Journal of General and Family Medicine最新文献

{"title":"Factors associated with the cancer survivorship care practices of primary care physicians: A cross-sectional questionnaire study in Japan","authors":"Akihiro Nishi MD,&nbsp;Hiroki Matsui MPH,&nbsp;Takashi Chinen MD, PhD,&nbsp;Sachi Takaoka MD,&nbsp;Takuji Seo MD, PhD,&nbsp;Satoshi Kanke MD, PhD,&nbsp;Teruhisa Azuma MD","doi":"10.1002/jgf2.70037","DOIUrl":"https://doi.org/10.1002/jgf2.70037","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The involvement of primary care physicians (PCPs) is essential to meet the diverse needs of cancer survivors, yet their engagement remains insufficient. Consequently, identifying the factors associated with PCPs' practices in each component of cancer survivorship care is crucial. However, there is no study on the factors for individual care components. Therefore, we conducted a survey to identify the involvement and factors related to PCPs' practice of each component of cancer survivorship care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A web-based questionnaire was distributed to 1091 family physicians in Japan. We identified four cancer survivorship care components: surveillance of recurrence, care for late effects, care for psychological problems, and care for social problems. The association between the practice of the components and the presence of knowledge or information resources, access to oncologists, and requests from patients and oncologists was evaluated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 191 PCPs (response rate: 17.5%) responded, and 180 were included in the analysis. Multivariate logistic regression analyses revealed that knowledge or information resources were associated with care for late effects (odds ratio (OR), 5.09; 95% confidence interval (CI), 1.54–23.1) and psychological problems (OR, 4.77; 95% CI, 1.52–17.8). Access to oncologists was associated with surveillance of recurrence (OR, 2.97; 95% CI, 1.08–8.75). Requests from patients and oncologists were associated with almost all survivorship care components.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Requests from patients and oncologists might be key to PCPs' involvement in cancer survivorship care. PCPs need to be proactive in identifying patient needs and fostering trust from patients and oncologists for better cancer survivorship care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"26 5","pages":"465-474"},"PeriodicalIF":2.3,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.70037","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144929918","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":"An infant with Kawasaki disease having gastrointestinal bleeding due to multiple gastric ulcers","authors":"Takeru Kanazawa MD,&nbsp;Tomokazu Nakagami MD, PhD,&nbsp;Jyoji Yoshizawa MD, PhD,&nbsp;Yoshifusa Abe MD, PhD","doi":"10.1002/jgf2.70035","DOIUrl":"https://doi.org/10.1002/jgf2.70035","url":null,"abstract":"<p>Kawasaki disease (KD) is an acute systemic vasculitis managed mainly through intravenous immunoglobulin (IVIG), aspirin, and steroids. Although gastrointestinal symptoms are common, gastrointestinal bleeding is rare. We present the case of an 11-month-old girl with incomplete KD who developed severe gastrointestinal bleeding due to multiple gastric ulcers, despite prophylactic H2-receptor antagonist therapy, requiring blood transfusion therapy. This case illustrates that gastrointestinal bleeding can occur as a direct consequence of KD and from the combined effects of corticosteroids and nonsteroidal anti-inflammatory drugs. It emphasizes the need for vigilant monitoring and further research to efficiently prevent gastrointestinal bleeding in patients with KD.</p>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"26 5","pages":"490-492"},"PeriodicalIF":2.3,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.70035","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144929561","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":"Evaluating antimicrobial effectiveness in acute uncomplicated cystitis: A retrospective single-center study","authors":"Takuhisa Nukaya MD, PhD,&nbsp;Kiyohito Ishikawa MD, PhD,&nbsp;Ryoichi Shiroki MD, PhD","doi":"10.1002/jgf2.70034","DOIUrl":"https://doi.org/10.1002/jgf2.70034","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Acute uncomplicated cystitis (AUC) is a urinary tract infection and is generally treated using antimicrobial therapy. <i>Escherichia coli</i> is the main causative agent of AUC. Recently, the prevalence of fluoroquinolone (FQ)-resistant-<i>E. coli</i> has demonstrated a noticeable increase. In this study, we aimed to investigate the effectiveness of appropriate antimicrobial treatment in AUC caused by <i>E. coli</i> in real-world clinical settings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective cohort study reviewed the records of patients with AUC treated at the urology department of Minami Cooperative Hospital between April 2016 and December 2020. Effectiveness was defined as clinical improvement.