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Determinants of polydoctoring among multimorbid older adults; a cross-sectional study in an urban area of Japan 在日本城市地区开展的一项横断面研究:多病老年人多病就医的决定因素
IF 1.8 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-09-08 DOI: 10.1002/jgf2.728
Takayuki Ando MD, MPH, Takashi Sasaki PhD, Yukiko Abe BA, Yoshinori Nishimoto MD, PhD, Takumi Hirata MD, MPH, PhD, Junji Haruta MD, PhD, Yasumichi Arai MD, PhD

Background

Multimorbidity increases with age, leading to various adverse outcomes, including higher mortality, care dependency, hospitalizations, and healthcare costs. Polydoctoring, managing a patient with multimorbidity by multiple healthcare providers, can be a risk of fragmented care and increased healthcare expenditures. This study aims to identify patient-related factors contributing to polydoctoring in older adults with multimorbidity.

Methods

This study is a cross-sectional study using baseline data from the Kawasaki Aging and Wellbeing Project. Participants were residents of Kawasaki City aged 85–89 years, without disability in basic activities of daily living, and being able to visit study site. The regularly visited facilities (RVF) index was employed to quantify polydoctoring. Polydoctoring was defined as having two or more RVFs. Poisson regression analysis was conducted to assess the association between polydoctoring and patient demographics, including types of chronic conditions and socioeconomic factors.

Results

A total of, 968 participants with multimorbidity were analyzed. Increased RVF was significantly associated with eye diseases (rate ratio [RR] 1.27, 95% confidence interval [CI] 1.12–1.44), osteoporosis (RR 1.22, 95% CI 1.08–1.38), prostate diseases (RR 1.22, 95% CI 1.07–1.40), and osteoarthritis (RR 1.16, 95% CI 1.05–1.27). No significant correlation was found with educational status or financial hardship.

Conclusion

The study indicated that certain chronic conditions are linked to increased polydoctoring among multimorbid older adults in Japan. However, most of those conditions are considered to be within a scope of family medicine/general practice. Training general practitioners to manage these conditions could reduce healthcare costs and the treatment burden, indicating a direction for future healthcare policy and medical education.

背景 多重疾病随着年龄的增长而增加,导致各种不良后果,包括更高的死亡率、护理依赖性、住院率和医疗费用。多病同治是指由多个医疗服务提供者对患有多病的患者进行管理,这可能会导致护理分散和医疗费用增加。本研究旨在确定导致患有多种疾病的老年人接受多科治疗的患者相关因素。 方法 本研究是一项横断面研究,使用的基线数据来自川崎老龄化与幸福项目。参与者为川崎市的居民,年龄在 85-89 岁之间,没有基本日常生活障碍,能够前往研究地点。定期访问设施(RVF)指数用于量化多门诊情况。拥有两个或两个以上经常光顾的设施即为多科性。研究人员进行了泊松回归分析,以评估多科性与患者人口统计学特征(包括慢性病类型和社会经济因素)之间的关联。 结果 共分析了 968 名患有多种疾病的参与者。RVF的增加与眼部疾病(比率[RR] 1.27,95%置信区间[CI] 1.12-1.44)、骨质疏松症(RR 1.22,95%置信区间[CI] 1.08-1.38)、前列腺疾病(RR 1.22,95%置信区间[CI] 1.07-1.40)和骨关节炎(RR 1.16,95%置信区间[CI] 1.05-1.27)明显相关。与教育状况或经济困难无明显相关性。 结论 该研究表明,某些慢性病与日本多病老年人多科性增加有关。然而,这些疾病大多被认为属于家庭医学/全科医学的范畴。培训全科医生管理这些疾病可以降低医疗成本和治疗负担,为未来的医疗政策和医学教育指明了方向。
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引用次数: 0
Empagliflozin add-on therapy is superior to metformin monotherapy in diabetic patients with NAFLD: An open-label, single-center, pilot clinical trial 在非酒精性脂肪肝糖尿病患者中,恩格列净附加疗法优于二甲双胍单药疗法:一项开放标签、单中心试点临床试验
IF 1.8 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-09-08 DOI: 10.1002/jgf2.723
Ayda Esmaeili PharmD, Reza Pourahmad Azar MD, Mohammadreza Mohammad Hosseiniazar MD, Laya Hooshmand Gharabagh MD

