Journal of General and Family Medicine最新文献

{"title":"Exogenous Insulin Antibody Syndrome: An Overlooked Cause of Severe Hypoglycemia and Insulin Resistance in a Patient With Type 2 Diabetes Treated With Insulin","authors":"Kazuki Miyaue,&nbsp;Hiroki Isono","doi":"10.1002/jgf2.70085","DOIUrl":"https://doi.org/10.1002/jgf2.70085","url":null,"abstract":"<p>We report an 80-year-old man with type 2 diabetes who presented with life-threatening hypoglycemia (36 mg/dL) and coma, requiring high-dose insulin (74 units/day). Exogenous insulin antibody syndrome (EIAS) was suspected due to his glycemic instability and high insulin requirements. Subsequent testing confirmed elevated insulin antibodies (8.7 U/mL). Switching insulin analogues (to 32 units/day) promptly achieved stable glycemic control. This case highlights that EIAS, an under-recognized cause of unpredictable glycemia in insulin-treated diabetes, should be considered in patients with severe hypoglycemia and high insulin requirements. Modifying the insulin regimen is key for diagnosis and treatment.</p>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"27 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.70085","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145970189","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}

{"title":"Improvement in Activities of Daily Living Among Older Adults With Physician-Led Home Visits: A Multicenter Retrospective Cohort Study in Japan","authors":"Yuki Hinata,&nbsp;Masato Matsushima,&nbsp;Takuya Aoki,&nbsp;Yoshifumi Sugiyama,&nbsp;Tetsuya Kanno,&nbsp;Yasuki Fujinuma,&nbsp;Takamasa Watanabe","doi":"10.1002/jgf2.70082","DOIUrl":"https://doi.org/10.1002/jgf2.70082","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Japan is promoting physician-led home visits. Among patients receiving home care, activities of daily living (ADLs) affect both caregiver burden and patients' quality of life. This study aimed to determine the incidence of ADL improvement in physician-led home care and to identify associated factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective cohort study included patients aged 65 years or older with a Barthel Index (BI) score of 90 or less who began receiving physician-led home visits between February 1, 2013, and January 31, 2016. The primary outcome was defined as a ≥ 10-point improvement in the BI score from baseline. Changes in BI following the initiation of home visits were analyzed using the cumulative incidence function, with death treated as a competing risk. Cause-specific Cox regression was conducted to identify factors associated with BI improvement.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 660 patients were analyzed, with a median follow-up of 308 days. The one-year cumulative incidence of ADL improvement, accounting for competing risks, was 27.1%. Cause-specific Cox regression showed that patients with MMSE-J scores &lt; 14 were less likely to improve ADLs, whereas those transitioning from hospital to home care had a higher likelihood of improvement.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Following the initiation of physician-led home visits, approximately one-quarter of patients experienced improvement in ADLs. Transition of care from hospital to home was associated with better ADL outcomes, while improvement was less likely among those with severe cognitive impairment. These findings may help estimate ADL changes at the start of home care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"27 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.70082","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145983944","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}

