Dtsch Arztebl Int
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4-10% of the general population and 20% of primary care patients have what are called "non-specific, functional, and somatoform bodily complaints." These often take a chronic course, markedly impair the sufferers' quality of life, and give rise to high costs. They can be made worse by inappropriate behavior on the physician's part. ⋯ A thorough, simultaneous biopsychosocial diagnostic assessment enables the early recognition of non-specific, functional, and somatoform bodily complaints. The appropriate treatment depends on the severity of the condition. Effective treatment requires the patient's active cooperation and the collaboration of all treating health professionals under the overall management of the patient's primary-care physician.
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Tourette syndrome is a combined motor and vocal tic disorder that begins in childhood and takes a chronic course. It arises in about 1% of all children, with highly varying severity. Transient and usually mild tics are seen in as many as 15% of all children in elementary school. The diagnosis is often delayed by several years. ⋯ Because of the low level of the available evidence, no definitive recommendations can be made for the treatment of tics.
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Ruling out a deep vein thrombosis (DVT) is difficult in general practice because the clinical manifestations of DVT are nonspecific and more often due to other diseases. The aim of diagnostic screening in primary care must be to rule out a DVT with high accuracy in most patients, so that only those who are likely to have a DVT will undergo further testing. In this study, we tested the accuracy of exclusion of DVT by the combination of a clinical score (the Wells score) with either a bedside D-dimer test or selective compression sonography. ⋯ We recommend the Wells score combined with either a D-dimer test or selective compression sonography according to the algorithm used in this study for use in primary care to rule out DVT. Clinical judgment alone is less effective.
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The health and physical fitness of adolescents and young adults are important not just to the individuals concerned, but also to society as a whole. Many studies from many different countries have dealt with the prevalence of overweight, the risk factors for it, and the morbidity it causes, but no more than a few have addressed the effects of unhealthy lifestyles on physical fitness. In this study, we show that young adults' physical performance depends on the number of risk factors they possess. We also compare the young adults' physical performance with that of adolescents aged 10 to 17. ⋯ Unhealthy lifestyles can impair physical fitness even before any chronic disease arises. Possession of even a single risk factor is associated with significantly worse performance. Unless comprehensive and effective interventions are introduced in school and at work, the further cementation and worsening of unhealthy lifestyles will be hard to stop.
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Conflicts of interest can bias the recommendations of clinical guidelines. In 2010, the Association of Scientific Medical Societies in Germany (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, AWMF) revised its rules about how conflicts of interest in guidelines should be managed. ⋯ From 2011 onward, all conflict-of-interest declarations by guideline authors have been published in the AWMF database. There is no current standard for the evaluation and management of conflicts of interest in guideline-creating groups, and this situation urgently needs to be remedied.