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Am Fam Physician. 2000;61(12):3733

Bornholm Disease

(Australia—Australian Family Physician, January 2000, p. 51.) While coxsackie B virus infection is rare in persons more than 60 years of age, it is more common in children and young adults. The infection is transmitted by hand-to-mouth contact and may become widespread in certain populations. This virus has been called “the great pretender” because of the variety of clinical syndromes it can produce. Many infections that are caused by the virus are subclinical. More serious conditions caused by coxsackie B virus include myocarditis, orchitis, myalgia and pleurodynia. Pleurodynia may be severe and can occur in epidemics referred to as “Bornholm disease,” named after the original description of an early epidemic on the Danish island of Bornholm. Patients with pleurodynia are usually children or young adults who present with severe pleuritic pain, tachypnea and systemic upset. If necessary, levels of serum immunoglobulin A can confirm the diagnosis. The condition is usually self limiting but there can be serious, though rare, long-term sequelae.

Update on Schizophrenia

(Australia—Australian Family Physician, February 2000, p. 129.) The lifetime risk of schizophrenia is about 1 percent. Symptom onset usually occurs between the ages of 17 and 30 in men and between the ages of 20 and 40 in women. Men and women are equally affected. Initial symptoms may be nonspecific and difficult to differentiate from “adolescent turmoil.” Patients with later age of onset tend to develop paranoid symptoms. Symptoms of schizophrenia may be “positive” (e.g., delusions, hallucinations and disordered thinking) or “negative” (e.g., negativism, flat affect and lack of motivation). In about one third of cases, the outcome is favorable, another one third have a remitting and relapsing course, and the remainder remain chronically disabled despite treatment. Antipsychotic medications allow many patients to live in the community under supervision, but the benefits of many of these drugs are limited by extrapyramidal side effects.

Prenatal Serum Screening Tests: Mothers' Perspectives

(Canada—Canadian Family Physician, March 2000, p. 614.) To explore women's attitudes toward maternal serum screening, feedback was sought from focus groups of new mothers. The 60 women in the focus groups varied greatly in their philosophies of life and views on abortion and the ethics of prenatal testing for congenital abnormality. The women all wanted to be offered prenatal genetic testing no matter what their moral or religious beliefs. The three dominant factors in the decision to accept prenatal testing were their personal values, social support (including support from their partners) and the quality of information provided by health professionals. Physicians were identified as the most important source of information. Women valued physicians who asked about personal values and the influence of social supports in discussing prenatal testing. The mothers overwhelmingly wanted accurate, unbiased and timely information. They particularly disliked arrangements where the mother was only contacted if the test indicated a problem. The researchers emphasize that all test results should be discussed with mothers to ensure that the results and the implications of the results are fully understood. Information needs described by the women in this study could apply to other prenatal genetic tests that might be available in the future.

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