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Seasonal Affective Disorder: Common Questions and Answers.
Galima, SV, Vogel, SR, Kowalski, AW
American family physician. 2020;(11):668-672
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Abstract
Seasonal affective disorder is a mood disorder that is a subtype or qualifier of major depressive disorder or bipolar disorder in the Diagnostic and Statistical Manual of Mental Disorders. It is characterized by depressive symptoms that occur at a specific time of year (typically fall or winter) with full remission at other times of year (typically spring or summer). Possible risk factors include family history, female sex, living at a more northern latitude, and young adulthood (18 to 30 years of age). With the temporal nature of the mood episodes, diagnosis requires full remission when the specified season ends and two consecutive years of episodes in the same season. First-line therapy for seasonal affective disorder includes light therapy, antidepressants, and cognitive behavior therapy, alone or in combination. Commercial devices are available for administering light therapy or dawn simulation. The light intensity and duration of treatment depend on the device and the patient's initial response, but 2,500 to 10,000 lux for 30 to 60 minutes at the same time every day is typically effective. Lifestyle interventions, such as increasing exercise and exposure to natural light, are also recommended. If seasonal affective disorder recurs, long-term treatment or preventive intervention is typically indicated, and bupropion appears to have the strongest evidence supporting long-term use. Continuing light therapy or other antidepressants is likely beneficial, although evidence is inconclusive. Evidence is also inconclusive for psychotherapy and vitamin D supplementation.
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[Intensive treatment in family medicine : use of pumps and continuous glucose measurement systems].
Gastaldi, G, Pautex, S, Jelk-Morales, L, LĂ©ocadie, F, Sierro, C, Sommer, J
Revue medicale suisse. 2020;(694):1022-1025
Abstract
New technologic devices are presented: insulin pumps and continuous glucose monitoring (CGM) devices as well as morphine pumps to help general practitioners to deal different intensive situations. Insulin pumps and CGM devices are revolutionary for the management of diabetes. However, their use requires strong patient involvement, the opposite of automated diabetes management. Morphine pumps are a great help when patients in end-of-life stage cannot swallow oral morphine anymore. This article summarizes the main principles of use of these technological devices, common problems and situations at risk primary care practice.
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An FP's guide to AI-enabled clinical decision support.
Halamka, J, Cerrato, P
The Journal of family practice. 2019;(9):486;488;490;492
Abstract
To better understand the capabilities and challenges of artificial intelligence and machine learning, we look at the role they can play in screening for retinopathy and colon cancer.
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4.
Issues in Nutrition: Nutritional Assessment of Adults.
Thompson, ME, Noel, MB
FP essentials. 2017;:11-17
Abstract
The assessment of nutritional status in adults should begin with a complete history, including intake of fruits and vegetables, sources of fat, and added sugar (eg, sugar-sweetened beverages). The history should include social factors that may impede a patient's ability to obtain food, as well as any factors that might interfere with preparing, chewing, and digesting food and absorbing nutrients. The physical examination should include measurement of height and weight and calculation of body mass index. It also may include measurements of waist circumference and waist to hip ratio, and an evaluation of strength. Laboratory evaluation should include measurement of albumin, prealbumin, and other markers of total body protein stores. No biomarker is completely sensitive or specific. With a range of dietary patterns, it is possible for nutritional gaps specific to those patterns to develop. Identification of a single nutrient deficiency typically reflects an overall weakness in the diet. The Mediterranean and Dietary Approaches to Stop Hypertension (DASH) diets have the most evidence to support them as healthy diets.
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The practical update for family physicians in the diagnosis and management of overactive bladder and lower urinary tract symptoms.
Barkin, J, Habert, J, Wong, A, Lee, LYT
The Canadian journal of urology. 2017;(5S1):1-11
Abstract
OBJECTIVE To provide family physicians with an up-to-date, practical overview of the diagnosis and management of overactive bladder (OAB) alone or with bladder outlet obstruction. MAIN MESSAGE OAB is urinary urgency with or without incontinence, often accompanied by frequency and nocturia, in the absence of urinary tract infection and can affect both men and women. Men often have co-existing OAB associated with bladder outlet obstruction, and benign prostatic hyperplasia. OAB can interfere with sleep, social activities, and sexual encounters, and it increases the risk of falls. CONCLUSION Many patients with OAB seek initial evaluation and treatment from their family physicians. Optimal management of OAB by family physicians will improve patients' quality of life. More severe cases or 'red flags' uncovered while making the diagnosis, might warrant referral to a urologist.
