American family physician
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Avian influenza A (H5N1) first emerged as a global public health threat in 1997 when it caused a major human outbreak in Hong Kong. Endemic in waterfowl and highly virulent in poultry, H5N1 is capable of incidentally infecting humans and other mammals. Although H5N1 is not yet capable of efficient human-to-human transmission, the protean nature of its genome could transform it into the source of the next human influenza pandemic. ⋯ Prompt case recognition, isolation, and treatment will be crucial for disease control. Pharmacologic interventions will focus on streamlining the production of vaccine, extending vaccine supplies, stockpiling antiviral drugs such as oseltamivir, and distributing these agents in a timely manner to persons who have the most need. Nonpharmacologic measures will include the use of masks, social distancing, quarantine, travel restrictions, and increasing the emergency capacity of health care systems.
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A combination of aerobic activity, strength training, and flexibility exercises, plus increased general daily activity can reduce medication dependence and health care costs while maintaining functional independence and improving quality of life in older adults. However, patients often do not benefit fully from exercise prescriptions because they receive vague or inappropriate instructions. ⋯ Helping patients identify emotionally rewarding and physically appropriate activities, contingencies, and social support will increase exercise continuation rates and facilitate desirable health outcomes. Through patient contact and community advocacy, physicians can promote lifestyle patterns that are essential for healthy aging.
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Antidepressant discontinuation syndrome occurs in approximately 20 percent of patients after abrupt discontinuation of an antidepressant medication that was taken for at least six weeks. Typical symptoms of antidepressant discontinuation syndrome include flu-like symptoms, insomnia, nausea, imbalance, sensory disturbances, and hyperarousal. These symptoms usually are mild, last one to two weeks, and are rapidly extinguished with reinstitution of antidepressant medication. ⋯ A high index of suspicion should be maintained for the emergence of discontinuation symptoms, which should prompt close questioning regarding accidental or purposeful self-discontinuation of medication. Before antidepressants are prescribed, patient education should include warnings about the potential problems associated with abrupt discontinuation. Education about this common and likely underrecognized clinical phenomenon will help prevent future episodes and minimize the risk of misdiagnosis.