Prostate Cancer Care in Rural Primary Care Contexts: A Narrative Review.

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.

Factors Affecting Recurrent Staphylococcus aureus Bacteremia Among Older Patients in Rural Community Hospitals: A Retrospective Cohort Study.

Introduction Staphylococcus 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. Methods A 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. Results Among 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. Conclusion This 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.

Persistent Fever in an Elderly Patient: Diagnostic Challenges and Management of Aspiration Pneumonitis and Organizing Pneumonia.

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.

Challenges in Managing External Dental Fistula in an Immunocompromised Elderly Patient: A Case Report.

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.

Aspiration as an Initial Symptom of Early-Stage Esophageal Cancer: A Case Report.

This case report discusses a rare presentation of esophageal adenocarcinoma located in the upper part of the esophagus in a 74-year-old male, where the sole initial symptom was silent aspiration. The absence of typical symptoms such as dysphagia or respiratory issues delayed the diagnosis of esophageal cancer. However, subsequent investigations, including endoscopy, revealed adenocarcinoma in the upper esophagus. This case underscores the importance of considering esophageal cancer in differential diagnoses when unexplained aspiration occurs, even in the absence of common symptoms, and highlights the critical need for early detection to improve patient outcomes.

Recurrence of Sigmoid Volvulus Associated With Constipation: A Retrospective Cohort Study.

Introduction Sigmoid 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. Methods A 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. Results Of 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. Conclusion Constipation 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.

Deepening the Understanding of Inflammatory Conditions Through Rheumatology Education in Family Medicine: An Autoethnography.

Introduction Rheumatic 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. Methods Using 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. Results Three 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. Conclusion The 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.

Polymyalgia Rheumatica Complicated by Nephrotic Syndrome in a Nonagenarian: A Case Report.

This case report describes a 91-year-old bedridden man with a complex medical history who presented with fever and low oxygen saturation, suspected to be aspiration pneumonia. Further investigation revealed nephrotic syndrome, microscopic hematuria, and joint pain. The diagnosis of polymyalgia rheumatica (PMR) was considered due to the presence of characteristic symptoms and elevated inflammatory markers despite the inability to perform a kidney biopsy. The patient was treated with low-dose prednisolone (PSL), leading to significant improvement in joint pain, renal function, and overall condition. This case highlights the importance of considering PMR in elderly patients with unexplained nephrotic syndrome and systemic inflammation. Early diagnosis and corticosteroid treatment can improve clinical outcomes and enhance activities of daily living. This report underscores the need for awareness of PMR as a potential cause of nephrotic syndrome in the elderly and the effectiveness of PSL in managing such cases.

Community Health Dialogue Implementation for the Solution of Loneliness in Rural Communities: Autoethnography.

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.

The effect of management of older patients with heart failure by general physicians on mortality and hospitalization rates: a retrospective cohort study.

BACKGROUND: The prevalence of heart failure is increasing owing to the aging of the population, resulting in growing medical costs and an increasing number of patients with multimorbidity. The optimal management of heart failure by general physicians in addition to internal medicine physicians, such as cardiologists, is essential, although the specifics are unclear. In this study, we aimed to determine the differences in heart failure management outcomes among older patients between those managed by general physicians and those managed by internal medicine physicians, especially in terms of hospitalization and mortality rates. METHODS: This was a retrospective cohort study of patients with heart failure who visited a community hospital in Japan. Patients with heart failure were selected based on International Classification of Diseases codes from electronic medical record data over 9 years, from September 2015 to August 2023. The independent variables were whether a general physician treated the patient; the primary outcome was death; the secondary outcome was hospitalization; and the covariates were patient background, including comorbidities. Multiple logistic regression analysis was used to evaluate the association between being managed by a general physician and death and hospitalization, after adjusting for confounding factors. RESULTS: A total of 1032 patients with heart failure were identified, with a mean age of 82.4 years, and 48.9% were men. Patients treated by general physicians were older, were more likely to have dementia and were more likely to need care than those treated by internal medicine physicians. Being treated by a general physician was significantly negatively associated with death (odds ratio [OR], 0.62) and hospitalization (OR, 0.73). CONCLUSIONS: In Japan, where medical specialties are increasingly differentiated, the comprehensive management of older patients with heart failure and multiple comorbidities by general physicians may reduce hospitalization and mortality rates. Appropriate education of general physicians and an increase in their numbers may prove essential for the successful management of patients with heart failure in aging communities.

