The trajectory of chronic pain: can a community-based exercise/education program soften the ride?
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The entire primary care record of six patients attending a community-based education/exercise self-management program for chronic noncancer pain (YMCA Pain Exercise/Education Program [Y-PEP]) was reviewed. Medical visits, consultations and hospital admissions were coded as related or unrelated to their pain diagnoses. Mood disruption, financial concerns, conflicts with employers/insurers, analgesic doses, medication side effects and major life events were also recorded. The 'chronic pain trajectory' resembled a roller coaster with increased health care visits at the time of initial injuries and during 'crises' (reinjury, conflict with insurers/employers, failed back-to-work attempts and life events). Visits decreased when conflicts were resolved. Analgesic doses increased during 'crises' but did not fall after resolution. After attending Y-PEP, health care use fell for four of six patients and two returned to work. Primary care physicians need to recognize the functional limitations and psychosocial complications experienced by their chronic pain patients. A program such as Y-PEP may promote active self-management strategies resulting in lowered health care use. (+info)
Family medicine in Arab countries.
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BACKGROUND AND OBJECTIVES: Information on the practice of family medicine in Arab countries is scant. In this study we aim to describe the current state of the specialty in the region. This includes scope of practice, practice setting, training programs, and the numbers and profiles of their graduates. METHODS: A survey of leaders in family medicine in Arab countries was conducted between October 2008 and June 2009. The survey was administered in person or via e-mail. Snowball sampling was used to obtain at least two respondents from each country. RESULTS: There are 31 family medicine residency programs in Arab countries graduating about 182 residents per year. In most Arab countries, the family physician to population ratio remains low. Most graduates work in clinical practice, and a large proportion of them are employed in government-run clinics. There is significant variability in the scope of practice among practicing physicians. CONCLUSIONS: Family medicine continues to struggle for a clear identity worldwide. In the Arab world, where the specialty is relatively new, steps can be taken to better define our identity as a specialty and increase its desirability as a specialty. (+info)
How can departments of community medicine shape the future of public health education in India?
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Cost-effectiveness of community-based strategies for blood pressure control in a low-income developing country: findings from a cluster-randomized, factorial-controlled trial.
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Diuretic use, increased serum urate levels, and risk of incident gout in a population-based study of adults with hypertension: the Atherosclerosis Risk in Communities cohort study.
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