Smartphone use significantly changes the lives of individuals. This study aimed to stratify sleep time by age and sex, examine the association between smartphone overuse and sleep deprivation, and measure their impact on self-rated health (SRH) outcomes. Focusing on communication and overuse, we also considered the association of active and passive smartphone use, as well as browsing, with sleep.
Methods
We conducted a questionnaire survey among residents of three towns in rural Japan to collect data on the sleeping hours, smartphone ownership rate, and smartphone usage time of residents, stratified according to sex and age. Logistic regression analysis was conducted to investigate the association among good SRH outcomes, sleep deprivation, and smartphone overuse.
Results
Among 2565 respondents to our questionnaire who possessed a smartphone (ownership 69.7%), 1172 men and 1393 women were analyzed. The mean age and sleep hours were 59.1 years and 6.7 h. Sleep time was shorter in middle-aged residents, and sex differences disappeared at younger ages. A total of 1295 participants experienced sleep deprivation. The smartphone overuse group comprised 627 participants. Good SRH outcomes were negatively associated with smartphone overuse and sleep deprivation. The group that used their smartphones for more than 1 h slept approximately 0.12–0.13 h less than the other group. Active/passive use and screen time were associated with good SRH outcomes.
Conclusion
Avoiding sleep deprivation and smartphone overuse are activities that are useful for good SRH outcomes. Smartphone use with a clear purpose may not be antagonistic to good SRH outcomes.
{"title":"Association between smartphone use, sleep deprivation, and self-rated health outcomes: A retrospective observational survey in rural Japan","authors":"Yoshio Hisata MD, PhD, Sakiya Nishida MD, Mamoru Urayama MD, Hiroshi Sekine 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","doi":"10.1002/jgf2.70024","DOIUrl":"https://doi.org/10.1002/jgf2.70024","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Smartphone use significantly changes the lives of individuals. This study aimed to stratify sleep time by age and sex, examine the association between smartphone overuse and sleep deprivation, and measure their impact on self-rated health (SRH) outcomes. Focusing on communication and overuse, we also considered the association of active and passive smartphone use, as well as browsing, with sleep.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a questionnaire survey among residents of three towns in rural Japan to collect data on the sleeping hours, smartphone ownership rate, and smartphone usage time of residents, stratified according to sex and age. Logistic regression analysis was conducted to investigate the association among good SRH outcomes, sleep deprivation, and smartphone overuse.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 2565 respondents to our questionnaire who possessed a smartphone (ownership 69.7%), 1172 men and 1393 women were analyzed. The mean age and sleep hours were 59.1 years and 6.7 h. Sleep time was shorter in middle-aged residents, and sex differences disappeared at younger ages. A total of 1295 participants experienced sleep deprivation. The smartphone overuse group comprised 627 participants. Good SRH outcomes were negatively associated with smartphone overuse and sleep deprivation. The group that used their smartphones for more than 1 h slept approximately 0.12–0.13 h less than the other group. Active/passive use and screen time were associated with good SRH outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Avoiding sleep deprivation and smartphone overuse are activities that are useful for good SRH outcomes. Smartphone use with a clear purpose may not be antagonistic to good SRH outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"26 5","pages":"408-415"},"PeriodicalIF":2.3,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.70024","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144929753","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}
<p>A 72-year-old woman with a history of hypertension and hyperlipidemia presented with difficulty in speaking and writing. She noticed she became reluctant to do calculations 3 months earlier. The symptoms of aphasia and agraphia had gradually worsened over the prior 3 weeks; thus, she visited our hospital. Physical examinations showed motor aphasia, agraphia, and a positive Barre sign on the right side; however, tendon reflexes and the finger-to-nose test were normal, and there was no decrease in temperature, pain, or touch sensation. Laboratory data and head computed tomography showed no abnormalities. She subsequently underwent brain magnetic resonance imaging (MRI), showing high signal intensity areas on diffusion-weighted imaging (DWI) and fluid-attenuated inversion recovery (FLAIR), predominantly in the right frontal lobe region and in the bilateral occipitotemporal lobes (cortical ribbon sign) (Figure 1A,B). As the differential diagnoses included encephalitis, epileptic seizures, and Creutzfeldt–Jakob disease (CJD), she was admitted for further evaluation. The cerebrospinal fluid (CSF) was clear, with a white blood cell count of 6/μL, total protein level of 18.9 mg/dL, and glucose concentration of 63 mg/dL. Electroencephalography performed on Day 2 revealed no abnormalities, which made the diagnosis of epileptic seizures less likely. One week after admission, the