{"title":"Building a Remote Network for Sustainable Supervision in Family Medicine Residency","authors":"Junki Shimokawa,&nbsp;Yuki Otsuka,&nbsp;Marina Kawaguchi,&nbsp;Akemi Ando,&nbsp;Kazushige Fujiwara","doi":"10.1002/jgf2.70083","DOIUrl":"https://doi.org/10.1002/jgf2.70083","url":null,"abstract":"&lt;p&gt;We are members of the Expert Training Support Committee of the Japan Primary Care Association (JPCA) in the Chugoku region and are involved in generalist education at each program. While the need for generalists is rapidly increasing, we face several challenges in supporting its education. In this context, we were especially encouraged by the recent letter from Matsumura et al. on “Sustainable Generalism Education.” [&lt;span&gt;1&lt;/span&gt;] The Chugoku region consists of five prefectures with both mountainous and island areas, and, as shown in Figure 1, supervising doctors and family medicine residents are geographically dispersed. Against this backdrop, their call for interdisciplinary collaboration, community-based educational guidance, and cross-organizational sharing of best practices strongly resonates with us.&lt;/p&gt;&lt;p&gt;What we want to emphasize is the need for support for residents who train in remote areas and for supervising doctors engaged in their education. Because generalist education in Japan is still in its early stages, the number of skillful supervising doctors is limited and tends to be concentrated at specific training sites. Meanwhile, residents are required to rotate through diverse clinical settings, and some residents are obliged by scholarship programs to work in resource-limited rural areas. In such contexts, residents may be forced to practice independently without nearby supervisors, missing opportunities for proper reflection, while routine supervision may be provided by physicians who are inexperienced in medical education. We consider these to be major challenges in this field.&lt;/p&gt;&lt;p&gt;One of the greatest challenges is portfolio education. Portfolios are essential to the development of a generalist identity, but they require specialized teaching skills and sufficient time [&lt;span&gt;2, 3&lt;/span&gt;]. Ideally, residents should be trained under a skillful supervising doctor and reflect on their practice. However, as noted above, geographical distance makes such interactions difficult. Moreover, supervising doctors at host institutions may not be familiar with portfolio education, and it is challenging to obtain a comprehensive overview of the wide range of topics involved. In particular, just-started-up programs often lack accumulated know-how and tend to depend heavily on the residents' ability to learn autonomously.&lt;/p&gt;&lt;p&gt;In recent years, online learning opportunities in our specialty have been increasing [&lt;span&gt;4, 5&lt;/span&gt;]. We have been discussing how these resources might help overcome current educational challenges. One of our efforts has been to open online sessions, conducted by well-established programs, to residents and their supervising doctors in our region. Through these sessions, participants could attend core lectures and learn methods of reflection. Interestingly, most participants were not residents but supervising doctors, highlighting a strong need for learning among educators themselves. This activity also created opp","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"27 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.70083","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145983823","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}

{"title":"A Thank You Note to Our Reviewers","authors":"","doi":"10.1002/jgf2.70079","DOIUrl":"https://doi.org/10.1002/jgf2.70079","url":null,"abstract":"&lt;p&gt;We would like to express our deepest gratitude to all the individuals who have provided their valuable time and expertise to support the &lt;i&gt;Journal of General and Family Medicine&lt;/i&gt;. The Editorial Board wishes to acknowledge with gratitude the following Reviewers for reviewing manuscripts during the past year.&lt;/p&gt;&lt;p&gt;Abe, Kazuhiro&lt;/p&gt;&lt;p&gt;Achterberg, Wilco&lt;/p&gt;&lt;p&gt;Aihara, Hidetoshi&lt;/p&gt;&lt;p&gt;Akimoto, Masatoshi&lt;/p&gt;&lt;p&gt;Akiyama, Yutaro&lt;/p&gt;&lt;p&gt;Almuammar, Sarah&lt;/p&gt;&lt;p&gt;Ando, Takayuki&lt;/p&gt;&lt;p&gt;Ang, Gary&lt;/p&gt;&lt;p&gt;Ang, Yee&lt;/p&gt;&lt;p&gt;Aoki, Takuya&lt;/p&gt;&lt;p&gt;Arai, Hidenori&lt;/p&gt;&lt;p&gt;Araki, Kazuo&lt;/p&gt;&lt;p&gt;Asakawa, Shoko&lt;/p&gt;&lt;p&gt;Asakura, Kentaro&lt;/p&gt;&lt;p&gt;Ayano, Masahiro&lt;/p&gt;&lt;p&gt;Ayusawa, Mamoru&lt;/p&gt;&lt;p&gt;Azuma, Teruhisa&lt;/p&gt;&lt;p&gt;Barary, Mohammad&lt;/p&gt;&lt;p&gt;Baz, Sarah&lt;/p&gt;&lt;p&gt;Borrow, Ray&lt;/p&gt;&lt;p&gt;Chang, Yu-Ting&lt;/p&gt;&lt;p&gt;Chen, Yang W.