Family medicine in Japan.

Two networks of medical care have grown up in Japan: 1 network based in hospitals and 1 based in private clinics. Most physicians in clinics practice general medicine, although only a small proportion of them are trained in primary care. Postgraduate medical education is oriented toward the training of specialists. Owing to the impending retirement of the cohort of clinic-based physicians who have dominated medical politics in Japan, the system is expected to change substantially in the next decade. Among the reformers is a small group of physicians who are attempting to introduce family practice.

Self-reported medical problems of adult female survivors of childhood sexual abuse.

BACKGROUND: Childhood sexual abuse has been established as an antecedent to specific psychological disorders in adulthood. Only recently have researchers begun to consider the effects of this early trauma on subsequent physical health status. The current study sought to explore the relationship between a history of childhood sexual abuse in female adults and subsequent self-reported medical complaints. METHODS: This consecutive sample study used a questionnaire to distinguish subjects with a sexual abuse history and those without such a history. Subjects were female patients over 18 years of age at a primary care health center. RESULTS: Twenty-six percent of the 523 subjects who completed the entire questionnaire acknowledged a history of sexual abuse in childhood. This percentage is consistent with estimates for the population at large. The abused group reported more problems in respiratory, gastrointestinal, musculoskeletal, neurological, and gynecological functions. Statistically significant discriminating variables for those who had been abused were (1) total medical complaints reported, (2) previous mental health treatment, and (3) age of first sexual intercourse. Among the abused group, only 5.1% had ever disclosed information about their sexual abuse experiences to a physician. CONCLUSIONS: At least one in four women are survivors of childhood sexual abuse. These women rarely spontaneously reveal this history to a physician, yet they are more likely than nonabused patients to report multisystemic medical complaints. To avoid misdiagnosis and misuse of medical services, physicians should routinely obtain a thorough sexual history, particularly when the patient has multisystem complaints.