patient became unable to say her name, and ataxic symptoms worsened. Given the possibility of autoimmune encephalitis, steroid pulse therapy was initiated; however, it was ineffective. Polymerase chain reaction testing for herpes simplex virus, as well as tests for anti-NMDA receptor antibody and paraneoplastic antibodies, submitted upon admission, later returned negative results, thereby ruling out encephalitis. By the third week of hospitalization, the patient had developed akinetic mutism, and myoclonus emerged on Day 25. Follow-up brain MRI one month after admission demonstrated extensive high signal intensity in the bilateral cerebral cortex and left striatum (Figure 1C,D), raising high suspicion for CJD. Electroencephalography revealed periodic sharp wave complexes (PSWC) (Figure 2). Moreover, additional CSF analysis revealed positive findings for T-Tau protein, 14-3-3 protein, and real-time quaking-induced conversion (RT-QuIC), confirming the diagnosis of CJD. Brain MRI 2 months after admission demonstrated high signal intensity in the bilateral cerebral cortex, as well as the bilateral striatum (Figure 1E,F), which was also characteristic of CJD. She was transferred to the rehabilitation hospital on Day 92.</p><p>CJD is a rare and fatal prion disease characterized by progressive dementia, typically over a period of a few weeks to months.<span><sup>1</sup></span> Although the diagnosis of CJD is challenging due to its non-specific manifestations, it is based on a combination of clinical symptoms, electroencephalography, CSF analysis, and MRI findings. Key clinical findings
{"title":"Cortical ribbon sign: Initial sign of Creutzfeldt–Jakob disease","authors":"Shiori Nakamichi MD, Ryohei Ono MD, Michihiro Kudo MD, Shigeto Horiuchi MD, Izumi Kitagawa MD","doi":"10.1002/jgf2.70019","DOIUrl":"https://doi.org/10.1002/jgf2.70019","url":null,"abstract":"<p>A 72-year-old woman with a history of hypertension and hyperlipidemia presented with difficulty in speaking and writing. She noticed she became reluctant to do calculations 3 months earlier. The symptoms of aphasia and agraphia had gradually worsened over the prior 3 weeks; thus, she visited our hospital. Physical examinations showed motor aphasia, agraphia, and a positive Barre sign on the right side; however, tendon reflexes and the finger-to-nose test were normal, and there was no decrease in temperature, pain, or touch sensation. Laboratory data and head computed tomography showed no abnormalities. She subsequently underwent brain magnetic resonance imaging (MRI), showing high signal intensity areas on diffusion-weighted imaging (DWI) and fluid-attenuated inversion recovery (FLAIR), predominantly in the right frontal lobe region and in the bilateral occipitotemporal lobes (cortical ribbon sign) (Figure 1A,B). As the differential diagnoses included encephalitis, epileptic seizures, and Creutzfeldt–Jakob disease (CJD), she was admitted for further evaluation. The cerebrospinal fluid (CSF) was clear, with a white blood cell count of 6/μL, total protein level of 18.9 mg/dL, and glucose concentration of 63 mg/dL. Electroencephalography performed on Day 2 revealed no abnormalities, which made the diagnosis of epileptic seizures less likely. One week after admission, the patient became unable to say her name, and ataxic symptoms worsened. Given the possibility of autoimmune encephalitis, steroid pulse therapy was initiated; however, it was ineffective. Polymerase chain reaction testing for herpes simplex virus, as well as tests for anti-NMDA receptor antibody and paraneoplastic antibodies, submitted upon admission, later returned negative results, thereby ruling out encephalitis. By the third week of hospitalization, the patient had developed akinetic mutism, and myoclonus emerged on Day 25. Follow-up brain MRI one month after admission demonstrated extensive high signal intensity in the bilateral cerebral cortex and left striatum (Figure 1C,D), raising high suspicion for CJD. Electroencephalography revealed periodic sharp wave complexes (PSWC) (Figure 2). Moreover, additional CSF analysis revealed positive findings for T-Tau protein, 14-3-3 protein, and real-time quaking-induced conversion (RT-QuIC), confirming the diagnosis of CJD. Brain MRI 2 months after admission demonstrated high signal intensity in the bilateral cerebral cortex, as well as the bilateral striatum (Figure 1E,F), which was also characteristic of CJD. She was transferred to the rehabilitation hospital on Day 92.</p><p>CJD is a rare and fatal prion disease characterized by progressive dementia, typically over a period of a few weeks to months.<span><sup>1</sup></span> Although the diagnosis of CJD is challenging due to its non-specific manifestations, it is based on a combination of clinical symptoms, electroencephalography, CSF analysis, and MRI findings. Key clinical findings","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"26 4","pages":"372-374"},"PeriodicalIF":1.8,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.70019","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144582435","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}
While Kampo medicines are deemed relatively safe and associated with few adverse effects, primary care physicians are well advised to be aware of the risk of drug-induced liver injury in patients prescribed Kampo medicines containing Scutellariae radix, such as Hangeshashinto, in clinical practice and to closely monitor their clinical course.