&lt;/p&gt;&lt;p&gt;Chiaranai, Chantira&lt;/p&gt;&lt;p&gt;Cho, Mi-Kyoung&lt;/p&gt;&lt;p&gt;Chojin, Yasuo&lt;/p&gt;&lt;p&gt;Cumming, Jacqueline&lt;/p&gt;&lt;p&gt;Daley, Stephanie&lt;/p&gt;&lt;p&gt;Devaraj, Navin Kumar&lt;/p&gt;&lt;p&gt;Dohi, Eisuke&lt;/p&gt;&lt;p&gt;Endo, Takeshi&lt;/p&gt;&lt;p&gt;Fujihara, Manabu&lt;/p&gt;&lt;p&gt;Fujii, Hirofumi&lt;/p&gt;&lt;p&gt;Fujikawa, Hirohisa&lt;/p&gt;&lt;p&gt;Fujino, Naoya&lt;/p&gt;&lt;p&gt;Fujita, Koji&lt;/p&gt;&lt;p&gt;Fujiwara, Motoshi&lt;/p&gt;&lt;p&gt;Fujiwara, Shinji&lt;/p&gt;&lt;p&gt;Fukuchi, Takahiko&lt;/p&gt;&lt;p&gt;Fukui, Sho&lt;/p&gt;&lt;p&gt;Goda, Ken&lt;/p&gt;&lt;p&gt;Gomi, Harumi&lt;/p&gt;&lt;p&gt;Goto, Tadao&lt;/p&gt;&lt;p&gt;Hagiwara, Shotaro&lt;/p&gt;&lt;p&gt;Hamada, Hisayuki&lt;/p&gt;&lt;p&gt;Hamada, Shota&lt;/p&gt;&lt;p&gt;Hamada, Shuhei&lt;/p&gt;&lt;p&gt;Hamamura, Toshitaka&lt;/p&gt;&lt;p&gt;Haneke, Eckart&lt;/p&gt;&lt;p&gt;Harada, Taku&lt;/p&gt;&lt;p&gt;Harada, Yukinori&lt;/p&gt;&lt;p&gt;Haraguchi, Masahiro&lt;/p&gt;&lt;p&gt;Haraguchi, Mizuki&lt;/p&gt;&lt;p&gt;Haruta, Junji&lt;/p&gt;&lt;p&gt;Hase, Ryota&lt;/p&gt;&lt;p&gt;HashimotoKunihiko&lt;/p&gt;&lt;p&gt;Hashizume, Naoki&lt;/p&gt;&lt;p&gt;Hasunuma, Naoko&lt;/p&gt;&lt;p&gt;Hattori, Tadashi&lt;/p&gt;&lt;p&gt;Higashimoto, Yuji&lt;/p&gt;&lt;p&gt;Hinata, Yuki&lt;/p&gt;&lt;p&gt;Hirai, Jun&lt;/p&gt;&lt;p&gt;Hirayama, Yoko&lt;/p&gt;&lt;p&gt;Hirose, Hideo&lt;/p&gt;&lt;p&gt;Hirose, Masahiro&lt;/p&gt;&lt;p&gt;Hokama, Akira&lt;/p&gt;&lt;p&gt;Horibata, Ken&lt;/p&gt;&lt;p&gt;Horinouchi, Noboru&lt;/p&gt;&lt;p&gt;Hsiao, Po-Jen&lt;/p&gt;&lt;p&gt;Hsu, Chao-Kai&lt;/p&gt;&lt;p&gt;Ichikawa, Shuhei&lt;/p&gt;&lt;p&gt;Igarashi, Shun&lt;/p&gt;&lt;p&gt;Iguchi, Seitaro&lt;/p&gt;&lt;p&gt;Ikeda, Kotaro&lt;/p&gt;&lt;p&gt;Ikeda, Takaaki&lt;/p&gt;&lt;p&gt;Ikuno, Masashi&lt;/p&gt;&lt;p&gt;Imanaga, Teruhiko&lt;/p&gt;&lt;p&gt;Inoue, Kenji&lt;/p&gt;&lt;p&gt;Inoue, Machiko&lt;/p&gt;&lt;p&gt;Inoue, Yoshie&lt;/p&gt;&lt;p&gt;Ishi, Mitsuaki&lt;/p&gt;&lt;p&gt;Ishibashi, Hiroki&lt;/p&gt;&lt;p&gt;Ishikane, Masahiro&lt;/p&gt;&lt;p&gt;Ishikawa, Yukiko&lt;/p&gt;&lt;p&gt;Ishimaru, Naoto&lt;/p&gt;&lt;p&gt;Ishimaru, Hiroyasu&lt;/p&gt;&lt;p&gt;Ishizuka, Kosuke&lt;/p&gt;&lt;p&gt;Isik, Arda&lt;/p&gt;&lt;p&gt;Isse, Naohi&lt;/p&gt;&lt;p&gt;Iwamuro, Masaya&lt;/p&gt;&lt;p&gt;Iwata, Hiroyoshi&lt;/p&gt;&lt;p&gt;Kako, Mayumi&lt;/p&gt;&lt;p&gt;Kamimoto, Minako&lt;/p&gt;&lt;p&gt;Kanakubo, Yusuke&lt;/p&gt;&lt;p&gt;Kaneko, Makoto&lt;/p&gt;&lt;p&gt;Kanke, Satoshi&lt;/p&gt;&lt;p&gt;Kanno, Tetsuya&lt;/p&gt;&lt;p&gt;Kano, Yasuhiro&lt;/p&gt;&lt;p&gt;Kanzawa, Yohei&lt;/p&gt;&lt;p&gt;Kashiura, Masahiro&lt;/p&gt;&lt;p&gt;Kataoka, Hitomi&lt;/p&gt;&lt;p&gt;Kataoka, Yuki&lt;/p&gt;&lt;p&gt;Katayama, Kohta&lt;/p&gt;&lt;p&gt;Kawamoto, Ryuichi&lt;/p&gt;&lt;p&gt;Kawashima, Atsushi&lt;/p&gt;&lt;p&gt;Kawauchi, Hideyuki&lt;/p&gt;&lt;p&gt;Kenzaka, Tsuneaki&lt;/p&gt;&lt;p&gt;Kikukawa, Makoto&lt;/p&gt;&lt;p&gt;Kimura, Takuma&lt;/p&gt;&lt;p&gt;Kishi, Tomomi&lt;/p&gt;&lt;p&gt;Koda, Masahide&lt;/p&gt;&lt;p&gt;Koike, Soichi&lt;/p&gt;&lt;p&gt;Kojima, Taro&lt;/p&gt;&lt;p&gt;Kokkinakis, Ioannis&lt;/p&gt;&lt;p&gt;Komagamine, Junpei&lt;/p&gt;&lt;p&gt;Kondo, Satoshi&lt;/p&gt;&lt;p&gt;Kosaka, Takeo&lt;/p&gt;&lt;p&gt;Kubota, Kazumi&lt;/p&gt;&lt;p&gt;Kudo, Takahiro&lt;/p&gt;&lt;p&gt;Kume, Yu&lt;/p&gt;&lt;p&gt;Kuroda, Kaku&lt;/p&gt;&lt;p&gt;Kuroda, Moe&lt;/p&gt;&lt;p&gt;Kuwahara, Susumu&lt;/p&gt;&lt;p&gt;Little, Sahoko&lt;/p&gt;&lt;p&gt;Longenecker, Randall&lt;/p&gt;&lt;p&gt;Maeno, Te","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"26 6","pages":"676-679"},"PeriodicalIF":2.3,"publicationDate":"2025-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.70079","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145529711","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}

