Diabetic Retinopathy.

The prevalence of diabetes is on the rise globally as are the consequences, such as diabetic retinopathy. Diabetic retinopathy is a leading cause of vision loss in working-age adults in developed countries. Visual impairment as a result of diabetic retinopathy has a significant negative impact on the patient's quality of life and their ability to successfully manage their disease. Glycemic control, blood pressure normalization, and lipid management form the basis for long-term diabetes management and protection from worsening eye disease.

Vaginitis.

Bacterial vaginosis, trichomoniasis, and vulvovaginal candidiasis are the most common infectious causes of vaginitis. Bacterial vaginosis occurs when the normal lactobacilli of the vagina are replaced by mostly anaerobic bacteria. Diagnosis is commonly made using the Amsel criteria, which include vaginal pH greater than 4.5, positive whiff test, milky discharge, and the presence of clue cells on microscopic examination of vaginal fluid. Oral and topical clindamycin and metronidazole are equally effective at eradicating bacterial vaginosis. Symptoms and signs of trichomoniasis are not specific; diagnosis by microscopy is more reliable. Features of trichomoniasis are trichomonads seen microscopically in saline, more leukocytes than epithelial cells, positive whiff test, and vaginal pH greater than 5.4. Any nitroimidazole drug (e.g., metronidazole) given orally as a single dose or over a longer period resolves 90 percent of trichomoniasis cases. Sex partners should be treated simultaneously. Most patients with vulvovaginal candidiasis are diagnosed by the presence of vulvar inflammation plus vaginal discharge or with microscopic examination of vaginal secretions in 10 percent potassium hydroxide solution. Vaginal pH is usually normal (4.0 to 4.5). Vulvovaginal candidiasis should be treated with one of many topical or oral antifungals, which appear to be equally effective. Rapid point-of-care tests are available to aid in accurate diagnosis of infectious vaginitis. Atrophic vaginitis, a form of vaginitis caused by estrogen deficiency, produces symptoms of vaginal dryness, itching, irritation, discharge, and dyspareunia. Both systemic and topical estrogen treatments are effective. Allergic and irritant contact forms of vaginitis can also occur.

Evaluation and treatment of bone disease after fragility fracture.

Bone mineral density and other measuring tests are part of the risk assessment of primary and secondary osteoporosis necessary in treating patients after fragility fracture. A better understanding of factors contributing to insufficiency fracture in osteoporotic bone is essential to guide the clinician's intervention in this disease affecting 25 million women in the United States and responsible for an estimated 700,000 vertebral and 300,000 hip fractures every year. Prevention of future fractures by slowing or stopping bone loss, maintaining bone strength, and minimizing or eliminating factors contributing to fractures, through pharmacotherapy, education, and lifestyle changes, can help slow annual health care expenditures for osteoporotic fractures, which now exceed 17 billion dollars, more than for breast and gynecological cancers combined.

Recruiting faculty to perform deliveries in family medicine residencies: results of a residency program survey.

BACKGROUND AND OBJECTIVES: One factor cited for the decline of family physicians delivering babies is a lack of faculty role models during residency training. This study's purpose was to determine how many residency programs experience difficulty recruiting faculty who perform deliveries and whether financial or not financial compensation are associated with recruiting difficulties. METHODS: Using an electronic questionnaire, we surveyed program directors of nonmilitary family medicine residencies in the United States, with a response rate of 60.7%. RESULTS: Among residency programs who tried to recruit faculty with delivery skills, 58% stated that they have difficulties. Two program characteristics were associated with recruitment difficulties: the number of delivery providers among faculty and whether the residency program directors included delivery in their own practices. There were no statistically significant associations between recruiting difficulties and any type of financial reimbursement methods, but nonfinancial incentives were offered more often by programs that had no difficulty recruiting. CONCLUSIONS: More than half of all family medicine residency programs have difficulty recruiting faculty members to provide delivery training. Changing the type of financial compensation for faculty providing maternity care is not likely to assist in recruiting. However, we did find that programs without recruiting difficulties were more likely to offer nonfinancial incentives to faculty members who perform deliveries.

Prevalence of breastfeeding and acculturation in Hispanics: results from NHANES 1999-2000 study.

BACKGROUND: A more current estimate to evaluate ethnic and acculturation differences in breastfeeding is warranted, given the rapid growth of the Hispanic population in the United States and the proliferation of breastfeeding promotion programs. The study objective was to describe current national estimates of the prevalence of breastfeeding and evaluate differences in reasons not to breastfeed by acculturation status. METHODS: Secondary data analysis of the National Health and Nutrition Examination Survey (NHANES) 1999-2000 was performed on a nationally representative sample of non-Hispanic white women born in the U.S. and Hispanic women with at least one live birth. Acculturation status among Hispanics was assessed using a validated language scale, and prevalence of breastfeeding was based on maternal self-report. RESULTS: Prevalence of breastfeeding was higher in less acculturated Hispanic women (59.2%) than high acculturated Hispanic women (33.1%) and white women (45.1%). Less acculturated Hispanic women were more likely to cite their child's physical/medical condition as a reason not to breastfeed (53.1%), whereas whites and more acculturated Hispanics were more likely to cite their child preferred the bottle (57.5% and 49.8%, respectively). A logistic regression analysis revealed no significant differences in likelihood to breastfeed between non-Hispanic whites and Hispanics after controlling for education, age, and income. Higher acculturated women were less likely to breastfeed their children than low acculturated women (95% CI: 0.14-0.40) even after education, age, and income were taken into account. CONCLUSIONS: Acculturation differences in prevalence of breastfeeding and reasons not to breastfeed may be the result of attitudinal changes that occur due to acculturation. Further research into the acculturation process and its impact on breastfeeding may help to prevent the decline in breastfeeding that occurs as mothers become more acculturated. Meanwhile, patient education that addresses women's perceptions of the child's health condition and benefits of breastfeeding would be helpful.

Management of hypertension in older persons.

Antihypertensive therapy has been shown to reduce morbidity and mortality in older patients with elevated systolic or diastolic blood pressures. This benefit appears to persist in patients older than 80 years, but less than one third of older patients have adequate blood pressure control. Systolic blood pressure is the most important predictor of cardiovascular disease. Blood pressure measurement in older persons should include an evaluation for orthostatic hypotension. Low-dose thiazide diuretics remain first-line therapy for older patients. Beta blockers, angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, and calcium channel blockers are second-line medications that should be selected based on comorbidities and risk factors.