American family physician
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Childhood and adolescent sports participation is encouraged because of health and wellness benefits. However, the increasing number of young athletes means there is the potential for more sports-related overuse injuries. Most youth sports injuries occur at the bone's relatively weaker growth centers: the epiphyses and apophyses. ⋯ Osgood-Schlatter disease and Sinding-Larsen-Johansson disease are forms of knee apophysitis. Calcaneal apophysitis is a common cause of heel pain in young athletes and can be diagnosed clinically with the calcaneal squeeze test. Calcaneal apophysitis is treated conservatively, with good evidence for the use of heel cups and physical therapy.
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Research in family medicine produces clinical information and improves care delivery, but it has yet to receive equitable federal investment. The National Institutes of Health (NIH) is the primary funder of medical research in the United States. In 2021, the NIH received $45 billion.1 Between 2017 and 2021, the NIH spent only 0.2% of its budget on family medicine research (Figure 1). Although other funding organizations exist, the NIH is the largest funder of biomedical research, and because it continues to undervalue family medicine research, its underinvestment impacts clinical care.
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Psoriasis is an inflammatory skin and systemic disorder that affects 3.2% of the U. S. population, including 1% of children. It is an immune-mediated process triggered by an interplay of genetic, environmental, physical (e.g., skin trauma), and infectious factors. ⋯ Disease management is improved with maintaining ideal body weight, avoiding tobacco products, limiting alcohol, and practicing stress reduction techniques. The Psoriasis Area and Severity Index is a tool to assess severity and monitor treatment effectiveness over time. Special consideration is needed for treatment of children and patients who are pregnant, breastfeeding, or trying to conceive.
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Primary care for women and other patients with similar reproductive potential can include a discussion about pregnancy and, depending on the patient's intent, contraceptive care or preconception care. Folic acid supplementation of at least 400 mcg per day is recommended to reduce the risk of neural tube defects, because many pregnancies are unplanned. Having a body mass index of 18.5 to 24.9 kg per m2 before pregnancy also reduces complications. ⋯ Vaccinations should be updated to prevent adverse outcomes related to infections. Infectious disease screenings should be updated before conception to allow for treatment, prophylaxis, or timing of pregnancy to avoid complications. Screening and counseling should be provided for substance use and potential environmental exposures to identify and mitigate detrimental exposures before pregnancy.
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Chronic kidney disease (CKD) affects approximately 15% of the U. S. population, and many people are unaware of their diagnosis. Screening may be considered for patients with cardiovascular disease, diabetes mellitus, hypertension, age 60 years and older, family history of kidney disease, previous acute kidney injury, or preeclampsia. ⋯ Sodium-glucose cotransporter-2 inhibitors and metformin should be considered in patients with CKD and type 2 diabetes who have not reached their glycemic goal. Intravenous iodinated contrast media temporarily reduces eGFR and should be avoided in patients with advanced CKD. Interdisciplinary management of patients with CKD is important for reducing morbidity and mortality, and patients at high risk of progression to end-stage renal disease should be referred to a nephrologist.