American family physician
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Approximately 75 percent of all fractures sustained by children occur in the upper extremities and frequently occur during a fall onto an outstretched hand. The majority of these injuries involve the wrist and forearm, but the elbow alone accounts for approximately 10 percent of all fractures in children. Elbow fractures in children are challenging because of the abundance of unossified cartilage and the high potential for limb-threatening damage to neurovascular structures. Common types of elbow fractures include supracondylar, lateral condylar, medial epicondylar, radial neck and transphyseal fractures.
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Gestational diabetes affects 3 to 6 percent of all pregnancies. Proper screening, diagnosis and management of this condition can reduce both maternal and neonatal morbidity. ⋯ Up to 90 percent of these patients do not need more intensive therapy. Since patients with gestational diabetes are at high risk for developing type II (non-insulin-dependent) diabetes mellitus later in life, they should be counseled and tested during the postpartum period and encouraged to lose weight (if necessary) and follow a diet to minimize the development of glucose intolerance.
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Because of the increasing popularity of recreational scuba diving, primary care physicians should be familiar with common diving injuries. One form of barotrauma, middle ear squeeze, is the most common diving injury. Other important diving injuries include inner ear barotrauma and pulmonary barotrauma. ⋯ Decompression sickness is the result of bubble formation in body tissue. Symptoms of decompression sickness range from joint pain to neurologic or pulmonary problems. Recompression is the mainstay of treatment.
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American family physician · Apr 1996
ReviewPreserving confidentiality in occupational medical practice.
The United States does not have a uniform law regarding medical confidentiality. However, codes of conduct from the American Medical Association, the American College of Occupational and Environmental Medicine and the International Commission of Occupational Health, as well as relevant parts of the Americans with Disabilities Act and the Occupational Safety and Health Act of 1970, can help physicians make informed decisions about requests for medical information. Such activities include preplacement and fitness-for-work evaluations medical surveillance examinations (including drug testing) and evaluation of symptoms and treatment of injuries that may be work-related. The patient should be the one to decide whether and when to release medical records to employers, unless overruled by public health risks or laws.