{"title":"Clinical Characteristics of Patients Initially Suspected of Long COVID: A Case Series From a Specialized Outpatient Clinic","authors":"Masayuki Ohira,&nbsp;Takashi Osada,&nbsp;Hiroaki Kimura,&nbsp;Terunori Sano,&nbsp;Masaki Takao","doi":"10.1002/jgf2.70081","DOIUrl":"https://doi.org/10.1002/jgf2.70081","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Sequelae of the acute phase of coronavirus disease 2019 (COVID-19), termed long COVID, are characterized by a variety of symptoms, including neurological manifestations. Diagnosing long COVID requires excluding alternative conditions that could explain the symptoms. The role of primary care physicians is considered essential in managing long COVID, particularly during the initial screening phase.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This observational, retrospective, single-center study was conducted at an outpatient clinic from 1 June 2021 to 31 December 2024. We confirmed final diagnoses for patients suspected of having long COVID and included those ultimately diagnosed with other conditions. Clinical data—including symptoms, demographic characteristics, results of clinical examinations, and final diagnoses—were collected.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 44 patients were diagnosed with alternative conditions. Of these, 30 were classified as having post-acute sequelae of SARS-CoV-2 mimic, and 14 patients (2.2% of those who believed they had long COVID and visited our clinic) were diagnosed with other diseases. The median age at the time of their clinic visit was 48 years (range, 42.5–61.5). Diagnoses included collagen diseases (5 patients, 35.7%) and central nervous system disorders (5 patients, 35.7%), among others. Weakness was the most common symptom. In contrast to long COVID, fatigue was less frequently reported in this group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>We identified a variety of alternative diagnoses among patients suspected of having long COVID. We recommend that primary care physicians exercise caution when diagnosing long COVID, particularly in patients who do not report fatigue.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"27 1","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.70081","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145986897","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}

{"title":"Lingering Effects on the Ecology of Medical Care After the COVID-19 Pandemic: A Nationwide Repeated Cross-Sectional Study in Japan","authors":"Takuya Aoki,&nbsp;Masato Matsushima","doi":"10.1002/jgf2.70080","DOIUrl":"https://doi.org/10.1002/jgf2.70080","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Previous studies have examined short-term changes in health care utilization during the COVID-19 pandemic, but research on long-term post-pandemic effects remains limited. We aimed to evaluate health care utilization after the pandemic based on the ecology of medical care model and to compare it with the results before and during the pandemic in Japan.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a nationwide repeated cross-sectional survey of a representative sample of the general Japanese adult population in 2021 and 2024. The main outcomes were health care utilization for new health problems. We estimated the number of each health care utilization per 1000 population per month and compared it with the previous study conducted before the pandemic.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Data from a total of 2992 participants were analyzed. Visits to physicians' offices that primarily provide primary care declined during the pandemic and increased after the pandemic, but have not fully recovered to pre-pandemic levels. The recovery in physician's office visits between during and after the pandemic tended to be smaller among younger adults, females, those with lower education levels, those with higher incomes, and those without chronic conditions. On the other hand, emergency room visits, which declined during the pandemic, increased to higher levels than before the pandemic.