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The study cohort of 730 patients had a median age of 65.5 years (interquartile range, 57–78 years) and 23.2% were aged &lt;55 years. <i>E. coli</i> was detected in 73.4% of patients, of whom 26.7% had levofloxacin (LVFX)-resistant strains. LVFX-resistant <i>E. coli</i> was associated with age ≥55 years and recurrent cases. Effectiveness was determined in 75.1% of cases, of which 75% complied with the Japanese or other international guidelines. The overall treatment effectiveness was highest with β-lactam (BL)/β-lactamase inhibitor (BLI) combinations (94.7%). The effectiveness of first- and third-generation cephalosporins (CPs) was 81.1–83.3%, and that of FQs and sulfamethoxazole–trimethoprim (ST) was 82.6–83.8%. For LVFX-resistant <i>E. coli</i>, the treatment effectiveness was highest (100%) with BL/BLI combinations, intermediate (75–81%) with first- and third-generation CPs and ST, and lowest (50%) with FQs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>BL/BLI combinations had the highest effectiveness for the treatment of AUC.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"26 5","pages":"451-457"},"PeriodicalIF":2.3,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.70034","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144929938","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":"Critical mistakes in managing chronic constipation in the older person and how to avoid them: A narrative review","authors":"Madunil Niriella MD, FRCP, AGAF,&nbsp;Hiruni Jayasena MD, MRCP,&nbsp;Prathibha Wijesingha MBBS,&nbsp;Janaka de Silva MD, FRCP, PhD","doi":"10.1002/jgf2.70033","DOIUrl":"https://doi.org/10.1002/jgf2.70033","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This narrative review identifies pitfalls in managing constipation in older adults and provides evidence-based recommendations to avoid them.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A selective literature search was conducted across electronic databases (PubMed, MEDLINE, Embase, and Cochrane Library) to identify relevant publications on constipation management in older adults. Randomized controlled trials, meta-analyses, systematic reviews, evidence-based clinical practice guidelines, and selected expert consensus statements and narrative reviews were included.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Constipation significantly impacts quality of life and healthcare costs in older adults. It is not a consequence of normal aging but results from decreased mobility, medications, underlying diseases, and pelvic floor dysfunction. A stepwise diagnostic and therapeutic approach is recommended, recognizing that multiple etiologic mechanisms often coexist in elderly patients. Before pharmacological interventions, initial management should include thorough history-taking, physical examination, medication review, and dietary and lifestyle modifications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Common management mistakes include inadequate assessment, overlooking underlying conditions, insufficient diagnostic workup, ignoring multifactorial causes, premature medication use, and neglecting patient education. Effective management requires systematic evaluation and personalized interventions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Clinical Implications</h3>\u0000 \u0000 <p>Clinicians should adopt a stepwise approach, from clinical assessment to diagnostic testing or medications. Patient education and individualized treatment based on comorbidities and preferences are essential, with regular efficacy reassessment.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"26 5","pages":"394-401"},"PeriodicalIF":2.3,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.70033","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144929939","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":"Effects of a two-night hospitalization program as a specific health guidance on obesity and cardiovascular disease risk factors","authors":"Maki Okazaki MD,&nbsp;Takeshi Katsuki MD,&nbsp;Hideaki Kurata MD/PhD,&nbsp;Shinichi Tanaka MD,&nbsp;Hajime Tanaka MD,&nbsp;Toshihide Kawai MD/PhD","doi":"10.1002/jgf2.70031","DOIUrl":"https://doi.org/10.1002/jgf2.70031","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>To assess the effects of a two-night hospitalization program conducted at our hospital as part of a domestic health guidance system. This program is designed for lifestyle modification within a health checkup framework for metabolic syndrome.