{"title":"Drug-induced liver injury associated with exposure to Hangeshashinto","authors":"Kimitoshi Kubo MD, PhD, Issei Ashida MD, Noriko Kimura MD, PhD","doi":"10.1002/jgf2.70018","DOIUrl":"https://doi.org/10.1002/jgf2.70018","url":null,"abstract":"<p>While Kampo medicines are deemed relatively safe and associated with few adverse effects, primary care physicians are well advised to be aware of the risk of drug-induced liver injury in patients prescribed Kampo medicines containing Scutellariae radix, such as Hangeshashinto, in clinical practice and to closely monitor their clinical course.\u0000 <figure>\u0000 <div><picture>\u0000 <source></source></picture><p></p>\u0000 </div>\u0000 </figure></p>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"26 4","pages":"370-371"},"PeriodicalIF":1.8,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.70018","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144582442","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}
<p>A previously healthy 27-year-old woman was referred from a nearby clinic for the treatment of pneumonia.</p><p> <i>The patient was referred with a diagnosis of community-acquired pneumonia (CAP). Hospitalization for CAP is generally indicated when the oxygen saturation on room air falls to ≤93%, or when severity scores such as a Pneumonia Severity Index score of ≥III or a CURB-65 score of ≥1 are present.</i> </p><p>Five days prior to referral, the patient visited her primary care physician with complaints of high fever, nasal discharge, and pharyngitis. Although a rapid influenza test was negative, baloxavir marboxil was administered based on the local outbreak situation. However, her fever persisted, and she revisited the clinic 1 day before referral. Blood tests and chest computed tomography (CT) were performed, leading to a diagnosis of pneumonia. She received an outpatient dose of 2 g of ceftriaxone and was prescribed levofloxacin at 500 mg/day. The next day, marked inflammatory markers were revealed in blood tests, prompting her referral.</p><p>Administering antibiotics without obtaining various cultures for infections such as pneumonia is not recommended. Additionally, initiating treatment with fluoroquinolones, such as levofloxacin, at the first visit is also discouraged. This is because fluoroquinolones have some efficacy against mycobacteria, including tuberculosis, which can delay the diagnosis of these conditions.</p><p>The patient reported intermittent high-grade fevers, sore throat, pleuritic chest pain, and fatigue. They reported no rash, cough, vomiting, constipation, diarrhea, genitourinary symptoms, or weakness. They had previously had sinusitis. She did not take prescription medications, smoke, drink alcohol, or use drugs. She was not sexually active. She had no recent exposures to sick contacts, hot springs, travel history, undercooked meats, or bites from insects or animals.</p><p>This review of systems highlights multisystem involvement and eliminates several potentially relevant exposures. The presence of fevers and fatigue points toward infectious, inflammatory, or malignant processes.</p><p>On physical examination, her consciousness was alert, the patient was febrile; her axillary temperature was 38.0°C, the heart rate was 110 beats per minute, the blood pressure was 99/50 mm Hg, the respiratory rate was 20 per minute, and the oxygen saturation was 97% while the patient was breathing ambient air. The body-mass index (BMI; the weight in kilograms divided by the square of the height in meters) was 19.9. Cardiopulmonary examinations revealed that holo crackles were auscultated in the right lower lung field, and a systolic murmur (Levine grade 3/6) was heard at the apex. No signs of arthritis or skin abnormalities were shown. The patient's mood, attention, and affect were appropriate.</p><p>If this case is confirmed to be pneumonia, hospitalization is indicated. While both the PSI and CURB-65 scores
{"title":"Avoiding early diagnosis","authors":"Takao Wakabayashi M.D., Ph.D., Goh Keng Wee M.D., Mikinosuke Ishibashi M.D., Yoshiki Akiyama M.D., Naoki Kanda M.D., Tomoyuki Watanabe M.D., Ph.D.","doi":"10.1002/jgf2.70015","DOIUrl":"https://doi.org/10.1002/jgf2.70015","url":null,"abstract":"<p>A previously healthy 27-year-old woman was referred from a nearby clinic for the treatment of pneumonia.</p><p>\u0000 <i>The patient was referred with a diagnosis of community-acquired pneumonia (CAP). Hospitalization for CAP is generally indicated when the oxygen saturation on room air falls to ≤93%, or when severity scores such as a Pneumonia Severity Index score of ≥III or a CURB-65 score of ≥1 are present.</i>\u0000 </p><p>Five days prior to referral, the patient visited her primary care physician with complaints of high fever, nasal discharge, and pharyngitis. Although a rapid influenza test was negative, baloxavir marboxil was administered based on the local outbreak situation. However, her fever persisted, and she revisited the clinic 1 day before referral. Blood tests and chest computed tomography (CT) were performed, leading to a diagnosis of pneumonia. She received an outpatient dose of 2 g of ceftriaxone and was prescribed levofloxacin at 500 mg/day. The next day, marked inflammatory markers were revealed in blood tests, prompting her referral.</p><p>Administering antibiotics without obtaining various cultures for infections such as pneumonia is not recommended. Additionally, initiating treatment with fluoroquinolones, such as levofloxacin, at the first visit is also discouraged. This is because fluoroquinolones have some efficacy against mycobacteria, including tuberculosis, which can delay the diagnosis of these conditions.</p><p>The patient reported intermittent high-grade fevers, sore throat, pleuritic chest pain, and fatigue. They reported no rash, cough, vomiting, constipation, diarrhea, genitourinary symptoms, or weakness. They had previously had sinusitis. She did not take prescription medications, smoke, drink alcohol, or use drugs. She was not sexually active. She had no recent exposures to sick contacts, hot springs, travel history, undercooked meats, or bites from insects or animals.</p><p>This review of systems highlights multisystem involvement and eliminates several potentially relevant exposures. The presence of fevers and fatigue points toward infectious, inflammatory, or malignant processes.</p><p>On physical examination, her consciousness was alert, the patient was febrile; her axillary temperature was 38.0°C, the heart rate was 110 beats per minute, the blood pressure was 99/50 mm Hg, the respiratory rate was 20 per minute, and the oxygen saturation was 97% while the patient was breathing ambient air. The body-mass index (BMI; the weight in kilograms divided by the square of the height in meters) was 19.9. Cardiopulmonary examinations revealed that holo crackles were auscultated in the right lower lung field, and a systolic murmur (Levine grade 3/6) was heard at the apex. No signs of arthritis or skin abnormalities were shown. The patient's mood, attention, and affect were appropriate.</p><p>If this case is confirmed to be pneumonia, hospitalization is indicated. While both the PSI and CURB-65 scores ","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"26 4","pages":"292-296"},"PeriodicalIF":1.8,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.70015","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144582443","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}
A 75-year-old woman had been taking a geniposide-containing herbal medicine for 7 years and was admitted to our hospital for nausea, abdominal pain, and distention. CT revealed colonic wall thickening, whereas CS revealed a dark-purple edematous mucosa. Furthermore, biopsy specimens revealed small vein hyalinization. Thus, she was diagnosed with idiopathic mesenteric phlebosclerosis (IMP) and underwent surgery. von Kossa staining revealed granules in the mucosal, submucosal, muscular, and subserosal layers, with mesenteric veins demonstrating calcium deposition. Taken together, calcium ion deposition was likely to have accounted for vascular wall calcification in IMP. The patient's course was uneventful for 3 months after surgery.