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Primary care utilization has not recovered to pre-pandemic levels, while emergency room visits have increased to higher levels than before the pandemic. Understanding long-term changes in health care utilization behaviors after the pandemic can help policymakers strengthen primary care systems.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"26 6","pages":"595-602"},"PeriodicalIF":2.3,"publicationDate":"2025-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.70080","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145436504","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}

{"title":"Subjective Cognitive Decline, Inter-Personal Attachment Style and Relationship Quality","authors":"Mohamed Eshmawey,&nbsp;Sonja M. Kagerer,&nbsp;Federica Ribaldi,&nbsp;Aïda B. Fall,&nbsp;Paul G. Unschuld","doi":"10.1002/jgf2.70076","DOIUrl":"https://doi.org/10.1002/jgf2.70076","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Subjective cognitive decline (SCD) is characterized by the perception of cognitive dysfunction, and it could be one of the early signs of dementia. While SCD is a common phenomenon in old persons, little is known about how it affects interpersonal relationships.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a cross-sectional study involving 16 patients with SCD and 39 volunteers recruited from the COSCODE study. The Hazan and Shafer questionnaires were used to assess patients' attachment styles. The Experience in Close Relationships Scale was used to assess individual differences in attachment-related anxiety and attachment-related avoidance. A Wilcoxon rank-sum test was performed to test for differences between groups, and <i>p</i>-values were Bonferroni-corrected.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>SCD is associated with lower disorganized attachment scores (<i>p</i> = 0.01). SCD was not associated with experience in close relationships.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Coping with progressive cognitive decline is a difficult mission. The results of our study on persons with SCD help us to better understand changes in couple relationships before the onset of dementia.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"26 6","pages":"620-625"},"PeriodicalIF":2.3,"publicationDate":"2025-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.70076","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145436255","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}

{"title":"Homemade and Handmade","authors":"Junki Mizumoto,&nbsp;Taro Shimizu","doi":"10.1002/jgf2.70077","DOIUrl":"https://doi.org/10.1002/jgf2.70077","url":null,"abstract":"&lt;p&gt;A 77-year-old man began receiving home care services at the request of his wife, reporting that the patient had been experiencing a persistent cough and wheezing for 2 weeks yet resolutely refused to seek medical care outside the home. The patient had retired prematurely from his office career at the age of 56 and thereafter engaged primarily in recreational sports and home carpentry. Two months before, he experienced a noticeable decline in appetite. One month before, he began spending most of his days bedridden due to pronounced fatigue, giving up his usual activities such as exercise and household chores. Two weeks prior, he developed a productive cough, which progressively worsened. Three days before, he had a severe episode of coughing, wheezing, and rapid breathing in the early morning. His wife recorded a body temperature of 36.5°C and an oxygen saturation level of 90% on ambient air. His wife eventually asked for home care, and the medical team conducted a home visit to assess his condition. The patient reported experiencing mild, dull pain in the right side of the chest and upper arm, though he was uncertain when it had begun. He also noted a weight loss of three kilograms over 3 months.