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Diagnosis and management of psychogenic diseases such as conversion disorder, somatic symptom disorder (SSD), illness anxiety disorder, falsehood disorder, and psychotic disorder require an elaborate biopsychosocial approach and are often challenging. Herein, we propose the following points to differentiate medical diseases from these psychogenic diseases: correspondence between symptoms and objective findings or activities of daily living (ADL) impairment; placebo effect; clear provocative or palliative factors; progressive time course; paroxysmal or intermittent symptoms; unfamiliar but not strange expressions; symptoms worsen during sleep or rest., Competing Interests: None., (© 2023 The Authors. Journal of General and Family Medicine published by John Wiley & Sons Australia, Ltd on behalf of Japan Primary Care Association.)

Background: We aimed to assess differences in health literacy between those who improved CPAP non-adherent and those who remained non-adherent., Methods: We included patients newly diagnosed with sleep apnea syndrome who had started CPAP therapy between February 2019 and October 2020 with ≥6 follow-up months or who self-interrupted CPAP therapy <6 months. We recorded the CPAP wearing time after 3 and 6 months. Patients were divided into the CPAP adherent (using CPAP for ≥4 h per night) and non-adherent (self-interrupted CPAP therapy/using CPAP for <4 h per night) groups. We compared the European Health Literacy Survey Questionnaire 47 (HLS-EU-Q47) score between those who were CPAP non-adherent after 3 months and become CPAP adherent after 6 months, and those who remained non-adherent after 6 months., Results: At 3 months, 34 patients were CPAP non-adherent. After 6 months, there were 7 and 27 patients in the CPAP adherent and non-adherent groups, respectively. There was a significant difference in the HLS-EU-Q47 score between the patients who became adherent to CPAP and who remained non-adherent after 6 months., Conclusion: Previously non-adherent patients who subsequently became adherent tended to have higher health literacy., Competing Interests: There are no conflicts of interest to declare for either the lead author or co‐authors., (© 2022 The Authors. Journal of General and Family Medicine published by John Wiley & Sons Australia, Ltd on behalf of Japan Primary Care Association.)

Behavioral science, the scientific study of human behavior and the elucidation of its laws, is also applied to medicine, and is included in pre-graduate education.Understanding patient behaviors that correspond to behavior-based medical diagnosis and interpreting the clinical information suggested by these patient behaviors can be useful in avoiding diagnostic errors in clinical practice., Competing Interests: The authors have stated explicity that there no conflicts of interest in connection with this article., (© 2022 The Authors. Journal of General and Family Medicine published by John Wiley & Sons Australia, Ltd on behalf of Japan Primary Care Association.)

Competing Interests: The authors have stated explicitly that there are no conflicts of interest in connection with this article.

Background: The supply of primary care physicians is associated with better health outcomes and a lower total cost of health services. However, the effect of the presence or absence of primary care physicians on health-related quality of life (QOL) is unknown. We comparatively investigated the health-related QOL of ordinary citizens according to the presence or absence of a primary care physician., Methods: We conducted an observational cross-sectional study using a propensity score analysis. A questionnaire on health-related QOL (SF-36v2, age, gender, presence or absence of a primary care physician, and chronic disease status) was mailed to 2200 individuals identified through stratified random sampling. We used propensity scores to compensate for covariates and analyzed three component SF-36 summary scores and subscale scores of the "primary care physician" and "no primary care physician" groups., Results: Valid responses were received from 1095 individuals (49.8%). The "primary care physician group" comprised 653 individuals (59.6%). The physical health component scores of the "primary care physician group" were significantly lower than those of the "no primary care physician group," and the "mental health component" scores were significantly higher ( p  = 0.032, p  = 0.009). For the subscales, scores for "vitality" and "mental health" were significantly higher in the "primary care physician group" ( p  = 0.014, p  = 0.018)., Conclusions: Patients who had a primary care physician with whom they could comfortably consult at any time had a high mental health component score, and low physical health component score in the health-related QOL., Competing Interests: Yoshiyuki Ohira, the Japan Society for the Promotion of Science (JSPS) “INSPIRING SCIENCE.” See 25870132 (grant number). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript., (© 2021 The Authors. Journal of General and Family Medicine published by John Wiley & Sons Australia, Ltd on behalf of Japan Primary Care Association.)