Background

The prevalence of non-alcoholic fatty liver disease (NAFLD), which is characterized by hepatic steatosis, inflammation, and advanced fibrosis, is high among type-2 diabetes mellitus (T2DM) patients. Empagliflozin (EMPA), a sodium-glucose cotransporter-2 inhibitor, has been well established to improve glycemic status in T2DM. However, evidence of the desirable effects of EMPA, when added to the standard treatment in diabetics with coexisting NAFLD, has yet to be determined.

Objective

The main objective of the current study is to explore the benefits of EMPA on hepatic fat content in patients with T2DM and NAFLD, who received metformin (MET) monotherapy.

Methods

In this open-label clinical trial study, 60 patients with T2DM and NAFLD were assigned to either the MET + EMPA or MET group in an up-titrated manner for 24 weeks. Anthropometric characteristics, blood glucose indices, lipid profile, liver enzymes, and steatosis grades were measured at baseline and 24 weeks after the intervention.

Results

The results showed that in patients with a mean age of 53.26 ± 7.64 who received MET+ EMPA, all the parameters had a greater decrease than the MET group. In addition, the reduction of FBS, BS, HbA1C, TG, and ALT had a statistically significant difference between the two groups after 24 weeks follow-up (p < 0.05). Notably, in the MET+ EMPA group, there was a substantial improvement in steatosis grades based on the fibroscan and ultrasound modality results.

Conclusion

The EMPA add-on therapeutic schedule in uncontrolled T2DM patients with NAFLD significantly ameliorated steatosis stages, liver function, anthropometric features, and biochemical parameters.

背景 2型糖尿病(T2DM)患者中以肝脏脂肪变性、炎症和晚期纤维化为特征的非酒精性脂肪肝(NAFLD)发病率很高。恩格列净(Empagliflozin,EMPA)是一种钠-葡萄糖共转运体-2抑制剂,在改善T2DM患者的血糖状况方面已得到广泛认可。然而,对于合并非酒精性脂肪肝的糖尿病患者,如果在标准治疗中加入 EMPA,其理想效果的证据尚待确定。 目的 本研究的主要目的是探讨 EMPA 对接受二甲双胍(MET)单药治疗的 T2DM 和非酒精性脂肪肝患者肝脏脂肪含量的益处。 方法 在这项开放标签临床试验研究中,60 名 T2DM 和非酒精性脂肪肝患者被分配到 MET + EMPA 组或 MET 组,接受为期 24 周的剂量递增治疗。在基线和干预 24 周后测量人体测量特征、血糖指数、血脂概况、肝酶和脂肪变性等级。 结果表明,平均年龄为(53.26 ± 7.64)的患者在接受 MET+ EMPA 治疗后,所有指标的下降幅度均大于 MET 组。此外,随访 24 周后,两组患者的 FBS、BS、HbA1C、TG 和 ALT 下降幅度差异有统计学意义(P < 0.05)。值得注意的是,根据纤维扫描和超声检查结果,MET+ EMPA 组的脂肪变性等级有了显著改善。 结论 在非酒精性脂肪肝的未控制 T2DM 患者中,EMPA 附加治疗方案显著改善了脂肪变性阶段、肝功能、人体测量特征和生化指标。
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引用次数: 0
A proposed medical system change in Japan inspired by Swedish primary health care: Important role of general practitioners and specialist nurses at primary health care centers 受瑞典初级卫生保健的启发,建议日本进行医疗制度改革:全科医生和专科护士在初级保健中心的重要作用
IF 1.8 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-09-05 DOI: 10.1002/jgf2.726
Rie Sato MD, PhD, Ulf Jakobsson PhD, RNT, PHN, Patrik Midlöv MD, PhD