{"title":"A case of idiopathic mesenteric phlebosclerosis: Insight into pathogenesis of associated vascular calcification","authors":"Kimitoshi Kubo MD, PhD, Noriko Kimura MD, PhD","doi":"10.1002/jgf2.70025","DOIUrl":"https://doi.org/10.1002/jgf2.70025","url":null,"abstract":"<p>A 75-year-old woman had been taking a geniposide-containing herbal medicine for 7 years and was admitted to our hospital for nausea, abdominal pain, and distention. CT revealed colonic wall thickening, whereas CS revealed a dark-purple edematous mucosa. Furthermore, biopsy specimens revealed small vein hyalinization. Thus, she was diagnosed with idiopathic mesenteric phlebosclerosis (IMP) and underwent surgery. von Kossa staining revealed granules in the mucosal, submucosal, muscular, and subserosal layers, with mesenteric veins demonstrating calcium deposition. Taken together, calcium ion deposition was likely to have accounted for vascular wall calcification in IMP. The patient's course was uneventful for 3 months after surgery.</p>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"26 5","pages":"475-478"},"PeriodicalIF":2.3,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.70025","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144929562","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}
Koki Nakamura MD, PhD, Tomoo Hidaka MD, PhD, Yoshihiro Toyoda MD, Mei Endo MD, Satoshi Kanke MD, PhD
Background
Despite the increasing demand for telemedicine, there have been few reports on telemedicine training for general practice/family medicine residents. This study aimed to qualitatively examine the educational effects of remote medical training for residents using role-play.
Methods
This study targeted first- and second-year residents enrolled in the General Medicine/Family Medicine Residency Program at Fukushima Medical University in 2023. The residents watched educational videos on telemedicine and engaged in role-playing training based on multiple scenarios. Subsequently, interviews were conducted with the residents, and the verbatim transcripts of the audio data were thematically analyzed using open coding.
Results
Eight residents participated in the study, with each undergoing 3–4 interviews. The identified codes were inductively summarized, and nine categories were generated: verbal cues to enhance the quality of history taking, nonverbal communication to connect with patients, addressing risks inherent in the convenience of telemedicine, co-creating a clinical environment with patients, anticipating issues different from those encountered in face-to-face consultation rooms, considering and supporting the elderly and those who are digitally disadvantaged, improving access restrictions due to busyness and resistance to telemedicine, understanding the living environment in connection with patient families and home care nurses, and awareness of the wide-ranging applications of telemedicine.
Conclusion
The results of telemedicine training via role-play suggest various educational effects. This study provides crucial findings for considering educational methods for GM/FM residents to respond to the increasing demand for telemedicine in primary health care.