Although patients with scrub typhus develop a maculopapular rash all over the body, patients with COVID-19 may also show a similar rash. At the first visit, we did not fully inspect his trunk and extremities under his clothes. Although scrub typhus and COVID-19 have some similar symptoms, an eschar is a characteristic symptom of the former, and careful inspection is important to distinguish between the diseases., Competing Interests: The authors have stated explicitly that there are no conflicts of interest in connection with this article., (© 2021 The Authors. Journal of General and Family Medicine published by John Wiley & Sons Australia, Ltd on behalf of Japan Primary Care Association.)

Stemmer's sign is useful in diagnosing lymphedema as it is present in 92% of the cases. Indocyanine green (ICG) lymphography is also useful for diagnosing lymphedema, and it allows them to see all the anatomy of the lymphatic vessels, leaking pumping capacity, and dermal reflux. The diagnostic ability of ICG lymphography and its evaluation capability for disease severity is similar to lymphoscintigraphy which is the gold-standard examination for extremity lymphoedema but with less invasiveness and a lower cost., Competing Interests: The authors have stated explicitly that there are no conflicts of interest in connection with this article., (© 2021 The Authors. Journal of General and Family Medicine published by John Wiley & Sons Australia, Ltd on behalf of Japan Primary Care Association.)

A 73-year-old man presented with an abdominal mass that gradually swells over 3 months. He denied any subjective symptoms. Physical examination revealed massive enlargement of the spleen-the spleen had crossed the midline and its lower margin extended into the lower abdomen., Competing Interests: None., (© 2020 The Authors. Journal of General and Family Medicine published by John Wiley & Sons Australia, Ltd on behalf of Japan Primary Care Association.)

A 72-year-old woman presented with a 3-day history of nausea, vomiting, and fever. She had rheumatoid arthritis and was taking prednisolone (10 mg), cyclosporine (150 mg), and actarit (200 mg) daily. Computed tomography revealed gases were detected in the bladder wall, and emphysematous cystitis was diagnosed. When an immunocompromised host is suspected of a severe urinary tract infection but lacks specific signs or symptoms such as costovertebral angle tapping pain, emphysematous cystitis should be considered., Competing Interests: The authors declare that they do not have a conflict of interest., (© 2020 The Authors. Journal of General and Family Medicine published by John Wiley & Sons Australia, Ltd on behalf of Japan Primary Care Association.)

We report the case of a 36-year-old woman who was referred to our hospital with a 10-week history of intractable gingivitis. Gingival telangiectases may represent the sign of dermatomyositis. Early identification is essential for diagnosis and immediate treatment., Competing Interests: The authors have stated explicitly that there are no conflicts of interest in connection with this article., (© 2020 The Authors. Journal of General and Family Medicine published by John Wiley & Sons Australia, Ltd on behalf of Japan Primary Care Association.)

A 61-year-old Japanese man presented with a 2-month history of colicky abdominal pain and watery diarrhea. He had begun organic farming using cattle manure 1 year previously., Competing Interests: The authors have stated explicitly that there are no conflicts of interest in connection with this article., (© 2020 The Authors. Journal of General and Family Medicine published by John Wiley & Sons Australia, Ltd on behalf of Japan Primary Care Association.)

Competing Interests: The authors have stated explicitly that there are no conflicts of interest in connection with this article.

Chest plain computed tomography revealed a high-density area along the pleura of the right lung base with pleural thickening (arrow heads)., Competing Interests: The authors have stated explicitly that there are no conflicts of interest in connection with this article., (© 2020 The Authors. Journal of General and Family Medicine published by John Wiley & Sons Australia, Ltd on behalf of Japan Primary Care Association.)

A 45-year-old woman presented with instant orthopnea and enlarged cardiomediastinal silhouette in her chest radiograph. Although anterior mediastinal tumor can be misdiagnosed as heart failure due to orthopnea with enlarged cardiomediastinal silhouette, "instant orthopnea" may be a useful sign to distinguish these conditions., Competing Interests: The authors have stated explicitly that there are no conflicts of interest in connection with this article., (© 2020 The Authors. Journal of General and Family Medicine published by John Wiley & Sons Australia, Ltd on behalf of Japan Primary Care Association.)