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International Primary Care Association

Clinical Focus Primary Care


Listening and Learning seems to be the order of the day. Before this issue hits your floor mat the government’s, “Listening Exercise”, on the NHS reforms will have been completed and the policy enunciated by Andrew Lansley, and at inception agreed and signed off with Lib/Dem approval, will be dead or marginally watered down for appeasement. If the former I suspect Mr Lansley will have to be politically sacrificed.


Attention deficit hyperactivity disorder (ADHD) comprises a triad of:
• Hyperactivity
• Impulsivity
• Inattention

These behaviours are inconsistent with the child’s developmental/chronological age, and are present in multiple settings, over a period of time (>6 months), causing functional impairment. Multidisciplinary management, including behavioural and pharmacological interventions, improves outcome.



Anorexia nervosa (AN) can be a challenging illness for a primary care team to detect and manage in the community. Early diagnosis and effective treatment of patients with AN has been shown to improve prognosis. General practitioners can play a vital role in diagnosis and providing medical support for AN patients.


This article summarizes idiopathic headaches in childhood, differentiating the clinical characteristics from those of intracranial hypertension. There is a discussion on migraine treatment, the importance of environmental influences and the less well recognized risk posed by analgesic overuse leading to chronic refractory headaches.


Sexually acquired oncogenic Human Papillomavirus (HPV) types are important co-factors in the development of anogenital tract malignancies. HPV vaccines are a major primary prevention strategy against cervical cancer, other HPV-associated malignancies, cervical dysplasia and genital warts. Improving vaccination uptake is key to the future success of the HPV vaccination programme, and could potentially be achieved by involving GPs, sexual health services and providers in its delivery.


Type 2 diabetes is increasingly prevalent, and is associated with increased morbidity and mortality. Studies have shown the benefit of tight glycaemic control in reducing complications, but with many conventional treatments this can result in weight gain and hypoglycaemia. Newer treatments may lessen these problems, but evidence of their long term efficacy is lacking.


The planned NHS reforms have kept our medical leaders and politicians very busy over the last few months. The focus has been on the process of commissioning and who should have control of the financial levers, the problem of the private sector cherry picking the lucrative elements and conflict of interest of GPs. The previous structure of PCTs was mired in stagnation, planning blight with an emphasis on managing the finances and not the delivery of care. Any reform that allows us to put clinicians at the front end of the decision making process will be better than what we have had in the past, even if there are warts on the new framework. The public still trust doctors more than most other professional groups, including politicians!


Temporal arteritis (TA) also known as giant cell arteritis (GCA) is the most commonly occurring chronic vasculitis, typically affecting individuals older than 50 years. GCA typically manifests as new onset headache with features of systemic illness although presentation is highly variable. Because many conditions can mimic GCA, accurate diagnosis is essential to avoid over-treatment.


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International Primary Care Association
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