Journal of General and Family Medicine最新文献

{"title":"Late Recognition of Suspected Ehlers-Danlos Syndrome After Recurrent Small-Bowel Perforations: A Case Report.","authors":"Norio Horiguchi, Etsuko Hisanaga, Hiroko Sato, Kuniko Yoshida, Akihito Kimura, Ayumi Ito, Miki Horita, Aya Suzuki, Keiko Kawai-Kowase","doi":"10.1002/jgf2.70183","DOIUrl":"10.1002/jgf2.70183","url":null,"abstract":"<p><strong>Background: </strong>Ehlers-Danlos syndrome (EDS) may be overlooked when gastrointestinal and musculoskeletal findings are assessed separately.</p><p><strong>Case presentation: </strong>An older woman with two previous small-bowel perforations had bilateral congenital hip dislocation, recurrent shoulder dislocations, skin hyperextensibility, and muscularis propria thinning in nonperforated jejunum. Systematic reassessment using the 2017 classification met minimal clinical criteria suggestive of arthrochalasia EDS, while recurrent bowel perforation raised concern for vascular EDS. Genetic testing was declined.</p><p><strong>Conclusion: </strong>The overall phenotype supported clinically suspected EDS, but molecular confirmation was required for definitive subtype assignment.</p>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"27 5","pages":"e70183"},"PeriodicalIF":1.3,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13594383/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149026654","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":"Current Gaps in Point-of-Care Ultrasound Supervision in Generalist Practice in Japan: A Nationwide Survey.","authors":"Toru Yamada, Takuma Kimura, Kyoko Shigetomi, Takahiro Shinohara, Shuji Ouchi, Suguru Mabuchi, Hiroyuki Ichige, Toru Kameda, Shumpei Yoshino, Yuka Kitano, Keita Endo, Kazuya Okada, Hiroshi Kamijo, Hiromizu Takahashi, Tomoko Kusama, Takeshi Ishida, Masayoshi Hashimoto","doi":"10.1002/jgf2.70180","DOIUrl":"10.1002/jgf2.70180","url":null,"abstract":"<p><strong>Background: </strong>Point-of-care ultrasound (POCUS) is increasingly used in generalist practice by physicians, nurse practitioners, and nurses. However, the current availability of clinical supervision and preferred supervision models for POCUS remains unclear.</p><p><strong>Methods: </strong>We conducted an anonymous web-based survey among members of five academic societies related to generalist practice in Japan between April 2024 and March 2025. The target respondents were physicians, nurse practitioners, and nurses. The survey assessed POCUS use in daily clinical practice, current supervision status, preferred supervision models, and previous training experience.</p><p><strong>Results: </strong>A total of 1056 valid responses were analyzed, including 835 physicians and 221 nurses or nurse practitioners. Overall, 735 respondents (69.6%) reported performing some form of POCUS in daily clinical practice. The most common current supervision status was having no available supervisor inside or outside the facility (36.9%), more common among physicians than among nurses and nurse practitioners (42.2% vs. 17.2%, <i>p</i> < 0.001). Real-time online supervision was reported as the current supervision status by 2.1% of respondents, whereas 56.3% selected it as a preferred model and 79.5% selected continuous in-person supervision; the two items used different response formats (single choice vs. multiple response) and are not directly comparable. Fewer than 40% of respondents had received previous POCUS training, although 77.8% expressed future training needs.</p><p><strong>Conclusions: </strong>POCUS is widely used in generalist practice in Japan, but clinical supervision remains insufficient. Reported current supervision differed from preferred supervision models, suggesting that real-time online supervision may be a feasible strategy to support safe and sustainable POCUS implementation.</p>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"27 5","pages":"e70180"},"PeriodicalIF":1.3,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13589104/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149009266","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":"Perceived Difficulty in Discharging Older Patients With Senility to Home or Care Facilities for End-of-Life Care: A Nationwide Cross-Sectional Study of Hospital-Based Geriatricians in Japan.","authors":"Teruhiko Imanaga","doi":"10.1002/jgf2.70181","DOIUrl":"10.1002/jgf2.70181","url":null,"abstract":"<p><strong>Background: </strong>Senility has become an increasingly common cause of death in aging societies such as Japan. However, many patients still die in hospitals, suggesting challenges in transitioning end-of-life care to community settings. This study examined hospital-based geriatricians' perceived difficulty in discharging patients with senility and associated physician-related factors.</p><p><strong>Methods: </strong>I conducted a nationwide postal cross-sectional survey of hospital-based board-certified geriatricians in Japan. Perceived difficulty in discharge and its reasons were assessed. A composite intervention frequency score was calculated based on four clinical practices used when patients were unable to maintain oral intake (hydration, central venous nutrition, nasogastric tube feeding, and percutaneous endoscopic gastrostomy). Ordinal logistic regression analyses were performed to examine the association between intervention frequency and perceived difficulty, adjusting for physician characteristics.