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Family medicine obstetrics: pregnancy and nutrition.
Harnisch, JM, Harnisch, PH, Harnisch, DR
Primary care. 2012;(1):39-54
Abstract
This article discusses pregnancy and nutrition in 3 main timeframes, the prepregnancy nutritional health evaluation, nutrition during pregnancy, and nutrition during the puerperium, and also includes comments on nutrition and lactation. This article begins with a brief review of the risks of obesity (increased body mass index [BMI]) and anorexia (decreased BMI), with special attention to these undesired conditions during pregnancy, followed by a section on nutrients other than calories. Information on body weight, minerals, and vitamins during pregnancy is reviewed. This article ends with information on nutrition in the postpartum period.
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[Summary of the practice guideline 'The intrauterine device' from the Dutch College of General Practitioners].
Boukes, FS, Kertzman, MG, Smeenk, RC, Goudswaard, AN
Nederlands tijdschrift voor geneeskunde. 2009;:A578
Abstract
The practice guideline 'The intrauterine device' from the Dutch College of General Practitioners, first published in 2000, has been revised. Copper and hormonal IUDs have more or less the same level of reliability with respect to preventing pregnancy. During the use of a copper IUD, menstruation tends to be longer with a greater loss of blood; in 70% of women who use a hormonal IUD oligomenorrhea or even amenorrhoea develops. Women with a history of venous thromboembolism can use a hormonal IUD safely. In the first weeks after IUD insertion, there is an increased risk of pelvic inflammatory disease (PID). Therefore prior to insertion, the general practitioner should enquire about the risk of a SOA being present and, if necessary, perform SOA tests. In the Netherlands, IUD insertion can usually be performed at a general practice.
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The role of the primary care physician during the active treatment phase.
Smith, GF, Toonen, TR
Primary care. 2009;(4):685-702
Abstract
Although more research needs to be done to determine the optimal role for PCPs during the active phase of cancer treatment, patients, PCPs, and oncologists all see a significant role for primary care in the care of patients with cancer. In the United States, family physicians are actively involved in the care of cancer patients, especially in provision of support, education, and care of intercurrent illness and chronic disease. Fatigue, depression, pain, and psychosocial distress are important symptoms that should be screened for and addressed. The PCP should be aware of adverse effects of chemotherapy and radiation and cancer-related emergencies. Sexual and intimacy concerns, including contraception and fertility, are important to patients entering active cancer treatment but may not be addressed adequately in usual cancer care. Advising the patient in active cancer treatment on issues of general health including common nutritional issues can provide value through the treatment period. Use of CAM is common and several modalities have been shown to benefit patients in the course of cancer treatment.
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9.
Fetal, childhood, and adolescence interventions leading to adult disease prevention.
Pratt, HD, Tsitsika, AK
Primary care. 2007;(2):203-17; abstract v
Abstract
Lifestyle choices result in the development and increased severity of many adult diseases that can cause death (eg, heart disease, stroke, cancer, obesity). Most health-damaging behaviors are learned during childhood and adolescence, making that time period a critical window of opportunity to teach health-promoting behaviors. Primary care physicians can implement their overall commitment to providing comprehensive health care to patients and their families by following the anticipatory guidelines of their discipline (eg, pediatrics, family and internal medicine) and by educating patients and their families about the recommendations included on the Web sites of the Centers for Disease Control and Prevention Office of Women's Health and Office of Strategy and Innovation.
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10.
Traveller's 'funny tummy' - reviewing the evidence for complementary medicine.
Cohen, M
Australian family physician. 2007;(5):335-6
Abstract
The gastrointestinal system is sensitive to both the place and means of travel and traveller's diarrhoea and motion sickness are among the most prevalent travel related conditions. There is now evidence to suggest that both of these ailments may be treated with safe and inexpensive complementary medicines.