Janet M. Torpy

Chronic Diseases of Children

Chronic Diseases of Children C hildren often have acute, short-term illnesses such as upper respiratory tract or ear infections, gastrointestinal illness with vomiting and diarrhea, or injury-related problems. However, some children develop chronic illness (lasting for years or even lifelong) as a result of genetic (inherited) conditions, environmental factors, or a combination of both. Because prenatal (before birth) exposure to tobacco smoke and alcohol can affect a baby’s health, it is important to extend environmental and nutritional concerns to women who may become pregnant. The February 17, 2010, issue of JAMA includes an article about changes in the prevalence of chronic conditions among US children from 1988 through 2006. This Patient Page is based on one previously published in the June 27, 2007, issue of JAMA.

Cancer: The Basics

Cancer is a word applied to different types of abnormal, unhealthy cells that grow in an uncontrolled way in the body’s tissues. Cancer causes malignant tumors (abnormal growths) and loss of normal body organ function. The cancer cells can metastasize (spread) to nearby organs or can spread through the bloodstream or lymph system to other areas of the body, depending on the type of cancer involved and the severity of the disease. In addition to causing changes in and damaging the area where it started, cancer often causes other symptoms, such as fatigue, weight loss, anemia (low blood count), pain, weakness, depression, and shortness of breath, and it can be associated with infection. More than 11 million persons in the United States have cancer. Worldwide, more than 12 million individuals are diagnosed with cancer every year. Health care professionals involved in cancer care include oncologists and hematologists (doctors with specialized education and training in treating cancer and diseases of the bloodstream), surgeons of different specialties including surgical oncologists (who focus on surgical management of cancer), radiation oncologists (doctors with specialized training in using x-ray therapy to treat cancer), and nurses with special expertise in cancer care. The March 17, 2010, issue of JAMA is a theme issue devoted to articles about cancer.

Mild Cognitive Impairment

Concerns about memory, word-finding, or other cognitive (mental function) problems are common among older adults. A mild cognitive problem is different from dementia, however, because dementia is diagnosed only when both memory and another cognitive function are each affected severely enough to interfere with a persons ability to carry out routine daily activities. Dementia is much more severe than a mild memory problem such as difficulty recalling names. The October 1, 2008, issue of JAMA includes an article about mild cognitive impairment.

Intensive Care Units

Correction Contact me if this article is corrected. Citations Contact me when this article is cited. Topic collections Contact me when new articles are published in these topic areas. Drug Therapy; Drug Therapy, Other; Infectious Diseases Surgical Infections; Randomized Controlled Trial; JAMA Patient Page; Care Medicine; Adult Critical Care; Surgery; Surgical Physiology; Bacterial Infections; Infectious Diseases, Other; Critical Care/ Intensive

JAMA patient page. Cystic fibrosis.

C ystic fibrosis (CF) is a genetic (inherited) disease that affects mainly the lungs, the pancreas, and the sweat glands. Some CF patients develop serious liver disease. The abnormal CF gene changes the makeup of mucus in the airways, making it thick and sticky. The body cannot clear this thick mucus from the airways, leading to recurrent lung infections that are difficult to treat. Thick secretions also block other glands, causing them to function poorly. About 30 000 persons in the United States have CF and more than 10 million carry the gene for CF. Carriers of the gene do not have symptoms of CF, but if they have a child who inherits 2 copies (one from each biological parent) of the CF gene, that child will develop cystic fibrosis and can also pass the CF gene on to any children he or she may have. In the past, most persons with CF found out about their condition when they had symptoms in childhood. Newborn screening programs can now lead to earlier diagnosis and therapy to limit the impact of the disease. The September 9, 2009, issue of JAMA includes an article about genetic variations that contribute to the development of serious liver disease in cystic fibrosis.

JAMA patient page. Ulcerative colitis.

Small intestine Inflammatory bowel diseases (IBD) such as ulcerative colitis and Crohn disease make the bowel (intestine) inflamed, irritated, swollen, and unable to function in a healthy way. Ulcerative colitis affects the large intestine (the colon) and the rectum but does not involve the small intestine (the part of the bowel that connects the stomach to the colon and that is responsible for almost all the body’s food digestion and absorption of nutrition). Crohn disease affects both the small intestine and the colon.

