J Am Board Fam Med
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Fetal alcohol exposure affects approximately 1% to 3% of live births in the United States. Family physicians are in a unique position to reduce the incidence of alcohol-exposed pregnancy. Fetal alcohol exposure can be minimized through 2 general approaches: reducing alcohol consumption or increasing effective contraception among childbearing-aged women who engage in "at-risk" drinking and encouraging pregnant women to abstain from alcohol. ⋯ Brief interventions, including education about alcohol's effects on the developing fetus, are effective among women not responding to screening. Unfortunately, many barriers exist to effective implementation of alcohol-exposed pregnancy (AEP) prevention in the clinical setting. Designing effective office base systems so the entire burden of implementing AEP prevention activities does fall solely on the family physician is critical.
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As high utilizers of health care resources, frequent attenders to medical practices pose a significant issue for primary health care. Studies documenting content of visits and characteristics of frequent attenders have paid limited attention to community health center populations. This study profiles these high utilizers comparing them to non-frequent attenders. ⋯ Through developing interventions such as customized social report cards and applying elements of the Chronic Care Model, these results can help administrators and policy makers ensure that frequent attenders are cared for adequately and that safety net providers' resources are appropriate to the tasks demanded of them.
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Review
Opioid analgesics in primary care: challenges and new advances in the management of noncancer pain.
Primary care attitudes affecting the use of strong opioids in pain management have changed considerably in the last 3 decades. Forces that have shaped current attitudes and trends in opioid prescribing include historical influences, regulatory factors, and technologic and scientific advances. The article identifies for primary care physicians the current challenges and issues surrounding the use of opioid analgesics for noncancer pain and examines how new technology and expanding knowledge have been applied to existing opioids such as morphine, oxymorphone, and fentanyl to address continuing challenges in pain management.
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Comparative Study
Religious attendance: more cost-effective than lipitor?
A recent meta-analysis demonstrates a robust but small association between weekly religious attendance and longer life. However, the practical significance of this finding remains controversial. ⋯ The real-world, practical significance of regular religious attendance is comparable to commonly recommended therapies, and rough estimates even suggest that religious attendance may be more cost-effective than statins. Religious attendance is not a mode of medical therapy, but these findings warrant more and better quality research designed to examine the associations between religion and health, and the potential relevance such associations might have for medical practice.