Japanese citizens of all socioeconomic statuses have benefited from the national insurance system by receiving high-quality healthcare. However, the Japanese healthcare service is facing a severe financial crisis because of the increasing aging society and social security expenses. Many consultations raise medical expenditure and doctors' work overload, which is about to be regulated, but is questionable how the goal can be achieved without delegating doctors' working tasks. Sweden has a similar health index to that of Japan, but the system is different and is anchored by general practitioners and specialist nurses assigned to primary health care centers. They collaborate to share the workload, responsibilities, and patients' continuous care needs. As a result, the number of consultations is kept small, the length of stay in hospitals is shortened, and doctors' working hours are protected. A system change inspired by Swedish primary health care can be a potential solution for Japanese society.

不同社会经济地位的日本公民都从国家保险制度中受益,获得了高质量的医疗保健服务。然而,由于老龄化社会的加剧和社会保障费用的增加,日本的医疗服务正面临着严重的财政危机。大量的就诊增加了医疗支出,医生的工作负担过重,而这一问题即将得到规范,但在不下放医生工作任务的情况下,如何实现这一目标值得商榷。瑞典的健康指数与日本相似,但体系不同,以全科医生和分配到初级保健中心的专科护士为基础。他们合作分担工作量、责任和病人的持续护理需求。因此,就诊次数减少,住院时间缩短,医生的工作时间也得到了保障。受瑞典初级医疗保健启发而进行的制度改革,可能是日本社会的一种解决方案。
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引用次数: 0
Characteristics of cancer patients dying at home during the COVID-19 pandemic: A study based on vital statistics from 2015 to 2022 in Japan 在 COVID-19 大流行期间死于家中的癌症患者的特征:基于日本 2015 年至 2022 年生命统计数据的研究
IF 1.8 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-08-27 DOI: 10.1002/jgf2.724
Yu Sun MD, PhD, Rie Masuda MD, PhD, Yuta Taniguchi MD, PhD, Masao Iwagami MD, PhD, Nobuo Sakata MD, PhD, Satoru Yoshie MS, Jun Komiyama PhD, Kazumasa Yamagishi MD, PhD, Tomomi Kihara MD, PhD, Taeko Watanabe MD, PhD, Hideto Takahashi PhD, Hiroyasu Iso MD, PhD, Nanako Tamiya MD, PhD

Background

The coronavirus disease 2019 (COVID-19) pandemic has markedly affected end-of-life care, notably increasing home deaths among cancer patients in Japan. This study investigated the characteristics of cancer patients who died at home during the pandemic and the associated factors before and during the pandemic.

Methods

Vital statistics from January 2015 to December 2022 were analyzed to evaluate trends in home deaths among cancer patients aged 0 to 113 years, pre-pandemic (January 2015 to March 2020) and during the pandemic (April 2020 to December 2022). Home deaths were assessed by demographics, including age, sex, marital status, and residential location. Multivariable modified Poisson regression analyses were performed to identify factors associated with home deaths in both periods.

Results

Among 3,010,374 individuals, 11.6% (226,571/1,959,304) and 20.8% (218,429/1,051,070) died at home before and during the pandemic, respectively. In subgroup analysis depicting the trend of in-home deaths by patient characteristics, only the age group showed a differential trend: the proportion of in-home deaths was higher among older people before the pandemic, whereas it was higher among younger people during the pandemic. The multivariable analysis revealed the excess risk of in-home deaths among people aged ≥65 years before the pandemic and among those aged <65 years during the pandemic.

Conclusions

The pandemic has increased home-based end-of-life care for terminal cancer patients, particularly younger individuals, possibly due to hospital visit restrictions. Ensuring sufficient resources for both home and hospital care is vital to allow individuals to receive end-of-life care in their preferred settings.