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This is a single-center, retrospective observational study. We reviewed the medical records of 170 subjects who completed the two-night hospitalization program between June 1, 2019, and October 31, 2023. The ideal dietary caloric intake was calculated based on standard body weight (kg) × 25 kcal/kg. Participants were advised to maintain a regular lifestyle and received face-to-face instruction from nurses, nutritionists, physiotherapists, technicians, and physicians. We instructed the patients to visit the outpatient clinic twice, one month and three months after discharge. We compared body weight, systolic and diastolic blood pressure, and various metabolic parameters from those recorded before the program to the final outpatient visit after the program.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Roughly half of the participants had been previously diagnosed with obesity and metabolic syndrome. At the second outpatient visit after completing the program, participants showed a significant body weight reduction (71.6 ± 13.5 kg vs. 70.1 ± 13.3 kg, <i>p</i> &lt; 0.001). Additionally, significant reductions in blood pressure and improvements in liver enzymes, glucose, and lipid metabolism were observed. Correlation analysis indicated that weight loss was associated with the amelioration of multiple metabolic abnormalities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The findings suggest that the two-night hospitalization program may offer significant benefits for managing coronary risk factors associated with metabolic syndrome.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"26 5","pages":"442-450"},"PeriodicalIF":2.3,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.70031","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144929742","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":"Evaluation of pediatric sleep screening practices in primary care in a northeastern region of France: A survey conducted among general practitioners","authors":"Anne-Laure Albert MD,&nbsp;Pauline Leblond MD,&nbsp;Sofia Da Mota MD,&nbsp;Cyril Schweitzer MD, PhD,&nbsp;Iulia Ioan MD, PhD","doi":"10.1002/jgf2.70026","DOIUrl":"https://doi.org/10.1002/jgf2.70026","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Pediatric sleep disorders are underreported and underdiagnosed in primary care settings. This study aimed to compare the screening and management of sleep in young children during routine follow-up consultations by general practitioners (GPs) and physicians from Maternal and Child Protection services (MCPPs) in a region of France.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A cross-sectional survey was conducted using a questionnaire with 20 closed questions designed to characterize knowledge and practices and to evaluate the perceived need for additional training in pediatric sleep. The survey was administered to 343 GPs and 28 MCPPs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 211 (62%) GPs and 17 (61%) MCPPs participated in the survey. The respondents indicated a strong focus on sleep, GPs reporting significantly lower scores compared to MCPPs (4 [3, 4] vs 4 [4, 5], <i>p &lt;</i> 0.008). A significantly higher proportion of physicians addressed the issue of sleep in the MCPPs group, 16 (94%), in contrast to an equivalent proportion of parents and physicians in the GPs group (<i>p =</i> 0.0007). The difficulties falling asleep were significantly less frequently addressed by GPs than MCPPs (<i>p</i> = 0.042), with no difference for the nighttime awakenings. A limited number of physicians, 24 (11%), have received training in sleep medicine, with significantly fewer GPs than MCPPs, while over half, 148 (65%), expressed a need for additional education.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>GPs demonstrated lower awareness and training in young children's sleep issues compared to MCPPs. These findings emphasize the need for improved training and awareness, highlighting the importance of evaluating children's sleep issues during pediatric consultations by GPs.