began offering preventive services for international travel in 1996.Local demand for such services has steadily increased, especially among families who need services for multi-generation members on the same itinerary. This paper discusses our clinic operation; the clients we serve and their destinations; and the specific services and counseling we provide. We feel many such needs could be met by more family medicine practitioners, as the volume of international travel continues to increase. Introduction: Each year more United States citizens travel abroad; this trend is expected to continue as the population increases, and larger proportions are expatriates. In 2015, U.S. citizens made more than 32,789,000 trips outside of North America, most during May through August. 1 As of November 30, 2016, U.S. citizens completed more than 72,550,000 trips outside the country, an 8.0% increase over 2015, year-to-date; trips outside of North America accounted for approximately 44.0%. 2 More "new" infectious diseases are being recognized; recent examples: influenza A (avian) H5N1, first recognized in humans in Viet Nam in 2004,became a widespread zoonotic disease by 2008; influenza A (pandemic) H1N1 was first identified and became a global concern in 2009; Lassa, Ebola, and Marburg viruses "reappeared" as human disease risks in Africa in 2012 through 2015. 3,4,5,6 Middle East respiratory syndrome corona virus (MERS-CoV) first appeared in 2013 and continues as a regional risk to human health; the ongoing risk of influenza A (avian) H7N9 in the Orient was first recognized in 2013, and, by the end of 2014, the H5N6 strain had appeared in China. 5,6 Since then, Chikungunya and Zika viruses have become human disease risks in the Western Hemisphere. 7,8 These agents have only added to, not replaced, already-existing infectious disease risks for international travelers.
Background Statins are the primary drug used to reduce morbidity and mortality for cardiovascular disease. However, many type II diabetes mellitus (T2DM) patients who are currently not on a statin would otherwise qualify. Therefore, we investigated the proportion of T2DM patients on a statin compared to the total number of T2DM patients eligible to be on a statin. We also examined potential barriers that prevent T2DM patients from being prescribed statins by physicians. Methods A retrospective chart study on family medicine patients was collected data on age, race, cholesterol readings, blood pressure, and whether the patient was on blood pressure medications, aspirin, and/or a statin. The information gathered was used to determine the patients’ 10-year risk of cardiovascular disease. A survey was given to residents and faculty to assess the cost, side effects, and other behavioral factors had on a patients’ choice to be on a statin. Results Among the 706 T2DM patients, we found that a large proportion (75.2%) were both eligible and prescribed a statin according to the American Heart Association Guidelines. In addition, over 58% of the patients had a 0%–25% 10-year risk of cardiovascular disease risk. Among the 14 family medicine physicians surveyed, the fear of or history of side effects with statin medications were the greatest barriers to starting statins. Conclusion The large proportion of family medicine patients that were eligible were prescribed a statin. According to the survey, physicians Believed that the greatest barrier for a patient starting on a statin is the fear of or history of side effects with statin medications.
Selective serotonin reuptake inhibitor therapy does not improve quality of life in adults with irritable bowel syndrome (SOR: A, meta-analysis of randomized controlled trials).
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