ABSTRACT
Background: Interprofessional collaboration in the community is becoming essential in primary care, particularly collaboration between public health nurses and general practitioners. However, the precise value of such collaboration has not been sufficiently studied. The purpose of this study was to conduct a qualitative analysis of collaboration between general practitioners and public health nurses in the community to explore the details of the phenomenon and its possible impact on the community. Methods: Since 2015, The University of Toyama has been implementing the Collaborative Health Activities Project, in which general practitioners and public health nurses work together to promote community health. Focus group and individual interviews were conducted with participating staff, and the data were analyzed qualitatively. Results: Fifteen themes were generated, in six categories. The categories were as follows: enhanced roles of public health nurses and physicians in the community, new perspectives on the community, public health nurses' sense of trust and empathy toward physicians, bonds of solidarity between public health nurses and physicians, proactive change in residents, and supporting "hangout places". Conclusion: The collaboration between general practitioners and public health nurses familiar with the same community fostered a sense of trust and empathy and created the bonds of solidarity between staff and residents. The results also suggest the collaboration may have a positive impact on the local community by inspiring residents to change proactively and supporting "hangouts" where residents and professionals can informally connect.
ABSTRACT
Introduction General internists in Japanese hospitals sometimes consult on adolescents. Our university hospital encounters more adolescents with mental health complaints than other city hospitals. Consequently, based on our experience, we hypothesized that psychiatric disorders are significantly more common among teenagers who visit general internists. Therefore, we retrospectively analyzed the clinical profiles of teenage outpatients who visited general internists at three hospitals to test this hypothesis. Methods This study included 342 patients aged 13-19 years who visited the Departments of General Internal Medicine at Toyama University Hospital, Nanto Municipal Hospital, and Kamicichi General Hospital between January 2019 and December 2021. Data on age, sex, chief complaint, the period from onset to visit, referral status, and final diagnosis were collected from medical records. We also identified the final diagnoses of 1,375 outpatients from the university hospital during the same period, stratifying them by age. Multiple comparison analyses, Chi-squared tests, and residual analyses were performed to analyze the data. Results The number of psychiatric teen patients was significantly higher in the university hospital group than in the other city hospital groups (p<0.01). The incidence of psychiatric disorders, such as stress-related mental disorders, including adjustment and eating disorders (p<0.001), was also significantly higher in the teenage group (13-19 years) than in other age groups. Most psychiatric disorders lead to complaints of physical symptoms. Conclusions The potential onset of clinical episodes during consultations with teenage patients can make treating this age group more challenging; thus, they may require care at university hospitals. Furthermore, Japanese general internists in university hospitals encounter patients in their late teens with physical signs more often than in other hospitals. This trend may be unique to general medicine departments ("Sogo-Shinryo") in Japanese university hospitals. However, if general internists act under primary care principles, they can adequately assist adolescent patients.
ABSTRACT
Spontaneous pneumomediastinum is a benign, self-limited condition that mainly affects young people. In this report, we present four cases of this uncommon condition and a review of the current literature. Two cases had no prior significant medical history: one had a history of asthma and the other underwent regular outpatient treatment for anorexia nervosa. The three patients who were not anorexic spontaneously improved within a few days. However, the patient with anorexia nervosa took 2 months to recover. It appears that spontaneous pneumomediastinum is an intractable complication of anorexia nervosa, and the improvement of nutritional status in the patient is essential to manage this condition.