&lt;/p&gt;&lt;p&gt;For many years, the patient had steadfastly avoided seeking medical attention at a hospital for unknown reasons and had no history of regular medication use. Routine medical examinations during his working years had not revealed any abnormalities. He had a history of heavy smoking, consuming 20–30 cigarettes daily since the age of 14, though he ceased smoking upon the recent onset of his cough. He consumed alcohol infrequently. Per his wife and daughter, he suffered from visual impairment, and his refusal to seek medical care was driven by a desire to conceal this condition from others.&lt;/p&gt;&lt;p&gt;The patient was reclined on the bed, fully conscious and articulate, with no observable signs of respiratory distress during conversation. Vital signs were recorded as follows: body temperature, 36.9°C; blood pressure, 144/60 mmHg; heart rate, 90 bpm; respiratory rate, 24 per minute; and oxygen saturation, 97% on ambient air. The mildly prolonged expiratory phase was noted.&lt;/p&gt;&lt;p&gt;Physical examination revealed a point of maximal impulse along the left midclavicular line, without any palpable thrill. The sternocleidomastoid muscle was hypertrophied, and the laryngeal height (distance from the thyroid cartilage to the suprasternal notch) was reduced. Cardiac auscultation detected a Levine grade II/VI holosystolic murmur, most prominent at the fourth left sternal border and radiating toward the left axilla. Mild holo-expiratory wheezes were present throughout the chest, and egophony was localized to the right anterior chest area. There was no tenderness or tactile fremitus, and percussion revealed resonant tones across all lung fields.&lt;/p&gt;&lt;p&gt;There were non-pale conjunctivae, and the jugular veins were not distended. No tenderness was noted over the extremities ","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"26 6","pages":"534-538"},"PeriodicalIF":2.3,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.70077","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145436324","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}

{"title":"Foaming at the mouth: A case of psychogenic nonepileptic seizure","authors":"Satoshi Saito MD,&nbsp;Go Taniguchi MD, PhD","doi":"10.1002/jgf2.70053","DOIUrl":"https://doi.org/10.1002/jgf2.70053","url":null,"abstract":"&lt;p&gt;The patient is a 19-year-old female with a history of tonic–clonic seizures. Treatment with valproic acid (VPA) began at age 3 and was discontinued upon achieving seizure freedom at age 10. At age 14, she experienced maternal abuse and school difficulties, followed by episodes of collapse and unresponsiveness, sometimes with foaming at the mouth and small shaking, lasting up to an hour. She was diagnosed with a dissociative disorder at a psychiatric clinic. At age 17, she was admitted to the emergency room for a similar seizure and began treatment for epilepsy with levetiracetam and VPA. At age 19, she underwent video electroencephalography (VEEG) to address persistent intractable seizures.&lt;/p&gt;&lt;p&gt;After discontinuation of antiepileptic medications, VEEG was performed over 4 days. On day 2, a psychogenic nonepileptic seizure (PNES) was recorded. Although lying in bed and stating she felt “sick,” she abruptly exhibited bilateral shoulder twitching, unresponsiveness, and foaming at the mouth, but lacked tonic posturing, cyanosis, or oxygen desaturation, with her eyes remaining closed (Figure 1A). The EEG showed a normal posterior-dominant rhythm (9–10 Hz) without epileptiform activity (Figure 1B). The physician examined her 5 min after seizure onset; she was unresponsive, exhibited strong resistance to forced eye-opening, scored positive in arm-drop and knee-standing tests, and exhibited a bilateral flexor plantar response. After the physician exited the room, urinary incontinence occurred, and she gradually regained full consciousness.&lt;/p&gt;&lt;p&gt;The patient's PNES likely stemmed from psychological stressors, such as maternal abuse and school difficulties. Addressing such underlying issues—through sustained psychiatric care, trauma-informed therapy, and social support—may be crucial not only for reducing PNES frequency but also for achieving long-term psychological stabilization.