Common Condition In Adults Research Articles

Incidence of nonspecific and radiating low back pain: followup of 24–39‐year‐old adults of the Young Finns Study

The full panorama of the types and severity of low back pain during the life course is poorly known. We studied the incidence and severity of nonspecific and radiating low back pain based on a recent followup on a representative sample of the Finnish general population. As part of the ongoing Young Finns Study, participants ages 24-39 years who were free from low back pain at baseline in 2001 were included (n = 1,224). We estimated the incidence of nonspecific and radiating low back pain in 2007. The incidence of moderate (8-30 days duration in the past 12 months) nonspecific low back pain was 13.2%, and that of radiating low back pain was 8.6%. The rates did not differ between men and women. The incidence of major (>30 days in the past 12 months) nonspecific low back pain was 7.8%, and that of radiating low back pain was 3.4%. The incidence of major nonspecific low back pain was higher in women than in men (P = 0.02). Moderate as well as major nonspecific low back pain declined with age, whereas major radiating low back pain increased with age. Our findings indicate that low back pain is a common condition in adults already in their 30s. It becomes more severe around the age of 40 years, showing different development of nonspecific and radiating low back pain. We recommend monitoring low back health in health surveillance, starting early and differentiating between nonspecific and radiating pain.

A 15-year-old boy with an esophageal pyogenic granuloma and subsequent Barrett's esophagus (with videos)

A pyogenic granuloma is very uncommon in the GI tract, especially in childhood. Although Barrett's esophagus is a common condition in adults, it is rare in childhood. In this case we describe a boy with both lesions.

V-04.04: Laparoscopic pyeloplasty: retroperitoneal approach

The uretero-pielic junction obstruction (UPJO) is not a common condition in adults; however, when present it may be deleterious for the function of the kidney. Various surgical techniques have been described for the treatment of this abnormality, being the dismember pyloplasty (Anderson_Hynes) one of the most frequently performed. In recent years, video surgery has been increasingly used for this procedure with similar results to open surgery, and the advantages of a less invasive operation.

Safety and tolerability of treatments for allergic rhinitis in children.

Allergic rhinitis is a common condition in adults and children and can have a large impact on patients' health and quality of life. The aim of current allergic rhinitis therapies is to treat the subjective symptoms and to improve objective measures of the disease. Of the available treatment options for paediatric allergic rhinitis, the newer oral antihistamines and intranasal corticosteroids are first-line treatments.First-generation antihistamines are associated with unwanted adverse effects such as cardiotoxicity, sedation and impairment of psychomotor function. Despite results from studies using first-generation antihistamines demonstrating impairment of cognitive and academic function in children, many of these agents are still commonly given to patients. The newer antihistamines, developed with the aim of being more specific for the histamine H(1) receptor and of overcoming these adverse effects, are the medication of choice in patients with mild intermittent allergic rhinitis. For children <12 years of age, three newer oral antihistamines are currently available: cetirizine, loratadine and fexofenadine. A lack of adverse effects with these antihistamines has been demonstrated in children using EEG and psychomotor performance tests, and in clinical studies. However, issues of receptor selectivity and the potential for CNS adverse effects still remain, and further studies are warranted.Intranasal corticosteroids are the most effective anti-inflammatory agents used for the treatment of paediatric allergic rhinitis; however, the safety of these compounds remains controversial. The safety implications associated with corticosteroids are long-term, dose-related systemic effects, such as suppression of adrenocortical function, growth and bone metabolism, and the extent of these effects is influenced by a number of factors including corticosteroid type, pharmacokinetic profile, mode of delivery and delivery device. Topical corticosteroids were introduced to reduce the systemic effects seen with the long-term use of oral agents. The intranasal corticosteroids currently available for the treatment of paediatric allergic rhinitis - beclometasone, budesonide, flunisolide, fluticasone propionate, mometasone and triamcinolone - have short half-lives and rapid first-pass hepatic metabolism; however, their pharmacokinetics vary in terms of systemic absorption, potency, binding affinity, lipophilicity, volume of distribution, and half-life. A number of studies - utilising hypothalamic-pituitary-adrenal axis function tests such as plasma cortisol levels, 24-hour urinary-free cortisol tests; stimulation tests with corticotropin (adrenocorticotropic hormone), lypressin, and corticotropin-releasing hormone; and growth assessment studies using knemometry and stadiometry - have indicated that these intranasal corticosteroids are well-tolerated in paediatric patients and do not significantly affect growth. The wealth of clinical data and the recommendations from evidence-based guidelines suggest that both antihistamines and intranasal corticosteroids have good safety profiles in children. Nevertheless, growth should be regularly monitored in children receiving intranasal corticosteroids. Other treatments such as immunotherapy, local chromones and decongestants can also be beneficial in managing paediatric allergic rhinitis, and therapies should be considered on an individual basis.

Preparedness of internal medicine and family practice residents for treating common conditions.

Although both internal medicine (IM) and family practice (FP) physicians frequently provide care for the same common adult conditions, IM and FP residency programs differ in their training emphases. To assess differences in IM and FP residents' self-perceived preparedness to diagnose and treat common adult medical conditions. Cross-sectional analysis of a national survey administered in the spring of 1998 to residents in their final year of residency at US academic health centers. A total of 279 IM residents in 25 programs and 326 FP residents in 75 programs responded to the survey. Residents' self-rated preparedness to diagnose and treat 4 inpatient conditions (acute myocardial infarction, diabetic ketoacidosis, acute asthma, and acute renal failure) and 8 outpatient conditions (diabetes, hypertension, low back pain, vaginitis, headache, depression, upper respiratory tract infection, and hyperlipidemia), controlling for resident sex, race/ethnicity, US medical school graduate status, intent to subspecialize, and estimates of exposure to patients in inpatient and outpatient settings. Internal medicine residents were more likely to report being very prepared for all 4 inpatient conditions (P< or =.001), while FP residents were more likely to report being very prepared for 5 of 8 outpatient conditions (P< or =.05). Differences between IM and FP residents persisted in multivariate analyses for all inpatient conditions and some outpatient conditions. Exposure to patients in inpatient and outpatient settings varied by specialty and was significantly associated with resident self-report of preparedness for a majority of conditions investigated. Internal medicine and FP residents report differences in preparedness to manage common adult conditions. These differences were consistent with the emphasis on an inpatient setting for IM residents and on office-based care for FP residents.

Sexually Inhibited Children

Hypoactive sexual desire disorder (HSDD) is an increasingly common condition in adults, one that is extraordinarily difficult to treat. The study of inhibitions—where they come from and what happens to them in the course of development—is basic to understanding human sexuality. This article presents a brief overview of HSDD in adults and material that would support the emergence of HSDD in childhood and adolescence. Excessive inhibitions could be related to parental constraint, guilt, effects of sex abuse prevention programs, unresolved pre-oedipal conflicts, and biologic factors. Common sense approaches to treatment are presented.

The treatment of large hydroceles by injection of sodium morrhuate

Hydrocele is a relatively common condition in adults. In infants it is frequently congenital and connects with the peritoneal cavity. Mild asymptomatic epididymitis is probably the underlying pathology responsible for the majority of hydroceles. Tapping is frequently curative in the young but seldom the adult. Excellent results can be secured with the injection treatment of large hydroceles without co-existing pathological conditions, but as is true of all closed methods of operation, hemorrhage and infection may occur. The use of the modified Bellvue adhesive suspensory will reduce the local reaction and increase the patients comfort.