Background In the home medical care setting, the factors causing emergency home visits (EHV) remain unclear. This study aimed to determine those factors and examine their relationship with EHV requests. Methods This is a single‐center retrospective observational study from data obtained from a home medical care clinic. We assessed the association between frequency of EHV and age, gender, level of care‐needed, cancer, and medical device in use with using Poisson regression analysis. Results A total of 608 EHV in 214 patients were analyzed. Common chief complaints were fever, death, and dyspnea. As factors that affect frequency of EHV because of fever, higher care‐needed level (RR: 3.35; 95% CI: 1.95‐5.74, P < .001), urinary catheter use (RR: 1.94; 95% CI: 1.22‐3.08, P = .005), and central venous port use (RR: 2.39; 95% CI: 1.44‐3.96, P = .001) showed significant correlation. Regarding EHV because of dyspnea, lung tumor (RR: 2.71; 95% CI: 1.26‐5.84, P = .011) and home oxygen use (RR: 3.96; 95% CI: 2.05‐7.68, P < .001) showed significant correlation. Regarding EHV because of all chief complaints, higher care‐needed level (RR: 1.59; 95% CI: 1.12‐2.26, P = .009), urinary catheter use (RR: 1.78; 95% CI: 1.13‐2.93, P = .014), and central venous port use (RR: 1.75; 95% CI: 1.04‐2.93, P = .034) showed positive correlation. Conclusion The factors associated with frequency of EHV because of fever or all chief complaints were urinary catheter use, central venous port use, and higher care‐needed level. As for dyspnea, they were lung cancer and home oxygen use. Our study suggests that the burdens on medical staffs, patients, and their families can be reduced through recognizing these risk factors.

On remote islands, interprofessional collaboration is essential to support older adults who live at home, despite the limited number of healthcare professionals (HCPs). Therefore, it is important for HCPs to collect and share information about older adults with health problems. This study aimed to clarify how rural HCPs collaborate using limited resources to support older adults in remote islands. We conducted semi-structured interviews with 10 healthcare providers for older adults on Zamami Island of Okinawa, Japan. We performed a qualitative analysis using the steps for coding and theorization method. Four themes were extracted: “Collection and communication of information between residents”, “Communication of information from non-HCPs to HCPs”, “Sharing of information between HCPs”, and “HCPs taking action to initiate their approach”. Islanders take care of each other and know each other’s health status, while HCPs gather their health information. When necessary, HCPs on the island gain essential information regarding older adult patients from islanders not only through work, but also through personal interactions. Afterward, HCPs approach older adults who need health care. The human connections on this remote island serve as social capital and enable flexibility in both gathering information and seamless communication among islanders who also serve as informal resources that contribute support for older adults.

ObjectivesThe rate of admissions for ambulatory care sensitive conditions (ACSCs) is a key outcome indicator for primary care, and patient experience (PX) is a crucial process indicator. Studies have reported higher rates of admission for ACSCs in rural areas than in urban areas. Whether there is an association between admissions for ACSCs and PX in rural areas has not been examined. This study aimed to document admissions for ACSCs on Japanese rural islands, and assess whether there was an association between the rate of admissions for ACSCs and PX.DesignMulticentred, prospective, cohort studySettingThis study was conducted on five rural islands in Okinawa, Japan.ParticipantsThe study participants were all island inhabitants aged 65 years or older.Primary outcome measuresThis study examined the association between ACSCs and PX assessed by a questionnaire, the Japanese Version of Primary Care Assessment Tool. ACSCs were classified using the International Classification of Diseases, Tenth Revision, and the rate of admissions for ACSCs in 1 year.ResultsOf 1258 residents, 740 completed the questionnaire. This study documented 38 admissions for ACSCs (29 patients, males/females: 15/14, median age 81.9) that included congestive heart failure (11), pneumonia (7) and influenza (5). After adjusting for covariates and geographical clustering, admissions for ACSCs had a significant positive association with each patient’s PX scores (OR per 1 SD increase=1.62, 95% CI 1.02–2.61).ConclusionsPhysicians serving rural areas need to stress the importance of preventive interventions for heart failure, pneumonia and influenza to reduce the number of admissions for ACSCs. Contrary to previous studies, our findings might be explained by close patient–doctor relationships on the rural islands.

Silicification, in the lithological record of the Colombian Upper Cretaceous, is present in certain lithostratigraphic units of the sedimentary basins of the Magdalena river valley and the eastern mountain range, such as the Lidita Superior, Lidita Inferior, Plaeners, Frontera and La Luna formations. From these, samples were taken at the levels with silicification and subsequently analyzed with petrographic techniques (optical microscopy, cathodoluminescence and scanning electron microscopy) and lithogeochemicals (X-ray diffraction, X-ray fluorescence and energy dispersive spectrometry) that allowed to characterize its geochemical and textural properties. To classify the collected samples more assertively, a table was proposed that relates their textural characteristics with their silica percentage, which, in turn, is directly linked to the degree of silicification. From this classification, the observations and the data acquired, it was determined that the cherts framed within the shallow calcareous sedimentary context of the Colombian Cretaceous, originated immediately after the deposit of the sediment, under an early diagenetic mechanism that includes the interaction of organic matter with aerobic and anaerobic bacteria, which modify the thermodynamic conditions of equilibrium in the first few meters of the sediment, facilitating the precipitation of silica polymorphs. In this vein, it is suggested that the most likely source of precipitated silica in these rocks is from the marine environment, where dissolved silicon polymers and ions take advantage of the sedimentary permeability and reach microbial areas with ideal geochemical conditions for the nucleation of silica, and in this way, cement and replace the original components of the sediment.

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