Public Health Exam 3

Hepatitis B vaccine

- Administered as a three-dose series is recommended for all children aged 0-18 years and high-risk individuals (i.e. health care workers, IV drug users, people with end-stage renal disease). - Adults with diabetes are also at increased risk for hepatitis B infection, and in October 2011, the ACIP recommended vaccination for hepatitis B in diabetic patients aged 19-59 years. In diabetic persons aged 60 and older, hepatitis B vaccination should be considered

Counseling about healthy diet and physical activity

- Although the correlation among healthful diet, physical activity, and the incidence of cardiovascular disease is strong, existing evidence indicates that the health benefit of initiating behavioral counseling in the primary care setting to promote a healthful diet and physical activity is small - Clinicians may choose to selectively counsel patients rather than incorporate counseling into the care of all adults in the general population.

Elder abuse

- Physical and psychological abuse, exploitation, and neglect of older adults are serious under-recognized problems.

Screening for diabetes

- Recommends screening for type 2 diabetes mellitus in asymptomatic adults with sustained blood pressure (either treated or untreated) > 135/80 mm Hg. - Current evidence is insufficient to assess the balance of benefits and harms of screening for type 2 diabetes mellitus in asymptomatic adults with blood pressure of 135/80 mm Hg or lower.

alcohol misuse risky drinking

- The spectrum of _____________ includes _____________ (alcohol consumption above the recommended daily, weekly, or per occasion amounts), harmful use (a pattern causing damage to health) - Alcohol abuse (a pattern leading to clinically significant impairment or distress) - Alcohol dependence includes three or more of the following: - tolerance - Withdrawal - increased consumption - desire to cut down use - giving up social activities - increased time using alcohol or recovering from use - continued use despite known adverse effects Estimating the prevalence of alcohol misuse is challenging; however, it has been suggested that 30% of the US population is affected.

Designer drugs

- Use of illegal drugs—including cocaine, methamphetamine, and so-called ___________________—either sporadically or episodically remains an important problem. - Lifetime prevalence of drug abuse is approximately 8% and is generally greater among men, young and unmarried individuals, Native Americans, and those of lower socioeconomic status. - As with alcohol, drug abuse disorders often coexist with personality, anxiety, and other substance abuse disorders. - Abuse of anabolic-androgenic steroids has been associated with use of other illicit drugs, alcohol, and cigarettes and with violence and criminal behavior.

1. Tuberculosis 2. Skin testing for tuberculosis

1. The rate of ______________ in the United States has been declining since 1992 2. ____________________ and treating selected patients reduce the risk of reactivation tuberculosis.

1. Group education 2. One-on-one education 3. Patient reminders 4. Reduction of structural barriers 5. Reduction of out-of-pocket costs 6. Provider assessment and feedback are effective in promoting recommended cancer screening

Despite an increase in rates of screening for breast, cervical, and colon cancer over the last decade, overall screening for these cancers is suboptimal. Interventions including:

Influenza vaccination

Evidence suggests annual _________________ is safe and effective with potential benefit in all age groups

Prevention of infectious diseases

Much of the decline in the incidence and fatality rates of infectious diseases is attributable to public health measures— especially immunization, improved sanitation, and better nutrition.

Hepatitis E

No FDA-approved vaccine for _____________ is currently available in the United States. A recombinant protein hepatitis E vaccine has been developed that has proven safe and efficacious in preventing hepatitis E among high-risk populations in China.

