What was happening in the collaboration between general practitioners and public health nurses in the community: A qualitative study

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.

Clinical Presentations of Teenage Outpatients Encountered by General Internists in Japanese Hospitals: A Cross-Sectional Study

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.

Spontaneous pneumomediastinum in young women: Comparison between anorexia nervosa and nonanorexic patients

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.

[Relation between the outcome of IVF-ET and subtle rise in serum progesterone during the follicular phase stimulated with a combination of gonadotropin-releasing hormone analog and gonadotropin]

This study was designed to investigate whether the rise in the serum progesterone concentration (1.0 to 2.0ng/ml) (P rise) during the follicular phase occurs in cycles stimulated with gonadotropin-releasing hormone analog (GnRHa) and gonadotropins (hMG and pure FSH), and whether the P rise affects the outcome of IVF-ET. Three hyperstimulation regimens were used for IVF-ET; short regimen (SR): 64 cycles of 44 patients, long regimen (LR): 78 cycles of 46 patients, and pure FSH regimen (PR): 16 cycles of 16 patients. Although serum LH levels did not significantly change during the follicular phase in any of the regimens, a P rise was observed frequently in all the three regimens (26.6% per cycle in SR, 15.4% per cycle in LR, and 18.8% per cycle in PR, respectively). Significantly higher serum E2 levels (p < 0.05) and a greater number of collected oocytes (p < 0.05) but significantly lower rates of mature oocytes (p < 0.05) and fertilization (p < 0.05) were observed in P rise cycles compared to no P rise cycles. Ten of 12 ongoing pregnancies in this study occurred in no P rise cycles. These results suggest that the increasing number of developing follicles related to a high concentration of serum E2 is responsible for the occurrence of P rise irrespective of whether LH is endogenous or exogenous, and that the P rise affects the outcome of IVF-ET.

Subtle rise in serum progesterone during the follicular phase as a predictor of the outcome of in vitro fertilization

OBJECTIVE

To investigate the effects of subtle rises in serum progesterone (P) during the follicular phase on the outcome of in vitro fertilization and embryo transfer (IVF-ET).

DESIGN, PATIENTS

One hundred one patients underwent IVF-ET for 170 cycles and were stimulated with a combination of clomiphene citrate and human menopausal gonadotropin. Based on their hormonal data, we divided the patients into two groups: those who had a cycle with an increase in serum P concentration (1.0 to 2.0 ng/mL) that was not associated with a pituitary LH release (subtle P rise) and those who had a cycle without any increase in serum P concentration (no P rise).

MAIN OUTCOME MEASURES

The daily serum estradiol (E2) concentration and the results of IVF-ET (number of developed and collected oocytes, rates of mature oocytes, fertilization, and pregnancy) were compared between the two groups.

RESULTS

Subtle P rises were observed in 31.7% (32/101) of the patients and 20.5% (36/170) of the cycles evaluated during the IVF-ET programs. A significantly higher serum E2 concentration (P less than 0.001) and a greater number of developed and collected oocytes (P less than 0.001 and P less than 0.05, respectively) also were observed in those cycles with a subtle P rise. The rates of mature oocyte formation and fertilization were significantly lower in cycles with a subtle P rise (P less than 0.001 and P less than 0.05, respectively). A lower pregnancy rate was observed in cycles with a subtle P rise, and all 12 ongoing pregnancies occurred only in cycles with a no P rise.

CONCLUSION

These results suggest that the development of an increased number of follicles may not necessarily improve the outcome of IVF-ET and that the measurement of serum P may be a better predictor for successful pregnancy.

[The survey on the perinatal variables and the incidence of cerebral palsy for 12 years before and after the application of the fetal monitoring systems]

The effects of electrical fetal monitoring such as cardiotocogram (CTG) and nonstress test (NST) were studied during the years 1975-86 in 6,981 cases (6,893 singletons, 41 twins and 2 triplets). These cases were divided into three groups according to the mode of fetal monitoring. The first group was managed without electrical fetal monitoring (control group). The second was managed mainly with intrapartum fetal monitoring (transitional group) and the third was managed with antepartum and intrapartum fetal monitoring (fully monitored group). The incidence of cerebral palsy (CP) was investigated at the social health center during the same period. The introduction of intrapartum fetal monitoring resulted in a reduction in neonatal asphyxia from 7.0% in the control group to 5.2% and 4.3% in the transitional group and fully monitored group respectively. The perinatal mortality rate showed a significant reduction from 0.61% in the period without antepartum fetal monitoring to 0.31% in the fully monitored group, and this was attributed to the significant reduction in the number of stillbirths. The incidence of CP in the district decreased from 2.2 to 0.2 per 1,000 children during the period studied. In these circumstances, the caesarean section rate increased from 7.0% in the control group to 11.8% in the transitional group but decreased to 9.8% in the fully monitored group. These results showed the clinical and social benefits of electrical fetal monitoring.

[The evaluation of ultrasonic oocyte collection techniques for IVF-ET--comparing the transabdominal and transvaginal methods]

In order to evaluate the effectiveness and safety of ultrasonic oocyte collection for IVF-ET, a comparative study was performed on the results of IVF-ET by the transabdominal and transvaginal methods in 145 cycles of 51 patients. The oocyte collection rate for the transvaginal method was significantly higher than that for the transabdominal method (77.1% vs. 68.7% per follicle, p less than 0.01). The majority of the oocytes were collected in three follicular flushings. The fertilization rate for oocytes collected by the transabdominal method was significantly higher than that for those collected by the transvaginal method in cases of tubal damage and endometriosis (81.1% vs. 65.6% per oocyte, p less than 0.01). There was no significant difference between the signs of complications seen with the two methods. Six successful pregnancies were obtained by IVF-ET in our hospital (4 cases by the transabdominal method, and 2 cases by the transvaginal method). Two of these cases have already delivered full term healthy male infants. In conclusion, these results indicate that ultrasonic oocyte collection has been established as the most effective method for IVF-ET by means of either the transabdominal or the transvaginal methods.