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To assess the consistency of return to sport and occupation recommendations following EHI provided in published clinical practice guidelines, consensus statements, position statements, and practice alerts. The agreement between medical policies governing the return to duty following EHI between the branches of the United States Armed Forces and published recommendations was assessed. Ovid MEDLINE, Web of Science, and CINAHL databases were searched for clinical practice guidelines and position statements published at any time that guided return to activity in individuals with EHI. Methodological quality was assessed, and the specific recommendations for clinical management were extracted. Consistency of recommendations was evaluated. Agreement between published guidelines and the policies governing return to activity in military tactical athletes with heat injury were also evaluated. Guidelines developed by two civilian sports medicine societies in the United States detailing recommendations for return to function following EHI were identified. There was consistency between guidelines regarding recommendations that addressed abstinence from activity; medical follow-up; graded resumption of activity; and return to function. Pertaining military policy, contemporary regulations published in recent years reflected the recommendations provided in the professional guidelines. The greatest incongruence was noted in older military policies. This systematic review highlights the need for consistent recommendations across all branches of the military and medical specialties pertaining to returning servicemembers to duty after EHI. [ABSTRACT FROM AUTHOR]

Third-party fertility treatments refer to use of egg donors, sperm donors, donated embryos, and/or third-party gestational carriers/surrogates to have a child. There are two main categories of fertility treatments: intrauterine insemination (IUI) and in vitro fertilization (IVF). IUI involves placement of sperm (from a donor or from the woman's partner) into a woman's uterus. In IVF, egg production is stimulated with drugs, after which the eggs are vaginally retrieved, fertilized with sperm in a laboratory, and then transferred into a uterus (of the intended parent or a gestational carrier) or cryopreserved for future use. Parents typically choose third-party fertility treatments because of problems with the ovaries, sperm, or uterus. When proceeding with third-party fertility treatments, donors and recipients should undergo medical review, screening for infectious disease, and psychological evaluation. Overall rates of successful pregnancy vary, with age being a key factor, ranging from 3% to 9% (with IUI) to 14% (with IVF) for women ages 40 to 41 years to approximately 50% (with IFV) for women younger than 35 years. There are many issues that adults considering IUI or IVF should consider during decision-making (eg, financial cost; legal status of parentage, which can vary by location; medical risks, which are low; psychological and ethical considerations). [ABSTRACT FROM AUTHOR]

Nuclear families (consisting of a married man and woman and their children) have long been regarded as the default domestic arrangement. Nonetheless, there are many other family structures that are becoming increasingly more common and complex. Single-parent families can result from divorce or the death of one parent, or may be intentionally planned before conception. Multigenerational families typically include children, parents, and grandparents living together, although sometimes parents are absent and grandparents are the caregivers. Blended families result from a union between divorced or widowed parents, with unrelated children from their prior relationships brought together. Caregivers in these various family structures should be aware of the stigma that they or their children may face. Although children in these modern families may experience higher rates of obesity, substance use, unsafe sex, and mental illness, confounding factors for these disparities often are neglected, and it is unclear whether there are truly worse long-term health outcomes for these children compared with those in nuclear families. When working with families with diverse structures, physicians should avoid assumptions about the roles of different family members, and provide screening and guidance as needed to support them. [ABSTRACT FROM AUTHOR]

Approximately 29% of LGBTQIA+ (lesbian, gay, bisexual, transgender, queer/questioning, intersex, asexual/agender, and other orientations/identities) adults are raising a child, and 2 to 3.7 million children have an LGBTQIA+ parent. These families often experience challenges. Social challenges include exclusion and homophobic hostility directed at the child and/or family. Medical challenges include difficulty finding clinicians who provide a welcoming environment, and dealing with clinicians who do not understand LGBTQIA+ issues. Physicians can help address those challenges by examining their implicit biases and by making changes in their offices and interactions with patients that make patients feel more welcomed. Other concerns relate to LGBTQIA+ children and adolescents, who often experience rejection and abuse by peers, likely contributing to higher rates of suicide. In addition, many youth feel discordance between their gender identity and their assigned birth sex, with some not feeling fully male or female (gender diverse) and others identifying as a gender opposite their sex assigned at birth (transgender). These individuals often experience gender dysphoria, and counseling can help. For some, there is an option to undergo hormone treatments to delay puberty until they have affirmed their gender identity. Others will want hormone treatments to transition to the gender they identify with. [ABSTRACT FROM AUTHOR]