JAMA patient page. Hepatitis B.

Hepatitis B is a viral infection of the liver. Along with other hepatitis types (such as hepatitis C and hepatitis E), hepatitis B is caused by transmission (spread) of the virus through blood and body fluids. Some persons infected with hepatitis B develop a chronic infection, become carriers, and are then able to pass on the infection to others. All individuals with hepatitis B are at higher risk of developing liver cancer and cirrhosis of the liver. Hepatitis A is a less serious type of viral liver infection that is transmitted by the fecal-oral route (by contaminated water, food, surfaces, and hands). Hepatitis B affects more than 300 million individuals worldwide and is a serious health problem in many industrialized nations and developing countries. Most people who have chronic hepatitis B were infected at birth or in early childhood. The April 13, 2011, issue of JAMA includes an article about hepatitis B vaccine.

JAMA patient page. Neurofibromatosis.

N eurofibromatosis (NF) is a genetic disorder causing skin abnormalities and tumors that form on nerve tissues. These tumors can be small or large and can occur anywhere in the body, including the brain, spinal cord, large nerves, or smaller nerves. NF affects persons of both sexes and all racial groups. There are 2 types of neurofibromatosis, called NF1 and NF2. These are 2 distinct disorders that are caused by mutations (changes) in different genes. NF1 is also referred to as von Recklinghausen disease and is a rather common genetic disease, affecting approximately 1 in 3000 individuals. Some patients who have NF1 only display characteristic skin abnormalities such as café au lait spots, which are flat, hyperpigmented (darker than surrounding skin) areas. Other patients can have severe physical complications such as malignant (cancerous) tumors or have mental retardation. NF2 is much more rare than NF1, affecting less than 1 in 30 000 individuals, usually becoming apparent in the late teens, and typically causing hearing loss and problems with balance due to tumors on nerves to the ears. The November 18, 2009, issue of JAMA includes an article about a recently described condition called Legius syndrome in which patients have skin pigment abnormalities indistinguishable from NF1. This Patient Page is based on one published in the July 16, 2008, issue of JAMA.

JAMA patient page. Irritable bowel syndrome.

Irritable bowel syndrome (IBS) affects the gastrointestinal (GI) tract, especially the colon (the large bowel). Irritable bowel syndrome causes diarrhea and sometimes constipation (difficulty with bowel movements). Approximately 20% of persons in the developed world have IBS symptoms at some time in their lives. Irritable bowel syndrome is generally diagnosed when more serious problems like inflammatory bowel disease (Crohn disease and ulcerative colitis), celiac disease, infection with parasites, cancer, or malabsorption (bowel does not absorb nutrients properly) have been looked for and not found. Women are more likely than men to have IBS. People who have continuous or recurring diarrhea, constipation, or both are often referred to a gastroenterologist, a doctor with specialized education in the management of digestive diseases, including bowel problems. Irritable bowel syndrome is called a functional disorder because there is no known physical cause for its signs and symptoms. It is important to seek medical attention if you have episodes of diarrhea or constipation on a regular basis, have a change in your bowel habits, or experience bloody stools because these may be signs of serious medical issues, such as colon or rectal cancer or inflammatory bowel disease.

JAMA patient page. Postoperative infections.

I nfections after surgical procedures (operations) can cause pain, poor wound healing, need for further treatment including antibiotics, longer hospital stays, and increased health care costs. Postoperative infections may cause severe problems, including failure of the surgical procedure, other surgical complications, sepsis, organ failure, and even death. Some persons are at higher risk of developing postoperative infections than others. Ways to try to prevent these types of infections include giving antibiotics before a procedure, when appropriate; making sure the patient is in the best condition possible before elective surgery; using an antiseptic solution to “prep” the area around a surgical incision; maintaining sterility (no bacteria or other organisms, such as viruses or parasites) of the surgical area (also called the “surgical field”) and operating tools; and having operating room staff wear clean scrub clothes, hats, and masks. The June 23/30, 2010, issue of JAMA contains an article evaluating measures designed to reduce the risk of infections that occur after surgical procedures.