Abstract：
:Persons whose experienced or expressed gender differs from their sex assigned at birth may identify as transgender. Transgender and gender-diverse persons may have gender dysphoria (i.e., distress related to this incongruence) and often face substantial health care disparities and barriers to care. Gender identity is distinct from sexual orientation, sex development, and external gender expression. Each construct is culturally variable and exists along continuums rather than as dichotomous entities. Training staff in culturally sensitive terminology and transgender topics (e.g., use of chosen name and pronouns), creating welcoming and affirming clinical environments, and assessing personal biases may facilitate improved patient interactions. Depending on their comfort level and the availability of local subspecialty support, primary care clinicians may evaluate gender dysphoria and manage applicable hormone therapy, or monitor well-being and provide primary care and referrals. The history and physical examination should be sensitive and tailored to the reason for each visit. Clinicians should identify and treat mental health conditions but avoid the assumption that such conditions are related to gender identity. Preventive services should be based on the patient's current anatomy, medication use, and behaviors. Gender-affirming hormone therapy, which involves the use of an estrogen and antiandrogen, or of testosterone, is generally safe but partially irreversible. Specialized referral-based surgical services may improve outcomes in select patients. Adolescents experiencing puberty should be evaluated for reversible puberty suppression, which may make future affirmation easier and safer. Aspects of affirming care should not be delayed until gender stability is ensured. Multidisciplinary care may be optimal but is not universally available.
journal_name
Am Fam Physicianjournal_title
American family physicianauthors
Klein DA,Paradise SL,Goodwin ETsubject
Has Abstractpub_date
2018-12-01 00:00:00pages
645-653issue
11eissn
0002-838Xissn
1532-0650pii
d13977journal_volume
98pub_type
杂志文章,评审abstract：:Hypertension is the most common chronic condition treated by family physicians. Elevated blood pressure is associated with an increased risk of heart failure, myocardial infarction, cerebrovascular disease, and death. Treatment of hypertension reduces the risk of these events. Several lifestyle modifications are assoc...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：2015-02-01 00:00:00
abstract：:The U.S. Preventive Services Task Force (USPSTF) has issued recommendations on behavioral counseling to prevent sexually transmitted infections (STIs) and recommendations about screening for individual STIs. Clinicians should obtain a sexual history to assess for behaviors that increase a patient's risk. Community and...
journal_title：American family physician
pub_type： 杂志文章
doi：
更新日期：2016-12-01 00:00:00
abstract：:Particularly in rural settings, Trichophyton verrucosum commonly causes an inflammatory tinea infection, sometimes called 'barn itch." There is usually a history of contact with animals. The demonstration of clusters of large spores in a potassium hydroxide preparation of scrappings obtained from clinically involved s...
journal_title：American family physician
pub_type： 杂志文章
doi：
更新日期：1983-01-01 00:00:00
abstract：:Nitrates are frequently found in vegetables and ground water. Nitrate levels in ground water have increased over the past two decades because of the heightened use of nitrogenous fertilizers. Following ingestion, nitrates are converted to nitrites by fecal organisms. Nitrites are absorbed and form methemoglobin, which...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：1992-07-01 00:00:00
abstract：:Prompt diagnosis and treatment of infectious arthritis can help prevent significant morbidity and mortality. The acute onset of monoarticular joint pain, erythema, heat, and immobility should raise suspicion of sepsis. Constitutional symptoms such as fever, chills, and rigors are poorly sensitive for septic arthritis....
