The Journal of family practice
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Cuba's accomplishments in primary care, while controversial, include several developments pertinent to family medicine. These accomplishments involve low-technology and organizational innovations such as neighborhood-based family medicine as the focus of primary care; regionalized systems of hospital services and professional training; innovative public health initiatives and epidemiologic surveillance; universal access to services without substantial barriers related to race, social class, gender, and age; and active programs in treatments such as "green medicine" and "thermalism." High-technology achievements include innovations in pharmacology and biotechnology, surgical procedures, and care of patients infected by the human immunodeficiency virus (HIV). Limited access to Cuban publications, impediments to presentations by Cuban health care professionals at professional meetings, and the prohibition on importing products of Cuban biotechnology to the United States inhibit a detached, scientific appraisal of Cuba's accomplishments. Cuba's isolation from the US clinical and research communities has prevented interchanges that would improve primary care services in both countries.
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Contraceptive use among women with an elevated risk of cardiovascular disease and stroke has generated little concern among primary care physicians. African Americans in the southeastern region of the United States are particularly vulnerable to hypertension but are often neglected in research studies of cardiovascular disease. The current study examines the effect of oral contraceptive use by African-American women on blood pressure response to orthostatic and mental challenges. ⋯ While absolute levels of systolic blood pressure never exceeded 126 mm Hg under either testing condition, the difference in blood pressure levels between the OC users and nonusers warrants concern about the long-term effects of oral contraceptive use among African-American women. Although all OC users in this study were taking low-dose formulations, OC use did not eliminate the risk of elevated blood pressure in this population. Our findings suggest that caution is warranted and that alternative birth control methods should be advised for African-American women who have additional risk factors for cardiovascular disease.
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Randomized Controlled Trial Clinical Trial
Penciclovir cream for herpes simplex labialis.
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The purpose of this study was to document the prevalence of panic states in patients presenting with chest pain in primary care settings, to determine the recognition rate of panic states by family physicians, and to assess the impact of lack of recognition on interventions and costs. ⋯ Although common, panic states are rarely recognized in patients presenting with complaints of chest pain. The presence of panic leads to more testing, follow-up, and referral with subsequent higher costs. Failure to diagnose panic results in increased prescribing of medications, higher costs, and inappropriate pharmacotherapy.