- Type 2 diabetes mellitus - Hypertension - Hyperlipidemia - Cancer - Osteoarthritis - Cardiovascular disease - Obstructive sleep apnea - Asthma

Obesity is clearly associated with:

Human papillomavirus (HPV) virus-like particle (VLP)

____________________ vaccines have demonstrated effectiveness in preventing persistent HPV infections, and thus may impact the rate of cervical intraepithelial neoplasia (CIN) II-III. - The American Academy of Pediatrics (AAP) recommends routine HPV vaccination for girls aged 11-12 years. - The AAP also recommends that all unvaccinated girls and women aged 13-26 years receive the HPV vaccine. - In October 2011, the ACIP approved recommendations for routine vaccination of males 11 or 12 years of age with three doses of HPV4 (quadrivalent vaccine). - Vaccination of males with HPV may lead to indirect protection of women by reducing transmission of HPV and may prevent anal intraepithelial neoplasia and squamous cell carcinoma in men who have sex with men. Despite the effectiveness of the vaccine, rates of immunization are low. Interventions addressing personal beliefs and system barriers to vaccinations may help address the slow adoption of this vaccine.

higher BMIs

Significant trends of increasing risk of death with __________________ are observed for: cancers of the stomach and prostate in men and for cancers of the breast, uterus, cervix, and ovary in women, and for cancers of the esophagus, colon and rectum, liver, gallbladder, pancreas, and kidney, non-Hodgkin lymphoma, and multiple myeloma in both men and women. The most recent national data reveal that one-third of adults in the United States are obese, and prevalence rates are higher in blacks and Hispanics compared to non-Hispanic whites. Prevention of overweight and obesity involves both increasing physical activity and dietary modification to reduce caloric intake.

- Minimizing /eliminating unsafe sexual behavior - Promoting abstinence - Later onset of first sexual activity - Decreased number of partners - Use of latex condoms

Since sexual contact is a common mode of transmission, primary prevention relies on:

Alcohol and illicit drug use

______________________ are associated with an increased risk of violent death. - Males aged 16-35 are at especially high risk for serious injury and death from accidents and violence, with blacks and Latinos at greatest risk. - For 16- and 17-year-old drivers, the risk of fatal crashes increases with the number of passengers. - Deaths from firearms have reached epidemic levels in the United States and will soon surpass the number of deaths from motor vehicle accidents. - Having a gun in the home increases the likelihood of homicide nearly threefold and of suicide fivefold. Educating clinicians to recognize and treat depression as well as restricting access to lethal methods have been found to reduce suicide rates.

Nicotine replacement

_________________________ therapy doubles the chance of successful quitting. The nicotine patch, gum, and lozenges are available over-the-counter and nicotine nasal spray and inhalers by prescription.

Screening for Osteoporosis

______________________________, on the basis of low bone mineral density, is also recommended for women over age 60 and that treatment of women with low bone density with bisphosphonates is effective in reducing fractures. - However, real-world adherence to pharmacologic therapy for osteoporosis is low: one-third to one-half of patients do not take their medication as directed. - The effectiveness of screening for osteoporosis in younger women and in men has not been established.

Methicillin-resistant Staphylococcus aureus (MRSA)

_________________________________, previously recognized as a nosocomial pathogen, has emerged as a common cause of staphylococcal infection in the outpatient setting: - It accounts for more than 50% of outpatient staphylococcal infections. - Strategies to prevent MRSA infection include screening asymptomatic carriers, however, universal screening of large populations is not cost-effective. - Screening high-risk populations needs additional study.

Primary prevention

aims to remove or reduce disease risk factors (e.g. immunization, giving up or not starting smoking)

- Hepatitis A - Hepatitis B - Influenza - Pneumococcal infections

Substantial vaccine-preventable morbidity and mortality continue to occur among adults from vaccine-preventable diseases, such as:

Sexually transmitted disease

The Centers for Disease Control and Prevention (CDC) updated guidelines for the prevention and treatment of ________________________.

Advisory Committee on Immunization Practices (ACIP)

The ____________________ recommends routine zoster vaccination, administered as a one-time subcutaneous dose (0.65 mL), of all persons aged 60 years or older. There are 2 vaccines, Shingrix® and Zostavax® II, that protect against shingles. Zostavax® II contains a weakened form of the virus while Shingrix® contains only a part of the virus. Persons who report a previous episode of zoster can be vaccinated; however, the vaccine is contraindicated in immunocompromised (primary or acquired) individuals.