</p><p><strong>Results: </strong>Of 409 respondents (response rate: 35.4%), 301 physicians with experience diagnosing senility were included. Most respondents reported experiencing difficulty in discharging patients with senility for end-of-life care to home (86.1% reported \"always\" or \"often\") and to long-term care facilities (72.5% reported \"always\" or \"often\"). Caregiver-related factors were prominent barriers to home discharge, whereas facility-related factors were more common for discharge to long-term care facilities. Higher intervention frequency was associated with greater perceived difficulty in discharge to home (OR 1.13, 95% CI 1.01-1.26) and long-term care facilities (OR 1.14, 95% CI 1.02-1.28).</p><p><strong>Conclusion: </strong>Hospital-based geriatricians frequently perceive difficulty in discharging patients with senility. Barriers differ by setting, and physicians' intervention tendencies may influence discharge planning.</p>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"27 5","pages":"e70181"},"PeriodicalIF":1.3,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13589096/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149009327","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":"Acute-On-Chronic Liver Failure With Discordant Severity Assessments Following Binge Drinking: A Case Report","authors":"Minami Seki,&nbsp;Tomoyuki Watanabe,&nbsp;Yuma Haraguchi","doi":"10.1002/jgf2.70165","DOIUrl":"https://doi.org/10.1002/jgf2.70165","url":null,"abstract":"<p>Acute-on-chronic liver failure (ACLF) is associated with high short-term mortality. We report a man in his 50s with alcohol-related cirrhosis who developed ACLF following binge drinking. Despite being classified as grade 1 ACLF according to the Japanese severity classification, he presented with severe metabolic acidosis and marked hyperlactatemia and died 4 h after admission. Another prognostic scoring system classified him in the most severe category. This case illustrates that different severity assessments may provide complementary information regarding ACLF severity and prognosis and underscores the importance of repeatedly addressing problematic alcohol use and facilitating engagement in specialized addiction treatment during outpatient care.</p>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"27 5","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.70165","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148994559","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":"Community-Based Participatory Research to Promote Social Inclusion in a Rural Town in Japan: Process Evaluation of a Pre-COVID-19 Collaboration Among Residents and Professionals.","authors":"Daisuke Son, Akira Matsushita, Michinori Tanaka, Mina Ueharu, Yusuke Yamauchi, Kunihiro Tsujikawa, Shoko Uetsuki, Naoko Tateishi, Masako Nishi, Akiko Ichii, Suhkye Shin, Naoki Sugawara","doi":"10.1002/jgf2.70179","DOIUrl":"10.1002/jgf2.70179","url":null,"abstract":"<p><strong>Background: </strong>Rural communities face aging, depopulation, shrinking resources, and increasing social isolation. This study examined how a Community-Based Participatory Research (CBPR) partnership was formed and negotiated in rural Japan, focusing on collaborative decision-making and arts-based engagement as a foundation for social inclusion.</p><p><strong>Methods: </strong>A qualitative descriptive study was conducted in Nagi Town, Okayama Prefecture, Japan. Between February 2018 and January 2020, eight CBPR meetings were held with 13 participants, including family physicians, public health nurses, community-based participants, and theater professionals. Audio-recorded discussions, field notes, and documents were analyzed thematically using Braun and Clarke's framework, focusing on partnership formation, equality and representation, arts-based knowledge generation, decision-making, and implementation challenges during the pre-action phase.</p><p><strong>Results: </strong>Four cross-cutting themes were identified: equality and mutual learning, discovery of hidden community strengths, arts as a bridge for dialogue and participation, and fragility and resilience of collaborative action planning. Collaboration evolved from facilitator-led learning to shared local interpretation and distributed action planning. Two working groups explored ways to identify socially isolated residents and designed art- and memory-based events. The \"<i>Choi-waru</i> Reunion\", using local photographs and films, created opportunities for intergenerational dialogue. The planned participatory theater workshop involving persons with disabilities or experiences of social withdrawal was canceled because of COVID-19, but the preceding process supported co-learning, creative planning, and cross-sector relationships.</p><p><strong>Conclusions: </strong>CBPR combined with arts-based engagement may support relationship-building, shared reflection, and collaborative planning in rural communities. Rather than demonstrating intervention effectiveness, this study highlights preparatory processes as a foundation for future social inclusion efforts.</p>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"27 5","pages":"e70179"},"PeriodicalIF":1.3,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13583457/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148992516","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":"Letter to the Editor: Dysphagia Screening in an Aging Population: A Scoping Review of Structural Gaps Between Triage and Comprehensive Evaluation in International and Japanese Practices.","authors":"Insbat Zafar","doi":"10.1002/jgf2.70168","DOIUrl":"https://doi.org/10.1002/jgf2.70168","url":null,"abstract":"","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"27 5","pages":"e70168"},"PeriodicalIF":1.3,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13579526/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148992541","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":"Diagnostic Reasoning in General Internal Medicine Consultations: A Text Mining Analysis of Consultation Requests.","authors":"Ren Kawamura, Yukinori Harada, Taro Shimizu","doi":"10.1002/jgf2.70176","DOIUrl":"10.1002/jgf2.70176","url":null,"abstract":"<p><strong>Background: </strong>Diagnostic reasoning is often difficult to evaluate because it is largely internal, and linguistic features associated with consultation quality remain poorly understood. Consultation requests may provide a useful window into real-time diagnostic thinking. We used text mining to examine how language in consultation requests reflects diagnostic reasoning in general internal medicine.