{"title":"The educational effects of telemedicine training using role-playing for general practice/family medicine residents: A qualitative study","authors":"Koki Nakamura MD, PhD, Tomoo Hidaka MD, PhD, Yoshihiro Toyoda MD, Mei Endo MD, Satoshi Kanke MD, PhD","doi":"10.1002/jgf2.70020","DOIUrl":"https://doi.org/10.1002/jgf2.70020","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Despite the increasing demand for telemedicine, there have been few reports on telemedicine training for general practice/family medicine residents. This study aimed to qualitatively examine the educational effects of remote medical training for residents using role-play.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study targeted first- and second-year residents enrolled in the General Medicine/Family Medicine Residency Program at Fukushima Medical University in 2023. The residents watched educational videos on telemedicine and engaged in role-playing training based on multiple scenarios. Subsequently, interviews were conducted with the residents, and the verbatim transcripts of the audio data were thematically analyzed using open coding.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Eight residents participated in the study, with each undergoing 3–4 interviews. The identified codes were inductively summarized, and nine categories were generated: verbal cues to enhance the quality of history taking, nonverbal communication to connect with patients, addressing risks inherent in the convenience of telemedicine, co-creating a clinical environment with patients, anticipating issues different from those encountered in face-to-face consultation rooms, considering and supporting the elderly and those who are digitally disadvantaged, improving access restrictions due to busyness and resistance to telemedicine, understanding the living environment in connection with patient families and home care nurses, and awareness of the wide-ranging applications of telemedicine.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The results of telemedicine training via role-play suggest various educational effects. This study provides crucial findings for considering educational methods for GM/FM residents to respond to the increasing demand for telemedicine in primary health care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"26 4","pages":"334-345"},"PeriodicalIF":1.8,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.70020","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144582411","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}
Ocular chemical injuries require immediate diagnosis and treatment, posing challenges in remote regions. We report a case of mild chemical injury caused by an alkali chemical injury, successfully diagnosed and managed using telemedicine. A primary care physician utilized a smartphone-based anterior segment imaging system (Smart Eye Camera), allowing an ophthalmologist to remotely evaluate and classify the injury as Roper-Hall grade. Conservative treatment with irrigation and topical medications led to symptom resolution within 1 week. This case highlights the effectiveness of teleophthalmology, suggesting its significant potential for improving ocular care accessibility and timely intervention in medically underserved rural areas.
{"title":"Telemedicine-based diagnosis and management of ocular chemical injury in a remote setting: A case report","authors":"Eisuke Shimizu MD, PhD, Hiroki Nishimura MSc, CO, Rohan Jeetendra Khemlani MD, Shintaro Nakayama MSc, Keitaro Suzuki MD, Katsuya Sato MD","doi":"10.1002/jgf2.70017","DOIUrl":"https://doi.org/10.1002/jgf2.70017","url":null,"abstract":"<p>Ocular chemical injuries require immediate diagnosis and treatment, posing challenges in remote regions. We report a case of mild chemical injury caused by an alkali chemical injury, successfully diagnosed and managed using telemedicine. A primary care physician utilized a smartphone-based anterior segment imaging system (Smart Eye Camera), allowing an ophthalmologist to remotely evaluate and classify the injury as Roper-Hall grade. Conservative treatment with irrigation and topical medications led to symptom resolution within 1 week. This case highlights the effectiveness of teleophthalmology, suggesting its significant potential for improving ocular care accessibility and timely intervention in medically underserved rural areas.</p>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"26 4","pages":"359-362"},"PeriodicalIF":1.8,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.70017","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144581917","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}
Family caregivers and care recipients do not always have the same usual source of care, which may create barriers to providing optimal care for caregivers. This study aimed to compare family caregivers' primary care experiences based on whether they used the same medical facility as their care recipient or a different facility.
Methods
We used cross-sectional data from a survey conducted in Japan in 2020. Participants were family caregivers aged 40–74 years who cared for community-dwelling adults with chronic conditions. Caregivers' primary care experiences were assessed using the Japanese version of the Primary Care Assessment Tool Short Form (JPCAT-SF). Multivariable linear regression analyses were conducted to evaluate differences in JPCAT-SF scores between caregivers who used the same medical facility as their care recipient and those who used a different facility.
Results
Of the 406 family caregivers analyzed, 216 (53.2%) used a different medical facility from their care recipient. After adjusting for possible confounders, JPCAT-SF total scores were significantly lower among family caregivers using a different facility compared with those using the same facility (adjusted mean difference −5.73, 95% confidence interval: −8.93 to −2.54). The JPCAT-SF subscale scores for longitudinality, comprehensiveness (services available), and community orientation were significantly lower in the different facility group than the same facility group.
Conclusions
Family caregivers who used a different medical facility from their care recipient reported more negative primary care experiences than caregivers using the same facility. Greater efforts may be needed to provide patient-centered, family-oriented primary care for these caregivers.
