Canadian Resources for Exercise

(Canada—Canadian Family Physician, October 2000, p. 2061, 2147.) Since its release in October 1998, more than 5 million copies of Canada's “Physical Activity Guide to Healthy Active Living” have been distributed. The guide is part of an intensive campaign to decrease the number of inactive Canadians by 10 percent by the year 2003. A large follow-up study reports that the majority of recipients read the guide and found it easy to understand. Three fourths of those surveyed reported learning something valuable from the guide and nearly 70 percent reported increasing their level of physical activity. About one half of those surveyed recommended the guide to others. There is also a guide that contains information specifically for the elderly. “Physical Activity Guide to Healthy, Active Living for Older Adults” is published in large print type and is particularly commended for its nontechnical language for elderly patients. The guides are available free of charge by calling 888–334–9769 or online athttp://www.paguide.com.

Irritable Bowel Syndrome

(Australia—Australian Family Physician, September 2000, p. 823.) Irritable bowel syndrome (IBS) is characterized by abdominal pain and disturbance of bowel function without clear structural explanation. Diagnostic guidelines, such as the Manning or Rome criteria, emphasize the relief of pain on defecation, the relationship of abdominal pain to the onset of diarrhea or constipation, abdominal distention and sense of incomplete rectal evacuation. The presence of “alarm” features, such as severe or unremitting pain, weight loss, pain or diarrhea that wakes the patient from sleep, anemia, vomiting or gastrointestinal bleeding, should alert the physician to underlying structural disease rather than IBS. In a younger patient, the principal differential diagnoses are ulcerative colitis or Crohn's disease, whereas carcinoma of the large bowel must be considered in the older patient. The management strategy depends on the specific symptoms in each patient, but generally will include dietary advice, psychologic support and consideration of medication. Fiber consumption should be increased slowly in most patients, but it may exacerbate bloating. Most patients require advice about exercise and stress reduction. Response to placebo occurs in up to 70 percent of patients with IBS, and cognitive therapy can be effective in reducing symptoms and enhancing coping abilities. Medications that work predominately on the gastrointestinal system are usually selected to address specific symptoms such as diarrhea or constipation. Low-dose tricyclic antidepressants have been successful in relieving the symptoms of IBS.

Scaphoid Fractures

(Canada—Canadian Family Physician, September 2000, p. 1825.) Scaphoid fractures result from extreme dorsiflexion of the wrist with compression to the lateral hand. They are most common in young men 15 to 30 years of age. The classic finding of tenderness in the anatomic snuffbox is not specific for scaphoid fracture. Tenderness of the scaphoid tubercle and the scaphoid compression test provide better diagnostic information. Four radiographic views are usually obtained. The proportion of scaphoid fractures that are visualized on first examination radiographs ranges from 84 to 98 percent. Uncomplicated and undisplaced scaphoid fractures may be treated with a short arm cast. Immobilization of the thumb appears to be unnecessary. Referral should be considered for high-risk scaphoid fractures, which include those that are displaced, oblique fractures and those involving the proximal pole, because the proximal scaphoid has no independent blood supply in approximately one third of adults. All proven or suspected scaphoid fractures should be reviewed every two weeks until resolution.

NSAID-Associated Peptic Ulcers

(Great Britain—The Practitioner, October 2000, p. 899.) As eradication therapy for Helicobacter pylori becomes more widely used, consumption of nonsteroidal anti-inflammatory drugs (NSAIDs) has become the leading cause of peptic ulceration. Approximately 20 to 30 percent of persons who use NSAIDs regularly are believed to develop peptic ulcers. Because of this, their risk of death is three to 10 times higher than would normally be expected. The risk of peptic ulceration depends on patient factors and the specific agent used. Ibuprofen and diclofenac appear to have lower risks than other NSAIDs, and the new COX-2 inhibitors were specifically designed to have a lower theoretic risk of peptic damage. Patients at greatest risk include the elderly and those with concurrent medical conditions or known peptic susceptibility. If treatment with NSAIDs is necessary in vulnerable patients, prophylaxis should be considered and omeprazole in a dosage of 20 mg daily may be the most effective preventive agent.