Items in AFP with MESH term: Physician's Role
ABSTRACT: Childhood obesity is an increasingly serious problem; 13.9 percent of children two to five years of age, 18.8 percent of children six to 11 years of age, and 17.4 percent of adolescents 12 to 19 years of age in America are obese. Practical strategies that primary care physicians can use to tackle the problem are scarce. The American Medical Association recently convened an expert panel to address this need. Evidence about how best to manage and prevent obesity was reviewed and incorporated into a series of reports. The Expert Committee on the Assessment, Prevention, and Treatment of Child and Adolescent Overweight and Obesity recommends addressing the issue of weight with all children at least once a year. Family physicians are urged to assess key dietary habits (e.g., consumption of sweetened beverages), physical activity habits, readiness to change lifestyle habits, and family history of obesity and obesity-related illnesses. Laboratory testing recommendations depend on the degree of obesity and associated illnesses. For children with a body mass index between the 85th and 94th percentiles but who have no obesity-related illnesses, a fasting lipid profile should be done. Those with the same body mass index and obesity-related illnesses should also have tests for alanine transaminase, aspartate transaminase, and fasting blood glucose levels. Measurement of blood urea nitrogen and creatinine levels should be added in children with a body mass index above the 95th percentile. A four-stage approach to treatment of childhood obesity is recommended. Many of these recommendations can be carried out by family physicians for treatment and prevention. These include advising families to limit consumption of sweetened beverages and fast food, limit screen time, engage in physical activity for at least 60 minutes per day, and encourage family meals on most, and preferably all, days of the week.
Family Physicians and the Childhood Obesity Epidemic - Editorials
ABSTRACT: Family physicians commonly care for patients with serious mental illness. Patients with psychotic and bipolar disorders have more comorbid medical conditions and higher mortality rates than patients without serious mental illness. Many medications prescribed for serious mental illness have significant metabolic and cardiovascular adverse effects. Patients treated with second-generation antipsychotics should receive preventive counseling and treatment for obesity, hyperglycemia, diabetes, and hyperlipidemia. First- and second-generation antipsychotics have been associated with QT prolongation. Many common medications can interact with antipsychotics, increasing the risk of cardiac arrhythmias and sudden death. Drug interactions can also lead to increased adverse effects, increased or decreased drug levels, toxicity, or treatment failure. Physicians should carefully consider the risks and benefits of second-generation antipsychotic medications, and patient care should be coordinated between primary care physicians and mental health professionals to prevent serious adverse effects.
ABSTRACT: Approximately 8,200 new cases of Hodgkin lymphoma are diagnosed annually in the United States. Common presenting features include painless lymphadenopathy (usually above the diaphragm), cough, fever, night sweats, and weight loss. To decrease late complications, treatment has gradually evolved toward shorter-duration chemotherapy with use of lower-dose, shorter-duration radiation therapy. ABVD (a chemotherapy regimen consisting of doxorubicin, bleomycin, vinblastine, and dacarbazine) is now more commonly used than MOPP (a regimen consisting of mechlorethamine, vincristine, procarbazine, and prednisone) in patients with Hodgkin lymphoma. Many significant complications of therapy (e.g., cardiovascular conditions, infertility, premature menopause, secondary neoplasms) directly reflect the choice of primary treatment and may be reduced by more current treatment strategies. Recurrences of Hodgkin lymphoma are most common in the first few years after diagnosis and treatment. Prognosis is related to the stage of lymphoma, disease bulk, and age of the patient. Currently, more than 80 percent of patients with newly diagnosed Hodgkin lymphoma are expected to be long-term survivors.
What Every Physician Should Know About Generic Drugs - Improving Patient Care
Escapist Medicine - Editor's Page
The Challenge of Urban Family Medicine - Editorial