Advisory Committee on Immunization Practices (ACIP)

The ________________________ recommends routine influenza vaccination for all persons aged 6 months and older, including all adults. When vaccine supply is limited, certain groups should be given priority, such as adults 50 years and older, individuals with chronic illness or immunosuppression, and pregnant women.

Sustained-release antidepressant drug bupropion (150-300 mg/d orally)

The _______________________________ is an effective smoking cessation agent and is associated with minimal weight gain, although seizures are a contraindication

CDC recommends universal HIV

The ________________________________ screening of all patients age 13-64, and the US Preventive Services Task Force (USPSTF) recommends that clinicians screen adolescents and adults age 15 to 65 years. In addition to reducing sexual transmission of HIV, initiation of antiretroviral therapy reduces the risk for AIDS-defining events and death among patients with less immunologically advanced disease. - In immunocompromised patients, live vaccines are contraindicated but many killed or component vaccines are safe and recommended. - Asymptomatic HIV-infected patients have not shown adverse consequences when given - live MMR and influenza vaccinations as well as tetanus, hepatitis B, H influenza type b and pneumococcal vaccinations—all should be given. - If poliomyelitis immunization is required, the inactivated poliomyelitis vaccine is indicated. - In symptomatic HIV-infected patients, live virus vaccines such as MMR should generally be avoided, but annual influenza vaccination is safe.

- Diligent hand hygiene - Rigorous infection control policies - Appropriate use of antibiotics

The key to preventing MRSA infections are:

Osteoporotic fractures

The lifetime risk of an ____________________ is approximately 50% for women and 30% for men. _____________________ can cause significant pain and disability. As such, research has focused on means of preventing osteoporosis and related fractures. Primary prevention strategies include : - calcium supplementation - vitamin D supplementation - exercise programs Calcium supplementation can decrease fracture risk but may also increase risk of cardiovascular events. Vitamin D supplements alone do not appear to reduce fracture risk, although higher dosages (800 international units/d orally) may be effective.

1. Disulfiram 2. Naltrexone 3. Acamprosate

Three drugs are FDA approved for treatment of alcohol dependence:

- Enzyme-linked immunospot [ELISpot]/[T-SPOT.TB] - Quantitative ELISA [QuantiFERON-TBGold] test) These T-cell-based assays have an excellent specificity that is higher than tuberculin skin testing in BCG-vaccinated populations.

Two blood tests, which are not confounded by prior BCG (bacillus Calmette-Guerin) vaccination, have been developed to detect tuberculosis infection by measuring in vitro T-cell interferon-gamma release in response to which two antigens?

1. Pre-exposure prophylaxis 2. Post-exposure prophylaxis

Unfortunately, as many as one-third of HIV-positive persons continue unprotected sexual practices after learning that they are HIV-infected. 1. __________________ with antiretroviral drugs in men who have sex with men could have a major impact on preventing HIV infection, and studies evaluating the impact in other groups are underway. 2. _______________________ is widely used after occupational and non-occupational contact, and it has been estimated to reduce the risk of transmission by approximately 80%.

- Hypertension - Obesity/Overweight - Physical Inactivity - Elevated Blood Glucose - High dietary salt (sodium) - Low dietary omega-3 fatty acids (seafood) - High dietary trans fatty acids - Alcohol use - Low intake of fruits and vegetables - Low dietary polyunsaturated fatty acids (in replacement of saturated fatty acids)

What are common preventable factors:

1. Diseases of the heart 2. Malignant neoplasms 3. Chronic lower respiratory diseases 4. Cerebrovascular diseases 5. Accidents (unintentional injuries) 6. Alzheimer disease 7. Diabetes mellitus 8. Influenza and pneumonia 9. Nephritis, nephrotic syndrome, and nephrosis 10. Intentional self-harm (suicide)

What are the leading causes of death in the USA?

Obesity

________________ is now a true epidemic and public health crisis that both clinicians and patients must face. - Normal body weight is defined as a body mass index (BMI), calculated as the weight in kilograms divided by the height in meters squared, of < 25 kg/m2 - Overweight is defined as a BMI = 25.0-29.9 kg/m2, and obesity as a BMI > 30 kg/m2.

