Clinical practice (London, England)最新文献

Cancer care at the extremes of life, in the young and the old, is characterized by unique issues associated with pediatrics and geriatric medicine, accentuated by the special vulnerabilities of these groups. In response to these needs, the field of pediatric oncology has been well honed to deal with the special problems associated with juvenile cancer patients. While most adult oncologists consider themselves well prepared to deal with older cancer patients, the current expansion of the geriatric population - their variable levels of fitness, frailty and vulnerability, the fact that cancer is primarily a disease of older adults, the significant expansion of agents and approaches to treat cancer, as well as their resultant toxicities and complications - has led to the development of specialized geriatric oncologists. Moreover, the special characteristics and needs of these patients have led to the evolution of new guidelines for evaluation, management and the conduct of research in older patients with cancer.

Though heritable, externalizing disorders have a number of robust associations with several environmental risk factors, including family, school, and peer contexts. To account for these associations, we integrate a behavioral genetic perspective with principles of a developmental cascade theory of antisocial behavior. The major environmental contexts associated with child externalizing problems are reviewed, as are the processes of gene-environment interplay underlying these associations. Throughout, we discuss implications for prevention and intervention. Three major approaches designed to reduce child externalizing behavior are reviewed. Prevention and intervention programs appear to be most successful when they target individuals or communities most at risk for developing externalizing disorders, rather than applied universally. We end by commenting on areas in need of additional research concerning environmental influences on persistent externalizing behaviors.

Chronic kidney disease (CKD) is a very common clinical problem in elderly patients and is associated with increased morbidity and mortality. As life expectancy continues to improve worldwide, there is a rising prevalence of comorbidities and risk factors such as hypertension and diabetes predisposing to a high burden of CKD in this population. The body of knowledge on the approach to elderly patient with CKD is still evolving. Thus, this review seeks to explore the epidemiology and to discuss current understanding of challenges in the diagnosis and management of elderly patients CKD.

Aims: The effect of race/ethnicity on the risk of obesity associated with short or long sleep durations is largely unknown. This study assessed whether the sleep-obesity link differentially affects black and whites.

Methods: Analysis was based on data obtained from 29,818 adult American respondents from the 2005 National Health Interview Survey, a cross-sectional household interview survey.

Results: Multivariate-adjusted odds ratios for obesity associated with short sleep (≤6 h) among blacks and whites were 1.98 (95% CI: 1.69-2.30) and 1.20 (95% CI: 1.10-1.31), respectively, and with long sleep (≥9 h) for blacks and whites were 1.48 (95% CI: 1.14-1.93) and 0.77 (95% CI: 0.67-0.89), respectively (all p < 0.001).

Conclusion: Race/ethnicity may have significantly influenced the likelihood of reporting obesity associated with short and long sleep durations. Relative to white respondents, an excess of 78% of black respondents showed increased obesity odds associated with short sleep. Black long sleepers also showed increased odds for obesity, but white long sleepers may be at a reduced obesity risk.

The therapeutic landscape of advanced renal cell carcinoma has grown increasingly more complex with the recent approval of several molecularly targeted agents. While researchers focus on developing predictive algorithms and identifying novel therapeutic targets and agents, clinical practitioners continue to face many practical challenges when determining therapeutic strategies for individual patients. This review will discuss several of these challenges including patient selection strategies, sequential therapy, optimal dose and schedule of various drugs, and therapeutic options for patients with nonclear-cell renal cell carcinoma.

Racial and ethnic disparities have been reported in every field of medicine. High costs associated with infertility treatment and restricted access to care has made assisted reproductive technologies particularly susceptible and vulnerable to disparity. Despite advances in the field, emerging literature has continued to demonstrate poorer outcomes in minority women receiving treatment with assisted reproductive technologies.

Alzheimer's disease, the most common cause of dementia, has a high global economic impact. To date, there is no curative treatment; therefore, many efforts are directed not only at novel potential disease-modifying treatments and interventions, but also to develop alternative symptomatic and supportive treatments. Examples of these efforts include the medical foods. There are three medical foods that claim to offer symptomatic benefits: Axona(®), Souvenaid(®) and CerefolinNAC(®). Axona supplies ketone bodies as alternative energy source to neurons. Souvenaid provides precursors thought to enhance synaptic function. CerefolinNAC addresses the role of oxidative stress related to memory loss. The current scientific evidence on these medical foods is reviewed in this article. Furthermore, we also review the concept and evidence supporting use of the Mediterranean diet, a possible alternative to medical foods that, if implemented correctly, may have lower costs, fewer side effects and stronger epidemiological health outcomes.