 completed all survey items (65.0%). A preference for shared transport options was significantly associated with an annual income below 5 million yen (OR=15.75, 95% CI: 1.07-232.52) and the need to adjust personal schedules for caregiving responsibilities (OR=18.33, 95% CI: 2.71-124.00). GIS analysis indicated a median travel time of 95.5 min (interquartile range [IQR]: 70.5-169.6) and a median travel distance of 97.7 km (IQR: 44.7-173.8). The longest recorded travel route required 588.7 min and covered 442.2 km. Conclusion: The findings indicate substantial caregiving burdens among caregivers with limited finances and employment constraints who do not live with care recipients. Long-distance travel affects caregivers' employment and well-being, highlighting the need for support systems that alleviate the burden of transporting cancer survivors.
Objective: Japan has the fastest aging population globally, with a growing demand for home medical care among older adults. The number of home visits by physicians is regarded as a key process indicator for evaluating the home medical care delivery system. Understanding the social factors affecting home visits by physicians may contribute to more equitable and effective care delivery. This study aimed to investigate the social factors associated with the number of home visits by physicians across 47 prefectures in Japan. Materials and Methods: This ecological study used 2019 data from the National Database (NDB), Open Data, and other government sources. The outcome was the number of physician home visits per 1,000 people aged ≥65 years. Social variables included the number of home care support clinics/hospitals (HCSCs), population density, proportion of single-elderly-person households, educational attainment, and other factors. Pearson's correlation coefficients and multiple regression analyses were performed. Results: Variables with Pearson correlation coefficients ≥0.4 were the number of HCSCs, the proportion of single-elderly-person households, population density, and the percentage of individuals whose highest level of education was college or higher. Multiple regression revealed that the number of HCSCs (β=0.546, P<0.001), population density (β=0.311, P=0.004), and the percentage of individuals whose highest level of education was college or higher (β=0.260, P=0.009) were significantly associated with physician home visits (adjusted R2=0.780). Conclusion: This study revealed that, in addition to healthcare system indicators such as the number of HCSCs, social determinants, including population density and educational attainment, were significantly associated with the number of physician home visits.
This study investigated the association between rurality and healthcare employees' income in Japan's secondary medical areas (SMAs), specifically focusing on whether hospital beds, particularly in public hospitals, contribute more to employee income in rural areas than in urban areas at the SMA level. To our knowledge, this is the first study to examine these associations using a validated rurality index for healthcare research in Japan (RIJ). This ecological cross-sectional study analyzed all the SMAs in Japan using publicly available data. SMAs were categorized into urban and rural areas using the RIJ cutoff values. Multiple linear regression analyses were conducted to examine the association between the proportion of employee income in healthcare (dependent variable) and number of hospital beds by type and ownership (explanatory variables). All variables were treated as continuous variables and the forced entry method was used. Hospital bed types included general and long-term care beds in both public and private hospitals, high-acuity hospital beds, and clinic beds per 100,000 population. Of the 334 SMAs, 158 were classified as urban (low RIJ score) and 176 as rural (high RIJ score). In urban areas, general beds in private hospitals had the strongest association with healthcare employee income (β=0.396, P<0.001). In rural areas, general beds in public hospitals showed the strongest association (β=0.452, P<0.001), followed by general beds in private hospitals (β=0.342, P<0.001). This study demonstrated that the contribution of hospital bed type to healthcare employee income differs substantially between urban and rural areas. Rural areas depend more on general beds in public hospitals, whereas urban areas rely primarily on general beds in private hospitals. This study suggests that public hospitals, particularly their general bed numbers, play a critical role in sustaining essential healthcare services and supporting employee incomes in rural areas.
This study aimed to examine whether vegetable supply sources and production areas are associated with the quantity and variety of vegetable intake. The setting of this cross-sectional study was one agricultural district (114 households) in Japan. Respondents were asked about their use of 10 vegetable supply sources (e.g., home-grown, receiving from others) and their vegetable intake frequency from five production areas (e.g., home-grown, district-grown). Vegetable intake quantity and variety were assessed using validated scales. Among the 163 included participants (73 men and 90 women), the quantity of vegetable intake was significantly greater among men who were home-grown vegetable consumers than among non-consumers. The variety of vegetable intake was significantly greater among men who received vegetables than among non-receivers, among supermarket non-users than among users, and among women who used farmers' markets outside the district than among non-users. For vegetable production areas, the variety was significantly greater among men with high district-grown vegetable intake than among those with low intake and among women with high city-grown vegetable intake than among those with low intake. Both vegetable supply sources and production areas were associated with the quantity and variety of vegetable intake, which may provide insights into potential environmental factors influencing eating behaviors. Specifically, home-grown, received, and farmers' market vegetable sources were positively associated with a greater quantity and variety of vegetable intake, whereas supermarket use was negatively associated with variety. Vegetable production areas, such as district- or city-grown areas, were also positively associated with variety.