Foster care is a service for children who cannot live with their families. There are many reasons for foster care, the most common of which is parental neglect and/or substance abuse. At any one time, more than 400,000 US children are in foster care. Although 59% are eventually reunited with their parents, some end up in other situations, including adoption. Children should undergo a physician evaluation within 72 hours of entering foster care, a comprehensive evaluation within 30 days, and a follow-up visit within 60 to 90 days, followed by routine care. Adoption occurs for 1 of every 50 children; approximately 1% of adoptees are from other countries. There are many forms of adoption, including open (birth parents have contact with the adopted child), closed (contact is not permitted), and kinship (adopting parents are relatives of the child). Approximately one-quarter of adoptions are transracial/transethnic. Adoptions by LGBTQIA+ (lesbian, gay, bisexual, transgender, queer/questioning, intersex, asexual/agender, and other identities) people also are common. Parents planning adoption should talk to the physician who will care for the child to review the child's health records, and continue with routine care after adoption. For international adoptions, numerous infectious disease tests are required before and after the child's arrival in the United States. Adoptees also should undergo developmental evaluation and screening for adverse childhood experiences and mental health issues. [ABSTRACT FROM AUTHOR]

The article presents guidelines from the American Physical Therapy Association about patellofemoral pain (PFP), a condition characterized by poorly defined knee pain in the anterior retropatellar or peripatellar region. Topics discussed include risk factors for PFP, diagnosis and general treatment approaches, and specific treatments based on assessment

Approximately 0.6% of adults (1 to 1.4 million adults) in the United States identify as transgender, and 2% of high school-aged individuals (150,000 to 300,000 individuals). Gender-affirming care for transgender and gender- diverse patients can include support with social transition or physical presentation, legal steps, and medical treatments (eg, hormone therapy) and surgeries. Adolescent and adult patients who request gender-affirming hormone therapy must meet several criteria. One is confirmed persistence of gender dysphoria or gender incongruence. Also, the patient must have reached the age of legal medical consent and be able to consent to therapy. For adolescent patients who are minors, meeting of additional criteria is recommended. In eligible adolescent patients, gender-affirming hormone therapy consists of two phases, pubertal suppression and then feminizing or masculinizing hormone therapy. Before puberty, hormone therapy is not recommended. When puberty begins, patients can receive a gonadotropin-releasing hormone agonist to suppress puberty (ie, puberty blocker). Feminizing or masculinizing hormone therapy, which usually is initiated at age 16 years, consists of estradiol or testosterone, respectively. For adult patients requesting gender-affirming hormone therapy, a thorough evaluation should be performed to assess for contraindications and conditions that may increase therapy-associated risks. Feminizing hormone therapy includes estrogen and an antiandrogen, and masculinizing therapy consists of testosterone. These patients should undergo regular monitoring. Cancer screening is based on risk factors, organ inventory, and screening guidelines.

Foster care is a service for children who cannot live with their families. There are many reasons for foster care, the most common of which is parental neglect and/or substance abuse. At any one time, more than 400,000 US children are in foster care. Although 59% are eventually reunited with their parents, some end up in other situations, including adoption. Children should undergo a physician evaluation within 72 hours of entering foster care, a comprehensive evaluation within 30 days, and a follow-up visit within 60 to 90 days, followed by routine care. Adoption occurs for 1 of every 50 children; approximately 1% of adoptees are from other countries. There are many forms of adoption, including open (birth parents have contact with the adopted child), closed (contact is not permitted), and kinship (adopting parents are relatives of the child). Approximately one-quarter of adoptions are transracial/transethnic. Adoptions by LGBTQIA+ (lesbian, gay, bisexual, transgender, queer/questioning, intersex, asexual/agender, and other identities) people also are common. Parents planning adoption should talk to the physician who will care for the child to review the child's health records, and continue with routine care after adoption. For international adoptions, numerous infectious disease tests are required before and after the child's arrival in the United States. Adoptees also should undergo developmental evaluation and screening for adverse childhood experiences and mental health issues., (Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.)