背景 2019 年冠状病毒病(COVID-19)大流行对临终关怀产生了显著影响,尤其是增加了日本癌症患者的居家死亡人数。本研究调查了大流行期间死于家中的癌症患者的特征以及大流行之前和期间的相关因素。 方法 分析了 2015 年 1 月至 2022 年 12 月的生命统计数据,以评估大流行前(2015 年 1 月至 2020 年 3 月)和大流行期间(2020 年 4 月至 2022 年 12 月)0 至 113 岁癌症患者居家死亡的趋势。居家死亡按人口统计学特征进行评估,包括年龄、性别、婚姻状况和居住地点。进行了多变量修正泊松回归分析,以确定这两个时期与居家死亡相关的因素。 结果 在 3,010,374 人中,大流行前和大流行期间分别有 11.6% (226,571/1,959,304)和 20.8% (218,429/1,051,070)的人死于家中。在按患者特征描述居家死亡趋势的分组分析中,只有年龄组显示出不同的趋势:大流行前,老年人居家死亡的比例较高,而大流行期间,年轻人居家死亡的比例较高。多变量分析显示,大流行前年龄≥65 岁的人群和大流行期间年龄为 65 岁的人群在家中死亡的风险过高。 结论 大流行增加了晚期癌症患者的居家临终关怀,尤其是年轻患者,这可能是由于医院就诊限制造成的。确保为居家和医院护理提供充足的资源对于让患者在自己喜欢的环境中接受临终护理至关重要。
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引用次数: 0
How is primary care nursing embedded in nursing undergraduate curricula: A mixed-method study from four countries 如何将初级护理纳入护理本科课程:来自四个国家的混合方法研究
IF 1.8 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-08-22 DOI: 10.1002/jgf2.711
Mayumi Kako PhD, RN, Elizabeth Halcomb PhD, RN, BN Honours, Mariko Mizukawa PhD, RN, Michiko Moriayama PhD, RN

Introduction

Given the increase in the primary care nursing workforce and the need to further grow nursing roles in the community understanding how this is included in undergraduate education is important. This study aimed to explore the inclusion of primary care in the undergraduate nursing education curriculum of four countries.

Method

A mixed-method design was employed to obtain a broader context of primary care nursing in nursing education and teaching approaches relating to primary care nursing. Subsequently, Australia, Canada, Spain, and Ireland were selected for this study because primary healthcare systems are established as a part of their healthcare system.

Results

In total, 136 nursing faculties (40 in Australia, 35 in Canada, 46 in Spain, and 15 in Ireland) were invited to participate in this study. Of these, 27 responses were obtained (19.8% response rate). Following the survey phase, in-depth interviews were conducted with 13 participants. The results indicated that the highest number was coded within the theme of “Understanding of PHC in the curriculum” (n = 108). The second highest number (n = 87) was within the theme of “Interpretation differences of PHC in curriculum,” and the third highest (n = 31) was coded within “Policy impact on health by national government and others.”

Conclusion

The results emphasized the ambiguity of primary care within the undergraduate nursing curriculum and that interpretation and implementation into the curriculum largely depended on the school's intentions.