To elucidate the trends in stroke and myocardial infarction (MI) over 24 years in O City, Ehime Prefecture, Japan. We conducted an annual survey of hospital-based disease registrations to determine the incidence and type of stroke (hemorrhagic stroke (HS) and ischemic stroke (IS)) and MI from 1996 to 2022. The numbers of deaths due to stroke and MI were determined using the electronic death certificate dataset provided by the Ministry of Health, Labour and Welfare. The number of deaths and incidences of stroke and MI in O City over 24 years were classified into four six-year periods: 1999-2004 (Period 1), 2005-2010 (Period 2), 2011-2016 (Period 3), and 2017-2022 (Period 4). Age-adjusted death rates from stroke and IS decreased in both men and women, while those from HS remained unchanged. However, the age-adjusted incidence of stroke and IS in men and women decreased from Periods 1 to 2 but increased from Periods 2 to 4. In women, the age-adjusted incidence of HS increased from Periods 2 to 4, whereas in men, the incidence of HS remained unchanged. In both men and women, the age-adjusted death rate of MI decreased. In women, the age-adjusted incidence of MI decreased from Periods 1 to 4. The age-adjusted incidence of MI in men did not change over time. For both men and women during the 24 years of follow-up, the age-adjusted death rates from stroke and MI decreased from Periods 1 to 4; however, the age-adjusted incidences of stroke and IS increased from Periods 2 to 4.
The purpose of this study was to clarify the meaning of the use of type-B continuous employment support facilities by individuals with mental disabilities and to examine the factors that make their transition to general employment difficult based on previous studies. This study sought to obtain insight into the role of nurses in employment-related disability welfare services. A literature search was conducted using the web version of the Igaku Chuo Zasshi (Index Medicus of Japan) and Medical Online search system. Sentences describing the meaning of Type B continuous employment support facilities were extracted, and the resulting data were collected and categorized. Factors that made the transition to regular employment difficult were summarized descriptively based on the extracted data. The use of type-B continuous employment support facilities by those with mental disabilities meant the following: [awareness as a member of society], [increased sense of self-efficacy], [attempts to stabilize psychiatric symptoms], and [independence in daily living]. The following factors complicated the transition of individuals with mental disabilities to regular employment: they found illness management challenging because of their psychiatric symptoms, which caused difficulties in continuing to work. They also perceived their workplace environment negatively, complaining that their coworkers did not understand their psychiatric symptoms. Individuals with mental disabilities found meaning in utilizing B-type continuous employment support facilities beyond simply aiming for a transition to general employment. However, numerous factors complicate the transition to full employment. One is that individuals with mental disabilities find it challenging to manage their psychiatric symptoms. Hence, our findings suggest an increasing need for collaboration with nursing professionals and for providing high-level nursing care.
This study aimed to assess and compare the readability, understandability, and actionability of radiation-related health information targeting fetuses and children, as provided by Japanese-language web-based sources and AI chatbot-generated content. Furthermore, this study aimed to explore the potential of AI tools to improve access to health information in rural and underserved regions. We analyzed 40 publicly accessible Japanese webpages and 30 AI-generated texts produced by ChatGPT (paid and free versions), Copilot, and Gemini. Two prompt types were used: one at the standard reading level and the other at the 6th-grade reading level. Texts were evaluated using the Japanese version of the Patient Education Materials Assessment Tool for Printable Materials (PEMAT-P) to assess understandability and actionability, and jReadability to evaluate text complexity. At the standard level, 46.7% of the ChatGPT-4o texts and 78.6% of the Gemini texts achieved PEMAT-P scores ≥70. At the 6th-grade level, all AI-generated texts exceeded this threshold. The AI texts were consistently easier to read than the web-based materials. The paid version of ChatGPT-4o generated slightly more comprehensible text than its free counterpart. However, both AI and web content lack sufficient actionable elements and visual support. Among chatbots, Gemini produced the most user-friendly content, whereas Copilot exhibited notable limitations in terms of coherence and clarity. Even free AI chatbots can generate health information that is easy to read and understand when guided by well-designed prompts. These tools have the potential to reduce health information disparities, especially in rural areas or during disasters where access to professional medical consultations may be limited. Future studies should address the accuracy, reliability, and practical implementation of AI-generated content in real-world health communications.
