Inappropriate use of emergency ambulance services and the implications for primary health care in Japan

The number and per-capita emergency transports by public ambulancesand the percentage of transports of patients with non-emergencyconditions has been increasing in Japan, especially in urbanareas. Public ambulance services are, of course, essential fortransporting patients with crucial health problems. However,inappropriate ambulance use by patients who do not need emergencytreatment, but who need primary health care, means that thesepatients cannot get suitable health care, and diminishes theeffectiveness and efficiency of emergency medical-care servicesystems. The purposes of this study were to identify the factorsrelating to usage of public ambulance services in urban areas,to determine how to make these services more effective and moreefficient, and to discuss how to provide primary health-careservices so as to reduce the inappropriate use of public ambulanceservices. We investigated the accessibility of primary health-careservices, the characteristics of public ambulance service utilization,and the potential needs of the elderly for emergency-care servicesin two Tokyo wards: Edogawa andSetagaya. There were less healthresources, such as clinics, hospital beds and physicians, percapita in Edogawa than in Setagaya. Both the percentage of ambulancetransports of patients suffering from mild problems and thepercentage of ambulance transports on Sundays were higher inEdogawa than in Setagaya. Our survey showed that the percentagesof the elderly who would call for ambulances for each of threespecific health problems (fever, chest pain and ankle sprain)were all higher in Edogawa than in Setagaya. In both wards,elderly people living with their children and/or grandchildrenwere more likely to choose different health resources accordingto the specific problem being experienced than were elderlypeople living with other aged persons but without young people.The insufficient development of primary healthcare resourcesand systems increased the inappropriate use of high-cost emergencyambulance services by the elderly living in urban areas, wherefamily support is weakening. Health systems therefore need tobe reoriented so as to enhance accessibility to primary healthcareservices.     

The Coordination of Gastrointestinal Hormones and the Autonomic Nerves

We have conducted investigations on the relatinship between gastro-intestinal hormones and the autonomic nervous system. In this paper are described main themes of our investigations where a close association between gastrointestinal hormones and the autonomic nervous system was shown from the functional and morphological points of view.
The "nervism" proposed by Pavlov, where the regulation of various organs in the body was thought to be accomplished wholly by the nervous system was based on the findings on the physiology of the digestive glands. In the meantime, the discovery of secretin from the duodenal mucosa led Bayliss and Starling to propose a chemical co-ordination or a humoral regulatory mechanism in additioin to the nervous system for the regulation of the various organs in the body. It is indeed surprising that the principle of two major regulatory mechanisms in the body was thus developed originally on the basic studies of the exocrine and body was thus developed orginally on the basic studies of the exocrine and endocrine funtion of the digestive system.
Our investigations reported in this paper disclosed the fact that the neural and humoral regulatory mechanisms for gastrointestinal secretions acted not separately but in close association both morphologically and functionally.