Natural history of thyroid abnormalities: prevalence, incidence, and regression of thyroid diseases in adolescents and young adults
Article Abstract:
The results are presented of long-term (20-year) study of a group of 3,121 people whose incidence of thyroid disease was recorded. The group was part of a larger cohort of school-age children, between 11 and 18 when the first phase of the study began (between 1965 and 1968), who lived in the southwestern US. The part of the country where some subjects lived (southwestern Utah and Nevada) was exposed to radiation from testing nuclear devices. Other subjects lived in Arizona during phase I, far from the Nevada test site. Thyroid abnormalities were identified in the early and in a later phase (between 1985 and 1987) by clinical examination, laboratory tests, and biopsies when appropriate. In phase I, thyroid abnormalities were found in 3.7 percent of the children. The most common diagnosis was adolescent goiter (19.3 cases per 1,000), followed by chronic lymphocytic thyroiditis (12.7 cases per 1,000), and nodular thyroid disease (4.6 cases per 1,000). Phase II examinations showed that the subjects' prevalence of thyroid disease increased to 10.5 percent, with goiter found at a rate of 28.7 per 1,000; chronic thyroiditis, at 51.3 per 1,000; hypothyroidism (insufficient thyroid gland activity), in 15.9 per 1,000; hyperthyroidism (excess thyroid gland activity) in 3.9 per 1,000; and nodular disease in 23.2 per 1,000. Sixty percent of the 92 subjects who had goiters in phase I tested normal in phase II, and 27 percent of the 61 subjects with thyroiditis in phase I had become normal by phase II. Twenty percent of the subjects with goiter in phase I were unchanged, while 33 percent of those with thyroiditis in phase I had become hypothyroid. The study shows that thyroid disease is quite variable and may change considerably over time. Further longitudinal studies of these disorders are recommended. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1991
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Teaching physical diagnosis in the nursing home
Article Abstract:
Medical students commonly learn techniques of physical diagnosis in an inpatient hospital setting. However, because of changes in hospital reimbursement and trends toward outpatient directed care, patients in the hospital tend to be more ill and less responsive to the needs of the medical student who is first learning to take a patient history and perform a physical examination. The outpatient setting is not the appropriate situation for the medical student to learn physical diagnosis. Hence, a program was developed to teach physical diagnosis in nursing homes affiliated with university hospitals. Patients in nursing homes are grouped by physical findings and long-term complaints into specific disease processes. Acute or sudden illnesses can also be identified in the nursing home on a daily basis. The patients are seen by second-year medical students during the physical diagnosis course. This new nursing home program was widely accepted by both faculty and students, and a variety of illnesses were amenable to students learning physical diagnosis and taking patient histories. In addition, the problems associated with inpatient and outpatient settings were decreased. The nursing home provides a useful setting for learning physical diagnosis. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1990
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