{"title":"Primary care experiences of family caregivers using the same medical facility as their care recipient or a different facility","authors":"Gen Nakayama MD, PhD, Shoichi Masumoto MD, MPH, PhD, Junji Haruta MD, PhD, Tetsuhiro Maeno MD, PhD","doi":"10.1002/jgf2.70000","DOIUrl":"https://doi.org/10.1002/jgf2.70000","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Family caregivers and care recipients do not always have the same usual source of care, which may create barriers to providing optimal care for caregivers. This study aimed to compare family caregivers' primary care experiences based on whether they used the same medical facility as their care recipient or a different facility.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We used cross-sectional data from a survey conducted in Japan in 2020. Participants were family caregivers aged 40–74 years who cared for community-dwelling adults with chronic conditions. Caregivers' primary care experiences were assessed using the Japanese version of the Primary Care Assessment Tool Short Form (JPCAT-SF). Multivariable linear regression analyses were conducted to evaluate differences in JPCAT-SF scores between caregivers who used the same medical facility as their care recipient and those who used a different facility.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 406 family caregivers analyzed, 216 (53.2%) used a different medical facility from their care recipient. After adjusting for possible confounders, JPCAT-SF total scores were significantly lower among family caregivers using a different facility compared with those using the same facility (adjusted mean difference −5.73, 95% confidence interval: −8.93 to −2.54). The JPCAT-SF subscale scores for longitudinality, comprehensiveness (services available), and community orientation were significantly lower in the different facility group than the same facility group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Family caregivers who used a different medical facility from their care recipient reported more negative primary care experiences than caregivers using the same facility. Greater efforts may be needed to provide patient-centered, family-oriented primary care for these caregivers.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"26 4","pages":"297-304"},"PeriodicalIF":1.8,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.70000","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144581919","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}
<p>A 35-year-old woman with epilepsy and infertility presented with a 2-day history of left upper extremity swelling. Symptoms began after traveling, likely due to prolonged immobility followed by vigorous upper extremity activity and pressure from a leather bag on the left arm, contributing to venous stasis. She also reported experiencing recurrent headaches over the past 6 months. The patient was taking levetiracetam, lamotrigine, folic acid, and loxoprofen, none of which are associated with thrombotic risk. On examination, the left upper extremity exhibited swelling (Figure 1A) and superficial venous dilatation extending to the chest (Figure 1B). Laboratory findings demonstrated leukopenia, lymphopenia, a prolonged activated partial thromboplastin time, and a D-dimer level of 0.9 μ/mL (reference <1.0 μ/mL).</p><p>Chest contrast-enhanced computed tomography (CT) revealed thrombosis in the left axillary to the subclavian vein (Figure 2A), with stenosis at the clavicle-first rib junction. Brain CT demonstrated calcifications in the cerebellar dentate nuclei and globus pallidus (Figure 2B). Serologic markers (antinuclear, anti-dsDNA, anti-β2 glycoprotein I, anticardiolipin) and hypocomplementemia confirmed systemic lupus erythematosus (SLE) and antiphospholipid antibody syndrome (APS). The patient fulfilled the 2012 Systemic Lupus International Collaborating Clinics classification criteria, 2019 European League Against Rheumatism/American College of Rheumatology Classification Criteria for SLE, and 2006 revised Sapporo classification criteria for APS, confirmed upper extremity deep vein thrombosis (UEDVT), APS, and SLE.</p><p>Percutaneous balloon angioplasty and aspiration thrombectomy were performed, followed by anticoagulation with warfarin. Corticosteroids, mizoribine, and hydroxychloroquine were initiated for SLE-associated leukopenia, resulting in clinical improvement without symptom recurrence.</p><p>UEDVT accounts for ~10% of DVT cases in Western countries but only 3% in Japan.<span><sup>1, 2</sup></span> Common symptoms include upper extremity discomfort, swelling, and superficial venous dilatation.<span><sup>1</sup></span> UEDVT is classified as primary (e.g., venous thoracic outlet syndrome and Paget-Schroetter syndrome) or secondary (e.g., central venous catheters, malignancy, trauma, pregnancy, and oral contraceptive use).<span><sup>1</sup></span> In this case, extrinsic compression of the left subclavian vein at the costoclavicular junction, combined with prolonged immobility followed by vigorous upper extremity activity, contributed to venous thoracic outlet syndrome and Paget-Schroetter syndrome, which increased the risk of UEDVT.</p><p>D-dimer measurement is a valuable diagnostic tool for suspected UEDVT. In this patient, D-dimer (0.9 μ/mL) was within institutional reference limits but mildly elevated under Western cut-offs (0.5 μ/mL). When the pre-test probability of venous thromboembolism is high, the negative predictive value