Efforts have been made in Japan to transition individuals with mental disorders from inpatient medical care to community life. To promote the development of a community-based comprehensive care system that effectively addresses mental disorders, it is essential to clarify the issues from an individual's perspective. This study aimed to examine the perspectives of individuals with mental disorders who have experienced long-term hospitalization to support their continued life in the community from the viewpoint of personal recovery. A descriptive, qualitative study was conducted. Nine individuals with mental disabilities living in Japan were interviewed. The interviews were conducted between September 2021 and December 2023 using a semi-structured format guided by the interview protocol. The interview transcripts were analyzed using reflexive thematic analysis. Seven themes regarding future life were identified: "desire to live in one's own way", "realizing hopes and goals", "desire to connect with the society and others", "positive attitude toward the future", "concerns and preparations for one's own later life and that of one's family", "an uncertain future", and "improvement of physical symptoms". Eight themes associated with issues in community living were identified: "difficulty in controlling symptoms and self-management of medication", "impact of deteriorating health on daily life, employment, and studies", "social withdrawal and loss of connection with others", "excessive interference from family members and deterioration of relationships", "caring for elderly parents and their health issues", "lack of understanding and support from others", "difficulty in utilizing public support", and "sustainable housing and financial issues". Professionals must believe in the ability of individuals with mental disorders to achieve personal recovery and persistently support their choices and decisions. It is necessary to build a recovery-oriented and comprehensive community care system that responds to mental disorders based on the needs of community-dwelling patients.
OBJECTIVE: The Integrated Management of Childhood Illness (IMCI) strategy is designed to address the five leading causes of childhood mortality, which together account for 70% of the 10 million deaths occurring among children worldwide annually. Although IMCI is associated with improved quality of care, which is a key determinant of better health outcomes, it has not yet been widely adopted, partly because it is assumed to be more expensive than routine care. Here we report the cost of IMCI compared with routine care in four districts in the United Republic of Tanzania. METHODS: Total district costs of child care were estimated from the societal perspective as the sum of child health-care costs incurred in a district at the household level, primary health-facility level and hospital level. We also included administrative and support costs incurred by national and district administrations. The incremental cost of IMCI is the difference in costs of child health-care between districts with and without IMCI, after standardization for population size. FINDINGS: The annual cost per child of caring for children less than five years old in districts with IMCI was USD 11.19, 44% lower than the cost in the districts without IMCI (USD 16.09). Much of the difference was due to higher rates of hospitalization of children less than 5 years old in the districts without IMCI. Not all of this difference can be attributed to IMCI but even when differences in hospitalization rates are excluded, the cost per child was still 6% lower in IMCI districts. CONCLUSION: IMCI was not associated with higher costs than routine child health-care in the four study districts in the United Republic of Tanzania. Given the evidence of improved quality of care in the IMCI districts, the results suggest that cost should not be a barrier to the adoption and scaling up of IMCI.
The Glasgow Prognostic Score (GPS), Prognostic Nutritional Index (PNI), and Neutrophil-to-Lymphocyte Ratio (NLR) have been shown to predict the prognosis of various cancer types. However, the prognostic roles of GPS, PNI, and NLR in patients with extensive-stage small cell lung cancer (ES-SCLC) remain controversial. This study aimed to assess the prognostic value of these three immunonutritional indicators in patients with ES-SCLC. We retrospectively analyzed 102 ES-SCLC patients who received first-line platinum-doublet chemotherapy. The GPS, PNI, and NLR were assessed before the initiation of first-line chemotherapy. Based on previous reports, the optimal cut-off levels were 40 for PNI and 3 for NLR. The Kaplan-Meier method and Cox proportional hazards models were used to evaluate progression-free survival (PFS) and overall survival (OS). Of the total participants, 102 had ES-SCLC. Patients with a GPS of 0/1 showed significantly longer PFS than those with a GPS of 2 (133 vs. 63 days, P<0.001), and a high PNI was also associated with longer PFS (133 vs. 80 days, P=0.007). No significant difference in PFS was observed between the low and high NLR groups (P=0.471). Similarly, OS was significantly longer in patients with a GPS of 0/1 than in those with a GPS of 2 (300 vs. 117 days, P<0.001) and in those with a high PNI than in those with a low PNI (296 vs. 136 days, P<0.001). The OS did not differ significantly in the NLR group (P=0.303). Multivariate analyses revealed that the GPS and PNI were independently associated with worse PFS and OS. Our study demonstrated that both the GPS and PNI were significantly associated with PFS and OS in patients with ES-SCLC. The GPS may be a simple and reliable immunonutritional marker for predicting outcomes in patients with ES-SCLC treated with platinum doublet chemotherapy.