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：2011-09-15 00:00:00
abstract：:Although the role of digoxin therapy has been the subject of debate, the drug is generally accepted as effective in the treatment of heart failure due to systolic dysfunction and as therapy for atrial fibrillation and supraventricular tachyarrhythmias. Serum digoxin concentrations are commonly used to gauge patient re...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：1997-08-01 00:00:00
abstract：:Anemia in children is commonly encountered by the family physician. Multiple causes exist, but with a thorough history, a physical examination and limited laboratory evaluation a specific diagnosis can usually be established. The use of the mean corpuscular volume to classify the anemia as microcytic, normocytic or ma...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：2001-10-15 00:00:00
abstract：:Family physicians can effectively help their patients stop smoking by using brief intervention and simple office organizational procedures. Intervention involves asking all patients about smoking, advising smokers to stop, assisting with self-help materials, establishing a date for quitting, possibly prescribing nicot...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：1990-10-01 00:00:00
abstract：:Tick-borne diseases in the United States include Rocky Mountain spotted fever, Lyme disease, ehrlichiosis, tularemia, babesiosis, Colorado tick fever, and relapsing fever. It is important for family physicians to consider these illnesses when patients present with influenza-like symptoms. A petechial rash initially af...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：2005-06-15 00:00:00
abstract：:Acute pancreatitis is a clinical syndrome characterized by midepigastric pain, nausea and vomiting. Numerous etiologies have been linked with this entity, principally alcoholism and biliary disease. Once the clinical suspicion of pancreatitis is confirmed, supportive therapy with intravenous hydration and close observ...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：1995-08-01 00:00:00
abstract：:Pretibial myxedema is a localized dermopathy seen in patients with past or present hyperthyroidism. Massive intradermal deposition of mucin (acid mucopolysaccharide) produces the classic indurated nodules or plaques on the anterior lower legs. Most patients have elevated levels of LATS in their serum; however, this ap...
journal_title：American family physician
pub_type： 杂志文章
doi：
更新日期：1985-05-01 00:00:00
abstract：:Acute abdominal pain in children presents a diagnostic dilemma. Although many cases of acute abdominal pain are benign, some require rapid diagnosis and treatment to minimize morbidity. Numerous disorders can cause abdominal pain. The most common medical cause is gastroenteritis, and the most common surgical cause is ...
journal_title：American family physician
pub_type： 杂志文章
doi：
更新日期：2003-06-01 00:00:00
abstract：:Subungual hemorrhage, onychauxis, onychogryphosis, mycotic infections, onychia and paronychia are common toenail disorders in the elderly. The many contributing factors include impaired vision, changes in gait, past foot conditions and neurovascular disease. Hyperkeratotic disorders are secondary to external or intern...
journal_title：American family physician
pub_type： 杂志文章
doi：
更新日期：1989-02-01 00:00:00
abstract：:Acute bronchitis is one of the top 10 conditions for which patients seek medical care. Physicians show considerable variability in describing the signs and symptoms necessary to its diagnosis. Because acute bronchitis most often has a viral cause, symptomatic treatment with protussives, antitussives, or bronchodilator...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：2002-05-15 00:00:00
abstract：:Family physicians can treat most finger fractures and dislocations, but when necessary, prompt referral to an orthopedic or hand surgeon is important to maximize future function. Examination includes radiography (oblique, anteroposterior, and true lateral views) and physical examination to detect fractures. Dislocatio...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：2006-03-01 00:00:00
abstract：:Delirium is characterized by a sudden deterioration in cognitive function and an inability to sustain attention. It is a medical emergency that occurs in more than 20 percent of hospitalized elderly patients. Misdiagnosis is common and contributes to high morbidity and mortality. Patients may present in hypoactive, hy...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：1994-11-01 00:00:00
abstract：:Patients with myopia, hyperopia and astigmatism can now reduce or eliminate their dependence on contact lenses and eyeglasses through refractive surgery that includes radial keratotomy (RK), photorefractive keratectomy (PRK), laser-assisted in situ keratomileusis (LASIK), laser thermal keratoplasty (LTK) and intrastro...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：2001-10-01 00:00:00
abstract：:Although VDRL and RPR tests are excellent screens for syphilis, false-positive reactions do occur. A positive VDRL or RPR test must be confirmed with an FTA-ABS test. Patients with positive serologic tests should have a thorough physical examination to determine the stage of syphilis. A patient with a low-titer VDRL o...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：1988-01-01 00:00:00
abstract：:Although laparoscopy has been available since the turn of the century, the technique did not become widely accepted for gastrointestinal surgery until it was used in cholecystectomy. Since then, various gastrointestinal operations have been performed using laparoscopic guidance. Laparoscopic operations must conform to...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：1996-01-01 00:00:00
abstract：:In patients with type 2 diabetes mellitus, insulin may be used to augment therapy with oral glycemic medications or as insulin replacement therapy. The American Diabetes Association suggests the use of long-acting (basal) insulin to augment therapy with one or two oral agents or one oral agent plus a glucagon-like pep...