The Relationship Between Hyperalbuminemia and Unscheduled Medical Visits: A Retrospective Cohort Study.

Introduction Hyperalbuminemia, defined as elevated serum albumin levels, may influence healthcare utilization, particularly unscheduled medical visits. The sympathetic nervous system (SNS) regulates serum albumin, which is crucial for maintaining oncotic pressure and substance transport. SNS instability, linked to chronic diseases, can impact albumin levels. This study investigates the association between hyperalbuminemia and unscheduled medical visits in community hospital outpatient departments, aiming to establish its potential as a predictor of healthcare utilization. Methods This retrospective cohort study utilized electronic medical records from Unnan City Hospital, Japan, from September 2021 to August 2023. Participants were over 15 years old and had albumin data available, excluding those with acute albumin conditions. The case group consisted of 321 hyperalbuminemia patients (serum albumin ≥ 5 g/dL), matched monthly with 16 controls. Data on demographics, chronic diseases, and unscheduled medical visits were collected. Multivariate logistic regression analyzed the association between hyperalbuminemia and unscheduled medical visits. Results Among 716 participants, the hyperalbuminemia group (mean age 59.13 years) was younger than the non-hyperalbuminemia group (mean age 74.36 years). Hyperalbuminemia patients had a higher BMI, pulse rate, and prevalence of diabetes, dyslipidemia, and brain stroke. Significant associations were found between hyperalbuminemia and unscheduled medical visits (OR 2.35, 95% CI 1.56-3.53, p < 0.001), age, BMI, pulse rate, and brain stroke. Conclusion Hyperalbuminemia is significantly associated with increased unscheduled medical visits in rural outpatient settings. Routine serum albumin assessments can aid in risk stratification and personalized care, potentially reducing acute healthcare needs. Future research should explore underlying mechanisms and broader populations to enhance clinical applications.

Evolution of the roles of family physicians through collaboration with rehabilitation therapists in rural community hospitals: a grounded theory approach.

BACKGROUND: The role of rural family physicians continues to evolve to accommodate the comprehensive care needs of aging societies. For older individuals in rural areas, rehabilitation is vital to ensure that they can continue to perform activities of daily living. In this population, a smooth discharge following periods of hospitalization is essential and requires management of multimorbidity, and rehabilitation therapists may require support from family physicians to achieve optimal outcomes. Therefore, this study aimed to investigate changes in the roles of rural family physicians in patient rehabilitation. METHODS: An ethnographic analysis was conducted with rural family physicians and rehabilitation therapists at a rural Japanese hospital. A constructivist grounded theory approach was applied as a qualitative research method. Data were collected from the participants via field notes and semi-structured interviews. RESULTS: Using a grounded theory approach, the following three themes were developed regarding the establishment of effective interprofessional collaboration between family physicians and therapists in the rehabilitation of older patients in rural communities: 1) establishment of mutual understanding and the perception of psychological safety; 2) improvement of relationships between healthcare professionals and their patients; and 3) creation of new roles in rural family medicine to meet evolving needs. CONCLUSION: Ensuring continual dialogue between family medicine and rehabilitation departments helped to establish understanding, enhance knowledge, and heighten mutual respect among healthcare workers, making the work more enjoyable. Continuous collaboration between departments also improved relationships between professionals and their patients, establishing trust in collaborative treatment paradigms and supporting patient-centered approaches to family medicine. Within this framework, understanding the capabilities of family physicians can lead to the establishment of new roles for them in rural hospitals. Family medicine plays a vital role in geriatric care in community hospitals, especially in rural primary care settings. The role of family medicine in hospitals should be investigated in other settings to improve geriatric care and promote mutual learning and improvement among healthcare professionals.

Perceptions of C-reactive Protein Measurement Among General Physicians: A Qualitative Study on Diagnostic Value, Clinical Dilemmas, and Professional Growth.

