Pub Date : 2025-12-13DOI: 10.1016/j.amjmed.2025.12.015
Jochen D Schipke, Ulrich Limper, Kay Tetzlaff
Decompression sickness (DCS), traditionally associated with SCUBA diving, increasingly occurs in breath-hold diving, particularly during repetitive shallow or deep dive profiles. This comprehensive review synthesizes 85 records documenting 244+ cases across 75 years, including historical Taravana syndrome in Polynesian pearl divers and cases among Japanese Ama, Korean Haenyeo, recreational freedivers, instructors, and spear fishers. Unlike SCUBA-related DCS, breath-hold DCS predominantly manifests as cerebral symptoms that can mimic stroke or transient ischemic attack, often presenting in young, healthy individuals. Key risk factors include inadequate surface intervals during repetitive shallow dives, deep dives exceeding 40 m, rapid ascent rates, and individual physiological factors including patent foramen ovale. Despite growing freediving popularity with an estimated one million participants globally, DCS remains underrecognized and underreported. Early recognition is critical, requiring high clinical suspicion in divers presenting with neurological symptoms. Immediate high-flow oxygen and urgent hyperbaric oxygen therapy remain essential treatments. This review emphasizes the need for enhanced education among both divers and medical professionals to improve prevention, recognition, and management of this potentially devastating condition.
{"title":"Breath-hold diving and decompression sickness.","authors":"Jochen D Schipke, Ulrich Limper, Kay Tetzlaff","doi":"10.1016/j.amjmed.2025.12.015","DOIUrl":"10.1016/j.amjmed.2025.12.015","url":null,"abstract":"<p><p>Decompression sickness (DCS), traditionally associated with SCUBA diving, increasingly occurs in breath-hold diving, particularly during repetitive shallow or deep dive profiles. This comprehensive review synthesizes 85 records documenting 244+ cases across 75 years, including historical Taravana syndrome in Polynesian pearl divers and cases among Japanese Ama, Korean Haenyeo, recreational freedivers, instructors, and spear fishers. Unlike SCUBA-related DCS, breath-hold DCS predominantly manifests as cerebral symptoms that can mimic stroke or transient ischemic attack, often presenting in young, healthy individuals. Key risk factors include inadequate surface intervals during repetitive shallow dives, deep dives exceeding 40 m, rapid ascent rates, and individual physiological factors including patent foramen ovale. Despite growing freediving popularity with an estimated one million participants globally, DCS remains underrecognized and underreported. Early recognition is critical, requiring high clinical suspicion in divers presenting with neurological symptoms. Immediate high-flow oxygen and urgent hyperbaric oxygen therapy remain essential treatments. This review emphasizes the need for enhanced education among both divers and medical professionals to improve prevention, recognition, and management of this potentially devastating condition.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145764159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-13DOI: 10.1016/j.amjmed.2025.12.017
Daniel M Gelfman
{"title":"When looking for treatable diseases, don't forget the jugular veins.","authors":"Daniel M Gelfman","doi":"10.1016/j.amjmed.2025.12.017","DOIUrl":"10.1016/j.amjmed.2025.12.017","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145764342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-13DOI: 10.1016/j.amjmed.2025.12.007
Randy J Horwitz
{"title":"Integrative Medicine: The companies we keep.","authors":"Randy J Horwitz","doi":"10.1016/j.amjmed.2025.12.007","DOIUrl":"10.1016/j.amjmed.2025.12.007","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145764294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-10DOI: 10.1016/j.amjmed.2025.12.001
Sandeep A Saha
{"title":"Social media and the health care professional - Watching your back (and your posts) and keeping your day job.","authors":"Sandeep A Saha","doi":"10.1016/j.amjmed.2025.12.001","DOIUrl":"10.1016/j.amjmed.2025.12.001","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145745581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-05DOI: 10.1016/j.amjmed.2025.11.027
Jack Purrington, Sandra Lindaman, Julia Jernberg
Mental health concerns in adults are increasingly common, especially among parents and caregivers, and our current conventional treatments often fail to take effective treatment for the whole family into consideration. Adults' emotional health can be inextricably linked to the mental health of their children. If a child's therapy is successful in helping the child while also engaging, educating, and empowering caregivers, this both has an indirect impact on caregivers' health, and the potential to directly and indirectly benefit the affected adults by nurturing a future healthy relationship. Theraplay is an integrative, intense, play-based, therapist-directed, and parent/caregiver-engaged therapy that helps forge healthy attachments between children and their adults. Theraplay has demonstrated marked benefits for multiple ailments in children, as reviewed below, and, by intentionally integrating their adult in the therapy, has potential to positively impact mental health of the caregivers engaged in their child's treatment. The effects of forging or restoring a child's ability to form healthy relationships could provide long-term, continuing benefits for the child and, potentially, their caregivers.