Objective: The majority of antiemetic administration for preventing aspiration in stroke patients is reported to occur after hospital admission. There are no reports on pre-hospital antiemetic administration or outcomes regarding stroke patients. Therefore, this retrospective study of stroke patients was conducted using data from the Japanese Society Aeromedical Services Registration System (JSAS-R). Material and Methods: Information on patients diagnosed with stroke was collected from the JSAS-R database, including age, sex, vital signs at the time of patient contact by helicopter staff at the rendezvous point, stroke type (cerebral ischemia, cerebral hemorrhage, or subarachnoid hemorrhage), medical interventions, and survival or death within one month. The exclusion criteria were cardiac arrest at emergency medical technician contact and unknown final outcome. Subjects were divided into two groups for each type of stroke, according to whether antiemetics were administered or not, and comparisons were made between the paired groups. Results: During the study period, 1,420 cerebral ischemia, 1,250 cerebral hemorrhage, and 445 subarachnoid hemorrhage cases were included. For cerebral ischemia, there was no association between antiemetic use and outcome. However, in cases of cerebral hemorrhage, the rate of tracheal intubation was lower and the survival rate higher for the antiemetic group than the non-antiemetic group. For subarachnoid hemorrhage, the antiemetic group was older, had a better level of consciousness, a lower rate of tracheal intubation, and a higher survival rate than the non-antiemetic group. Additional multivariate analysis of the subarachnoid hemorrhage group was conducted, but antiemetic treatment was not selected as an independent factor for survival. Conclusion: In the case of cerebral hemorrhage after stroke, pre-hospital antiemetic administration may contribute to an improved outcome.
OBJECTIVE: To document the prevalence, age-distribution, and risk factors for anaemia in Tanzanian children less than 5 years old, thereby assisting in the development of effective strategies for controlling anaemia. METHODS: Cluster sampling was used to identify 2417 households at random from four contiguous districts in south-eastern United Republic of Tanzania in mid-1999. Data on various social and medical parameters were collected and analysed. FINDINGS: Blood haemoglobin concentrations (Hb) were available for 1979 of the 2131 (93%) children identified and ranged from 1.7 to 18.6 g/dl. Overall, 87% (1722) of children had an Hb <11 g/dl, 39% (775) had an Hb <8 g/dl and 3% (65) had an Hb <5 g/dl. The highest prevalence of anaemia of all three levels was in children aged 6-11 months, of whom 10% (22/226) had an Hb <5 g/dl. However, the prevalence of anaemia was already high in children aged 1-5 months (85% had an Hb <11 g/dl, 42% had an Hb <8 g/dl, and 6% had an Hb <5 g/dl). Anaemia was usually asymptomatic and when symptoms arose they were nonspecific and rarely identified as a serious illness by the care provider. A recent history of treatment with antimalarials and iron was rare. Compliance with vaccinations delivered through the Expanded Programme of Immunization (EPI) was 82% and was not associated with risk of anaemia. CONCLUSION: Anaemia is extremely common in south-eastern United Republic of Tanzania, even in very young infants. Further implementation of the Integrated Management of Childhood Illness algorithm should improve the case management of anaemia. However, the asymptomatic nature of most episodes of anaemia highlights the need for preventive strategies. The EPI has good coverage of the target population and it may be an appropriate channel for delivering tools for controlling anaemia and malaria.
To elucidate the relationship between health-related quality of life (HRQOL) and all-cause mortality in O City, Ehime Prefecture, Japan, using the Basic Resident Registration data collected over a 13-year follow-up period. Using the Basic Resident Registration System, we analyzed data from 3,398 middle-aged Japanese participants (1,409 men and 1,989 women) who had completed a detailed lifestyle questionnaire and were followed until death, relocation, or survival between 2009 and 2022. HRQOL was measured using the Short Form-8 Health Survey (SF-8). Physical component summary (PCS) and mental component summary scores were derived from the eight SF-8 subscales. A Cox proportional hazards regression model was applied to examine the associations between HRQOL and all-cause mortality, adjusting for the following covariates: age, body mass index, elevated blood pressure/hypertension, dyslipidemia, prediabetes/diabetes, alcohol consumption, smoking, solitary living, and physical activity. A total of 317 deaths occurred during the 13-year follow-up period. After adjustment for nine covariates, a low PCS score (hazard ratio=1.51; 95% confidence interval: 1.05-2.15) in men was significantly associated with all-cause mortality. Among men, a low PCS score was significantly associated with all-cause mortality.
