Fibromyalgia syndrome: a review.

Fibromyalgia syndrome includes symptoms of widespread, chronic musculoskeletal aching and stiffness and soft tissue tender points. It is frequently accompanied by fatigue and sleep disturbance. Fibromyalgia is more common in women than in men, and it occurs at a mean age of 49 years. Differential diagnosis includes myofascial pain syndrome and chronic fatigue syndrome. Fibromyalgia is a multifactorial problem and no universal treatment guidelines apply to all cases. Pharmacologic therapy may incude tricyclic antidepressants. In addition to commonly used pharmacologic therapies, patient education, reassurance and an exercise program can each play an important role in relieving the symptoms associated with this common musculoskeletal syndrome.

Rural health care networks in South Dakota.

To address health care access concerns, a Regional Coordinated Care Network (RCCN) program, through Robert Wood Johnson Foundation Practice Sights Initiative funding, is being developed by the South Dakota Office of Rural Health. The intent of the initiative is to expand primary and preventive care and, hopefully, permanently reduce the number of Health Professional Shortage Areas (HPSAs) in the state by linking and enhancing providers and services. In rural areas such networking will be crucial for the delivery of health care. Surely, the impact on family physicians will be significant and salutary.

Depression and chronic fatigue in the high school student and athlete.

By presenting the salient aspects of a case study of a high school student athlete, we have attempted to show how participation in sports can negatively impact on self-concept, self-esteem, physical acceptance, and self-efficacy, thereby contributing to an overall feeling of inadequacy, helplessness, hopelessness, and ultimately leading to depression and chronic fatigue. An early maturer, this student experienced early success in several sports without a great deal of effort and investment, and derived much of his sense of being from the recognition and reinforcement accorded him by significant others, most notably from a father who placed a higher premium on success in athletics than on other equally worthwhile pursuits. When continued success was not forthcoming, and as later-maturing peers caught up to and surpassed his athletic accomplishments, the student sought to protect his sense of self-esteem by rationalizing that his lack of success was due to a physical problem. He became obsessed with the thought that he was gradually losing his athletic identity and he lapsed deeper and deeper into a depressed state. His compulsive overtraining and starvation diet failed to produce his image of the "ideal body" that, of course, was unachievable because of his distorted view of reality. Ultimately, this behavior resulted in hospitalization for treatment of an eating disorder and clinical depression. Even a successful senior football season after his psychiatric care could not filter through his distorted perceptions and he could not cope with the thought of participating in another track and field season and having his performance bested by others whom he had once handily beaten. Thus, once again, he engaged in self-protective behavior and sought verification from sportsmedicine professionals. Diagnosis of Tom's condition was possible only through the collaborative efforts of the athletic trainer, physical therapist, sport psychologist, and family physician. Professionals involved in sportsmedicine must be aware of the critical role that highly valued activities like sports play in the psychosocial development of adolescents. To the adult, these activities may seem trivial, frivolous, and removed from the "real world," but to the adolescent, they are an important source of self-esteem during a critical and volatile period of self-concept edification. During a period of awakening sexuality and heightened awareness of their physical being, activities that emphasize the physical aspect of self gain prominence. Those who derive positive experiences benefit from enhanced feelings of physical self-efficacy and self-esteem.(ABSTRACT TRUNCATED AT 400 WORDS)

Disorders of the external ear.

External ear disorders are diffuse, varying from cosmetically unacceptable anomalies to serious neoplasms. Between these extremes lie the more common problems presenting to the primary care physician in an ambulatory setting. These problems include trauma, obstructions, dermatoses, and infections, some or all of which may be vexing to the busy clinician. Most of these problems are not serious and can be approached with the confidence of a salutary outcome with appropriate therapy.

The consultant family physician.

Family physicians frequently consult and refer to other specialists, both generalist and subspecialist. Less commonly has the family physician been used as a consultant. A randomized questionnaire survey of family physicians in five midwestern states was used to consider the frequency and reasons for other specialists collaborating with the family physician as a consultant. Fifty percent of the respondents consult and refer to as well as receive consultations/referrals from other family physicians. Thirty-five percent of the respondents receive consultations and referrals from other generalist specialists, and 28 percent receive theirs from subspecialists. Most often these occur because the patient has no family physician, but family physicians are also used for their procedural skills and coordination of patient evaluation and management, including preoperative evaluation of patients. This study confirms that the consultant family physician is an important part of the health care team.

Family physician consultation/referral patterns.

Family physicians, regardless of training, board certification, or practice setting, more commonly consult or refer to internal medicine subspecialists than to general internists. The primary reason is need for a consultant with technical (procedural) skill. In the case of pediatric referrals, family physicians more commonly refer to general pediatricians than to pediatric subspecialists. Physicians who use pediatric subspecialists more when both are available, however, do so because of the need for a consultant with technical skill. Large numbers of internal medicine and pediatric residents are choosing subspecialties, thereby increasing availability of these subspecialties. At the same time, there is a documented need for an increased number of primary care physicians. Family physicians, general internists, and general pediatricians all need to be trained; however, because the breadth of training of the family physician prepares this practitioner to provide comprehensive primary care in a broad variety of settings, there should be an emphasis on training this specialist.