Introduction C-reactive protein (CRP) is a widely used laboratory test for assessing infections, inflammatory diseases, and malignancies, playing a critical role in clinical diagnosis and management. Despite its utility, CRP measurement practices vary among physicians, often influenced by training and clinical experience. This study explores general physicians' perceptions of CRP measurement in clinical practice, focusing on its diagnostic value, associated dilemmas, and impact on clinical growth and decision-making. Methods This qualitative study employed thematic analysis to examine the perceptions of general physicians at Unnan City Hospital, Unnan, Japan regarding CRP measurement. Sixteen general physicians were selected through purposive sampling and participated in one-on-one semi-structured interviews. The interviews were conducted in Japanese, recorded, transcribed verbatim, and analyzed inductively to identify themes. The analysis involved iterative coding and extensive discussion among the research team to ensure the reliability and validity of the findings. Results Three main themes emerged from the analysis: the usefulness of CRP for diagnosis and collaboration, dilemmas associated with CRP usage, and clinical growth through reconsideration of CRP's importance. Physicians highlighted CRP's value in distinguishing inflammatory from non-inflammatory diseases, predicting clinical courses, and facilitating communication with specialists. However, dilemmas arose from discrepancies between CRP levels and clinical symptoms, the influence of various non-specific factors, and habitual testing driven by training, leading to unnecessary tests and diminished clinical skills. Participants recognized the need to view CRP as one of many diagnostic tools, cultivate a habit of questioning its necessity, and reflect on its use to enhance clinical reasoning and professional growth. Conclusions CRP measurement is a valuable diagnostic tool, but effective use requires a balanced and critical approach. Discrepancies between CRP levels and clinical symptoms can lead to over-reliance on laboratory results and unnecessary testing. General physicians should integrate CRP within a broader diagnostic framework, combining it with patient history, physical examination, and other tests. Reflecting on the necessity and implications of CRP measurements can improve clinical reasoning and decision-making, ultimately enhancing patient care and resource management. Future research should explore similar perceptions in diverse healthcare settings and develop strategies to optimize CRP use in clinical practice.

Association Between Pneumococcal Vaccination Uptake and Loneliness Among Regular Patients in Rural Community Hospitals: A Cross-Sectional Study.

Introduction Vaccination is essential for preventing infectious diseases such as pneumonia and seasonal viral infections. The COVID-19 pandemic has underscored the critical role of vaccination in public health. However, vaccination uptake can be influenced by biopsychosocial conditions. Immunocompromised individuals, for instance, face restrictions with live vaccines, and psychosocial factors like loneliness can negatively impact attitudes towards vaccination. This study aims to clarify the association between loneliness and pneumococcal vaccination rate among regular patients in a rural Japanese community. Method A cross-sectional study was conducted at Unnan City Hospital in Unnan City, a rural area in southeastern Shimane Prefecture, Japan. Participants included patients over 40 who regularly visited the general medicine department between September 1, 2023, and November 31, 2023. Data on vaccination rates for pneumococcal pneumonia and loneliness levels assessed using the Japanese version of the three-item University of California, Los Angeles (UCLA) Loneliness Scale were collected. Additional data on demographics, BMI, renal function, and comorbidities were extracted from electronic medical records. Statistical analyses were performed to identify factors associated with vaccination rates, including univariate and multivariate logistic regression. Results Out of 1,024 eligible patients, 647 participated in the study. Participants with higher loneliness had significantly lower vaccination rates for pneumococcal pneumonia (22.3% vs. 34.2%, p = 0.001). The multivariate logistic regression model showed that higher loneliness was significantly associated with lower vaccination likelihood (odds ratio (OR) = 0.54, 95% CI = 0.37-0.78, p = 0.0011). Age was positively associated with vaccination (OR = 1.08, 95% CI = 1.06-1.11, p < 0.001), whereas higher comorbidity scores (Charlson Comorbidity Index (CCI) ≥ 5) and frequent healthy eating practices were associated with lower vaccination rates. Conclusion This study demonstrates a significant association between higher loneliness levels and lower pneumococcal vaccination rates among patients in a rural Japanese community. Addressing psychosocial barriers such as loneliness could enhance vaccination uptake. Public health interventions focused on reducing loneliness and enhancing social support are essential to improving vaccination rates and preventing infectious diseases. Further research should explore the causal mechanisms and develop targeted strategies to mitigate the impact of loneliness on health behaviors.

The Quality of Family Medicine Team Conferences Through the Lens of a Director: An Autoethnography.