引言 鉴于初级护理人员队伍的增加以及进一步扩大社区护理角色的需要,了解如何将其纳入本科教育非常重要。本研究旨在探讨四个国家将初级护理纳入本科护理教育课程的情况。 方法 采用混合方法设计,以获得护理教育中初级护理的更广泛背景以及与初级护理相关的教学方法。随后,本研究选择了澳大利亚、加拿大、西班牙和爱尔兰作为研究对象,因为这些国家的医疗保健系统中都建立了初级医疗保健系统。 结果 共有 136 所护理学院(澳大利亚 40 所、加拿大 35 所、西班牙 46 所、爱尔兰 15 所)受邀参与本研究。其中,共收到 27 份回复(回复率为 19.8%)。调查阶段结束后,对 13 名参与者进行了深入访谈。结果显示,在 "课程中对初级保健的理解 "这一主题下进行编码的人数最多(n = 108)。在 "课程中对初级保健的解释差异 "这一主题下的编码人数次之(n = 87),在 "国家政府和其他方面对保健的政策影响 "这一主题下的编码人数次之(n = 31)。 结论 研究结果强调了初级保健在护理本科课程中的模糊性,对课程的解释和实施在很大程度上取决于学校的意图。
{"title":"How is primary care nursing embedded in nursing undergraduate curricula: A mixed-method study from four countries","authors":"Mayumi Kako PhD, RN,&nbsp;Elizabeth Halcomb PhD, RN, BN Honours,&nbsp;Mariko Mizukawa PhD, RN,&nbsp;Michiko Moriayama PhD, RN","doi":"10.1002/jgf2.711","DOIUrl":"https://doi.org/10.1002/jgf2.711","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Given the increase in the primary care nursing workforce and the need to further grow nursing roles in the community understanding how this is included in undergraduate education is important. This study aimed to explore the inclusion of primary care in the undergraduate nursing education curriculum of four countries.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>A mixed-method design was employed to obtain a broader context of primary care nursing in nursing education and teaching approaches relating to primary care nursing. Subsequently, Australia, Canada, Spain, and Ireland were selected for this study because primary healthcare systems are established as a part of their healthcare system.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 136 nursing faculties (40 in Australia, 35 in Canada, 46 in Spain, and 15 in Ireland) were invited to participate in this study. Of these, 27 responses were obtained (19.8% response rate). Following the survey phase, in-depth interviews were conducted with 13 participants. The results indicated that the highest number was coded within the theme of “Understanding of PHC in the curriculum” (<i>n</i> = 108). The second highest number (<i>n</i> = 87) was within the theme of “Interpretation differences of PHC in curriculum,” and the third highest (<i>n</i> = 31) was coded within “Policy impact on health by national government and others.”</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The results emphasized the ambiguity of primary care within the undergraduate nursing curriculum and that interpretation and implementation into the curriculum largely depended on the school's intentions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"25 6","pages":"309-316"},"PeriodicalIF":1.8,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.711","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142642450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Positive association between patient experience of primary care with chronic disease and self-rated health in a Japanese rural area: A cross-sectional questionnaire survey using the Japanese primary care assessment tool short form 日本农村地区慢性病患者的初级医疗体验与自我健康评价之间存在正相关:使用日本初级医疗评估工具简表进行的横断面问卷调查
IF 1.8 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-07-29 DOI: 10.1002/jgf2.721
Sakiya Nishida MD, Yoshio Hisata MD, PhD, Aki Yasaka MD, Takashi Sugioka MD, PhD, Risa Hirata MD, PhD, Naoko E. Katsuki MD, PhD, Masaki Tago MD, PhD, FACP, Yuki Ueda MD, Masaki Amenomori MD, Katsumi Higashino MD, PhD, Yoshio Naya MD, PhD

Background

Low birthrates and an aging society during population decline have brought about labor shortages and increased medical care needs. Medical resources should be distributed appropriately, particularly in rural areas. High-quality primary care can make the medical system more effective and contribute to rural residents' health. However, there are no reports on the impact of primary care on health in the rural areas of Japan. This study examined the effect of primary care quality on self-rated health in a rural Japanese area.

Methods

We conducted a cross-sectional study using a questionnaire survey of residents of a rural area in northern Shiga Prefecture in 2021. Self-rated health (SRH) was used as the health outcome (1–5 points), and the Japanese Primary Care Assessment Tool Short Form (JPCAT-SF) was used to measure the patients' experience of primary care (0–100 points). We conducted a multivariate analysis using logistic regression analysis and examined the association between good SRH (4 points or more) and high JPCAT-SF scores (above average score), adjusted for sociodemographic confounding factors.

Results

A total of 1108 men and 1412 women responded to the survey. The mean patient age was 69.8 years. The mean JPCAT-SF score was 51.8 points. Among the 1172 patients with chronic diseases, good SRH was associated with high JPCAT-SF scores (odds ratio [OR] 1.32, 95% confidence interval [CI] 1.009–1.73).

Conclusions

Good SRH among rural residents with chronic disease was associated with high primary care quality.

