American family physician
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Even when simple iron deficiency is strongly suspected, the child with severe anemia deserves a careful and thorough work-up before treatment is begun. Many other possible causes of anemia need to be excluded. No one test specifically identifies iron deficiency, but the combined use of several tests of iron status can establish iron deficiency with certainty. Hemoglobin level, mean corpuscular volume, serum iron, total iron binding capacity, free erythrocyte porphyrin and serum ferritin are the important studies.
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Self-destructive behavior is the final pathway for a variety of underlying problems. Because there is such a wide range of diagnostic possibilities in patients who attempt suicide, more precise diagnosis is essential. The often-asked question "Will the patient attempt suicide again?" is insufficient. Rather, an understanding of why the person is unhappy facilitates identification of the suicidal subtype and the necessary therapeutic interventions.
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Radial head subluxation occurs when the thin, weakly attached annular ligament of the forearm becomes entrapped in the radiocapitellar space after marked traction on the extended, pronated arm. It is the most common musculoskeletal injury in children between two and five years of age. Awareness of this condition permits easy diagnosis and rapid treatment by simple manipulation.
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Behavioral complications of alcoholism are frequently found in young alcoholics before medical complications develop. The antisocial alcoholic is at high risk of behavioral complications, including aggressive, violent behavior and accidental injury. Because of the markedly increased risk of trauma in alcoholism, the family physician should investigate the possible role of alcohol or other drug use in any patient with an injury.
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Stillbirth is a professional blind spot for physicians and nurses, who may experience denial in dealing with the bereaved mother and her family. Providing choices and information about the conduct of labor and perinatal decisions, as well as pictures of the infant, a hospital birth certificate and other memory items, may be helpful to the parents in their grief. Hospital perinatal loss teams can provide support both to families and to medical staff.