Introduction In rural medical settings, team conferences are essential for effective patient care, especially given the challenges of limited resources and personnel. These conferences promote collaborative discussions on patient management and serve as vital educational sessions. This study explores the dynamics and efficacy of team conferences in the family medicine department of a rural hospital to optimize patient care and educational outcomes. Methods This qualitative study used autoethnography at Unnan City Hospital, Unnan, Japan. Data collection included semi-structured interviews, direct observation, reflective field notes, and informal conversations with medical students, junior residents, and general medicine trainees. The focus was on conference interactions, educational content, and operational challenges. Data analysis involved coding and theming, with ongoing discussions among researchers and participants to refine findings. Results Three key themes emerged. First, patient outcomes suffered from a lack of professional awareness. Second, mutual understanding and individual autonomy enhanced team quality. Third, team healthcare quality improved through diverse and inclusive learning experiences. Effective facilitation, structured time management, and integrating practical bedside learning with theoretical discussions were crucial for optimizing team conferences. Psychological safety, respect for individual differences, and maintaining motivation were essential for productive team interactions. Conclusion The study highlights the importance of effective facilitation, time management, and integrating practical and theoretical learning in enhancing team conferences in rural medical settings. Psychological safety and mutual respect are vital for fostering a collaborative and motivated team environment. Addressing these factors can improve patient care and educational experiences. Future research should include diverse settings and quantitative measures to validate and refine these insights, enhancing team conferences in rural healthcare environments.

Extended Follow-Up and Analysis of Non-secretory IgG-Type Multiple Myeloma in a Patient With Fibromyalgia: A Case Report.

Fibromyalgia (FM) presents a diagnostic challenge due to its complex symptoms and lack of definitive tests. This study discusses a 54-year-old female initially diagnosed with FM, characterized by widespread pain, fatigue, and tender points. Despite treatment, she developed elevated C-reactive protein (CRP) and anemia after two years, leading to further investigations. These tests revealed non-secretory multiple myeloma, underscoring the importance of vigilant monitoring in FM patients. This case highlights the need for regular CRP measurements and thorough follow-up to detect underlying conditions. Early detection and appropriate intervention are crucial in managing FM and improving patient outcomes.

The Association Between the Frequency of Agriculture and Control of Chronic Diseases Among Regular Patients in Rural Community Hospitals: A Cross-Sectional Study.

Introduction The importance of exercise in chronic disease management among older people is paramount, especially as the global population ages and the prevalence of chronic diseases such as cardiovascular disease, diabetes, and arthritis increases. Regular physical activity enhances cardiovascular health, improves metabolic function, and alleviates symptoms of musculoskeletal disorders. As a form of exercise, agriculture provides physical and mental benefits for older adults. However, its impact on chronic disease management can be mixed, as the physical demands and potential stress associated with agricultural tasks can exacerbate certain health conditions. Method This cross-sectional study was conducted in Unnan City, a rural area in Japan, focusing on residents aged 40 and older who regularly visited Unnan City Hospital. Data were collected from 647 participants between September 1, 2023, and November 31, 2023, through questionnaires and electronic medical records. The primary outcome was the management of chronic diseases, assessed through hypertension, dyslipidemia, diabetes mellitus, and obesity control. Participants reported their frequency of agricultural activities, exercise, eating habits, and sleep. Statistical analyses included t-tests, Mann-Whitney U tests, and multivariate logistic regression models. Results Participants engaging frequently in agricultural activities were younger, had better hypertension control, and reported healthier eating habits and sleep patterns. Frequent agricultural activities were associated with a lower likelihood of hypertension (OR: 0.62, 95% CI: 0.39-0.97, p = 0.034). Older age (≥75 years), higher BMI (≥25), and a Charlson comorbidity index (CCI) score of ≥5 were significantly associated with hypertension. No significant associations were found between hypertension and other health-related variables such as healthy eating, adequate sleep, and regular exercise. Conclusion The study highlights the potential benefits of agricultural activities in managing chronic diseases, particularly hypertension, among older adults. However, the physical demands and possible social isolation associated with agricultural tasks require a nuanced approach to promoting these activities. Tailored, community-based agricultural programs that foster social interaction and support can enhance physical and mental health benefits. Future research should focus on longitudinal studies to confirm these findings and explore the long-term health outcomes of agricultural activities in diverse contexts.