HIV infection

_________________ is a major infectious disease problem in the world

Serum lipid

_________________ screening: - Strongly recommends screening men aged 35 and older for lipid disorders. - Recommends screening men aged 20-35 for lipid disorders if they are at increased risk for coronary heart disease. - Strongly recommends screening women aged 45 and older for lipid disorders if they are at increased risk for coronary heart disease. - Recommends screening women aged 20-45 for lipid disorders if they are at increased risk for coronary heart disease. - No recommendation for or against routine screening for lipid disorders in men aged 20-35, or in women aged 20 and older who are not at increased risk for coronary heart disease.

Immunization

___________________ remains the best means of preventing many infectious diseases

Herpes zoster

___________________, caused by reactivation from previous varicella zoster virus infection, affects many older adults and people with immune system dysfunction. - Whites are at higher risk than other ethnic groups - The incidence in adults aged 65 and older may be higher than previously described. - A varicella vaccine is available for the prevention of herpes zoster

- Modifiable (e.g., lipid disorders, hypertension, cigarette smoking) - Those that are, not modifiable(e.g. age, sex, family history of early coronary disease).

Cardiovascular diseases, including coronary heart disease (CHD) and stroke, represent two of the most important causes of morbidity and mortality in developed countries. Impressive declines in age-specific mortality rates from heart disease and stroke have been achieved in all age groups in North America during the past two decades, in large part through improvement of modifiable risk factors: reductions in cigarette smoking, improvements in lipid levels, and more aggressive detection and treatment of hypertension. Several risk factors increase the risk for coronary disease and stroke. These risk factors can be divided into those that are:

The Advisory Committee on Immunization Practices (ACIP)

A single dose of tetanus, diphtheria and pertussis vaccine (Tdap) for adults aged 19-64 years to replace the next booster dose of tetanus and diphtheria toxoids vaccine (Td) is recommended by what committee?

The Alcohol Use Disorder Identification Test (AUDIT)

- An estimated 15-30% of hospitalized patients have problems with alcohol abuse or dependence, but the connection between patients' presenting complaints and their alcohol use is often missed. - _____________________ consists of questions on the quantity and frequency of alcohol consumption, on alcohol dependence symptoms, and on alcohol-related problems. AUDIT questionnaire is a cost effective and efficient diagnostic tool for routine screening of alcohol use disorders in primary care settings. - Time restraints may prevent clinicians from screening patients and single-question screening tests for unhealthy alcohol use may help increase the frequency of screening in primary care settings. -In acute alcohol detoxification, standard treatment regimens use long-acting benzodiazepines, the preferred medications for alcohol detoxification, because they can be given on a fixed schedule or through "front-loading" or "symptom-triggered" regimens. - Adjuvant sympatholytic medications can be used to treat hyper-adrenergic symptoms that persist despite adequate sedation.

Prevention of injuries and violence

- Injuries remain the most important cause of loss of potential years of life before age 65. - Homicide and motor vehicle accidents are a major cause of injury related deaths among young adults, and accidental falls are the most common cause of injury-related death in the elderly. - Approximately one-third of all injury deaths include a diagnosis of traumatic brain injury. - Other causes of injury-related deaths include suicide and accidental exposure to smoke, fire, and flames

Prevention of Physical Activity

- Lack of sufficient physical activity is the second most important contributor to preventable deaths, trailing only tobacco use. - A sedentary lifestyle has been linked to 28% of deaths from leading chronic diseases. - Worldwide, approximately 30% of adults are physically inactive. - Inactivity rates are higher in women, those from high-income countries (such as the Americas), and increase with age. - Among teens age 13-15, 80% report doing fewer than 60 minutes of moderate to vigorous intensity per day and boys are more active than girls. The US Department of Health and Human Services and the CDC recommends: - That adults and older adults engage in 150 minutes of moderate-intensity (such as brisk walking) or 75 minutes of vigorous-intensity aerobic activity (such as jogging or running) or an equivalent mix of moderate- and vigorous-intensity aerobic activity each week