{"title":"Healing through play: Theraplay as an integrative therapy for parents and caregivers.","authors":"Jack Purrington, Sandra Lindaman, Julia Jernberg","doi":"10.1016/j.amjmed.2025.11.027","DOIUrl":"10.1016/j.amjmed.2025.11.027","url":null,"abstract":"<p><p>Mental health concerns in adults are increasingly common, especially among parents and caregivers, and our current conventional treatments often fail to take effective treatment for the whole family into consideration. Adults' emotional health can be inextricably linked to the mental health of their children. If a child's therapy is successful in helping the child while also engaging, educating, and empowering caregivers, this both has an indirect impact on caregivers' health, and the potential to directly and indirectly benefit the affected adults by nurturing a future healthy relationship. Theraplay is an integrative, intense, play-based, therapist-directed, and parent/caregiver-engaged therapy that helps forge healthy attachments between children and their adults. Theraplay has demonstrated marked benefits for multiple ailments in children, as reviewed below, and, by intentionally integrating their adult in the therapy, has potential to positively impact mental health of the caregivers engaged in their child's treatment. The effects of forging or restoring a child's ability to form healthy relationships could provide long-term, continuing benefits for the child and, potentially, their caregivers.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145702451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-29DOI: 10.1016/j.amjmed.2025.11.024
Dor Atias MD, MPH , Yariv Gerber PhD , Tal Hasin MD , Uri Obolski PhD
Background
The Six-Minute Walk Test (6MWT) is a widely used, low-cost measure of functional capacity in heart failure patients. While baseline 6MWT distance is a known prognostic marker, the added value of serial assessments remains underexplored. This study examined whether serial 6MWT measurements and their temporal trajectories improve mortality prediction.
Methods
This retrospective cohort study included 1,114 patients with heart failure who underwent at least one 6MWT at Shaare Zedek Medical Center during 2014-2023. All-cause mortality was the primary outcome. Two modelling approaches were applied: 1) a Cox proportional hazards model using a single 6MWT assessment; and 2) a joint model incorporating repeated 6MWT assessments. Models were evaluated at baseline and after 12 months, for forward predictions of 36- and 60-month mortality, with performance assessed using the area under the curve (AUC) and Brier Score on data not used for model development.
Results
The joint models demonstrated superior predictive accuracy; in patients with ≥3 6MWTs, AUC improved by 0.116 (95% CI: 0.010-0.238) and Brier Score decreased by −0.032 (95% CI: −0.072, −0.003) at 36 months. In the joint model survival submodel, each 10-meter increase in 6MWT distance was associated with reduced mortality risk (HR=0.95, 95% CrI: 0.93-0.96), as was a 10-meter/year predicted improvement in slope (HR=0.86, 95% CrI: 0.80-0.97).
Conclusion
Serial 6MWT assessment offers prognostic value beyond a baseline measurement. Both absolute walking distance and improvement over time were independently associated with mortality. Modelling functional trajectories over time may improve mortality risk prediction and support personalized clinical management in heart failure.
{"title":"The prognostic value of serial six-minute walk testing for mortality prediction in heart failure patients","authors":"Dor Atias MD, MPH , Yariv Gerber PhD , Tal Hasin MD , Uri Obolski PhD","doi":"10.1016/j.amjmed.2025.11.024","DOIUrl":"10.1016/j.amjmed.2025.11.024","url":null,"abstract":"<div><h3>Background</h3><div>The Six-Minute Walk Test (6MWT) is a widely used, low-cost measure of functional capacity in heart failure patients. While baseline 6MWT distance is a known prognostic marker, the added value of serial assessments remains underexplored. This study examined whether serial 6MWT measurements and their temporal trajectories improve mortality prediction.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included 1,114 patients with heart failure who underwent at least one 6MWT at Shaare Zedek Medical Center during 2014-2023. All-cause mortality was the primary outcome. Two modelling approaches were applied: 1) a Cox proportional hazards model using a single 6MWT assessment; and 2) a joint model incorporating repeated 6MWT assessments. Models were evaluated at baseline and after 12 months, for forward predictions of 36- and 60-month mortality, with performance assessed using the area under the curve (AUC) and Brier Score on data not used for model development.</div></div><div><h3>Results</h3><div>The joint models demonstrated superior predictive accuracy; in patients with ≥3 6MWTs, AUC improved by 0.116 (95% CI: 0.010-0.238) and Brier Score decreased by −0.032 (95% CI: −0.072, −0.003) at 36 months. In the joint model survival submodel, each 10-meter increase in 6MWT distance was associated with reduced mortality risk (HR=0.95, 95% CrI: 0.93-0.96), as was a 10-meter/year predicted improvement in slope (HR=0.86, 95% CrI: 0.80-0.97).</div></div><div><h3>Conclusion</h3><div>Serial 6MWT assessment offers prognostic value beyond a baseline measurement. Both absolute walking distance and improvement over time were independently associated with mortality. Modelling functional trajectories over time may improve mortality risk prediction and support personalized clinical management in heart failure.</div></div>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":"139 3","pages":"Pages 341-349.e3"},"PeriodicalIF":5.3,"publicationDate":"2025-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145649804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-28DOI: 10.1016/j.amjmed.2025.08.040
Kevin Fiscella MD, MPH
{"title":"Value-based drug expenditures: Some questions","authors":"Kevin Fiscella MD, MPH","doi":"10.1016/j.amjmed.2025.08.040","DOIUrl":"10.1016/j.amjmed.2025.08.040","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":"139 1","pages":"Page e30"},"PeriodicalIF":5.3,"publicationDate":"2025-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145618733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-28DOI: 10.1016/j.amjmed.2025.08.003
Alain Braillon MD, PhD
{"title":"RAS inhibitors and beyond: The chronic failure of teratogenic risk prevention in women of childbearing age","authors":"Alain Braillon MD, PhD","doi":"10.1016/j.amjmed.2025.08.003","DOIUrl":"10.1016/j.amjmed.2025.08.003","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":"139 1","pages":"Pages e26-e27"},"PeriodicalIF":5.3,"publicationDate":"2025-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145618730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号