Primary care
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The major differences that have been recognized between black and white hypertensives are primarily epidemiologic, with hypertension being more prevalent, having an earlier onset, and having more severe sequelae in the black population. The cause of the problem in both black and white people remains obscure, but it appears that a difference in sodium handling may contribute to the particular hemodynamic and hormonal profile of black hypertensives. ⋯ Complications such as stroke and left ventricular hypertrophy remain the major sequelae of this disease in blacks. Finally, a current study confirmed the improved efficacy of antihypertensive therapy in blacks to diuretics and calcium channel blockers and a somewhat lower efficacy profile to angiotensin converting enzyme inhibitors and beta blockers, although the latter classes of agents have shown better response in blacks than previously thought.
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Chronic benign pain is commonly associated with chronic fatigue and depression. Depression and chronic fatigue syndrome are also associated with each other and often include pain. ⋯ Management requires separately addressing each component of patients' distress and usually includes physical rehabilitation, education, administration of nonhabituating medications and often counseling. Depression may be a favorable prognostic sign, as it suggests a treatable condition and provides incentive for recovery.
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Mental status testing is an essential element of evaluating elderly patients. A structured examination often helps identify the etiology of symptoms that are responsible for changes in patient behavior, that lead to family stress, but that are otherwise not indicative of cognitive dysfunction. ⋯ This article examines the steps in mental status assessment and the commonly used assessment instruments. The experience of a family medicine ambulatory multidisciplinary evaluation service in mental status testing is discussed.
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Acute confusion in the elderly is a problem that has high prevalence with significant morbidity and mortality, and that may lead to institutional placement. It is imperative that delirium be recognized promptly and its underlying cause(s) identified and treated. Management requires a multifaceted approach that addresses the precipitating cause(s), maintenance and support of vital functions, management of behaviors with use of nursing staff and family, attention to the environment, and sometimes the use of appropriate psychotropic medication. Prompt treatment is likely to result in a return to normalcy.
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Allergy to foreign proteins in house dust is extremely common. Despite the fact that immunotherapy with house dust extract has been utilized for over sixty years, environmental control is still infrequently employed as a therapeutic measure. In this article the major allergen content of house dust is defined and strategies for decreasing the levels of these allergens in homes are described.