背景 人口减少期间的低出生率和老龄化社会带来了劳动力短缺和医疗需求增加。医疗资源应合理分配,尤其是在农村地区。高质量的初级保健可以提高医疗系统的效率,促进农村居民的健康。然而,目前还没有关于初级医疗对日本农村地区健康影响的报告。本研究探讨了日本农村地区初级医疗质量对自我健康评价的影响。 方法 我们于 2021 年对滋贺县北部农村地区的居民进行了一次横断面问卷调查。自评健康(SRH)作为健康结果(1-5 分),日本初级医疗评估工具简表(JPCAT-SF)用于测量患者对初级医疗的体验(0-100 分)。我们采用逻辑回归分析法进行了多变量分析,研究了良好 SRH(4 分或以上)与 JPCAT-SF 高分(高于平均分)之间的关联,并对社会人口学混杂因素进行了调整。 结果 共有 1108 名男性和 1412 名女性参与了调查。患者平均年龄为 69.8 岁。JPCAT-SF 的平均得分为 51.8 分。在 1172 名慢性病患者中,良好的性健康和生殖健康与较高的 JPCAT-SF 分数相关(几率比 [OR] 1.32,95% 置信区间 [CI] 1.009-1.73)。 结论 农村慢性病患者良好的性健康和生殖健康与较高的初级保健质量相关。
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引用次数: 0
Age and sex differences in sarcopenic dysphagia: A secondary data analysis 肌肉萎缩性吞咽困难的年龄和性别差异:二手数据分析
IF 1.8 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-07-24 DOI: 10.1002/jgf2.722
Hidetaka Wakabayashi MD, PhD, Shingo Kakehi PT, MS, Ayano Nagano RN, PhD, Masako Kishima DDS, PhD, Masataka Itoda DDS, PhD, Shinta Nishioka RD, PhD, Ryo Momosaki MD, PhD

Background

Age and sex differences in sarcopenic dysphagia are unknown. The purpose is to characterize age and sex differences in sarcopenic dysphagia.

Methods

A cross-sectional and retrospective cohort study using information from the Japanese database on sarcopenic dysphagia was performed. We investigated age and sex differences between sarcopenic dysphagia and other forms of dysphagia. We investigated whether differences in prognosis for swallowing function, as assessed by the Food Intake Level Scale, and activities of daily living (ADL), as assessed by the Barthel Index were influenced by age and sex in patients with sarcopenic dysphagia.

Results

The study included 460 patients, including 229 men and 231 women, with a mean age of 81 ± 10 years. Fifty-eight percent of the patients had sarcopenic dysphagia. Age was independently associated with sarcopenic dysphagia (odds ratio (OR): 1.056, 95% confidence interval (CI): 1.035, 1.078), although sarcopenic dysphagia could also be seen in those younger than 65 years. Sex was not independently associated with sarcopenic dysphagia. The age cut-off for the diagnosis of sarcopenic dysphagia was 82 years in all patients (sensitivity, 0.660; specificity, 0.644), 80 years in men (sensitivity, 0.619; specificity, 0.631), and 83 years in women (sensitivity, 0.723; specificity, 0.577). Sarcopenic dysphagia showed no significant differences in the improvement of swallowing function and ADL based on age and sex.

Conclusions

Sarcopenic dysphagia was most common in older adults in their 80s or older. The possibility of sarcopenic dysphagia should be considered when dysphagia is present in people 80 years of age or older.