&lt;/p&gt;&lt;p&gt;PNESs have a prevalence of 2–33 per 100,000, whereas epilepsy affects approximately 0.5%–1% of the population.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; Unlike epilepsy, PNES are not caused by neuronal hypersynchrony or cerebral hypoperfusion but rather by complex neuropsychiatric mechanisms.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt; Nonetheless, their semiology often mimics that of epileptic seizures, leading to misdiagnosis in 20%–30% of cases.&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt; Symptoms such as foaming at the mouth and urinary incontinence—observed in this case—are typically associated with generalized tonic–clonic seizures. In epilepsy, foaming is thought to result from hypersalivation and clonic breathing&lt;span&gt;&lt;sup&gt;3&lt;/sup&gt;&lt;/span&gt;; however, the mechanism behind this phenomenon in PNES remains unclear and warrants further investigation. This case contributes to the limited literature on such rare PNES manifestations and may serve as a reference for future research.&lt;/p&gt;&lt;p&gt;VEEG remains the gold standard for distinguishing PNES from epilepsy, although the likelihood of capturing an event during monitoring is only","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"26 6","pages":"650-651"},"PeriodicalIF":2.3,"publicationDate":"2025-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.70053","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145436440","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}

{"title":"Non-Physician Contributors to Patient Satisfaction in a Japanese Primary Care: A Cross-Sectional Secondary Analysis of Patient Satisfaction Surveys","authors":"Keita Morikawa,&nbsp;Takayuki Ando,&nbsp;Shun Tezen,&nbsp;Tadao Okada","doi":"10.1002/jgf2.70073","DOIUrl":"https://doi.org/10.1002/jgf2.70073","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Patient satisfaction is a key indicator of healthcare quality. While physician-related factors are well studied, less is known about how non-physician staff contribute to satisfaction in primary care. This study examined the association between patient satisfaction and multidisciplinary staff involvement in a Japanese primary care clinic.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a secondary analysis of patient satisfaction survey data collected from 2019 to 2022. The primary outcome was overall satisfaction with the visit, dichotomized as “highly satisfied” versus “less than highly satisfied.” Modified Poisson regression with robust standard errors estimated prevalence ratios (PRs) and 95% confidence intervals (CIs). Multivariable models included satisfaction with non-physician staff, patient demographics, and physician-related satisfaction via principal component analysis. Sensitivity analyses included consultation duration and access to care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 1415 patients, higher satisfaction with the demeanor of nursing staff (PR 2.06, 95% CI 1.39–3.05) and waiting time care (PR 1.43, 95% CI 1.33–1.54) were significantly associated with greater overall satisfaction. Receptionist demeanor also showed a modest but significant association (PR 1.30, 95% CI 1.05–1.61). In the sensitivity analysis, these associations persisted for nursing staff (PR 1.64, 95% CI 1.20–2.24) and waiting time care (PR 1.08, 95% CI 1.02–1.14), while the receptionist association was attenuated (PR 1.15, 95% CI 0.97–1.35).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Beyond physician-related factors, nursing staff demeanor and waiting time care were found to be associated with patient satisfaction. These findings support the importance of multidisciplinary contributions to patient-centered care in primary care clinics.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"26 6","pages":"612-619"},"PeriodicalIF":2.3,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.70073","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145436311","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}