1. Seat belts 2. Safety helmets 3. The risks of using cellular telephones while driving 4. Drinking and driving—or using other intoxicants or long-acting benzodiazepines and then driving 5. The risks of having guns in the home/need to safely storing guns

- Motor vehicle accident deaths per miles driven continue to decline in the United States. - Each year in the United States, more than 500,000 people are non-fatally injured while riding bicycles. - The rate of helmet use by bicyclists and motorcyclists is significantly increased in states with helmet laws. Young men appear most likely to resist wearing helmets. - Clinicians should try to educate their patients about: Long-term alcohol abuse adversely affects outcome from trauma and increases the risk of readmission for new trauma.

1. HPV vaccine 2. USPSTF 3. Colonoscopy 4. CT colonography (virtual colonoscopy)

1. The use of ________________ to prevent cervical and possibly anal cancer. HPV vaccines may have a role in the prevention of HPV related head and neck cancers. - Annual or biennial fecal occult blood testing reduces mortality from colorectal cancer by 16-33%. 2. The ________________ recommends screening for cervical cancer in women with a Papanicolaou smear: - aged 21-65 years (cytology) every 3 years or, for women - aged 30-65 years who desire longer intervals, - screening with cytology and HPV testing every 5 years. - The risk of death from colon cancer among patients undergoing at least one sigmoidoscopic examination is reduced by 60-80% compared with that among those not having sigmoidoscopy. 3. _________________ has also been advocated as a screening examination. - It is more accurate than flexible sigmoidoscopy for detecting cancer and polyps, but its value in reducing colon cancer mortality has not been studied directly 4. ______________________ is a noninvasive option in screening for colorectal cancer. - It has been shown to have a high safety profile and performance similar to colonoscopy.

1. Substance abuse 2. three or fewer drinks 3. four or fewer drinks

1. _____________________ is a major public health problem in the United States. - In the United States, approximately 51% of adults 18 years and older are current regular drinkers (at least 12 drinks in the past year) Maximum recommended consumption: 2. For adult women and those older than 65 years is ____________ per day (seven per week) 3. For adult men, ______________ per day (14 per week).

Hepatitis A vaccine and immune globulin

Both __________________ and _________________ provide protection against hepatitis A The hepatitis A vaccine is given in two doses at least six months apart. One dose gives very good protection against hepatitis A and two doses gives 100 percent protection.

1. Regular physical exercise 2. Skin cancer 3. Hepatitis B vaccination can prevent hepatocellular carcinoma (HCC)

Cancer mortality rates continue to decrease in U.S. part of this decrease results from reductions in tobacco use 1. Persons who engage in _________________ and avoid obesity have lower rates of breast and colon cancer. - In the past two decades, there has been a threefold increase in the incidence of squamous cell carcinoma and a fourfold increase in melanoma in the United States. 2. Primary prevention of ________________ consists of restricting exposure to ultraviolet light by wearing appropriate clothing and use of sunscreens. - Prevention of occupationally induced cancers involves minimizing exposure to carcinogenic substances such as asbestos, ionizing radiation, and benzene compounds. - Chemoprevention has been widely studied for primary cancer prevention (use of tamoxifen, raloxifene, and aromatase inhibitors for breast cancer Prevention) 3. ______________________________(HCC), and screening and vaccination programs may be cost-effective and useful in preventing HCC in high-risk groups such as Asians and Pacific Islanders.