{"title":"Upper extremity deep vein thrombosis associated with systemic lupus erythematosus and antiphospholipid syndrome","authors":"Masahiro Yabe MD, Nozomi Ozaki MD, Nobuhiro Sato MD, MPH, PhD, Norihito Nakamura MD, PhD, Azusa Aoyama MD, Shuichi Murakami MD, PhD, Yasuo Hirose MD","doi":"10.1002/jgf2.70023","DOIUrl":"https://doi.org/10.1002/jgf2.70023","url":null,"abstract":"<p>A 35-year-old woman with epilepsy and infertility presented with a 2-day history of left upper extremity swelling. Symptoms began after traveling, likely due to prolonged immobility followed by vigorous upper extremity activity and pressure from a leather bag on the left arm, contributing to venous stasis. She also reported experiencing recurrent headaches over the past 6 months. The patient was taking levetiracetam, lamotrigine, folic acid, and loxoprofen, none of which are associated with thrombotic risk. On examination, the left upper extremity exhibited swelling (Figure 1A) and superficial venous dilatation extending to the chest (Figure 1B). Laboratory findings demonstrated leukopenia, lymphopenia, a prolonged activated partial thromboplastin time, and a D-dimer level of 0.9 μ/mL (reference <1.0 μ/mL).</p><p>Chest contrast-enhanced computed tomography (CT) revealed thrombosis in the left axillary to the subclavian vein (Figure 2A), with stenosis at the clavicle-first rib junction. Brain CT demonstrated calcifications in the cerebellar dentate nuclei and globus pallidus (Figure 2B). Serologic markers (antinuclear, anti-dsDNA, anti-β2 glycoprotein I, anticardiolipin) and hypocomplementemia confirmed systemic lupus erythematosus (SLE) and antiphospholipid antibody syndrome (APS). The patient fulfilled the 2012 Systemic Lupus International Collaborating Clinics classification criteria, 2019 European League Against Rheumatism/American College of Rheumatology Classification Criteria for SLE, and 2006 revised Sapporo classification criteria for APS, confirmed upper extremity deep vein thrombosis (UEDVT), APS, and SLE.</p><p>Percutaneous balloon angioplasty and aspiration thrombectomy were performed, followed by anticoagulation with warfarin. Corticosteroids, mizoribine, and hydroxychloroquine were initiated for SLE-associated leukopenia, resulting in clinical improvement without symptom recurrence.</p><p>UEDVT accounts for ~10% of DVT cases in Western countries but only 3% in Japan.<span><sup>1, 2</sup></span> Common symptoms include upper extremity discomfort, swelling, and superficial venous dilatation.<span><sup>1</sup></span> UEDVT is classified as primary (e.g., venous thoracic outlet syndrome and Paget-Schroetter syndrome) or secondary (e.g., central venous catheters, malignancy, trauma, pregnancy, and oral contraceptive use).<span><sup>1</sup></span> In this case, extrinsic compression of the left subclavian vein at the costoclavicular junction, combined with prolonged immobility followed by vigorous upper extremity activity, contributed to venous thoracic outlet syndrome and Paget-Schroetter syndrome, which increased the risk of UEDVT.</p><p>D-dimer measurement is a valuable diagnostic tool for suspected UEDVT. In this patient, D-dimer (0.9 μ/mL) was within institutional reference limits but mildly elevated under Western cut-offs (0.5 μ/mL). When the pre-test probability of venous thromboembolism is high, the negative predictive value","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"26 6","pages":"652-654"},"PeriodicalIF":2.3,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.70023","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145436230","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}
<p>Reports from the United States underscore the vital role of chief residents in clinical practice and medical education, serving as leaders for their fellow residents.<span><sup>1</sup></span> While early leadership experience offers numerous benefits, a significant challenge persists in Japan: leadership positions remain predominantly held by men. Beyond leadership roles, Japan grapples with a pervasive gender gap within its medical field. For instance, the proportion of female physicians in Japan is the lowest among OECD countries, standing at just 23.6%.<span><sup>2</sup></span> This leadership disparity extends across hospital executive boards, professional societies, and academic institutions, limiting diversity at decision-making levels.</p><p>At the JACRA (Japan Chief Resident Association) Chief Resident Meeting in March 2024, about 40 current and incoming chief residents convened to discuss two key questions: “Why are there so few female leaders?” and “What actions are necessary to foster gender-diverse leadership?” To encourage candid feedback, an anonymous online polling system was utilized. Table 1 presents a categorization of audience responses. Results highlighted key challenges such as work-life balance struggles and inadequate leadership training. Many participants emphasized the unequal distribution of clinical and administrative workloads among female leaders. This letter presents insights from the discussion and potential solutions to advance gender equity.</p><p>Participants noted that traits such as modesty and humility, often associated with women, contribute to their hesitation in assuming leadership roles. The “imposter phenomenon,” characterized by a tendency to underestimate one's abilities, was also frequently mentioned.<span><sup>3</sup></span> These observations underscore deep-rooted biases affecting leadership perceptions and career advancement.</p><p>The physical demands on women and their career impact were recurring themes. Mid-career breaks due to childbirth and childcare responsibilities pose major obstacles, affecting promotion opportunities. Matsui et al. found that female medical students prioritize family-career balance when making career choices, whereas male students focus on work initially and adjust later.<span><sup>4</sup></span> </p><p>Systemic barriers also hinder women's advancement. Female leaders often face excessive clinical and administrative workloads, compounded by insufficient institutional support. Limited networking opportunities and lack of visibility within professional circles further exacerbate these challenges, making career progression more difficult.</p><p>Addressing these issues requires a comprehensive, multi-pronged approach. Institutions must take proactive steps to increase female representation in leadership. Establishing mentorship programs, particularly group mentorship, can foster confidence, skill development, and career progression. Systemic reforms such as pr