</p><p><strong>Methods: </strong>We conducted a single-center retrospective observational study of diagnostic consultation requests from the Department of Diagnostic and Generalist Medicine at a Japanese university hospital in 2021. Consultations were grouped using an outcome-based operational definition of appropriateness, centered on whether the first specialty department established the correct final diagnosis, with an additional concordance requirement when a specific diagnosis was strongly suspected. Text mining using KH Coder included co-occurrence network analysis, correspondence analysis, and keyword-in-context (KWIC) concordance analysis.</p><p><strong>Results: </strong>Among 352 consultations, 229 were classified as appropriate and 123 as inappropriate. Appropriate consultations were characterized by terms indicating clear abnormalities and disease progression, whereas inappropriate consultations were associated with terms reflecting limited diagnostic direction, such as \"unknown\" and \"negative\". KWIC analysis showed two uses of \"negative\": revising the differential diagnosis after negative results and maintaining suspicion despite negative findings. In inappropriate consultations, these patterns were accompanied by potentially insufficient assessment/documentation and diagnostic uncertainty.</p><p><strong>Conclusions: </strong>Text mining of consultation requests revealed linguistic features associated with consultation appropriateness and showed that \"negative\" reflected distinct diagnostic reasoning moves. Consultation request text may provide a scalable window into diagnostic reasoning and identify opportunities to improve diagnostic communication and consultation quality.</p>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"27 5","pages":"e70176"},"PeriodicalIF":1.3,"publicationDate":"2026-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13571846/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148963470","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":"Genito-Pelvic Pain/Penetration Disorder Presenting as an Unconsummated Marriage Managed in Japanese Primary Care","authors":"Hisashi Yoshimoto,&nbsp;Sayaka Ohsawa,&nbsp;Hiroki Isono,&nbsp;Satoko Komori,&nbsp;Shoji Yokoya","doi":"10.1002/jgf2.70177","DOIUrl":"https://doi.org/10.1002/jgf2.70177","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Genito-pelvic pain/penetration disorder (GPPPD) may present as unconsummated marriage and receive less attention when pregnancy is prioritized.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case</h3>\u0000 \u0000 <p>A 39-year-old woman and her husband presented after 5 years without penovaginal intercourse despite fertility treatment. Clinical history supported GPPPD. Primary care included biopsychosocial assessment, psychoeducation, and couple support. Stepwise care included paced breathing, pelvic floor relaxation stretches, lubricant, graded insertion, and vaginal dilation. Intercourse was achieved after 8 months, patient-rated overall satisfaction rose from 0 to 85/100, and she had a child.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Family physicians may support couples with GPPPD using biopsychosocial, stepwise care when specialist services are limited.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"27 5","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.70177","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148943288","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":"Functional Hyperthermia Presenting as Fever of Unknown Origin With Normal Inflammatory Markers in an Adolescent","authors":"Ryuichi Minoda Sada,&nbsp;Hirofumi Miyake,&nbsp;Hiroyuki Akebo,&nbsp;Kazuhiro Hatta","doi":"10.1002/jgf2.70175","DOIUrl":"10.1002/jgf2.70175","url":null,"abstract":"&lt;p&gt;A 17-year-old boy was referred to our general internal medicine service for a 3-week history of recurrent fever and headache. Nine weeks before referral, he had begun a 2-week school program in Bangkok, Thailand, where he stayed in a hotel, remained within urban Bangkok throughout the program without travel to rural or highland areas, and interacted with local students. He reported no consumption of untreated water or raw meat, freshwater or seawater exposure, animal contact, sick contact, or sexual exposure. He remained well after returning to Japan and developed symptoms approximately 4 weeks later. Fever was accompanied by chills, headache, and reduced appetite, but not weight loss, respiratory or gastrointestinal symptoms, urinary symptoms, arthralgia, or rash. Acetaminophen did not produce sustained improvement. Blood tests, head computed tomography, an interferon-gamma release assay (IGRA), and cerebrospinal fluid examination at another hospital had shown no apparent abnormality.