To report a rare case of a solitary juvenile polyp in the transverse colon causing hematochezia in an older patient. A 78-year-old woman presented with hematochezia. She denied experiencing abdominal pain and had no history of colonoscopy. Colonoscopy performed at a local hospital revealed a 12 mm pedunculated lesion in the transverse colon covered with fresh blood. The patient was then referred for further evaluation. After confirming the cessation of bleeding, the lesion was removed via endoscopic mucosal resection. Histopathological analysis was performed on the resected specimen. The lesion was successfully resected without complications. Histological examination revealed the typical features of juvenile polyps, including stromal expansion, edema, inflammatory cell infiltration, and crypt dilation without cytological atypia. The surgical margins were negative. The patient remained asymptomatic after the procedure and experienced no recurrence of bleeding. Juvenile polyps are typically found in children but can occasionally occur in older patients. This case underscores the importance of considering juvenile polyps in the differential diagnosis of lower gastrointestinal bleeding, regardless of patient age. Complete endoscopic and histopathological evaluation is essential for accurate diagnosis and appropriate management.
Objective: Hospital and obstetric unit closures in U.S. counties often lead to expansion of maternal healthcare deserts, defined as counties without a birth center offering obstetric care. This study describes the maternal demographic profile and geographic scarcity of obstetric care across the large and sparsely populated west Texas region. Materials and Methods: Aggregate population data are obtained from the U.S. Census and American Community Survey. Maternal healthcare centers for 107 counties across west Texas, defined here as public health regions 1, 2, 9, and 10, are identified using data from the Texas Collaborative for Healthy Mothers and Babies. Results: Across west Texas, 76 of 107 counties are maternal healthcare deserts, with no available obstetric care. Approximately 82,000 women of childbearing age live in these counties, with about 5,000 reporting having given birth in the past 12 months. Level II or higher obstetric care is available in just 12 (about 11%) of west Texas counties. Conclusion: A majority of rural counties across the large geographic area of west Texas lack labor and delivery services, leading expectant mothers to travel to neighboring counties for obstetric care, or further for high-risk care. Greater coordination between higher level maternal care centers and rural hospitals and providers, as well as telehealth and community health worker outreach, may provide some level of connection to obstetric services for women in rural areas.
Objective: The Hyodo scoring system, applied during flexible endoscopic evaluation of swallowing (FEES), has been proposed as a useful tool for assessing oral intake. However, patients hospitalized with aspiration pneumonia often present with severe dysphagia, making it difficult to advance their diets even when their Hyodo scores are relatively good. This study aimed to evaluate the ability of the Hyodo score to predict swallowing function outcomes in patients with aspiration pneumonia. Methods: FEES was performed in patients with aspiration pneumonia. The relationship between the Hyodo score and swallowing function at discharge was analyzed. Results: A total of 57 patients with aspiration pneumonia were included. At the time of discharge, 9 of 11 patients (82%) with scores below than 5, 15 of 29 patients (52%) with scores between 5 and 8, and 3 of 17 patients (18%) with scores above 8 were able to consume pureed diets. Conclusion: The Hyodo score appears to be a useful indicator for predicting swallowing function and dietary status at discharge among patients with aspiration pneumonia.
Objective: As more women continue their careers, health support throughout their life has become crucial. Menopausal symptoms, influenced by hormonal shifts and complex social roles, often lead to reduced work performance and even job attrition among working women. This study aimed to identify the physical, psychological, and social health challenges faced by working women during menopause and the underlying factors for the same. Our goal was to provide foundational insights to enable development of effective support strategies. Patients and Methods: We recruited 20 working women aged 37-67 years, primarily care workers, a profession with a high proportion of female employees. The participants were selected using snowball sampling. Semi-structured interviews were conducted with 3 to 6 participants per group. Each session lasted approximately 60 minutes and took place through direct meetings using social networking service chat functions. The collected data were analyzed using qualitative content analysis. Results: Physical health challenges included fatigue, decreased concentration, and emotional fluctuations; these non-specific symptoms were often difficult for individuals to recognize. From a psychological perspective, anxiety about ageing and reduced self-esteem have been identified as hindering women's self-acceptance of menopause. Socially, the taboos surrounding menopause and feelings of workplace isolation are evident, acting as barriers to appropriate workplace support. The findings indicated that an unsupportive workplace environment and lack of social support further exacerbated these menopausal health problems. Conclusion: Supporting working women during menopause requires a comprehensive approach that addresses physical, psychological, and social aspects. Key priorities include disseminating accurate information, promoting women's self-acceptance, and establishing supportive systems within the workplace.