肌无力性吞咽困难的年龄和性别差异尚不清楚。我们利用日本肌肉疏松性吞咽困难数据库中的信息,开展了一项横断面回顾性队列研究。我们调查了肌无力性吞咽困难与其他形式吞咽困难之间的年龄和性别差异。我们还调查了肌肉疏松性吞咽困难患者的吞咽功能(通过食物摄入量等级量表进行评估)和日常生活活动(通过巴特尔指数进行评估)的预后差异是否受年龄和性别的影响。58%的患者患有肌肉松弛性吞咽困难。年龄与肌肉疏松性吞咽困难密切相关(几率比(OR):1.056,95% 置信区间(CI):1.035, 1.078),但肌肉疏松性吞咽困难也可见于 65 岁以下的人群。性别与肌肉疏松性吞咽困难无关。所有患者被诊断为肌肉疏松性吞咽困难的年龄分界线为 82 岁(灵敏度为 0.660;特异度为 0.644),男性为 80 岁(灵敏度为 0.619;特异度为 0.631),女性为 83 岁(灵敏度为 0.723;特异度为 0.577)。肌肉疏松性吞咽困难在吞咽功能和日常活动能力的改善方面与年龄和性别无明显差异。当 80 岁或以上的老年人出现吞咽困难时,应考虑肌肉疏松性吞咽困难的可能性。
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引用次数: 0
Assessment and management of allergic rhinitis: A review and evidence-informed approach for family medicine 过敏性鼻炎的评估和管理:家庭医学回顾与循证方法
IF 1.8 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-07-14 DOI: 10.1002/jgf2.720
Akash Jangan MRCS (ENT), Zahir Mughal FRCS (ORL-HNS), Ahmar Ahmad MBChB, Mark Simmons FRCS (ORL-HNS), Aziz Sheikh OBE, FRSE, FRCGP, FMedSci, Faraz Mughal DCH, MPhil, FRCGP

Allergic rhinitis is an inflammatory disorder affecting nasal mucosa in response to allergen exposure and is commonly assessed and managed in family medicine. In this article, we review new international guidelines on the diagnosis and management of allergic rhinitis and generate evidence-informed recommendations for family medicine doctors.

过敏性鼻炎是一种因接触过敏原而影响鼻粘膜的炎症性疾病,通常由家庭医生进行评估和处理。在这篇文章中,我们回顾了有关过敏性鼻炎诊断和管理的新国际指南,并为家庭医生提出了循证建议。
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引用次数: 0
Identification of atypical hypoglycemia via continuous glucose monitoring in a patient presenting with hot flashes 通过连续血糖监测识别一名潮热患者的非典型低血糖症
IF 1.8 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-07-10 DOI: 10.1002/jgf2.718
Takuya Omura MD, PhD, Akemi Inami MS, Takahiro Kamihara MD, PhD, Yuki Tsuboi MD, Shuji Kawashima MD, Ken Tanaka MD, Taiki Sugimoto PhD, Takashi Sakurai MD, PhD, Haruhiko Tokuda MD, PhD

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引用次数: 0
Computed tomography findings of 50 patients diagnosed with aspiration pneumonia: A case series 50 例吸入性肺炎患者的计算机断层扫描结果:病例系列
IF 1.8 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-07-09 DOI: 10.1002/jgf2.717
Akihito Ueda MD, Kanji Nohara DDS, PhD, Nami Fujii DDS, Kazuhiro Nakajima MD, PhD, Yumiko Miyauchi MD, Yutaka Inoue MD

The effect of neglecting imaging in aspiration pneumonia diagnosis is not well understood. In this study, the computed tomography images of 50 patients diagnosed with aspiration pneumonia were retrospectively analyzed by three radiologists at a different hospital. Among these cases, 32%–42% were not classified as aspiration pneumonia based on imaging. Thus, imaging features may not have been adequately considered for diagnosing aspiration pneumonia. Although not all patients with aspiration pneumonia can be diagnosed based on imaging, aspiration pneumonia should be considered in the diagnosis as cases that are clearly nonaspiration pneumonia can be misdiagnosed as aspiration pneumonia.

在吸入性肺炎诊断中忽视影像学检查的影响尚不十分清楚。在这项研究中,一家不同医院的三位放射科医生对 50 名确诊为吸入性肺炎患者的计算机断层扫描图像进行了回顾性分析。在这些病例中,有 32%-42% 未根据影像学特征被归类为吸入性肺炎。因此,诊断吸入性肺炎时可能没有充分考虑影像学特征。虽然并非所有吸入性肺炎患者都能通过影像学诊断,但在诊断时应考虑吸入性肺炎,因为明显非吸入性肺炎的病例可能会被误诊为吸入性肺炎。
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Journal of General and Family Medicine
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