&lt;/p&gt;&lt;p&gt;He had migraine since age 15 and regularly took lomerizine and fluvoxamine, with eletriptan as needed. He had never smoked or consumed alcohol and reported no sexual history. He was a high-school student living in a dormitory and participated in a music club. The dormitory initially appeared to be background information rather than a diagnostic clue. On referral, his temperature was 38.5°C, blood pressure 113/71 mmHg, pulse 81 beats/min, and respiratory rate 16 breaths/min. He appeared chronically unwell but was alert and hemodynamically stable. There was no lymphadenopathy, thyroid enlargement, heart murmur, abnormal lung sound, abdominal tenderness, hepatosplenomegaly, joint swelling, rash, meningeal sign, or focal neurologic deficit.&lt;/p&gt;&lt;p&gt;The white blood cell count was 4400/μL with a normal differential, hemoglobin 15.2 g/dL, and platelet count 299 × 10&lt;sup&gt;3&lt;/sup&gt;/μL. Renal function, electrolytes, glucose, corrected calcium, lactate dehydrogenase, and liver-associated enzymes were unremarkable. C-reactive protein (CRP) was &lt; 0.2 mg/dL and the erythrocyte sedimentation rate (ESR) was 4 mm/h. Urinalysis and urine sediment were normal. The initial problem representation was an immunocompetent adolescent with objectively documented prolonged fever and headache, no localizing findings, and persistently normal systemic inflammatory markers.&lt;/p&gt;&lt;p&gt;The duration and documented temperature met a conventional clinical frame for fever of unknown origin (FUO), although modern FUO practice emphasizes the diagnostic process rather than rigid historical criteria [&lt;span&gt;1&lt;/span&gt;]. The most conspicuous findings were not positive ones but the absence of an acute-phase response. Normal CRP and ESR substantially lowered the probability of many bacterial infections and systemic inflammatory diseases, yet they could not by themselves establish a nonorganic diagnosis. CRP production begins several hours after an inflammatory stimulus and is influenced by disease timing, a","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"27 5","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13555266/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148921502","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":"Incorporating Diversity, Equity, and Inclusion Into the History of the Japan Primary Care Association","authors":"Makiko Ozaki","doi":"10.1002/jgf2.70174","DOIUrl":"10.1002/jgf2.70174","url":null,"abstract":"&lt;p&gt;I read with great interest the special article by Matsumura et al., “The Formation and Evolution of the Japan Primary Care Association: A 15-Year Retrospective” [&lt;span&gt;1&lt;/span&gt;]. The article provides a valuable overview of the Japan Primary Care Association (JPCA), including its merger of three predecessor societies, certification systems, disaster response, infectious disease activities, academic awards, and interprofessional training. I appreciate this effort to document JPCA's first 15 years and its contributions to primary care in Japan.&lt;/p&gt;&lt;p&gt;This account, however, would be more complete if it incorporated a diversity, equity, and inclusion (DE&amp;I) perspective. No women physicians are mentioned by name, and the contributions of women and inter-professional members receive limited attention. This raises a broader question about how institutional histories are written, whose contributions are recognized, and whose work remains unnamed in narratives of professional development.&lt;/p&gt;&lt;p&gt;Professional societies shape education, research, clinical practice, leadership, visibility, legitimacy, and career opportunities. Historical accounts of such societies therefore shape which contributions are remembered as institution-building. When retrospectives focus on formal structures, certification systems, named leaders, awards, and institutional milestones, the contributions of women physicians and inter-professional members may become less visible, especially when they involve education, committee work, conference organization, community-based practice, collaboration, and DE&amp;I-related initiatives. Such contributions are essential to primary care but may be underrecognized in conventional institutional narratives.&lt;/p&gt;&lt;p&gt;JPCA's 2023 amendment to its officer selection rules is relevant in this regard. Approved at the General Assembly on June 11, 2023, the reform introduced a quota system for board elections [&lt;span&gt;2&lt;/span&gt;]. The related announcement also noted the inclusion of women and inter-professional members on the election management committee and emphasized the need to increase their representation among delegates. Including this reform would provide a fuller account of JPCA's efforts to enhance diversity in decision-making.&lt;/p&gt;&lt;p&gt;This issue is important in Japanese medicine, where women physicians remain underrepresented in leadership positions within professional medical societies. Across 19 Japanese professional medical societies, women accounted for only 7% of board members, despite comprising nearly one-quarter of the physician workforce [&lt;span&gt;3&lt;/span&gt;]. These disparities highlight the historical significance of JPCA's efforts to improve representation in governance and the importance of documenting them as part of the association's development.&lt;/p&gt;&lt;p&gt;Future historical accounts could examine whether representation within JPCA has changed over time across membership, board membership, delegates, committees, conference leadership, invite","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"27 5","pages":""},"PeriodicalIF":1.3,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13551089/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148914381","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}