Anti-neutrophil Cytoplasmic Antibody-Negative Rapid Progressive Glomerulonephritis With Mild Pathological Presentation in an Older Patient: A Case Report.

This case report discusses the management of anti-neutrophil cytoplasmic antibodies (ANCA)-negative rapid progressive glomerulonephritis (RPGN) in a 68-year-old man with a complex medical history, presenting with fatigue, edema, and acute renal failure. Despite the absence of positive biomarkers for specific RPGN types, the clinical progression suggested microscopic polyangiitis, leading to intensive immunosuppressive therapy with cyclophosphamide and rituximab. The patient's condition was further complicated by the coexistence of nephritic and nephrotic syndromes, requiring nuanced management strategies, including prolonged hemodialysis. After initial treatment failure, remission was eventually achieved, allowing cessation of dialysis and significant recovery of renal function. This case highlights the challenges of diagnosing and managing ANCA-negative RPGN, particularly the importance of a tailored, dynamic approach to treatment in resource-limited settings. The recovery observed underscores the potential for renal function improvement even after prolonged periods of intensive therapy, reinforcing the need for persistence and adaptability in managing complex RPGN cases.

Chronic and Acute Drug-Induced Hypersensitivity Syndrome in a Rural Patient With Cytomegalovirus Infection: A Case Report.

A 50-year-old man presented with fever and a generalized rash, with chronic fatigue and lymphadenopathy for a year and a half. Initial tests ruled out lymphoproliferative disorders, showing reactive hyperplasia and cytomegalovirus. Symptoms worsened after ampicillin treatment, leading to suspected drug-induced hypersensitivity syndrome (DIHS). Upon admission, amoxicillin was discontinued, and prednisolone and antiviral treatment were initiated. The patient's condition improved with this therapy. A drug-induced lymphocyte stimulation test confirmed hypersensitivity to both ampicillin and allopurinol. This case illustrates the diagnostic challenge of chronic and acute DIHS because of the rare presentation. It underscores the need for high suspicion of DIHS in patients with chronic lymphadenopathy and fatigue, particularly with recent drug exposure. Effective management involves recognizing symptoms, withdrawing the offending drug, and using corticosteroids. Viral infections like cytomegalovirus can complicate DIHS diagnosis and treatment, necessitating a comprehensive approach. This case highlights the importance of considering DIHS in differential diagnoses and the complexities of managing it alongside co-infections in rural healthcare settings.

Linking Agricultural Activity Frequency to Loneliness in Rural Hospital Patients: A Cross-Sectional Study.

Introduction Agriculture is deeply woven into the fabric of rural life, influencing the economy, and the social and health dynamics of rural communities. While it offers physical and mental health benefits through regular physical activity and interaction with nature, the solitary nature of farming activities may also lead to social isolation. This study explores the complex relationship between the frequency of agricultural engagement and feelings of loneliness among rural inhabitants with chronic diseases, addressing a gap in the literature concerning the impact of agricultural practices on social well-being. Method A cross-sectional analysis was conducted among patients over 40 who frequented the general medicine department in Unnan City, a rural area of Japan. The study utilized the Japanese version of the University of California, Los Angeles (UCLA) Loneliness Scale to assess loneliness and collected data on agricultural activity frequency through questionnaires. Multivariate logistic regression analyses examined the association between agricultural activities and loneliness, controlling for demographic and health-related variables. Results Among 647 participants, higher frequencies of agricultural activities were significantly associated with increased loneliness, especially for individuals engaging in agriculture four to five times weekly or daily. Engaging in agricultural activities four to five times weekly and daily significantly increased the likelihood of higher loneliness levels, with odds ratios (OR) of 1.80 (p = 0.039) and 2.47 (p < 0.01), respectively, when compared to engagement less than once a week. Age emerged as an influential factor, with individuals aged 75 and older showing increased odds of experiencing higher loneliness (OR 1.56, p = 0.025). Conclusion The study underscores the dual nature of agricultural engagement in rural communities, highlighting its role in both supporting physical health and contributing to social isolation. These findings advocate for developing targeted interventions that mitigate loneliness among rural populations, suggesting the need for a balanced approach that encompasses social and healthcare strategies to enhance the overall well-being of individuals engaged in agriculture.