J Am Board Fam Med
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Immunization rates are static in the United States. Risk factors for not being up to date (UTD) include ethnicity and lower socioeconomic status. Reminder cards increase immunization rates in urban settings. Their effect in poor, Latino, and rural children is unknown. ⋯ In poor, rural, and Latino populations, language-appropriate reminder/order cards increase immunization rates.
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Heterogeneity in management of diabetes mellitus among Latino ethnic subgroups in the United States.
Recent debate suggests that general racial/ethnic categories may obscure potentially important subgroup differences within minority groups. The purpose of this study was to examine the quality of diabetes care among ethnic subgroups of the Latino population in the United States while accounting for aspects of acculturation and access to care. ⋯ Differences in diabetes management exist between Latino ethnic subgroups; treating Latinos in the United States as one homogenous category may be a barrier to the appropriate provision of care.
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Global health provides a special challenge for primary care and general practice, which will become increasingly important in the future as the prevalence of multimorbidity increases with increasing likelihood of survival from acute manifestations of illness, as populations age, and as costs of care increase with increasing availability of technologic interventions. World organizations of primary care physicians need to take up the challenge before it becomes a crisis.
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Multicenter Study
Why hasn't this patient been screened for colon cancer? An Iowa Research Network study.
Less than half of eligible Americans have been screened for colorectal cancer (CRC). The objective of this study was to describe physicians' reasons for screening or not screening specific patients for CRC and their approach to CRC testing discussions. ⋯ Reasons many patients remain unscreened for CRC include (1) factors related to the health care system, patient, and physician that impede or prevent discussion; (2) patient refusal; and (3) the focus on diagnostic testing. Strategies to improve screening might include patient and physician education about the rationale for screening, universal coverage for health maintenance exams, and development of effective tracking and reminder systems. The words physicians choose to frame their recommendations are important and should be explored further.
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Adults with intellectual disabilities need thoughtful, well-coordinated primary care from family physicians. However, evidence-based screening recommendations are lacking. We examined screening recommendations for common preventable conditions using the US Preventative Service Task Force guidelines. ⋯ Obesity, osteoporosis, and smoking are more prevalent in adults with intellectual disabilities, and enhanced screening for these conditions is recommended. Abnormal Papanicolaou smears and cervical cancer are less common in adults with intellectual disabilities and screening recommendations should be individualized. We also discussed strategies to make screening procedures less stressful for these patients.