journal_title：American family physician
pub_type： 杂志文章
doi：
更新日期：2018-01-01 00:00:00
abstract：:Systemic lupus erythematosus, chronic cutaneous lupus erythematosus and subacute and acute cutaneous lupus erythematosus are associated with distinct cutaneous manifestations, and each disease has a particular clinical course and prognosis. Dermatomyositis, an immune-mediated disorder of unknown etiology that is often...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：1996-04-01 00:00:00
abstract：:Although falls are a common cause of injury in older persons, they are not just a normal part of the aging process. The American Geriatrics Society and British Geriatrics Society recommend that all adults older than 65 years be screened annually for a history of falls or balance impairment. An individualized risk asse...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：2011-12-01 00:00:00
abstract：:The diagnosis of sleep apnea should be considered when a patient complains of snoring and excessive daytime somnolence. Middle-aged obese men are at particular risk, although apnea can occur in women and the elderly, as well as in persons who are not obese. An overnight polysomnographic sleep study can reveal the degr...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：1994-02-01 00:00:00
abstract：:The incidence of work-related repetitive motion disorders has increased rapidly during the past 20 years. While it appears that psychosocial factors have contributed largely to the increasing incidence of these disorders, ergonomic factors and other medical conditions also play a role. The most common single diagnosti...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：1997-03-01 00:00:00
abstract：:Herpes zoster ("shingles") is usually a benign, self-limited disease. However, it can be debilitating or even fatal. The potentially serious complications of ocular involvement or postherpetic neuralgia and the confusing therapeutic regimens that are often advocated make this a complicated subject. Dissemination is mo...
journal_title：American family physician
pub_type： 杂志文章
doi：
更新日期：1983-12-01 00:00:00
abstract：:More than 30% of U.S. adults report having experienced low back pain within the preceding three months. Although most low back pain is nonspecific and self-limiting, a subset of patients develop chronic low back pain, defined as persistent symptoms for longer than three months. Low back pain is categorized as nonspeci...
journal_title：American family physician
pub_type： 杂志文章
doi：
更新日期：2015-05-15 00:00:00
abstract：:Patients with symptomatic lumbar disk disease may present with back pain, referred leg pain, radicular leg pain, sensory changes and leg weakness. Because neurologic deficits are commonly localized to the L5 or S1 nerve roots, evaluation of patients with such symptoms should focus on these dermatomes and muscle groups...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：1993-04-01 00:00:00
abstract：:Despite steady increases in U.S. health care spending, the population's self-perceived health status has been in a long-term decline. Increased support for public health, prevention, and primary care could reduce growth in spending and improve actual and perceived health. ...
journal_title：American family physician
pub_type： 杂志文章
doi：
更新日期：2009-09-01 00:00:00
abstract：:Parkinson's disease is a common neurodegenerative disorder that can cause significant disability and decreased quality of life. The cardinal physical signs of the disease are distal resting tremor, rigidity, bradykinesia, and asymmetric onset. Levodopa is the primary treatment for Parkinson's disease; however, its lon...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：2006-12-15 00:00:00
abstract：:Substantial advances have been made in the management of inflammatory bowel disease. Mesalamine and olsalazine are new anti-inflammatory agents that may serve as alternatives to corticosteroids and sulfasalazine, which have been the mainstays of medical therapy. These new agents are available in oral, enema and suppos...
journal_title：American family physician
pub_type： 杂志文章,评审
doi：
更新日期：1993-03-01 00:00:00