Intimate partner violence

Clinicians have a critical role in detection, prevention, and management of _________________________. Inclusion of a single question in the medical history— - "At any time, has a partner ever hit you, kicked you, or otherwise physically hurt you?"—can increase identification of this common problem. Another screen consists of three questions: - "Have you ever been hit, kicked, punched, or otherwise hurt by someone within the past year? If so, by whom?" - "Do you feel safe in your current relationship?" - "Is there a partner from a previous relationship who is making you feel unsafe now?" - Assessment for abuse and offering of referrals to community resources creates potential to interrupt and prevent recurrence of domestic violence and associated trauma. - Screening patients in emergency departments for intimate partner violence appears to have no adverse effects related to screening and may lead to increased patient contact with community resources. - Clinicians should take an active role in following up with patients whenever possible, since intimate partner violence screening with passive referrals to services may not be adequate

- The patient's appearance - Recurrent urgent-care visits - Missed appointments - Suspicious physical findings - Implausible explanations for injuries

Clues to elder mistreatment include:

Aspirin

Current evidence is insufficient to assess the balance of benefits and harms of aspirin for cardiovascular disease prevention in men and women 80 years or older. Recommends against the use of __________ for stroke prevention in women younger than 55 years and for myocardial infarction prevention in men younger than 45.

Neisseria gonorrhoeae

Highlights of these guidelines include updated treatments for bacterial vaginosis and genital warts as well as antibiotic-resistant ______________________.

- Discussing aspirin use with high-risk adults - Tobacco-use screening and brief interventions - Immunizing children

Many effective preventive services are underutilized and few adults receive all of the most strongly recommended services. The three highest-ranking services in terms of potential health benefits and cost effectiveness include:

Pertussis

Increasing reports of ___________ among US adolescents, adults, and their infant contacts have stimulated vaccine development for older age groups.

- Screening adults aged 50 (earlier for some patient) and older for colorectal cancer - Immunizing adults aged 65 and older against pneumococcal disease - Screening young women for Chlamydia - HPV for routine vaccination in adolescents

Other high-ranking services with data indicating substantial room for improvement in utilization are:

Prescription drug abuse

Over the last decade, the rate of ______________________ has increased dramatically, particularly at both ends of the age spectrum. - The most commonly abused classes of medications are pain relievers, tranquilizers, stimulants, and sedatives. - Opioid-based prescription drug abuse, misuse, and overdose has reached epidemic proportions in the U.S.

Primary, Secondary and Tertiary

Preventive medicine can be categorized as:

Aspirin

Recommendations for ___________: - Recommends the use of aspirin for men aged 45-79 years when the potential benefit due to a reduction in myocardial infarctions outweighs the potential harm due to an increase in gastrointestinal hemorrhage. - Recommends the use of aspirin for women aged 55-79 years when the potential benefit of a reduction in ischemic strokes outweighs the potential harm of an increase in gastrointestinal hemorrhage.

Blood pressure screening

Recommends screening for high blood pressure in adults aged 18 and older

Screening for smoking and counseling to promote cessation

Recommends that clinicians ask all adults about tobacco use and provide tobacco cessation interventions for those who use tobacco products Intervention: - Ask-Discuss use - Options to aid in cessation - Support groups o Individual or group counseling - Literature - Physical activity - Medications

- A culture of violence in the family - Dementia - Debilitated - Depressed - Socially isolation of victim - A perpetrator profile of mental illness, alcohol or drug abuse - Emotional and/or financial dependence on the victim

Risk factors for elder abuse include:

Abdominal Aortic Aneurysm

Screening for: - Recommends one-time screening for _________________________________ by ultrasonography in men aged 65-75 years who have ever smoked. - No recommendation for or against screening for AAA in men aged 65-75 years who have never smoked. - Recommends against routine screening for AAA in women

Hepatitis C

There is no vaccine for _____________. - Prevention is through minimizing exposure. Testing is important because there are treatment options: drugs for the treatment of hepatitis C include: - Mavyret (glecaprevir and pibrentasvir) - Vosevi (sofosbuvir, velpatasvir, and voxilaprevir) - Epclusa (sofosbuvir and velpatasvir)

Tertiary prevention

measures are aimed at limiting the impact of established disease (e.g., partial mastectomy and radiation therapy to remove and control localized breast cancer)

Secondary prevention

n techniques promote early detection of disease or precursor states (e.g. routine cervical Papanicolaou screening to detect carcinoma or dysplasia of the cervix)