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"26 5","pages":"458-464"},"PeriodicalIF":2.3,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.70026","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144929582","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":"Impact of longitudinal integrated clerkship programs on career path selection: A case study from Japan","authors":"Michiko Goto MA, PhD,&nbsp;Satoshi Kondo MD, PhD,&nbsp;Ryutaro Tanizaki MD, PhD,&nbsp;Norihiko Yamamoto MD, PhD,&nbsp;Hideki Wakabayashi MD, PhD","doi":"10.1002/jgf2.70021","DOIUrl":"https://doi.org/10.1002/jgf2.70021","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>To address the shortage of healthcare professionals in rural regions of Japan, Longitudinal Integrated Clerkship (LIC) programs were introduced with the objective of training community-oriented generalists. LIC provides students with a longitudinal approach to clinical education, fostering a commitment to primary care careers. Studies have shown that LIC graduates are more likely to work in rural settings, with a significant proportion pursuing primary care. The LIC model has recently garnered increased interest, leading several institutions in Japan to adopt this educational framework to enhance regional healthcare delivery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study employed semi-structured interviews with three sixth-year medical students who completed the LIC program between 2014 and 2020. Interview transcripts were subjected to thematic analysis to identify factors influencing career choices.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The analysis revealed six key themes that influenced the career decisions of the LIC participants. The students' interactions with mentors and their involvement in long-term patient care emerged as pivotal experiences, reinforcing their dedication to community healthcare and primary care. The participants reported an enhancement of their clinical competencies and a growing confidence in their roles as generalists.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Despite the limited number of LIC participants, the findings indicate that the program effectively promotes interest in general practice careers. The study identified potential areas for program enhancement and elucidated the mechanisms by which LIC influences career decision-making. Additionally, the results highlight the importance of educational strategies based on established learning theories, which foster students' professional growth, adaptation to community healthcare, and reinforce their commitment to primary care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"26 4","pages":"346-354"},"PeriodicalIF":1.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.70021","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144582018","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 case of idiosyncratic drug-induced agranulocytosis because of sulbactam/ampicillin","authors":"Kazuya Toda MD,&nbsp;Kaku Kuroda MD, CAS,&nbsp;Moe Kuroda MD, MPH,&nbsp;Kota Kawai MD,&nbsp;Yukihiro Sato MD","doi":"10.1002/jgf2.70027","DOIUrl":"https://doi.org/10.1002/jgf2.70027","url":null,"abstract":"<p>Idiosyncratic drug-induced agranulocytosis is a rare but life-threatening condition that requires immediate medical intervention. Although sulbactam/ampicillin (SBT/ABPC) is a widely used antibiotic, no prior case reports of its associated agranulocytosis were identified in our narrative literature review. We present a case of an 85-year-old man who developed agranulocytosis following SBT/ABPC treatment for pressure ulcer infection and aspiration pneumonia, accompanied by a narrative literature review. Awareness of this condition, prompt discontinuation of the suspected agent, and close monitoring of total white blood cell counts are essential for early detection and management of this life-threatening complication.</p>","PeriodicalId":51861,"journal":{"name":"Journal of General and Family Medicine","volume":"26 5","pages":"479-484"},"PeriodicalIF":2.3,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jgf2.70027","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144929752","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":"Association between smartphone use, sleep deprivation, and self-rated health outcomes: A retrospective observational survey in rural Japan","authors":"Yoshio Hisata MD, PhD,&nbsp;Sakiya Nishida MD,&nbsp;Mamoru Urayama MD,&nbsp;Hiroshi Sekine MD,&nbsp;Takashi Sugioka MD, PhD,&nbsp;Risa Hirata MD, PhD,&nbsp;Naoko E. Katsuki MD, PhD,&nbsp;Masaki Tago MD, PhD, FACP,&nbsp;Yuki Ueda MD,&nbsp;Masaki Amenomori MD,&nbsp;Katsumi Higashino MD, PhD,&nbsp;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}

{"title":"Cortical ribbon sign: Initial sign of Creutzfeldt–Jakob disease","authors":"Shiori Nakamichi MD,&nbsp;Ryohei Ono MD,&nbsp;Michihiro Kudo MD,&nbsp;Shigeto Horiuchi MD,&nbsp;Izumi Kitagawa MD","doi":"10.1002/jgf2.70019","DOIUrl":"https://doi.org/10.1002/jgf2.70019","url":null,"abstract":"&lt;p&gt;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.&lt;/p&gt;&lt;p&gt;CJD is a rare and fatal prion disease characterized by progressive dementia, typically over a period of a few weeks to months.&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; 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}