来自美国的报告强调了总住院医师在临床实践和医学教育中的重要作用，他们是其他住院医师的领导者虽然早期的领导经验给女性带来了很多好处，但日本仍然存在一个重大挑战：领导职位仍然主要由男性担任。除了领导角色，日本还在努力解决医疗领域普遍存在的性别差距问题。例如，日本女医生的比例是经合组织国家中最低的，仅为23.6%这种领导力差异在医院执行委员会、专业协会和学术机构中普遍存在，限制了决策层面的多样性。在2024年3月举行的日本总住院医师协会（JACRA）总住院医师会议上，约40名现任和即将上任的总住院医师聚集在一起，讨论了“为什么女性领导者这么少”和“为了培养性别多元化的领导力，需要采取哪些行动”这两个关键问题。为了鼓励坦率的反馈，采用了匿名在线投票系统。表1给出了听众反应的分类。调查结果突出了一些关键挑战，如工作与生活的平衡问题和领导力培训不足。许多与会者强调，临床和行政工作量在女性领导人之间的分配不平等。这封信提出了讨论中的见解和促进性别平等的潜在解决方案。与会者指出，谦虚和谦逊等通常与女性有关的特质，导致她们在担任领导角色时犹豫不决。以低估自己能力为特征的“冒名顶替者现象”也经常被提及这些观察结果强调了影响领导力认知和职业发展的根深蒂固的偏见。对妇女的体力要求及其对职业的影响是反复出现的主题。由于生育和照顾孩子的责任而导致的职业中期中断是主要障碍，影响晋升机会。Matsui et al.发现女医学生在职业选择时优先考虑家庭与事业的平衡，而男医学生在职业选择时优先考虑工作，然后再进行调整体制障碍也阻碍了妇女的进步。女性领导人往往面临过多的临床和行政工作量，加上机构支持不足。有限的社交机会和在专业圈子中缺乏知名度进一步加剧了这些挑战，使职业发展更加困难。解决这些问题需要采取综合、多管齐下的办法。各机构必须采取积极措施，增加女性在领导层中的代表性。建立师徒关系项目，特别是团体师徒关系，可以培养信心、技能发展和职业发展。促进家庭责任分担、扩大男性育儿假和防止过度工作等系统性改革至关重要。通过实施协作式领导模式和减轻行政负担来重组领导角色，也将使领导者专注于核心责任和专业成长。研究表明，在医疗保健领域实行性别多样化的领导是有益的。Naciti et al.（2022）发现，女性领导越多的医院财务绩效越好，效率越高，决策能力也越好这些调查结果强调需要促进性别多样性，以提高保健质量和效率。JACRA继续致力于通过有针对性的领导力教育和培训举措来支持这些努力。通过解决系统性障碍、加强指导和促进包容性，我们的目标是赋予妇女权力，使她们能够发挥领导作用，贡献她们的专业知识，推动医疗行业发生有意义的变化。这项工作尚未发表。Masumi Ogushi：写作-原稿；写作——审阅和编辑；资源;项目管理;可视化;概念化;方法;调查。长崎和也：监督；写作——审阅和编辑；项目管理。西泽俊典：概念化；调查;监督;项目管理;写作——审阅和编辑；方法。村岛裕子：调查；概念化。田中kosuke：概念化；调查。Takuma Hata：概念化；调查;方法;监督;项目管理。野木雅之：写作-评论和编辑；资源;项目管理。这封信没有得到外部或内部的资金支持。作者无利益冲突需要申报。我们确认已从图的主体处获得发表的同意。
{"title":"How to promote female medical leaders? Insights and solutions from the JACRA Chief Resident Meeting","authors":"Masumi Ogushi MD, Kazuya Nagasaki MD, PhD, Toshinori Nishizawa MD, Yuko Murashima MD, Kosuke Tanaka MD, Takuma Hata MD, Masayuki Nogi MD, MHPE, FACP","doi":"10.1002/jgf2.70022","DOIUrl":"https://doi.org/10.1002/jgf2.70022","url":null,"abstract":"<p>Reports from the United States underscore the vital role of chief residents in clinical practice and medical education, serving as leaders for their fellow residents.<span><sup>1</sup></span> While early leadership experience offers numerous benefits, a significant challenge persists in Japan: leadership positions remain predominantly held by men. Beyond leadership roles, Japan grapples with a pervasive gender gap within its medical field. For instance, the proportion of female physicians in Japan is the lowest among OECD countries, standing at just 23.6%.<span><sup>2</sup></span> This leadership disparity extends across hospital executive boards, professional societies, and academic institutions, limiting diversity at decision-making levels.</p><p>At the JACRA (Japan Chief Resident Association) Chief Resident Meeting in March 2024, about 40 current and incoming chief residents convened to discuss two key questions: “Why are there so few female leaders?” and “What actions are necessary to foster gender-diverse leadership?” To encourage candid feedback, an anonymous online polling system was utilized. Table 1 presents a categorization of audience responses. Results highlighted key challenges such as work-life balance struggles and inadequate leadership training. Many participants emphasized the unequal distribution of clinical and administrative workloads among female leaders. This letter presents insights from the discussion and potential solutions to advance gender equity.</p><p>Participants noted that traits such as modesty and humility, often associated with women, contribute to their hesitation in assuming leadership roles. The “imposter phenomenon,” characterized by a tendency to underestimate one's abilities, was also frequently mentioned.<span><sup>3</sup></span> These observations underscore deep-rooted biases affecting leadership perceptions and career advancement.</p><p>The physical demands on women and their career impact were recurring themes. Mid-career breaks due to childbirth and childcare responsibilities pose major obstacles, affecting promotion opportunities. Matsui et al. found that female medical students prioritize family-career balance when making career choices, whereas male students focus on work initially and adjust later.<span><sup>4</sup></span>\u0000 </p><p>Systemic barriers also hinder women's advancement. Female leaders often face excessive clinical and administrative workloads, compounded by insufficient institutional support. Limited networking opportunities and lack of visibility within professional circles further exacerbate these challenges, making career progression more difficult.</p><p>Addressing these issues requires a comprehensive, multi-pronged approach. Institutions must take proactive steps to increase female representation in leadership. Establishing mentorship programs, particularly group mentorship, can foster confidence, skill development, and career progression. Systemic reforms such as pr","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"26 6","pages":"667-669"},"PeriodicalIF":2.3,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.70022","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145436221","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}
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