Health Promotion and Disease Prevention Week 1,2,3

At what ages is Zoster always recommended for both men and women (even including most risk factors)

1 dose starting at age 60

Under what special circumstances would a patient be vaccinated for PSV 13?

1 dose vaccinated for those over 65 1 dose vaccinated for those immunosuppression, HIV, kidney failure, end stage renal, on dialysis, asplenia and chronic component deficiencies

When do we ALWAYS VACCINATE for homophiles influenza type b (Hib?

1 dose= asplenia and persistent complement component def 3 dose post HSCT recipient only= immunosuppression (minus HIV)

Under what circumstances should we always vaccinate for PPSV 23?

1 dose= over 65 1,2, or 3 depending= immunosuppression HIV at any stage kidney failure, end stage renal, on dialysis, heart disease, chronic lung disease, chronic alcoholism, asplenia and chronic complement component def, chronic liver disease

When should we give the measles, mumps, and rubella (MMR)?

1 or 2 doses depending for ages 19-59 in those without pregnancy, immunosuppression, and HIV CD4+ <200 If pregnancy, immunosuppression, and HIV CD4+ <200 = COUNTERINDICATIVE!

Under what circumstances would someone get a PPSV23 only if they are at increased risk?

1 or 2 doses depending on indication= healthy people under 65 pregnancy MSM healthcare professional

When do we only vaccinate if at risk for homophiles influenza type b (Hib)?

1 or 3 doses depending= all adults except immunosuppression (minus HIV), asplenia and chronic complement component def

When vaccinate only at risk for meningococcal 4-valent conjugate or polysaccharide MPSV4?

1 or more dose depending= all adults except those with asplenia and chronic complement component def

When vaccinate EVERY TIME for meningococcal 4-valent conjugate or polysaccharide MPSV4?

1 or more doses depending= asplenia and chronic complement component def

When do we give the HPV vaccine to HEALTHY men?

19-21 3 doses

When should we vaccinate against varicella? When not to?

2 doses for all adults and those with HIV CD4+ >200 every 10 years 3 exceptions NOT WHILE PREGNANT NOT WITH IMMUNOSUPPRESSION NOT WITH HIV CD4+ <200 (weirdly enough, having >200+ CD4+ is okay to vaccinate

When do we vaccinate with the meningococcal B (MenB) ALWAYS?

2 or 3 doses depending Asplenia and persistent complement component def

When would we vaccinate for Hep A only if at increased risk?

2 or 3 doses depending= all healthy adults pregnancy, immunosuppression, hiv at any stage kidney failure, end stage renal, on dialysis heart disease, chronic lung disease, chronic alcoholism, asplenia and chronic complement component def, diabetes, healthcare personnel

When do we vaccinate with the meningococcal B (MenB) only if at increased risk?

2 or 3 doses depending= All healthy adults except those with asplenia and chronic complement component def

When would we definitely vaccinate for Hep A?

2 or 3 doses depending= MSM Chronic liver disease

When to screen for cervical cancer?

21-65 women- PAP every 3 years 30-65- every 5 years combine both tests: PAP and HPV

When do we give the HPV vaccine to men with special consideration?

22-26 with 3 doses= men 22-26 with risk factor until age 26 with 3 doses= men immunosuppression, HIV, and whom have sex with other men 19-21 3 doses- kidney failure on dialysis, heart disease, chronic lung disease, chronic alcoholism, chronic liver disease, diabetes, healthcare profession, asplenia/ chronic complement component deficiency

When do we give the HPV vaccine to healthy women?

3 doses ages 19-26. just don't give it to someone who is pregnant.

When do vaccinate definitely for Hep B?

3 doses= MSM HIV any stage diabetes, healthcare professional kidney failure, end stage renal, on dialysis chronic liver disease

When do vaccinate only if increased risk for Hep B?

3 doses= health adult pregnancy immunosuppression heart disease, chronic lung disease, chronic alcoholism, asplenia and chronic compliment component def.

When should we screen for abnormal glucose/diabetes?

After age 35 for both men and women if overweight/obese

According to the USPSTF, ALL PPL BOTH MEN AND WOMEN would get moderate benefit from screening for what at ALL AGES?

Alcohol misuse Depression Obesity

What is secondary prevention?

Already have disease. Screening to prevent it from being worse or to make the disease more bearable. ex. colon, cervical, breast cancer screening

When is fall prevention (vitamin D) assessed?

BOTH MEN AND WOMEN IF COMMUNITY DWELLING AND INCREASED FALL RISK AFTER AGE 60

What are the current diseases the CDC is currently focused on?

Currently, the CDC focuses on heart disease/stroke, cancers, diabetes, arthritis, obesity, respiratory disease and oral disease. Heart disease is the leading cause of death, while stroke is the 3rd leading cause. Risk factors for these diseases include: hypertension, high cholesterol, smoking, obesity, and a sedentary lifestyle. Although breast cancer in women and colorectal cancers for both sexes are decreasing, cancer is still a leading concern for the CDC as the 2nd leading cause of death in the US. Lung cancer is the leading preventable cancer, as more than 80% of those affected in both sexes is linked to smoking. The most common cancers are prostate, female breast, lung/bronchus, and colorectal. Diabetes is the leading cause of renal complications, lower extremity amputations, and blindness from ages 20 to 74. Native and Alaskan Americans are most at risk. Arthritis is the most common cause of disability and African Americans are most at risk. Obesity increases patient risk for heart disease, hypertension, type 2 diabetes, arthritis, and some cancers. Currently, it has leveled in younger populations, but is still a concern as 1 in 3 adults and 1 in 5 kids ages 6-19 suffer from this disease. Respiratory disease, especially COPD, is another chronic disease monitored by the CDC. Smoking exacerbates COPD, which is increasing in both men and women! Oral disease, such as peridontal disease and tooth decay concern health professionals as well; those in poverty suffer more instances of these disease states than others.

What are the guidelines for pap smears?

Every 3 years (starting 20) or every 5 years with HPV contesting at age 30.

True or false Both men and women are screened for osteoporosis.

False. women should be screened if at risk starting age 40 (more than or equal to 9.3 % 10 yr fracture risk). They should always be screened for osteoporeosis if older than age 60.

True or False. Adult women should always be screened for chlymydia and gonorrhea.

False. Women under 25 are recommended to be screened if they are sexually active and at increased risk. Over 25, if they are at increased risk.

At what age does colorectal cancer screening begin?

For both sexes, at age 50 until ~ 79.

Name some social determinants of health.

Health/Health care Education Social/Community context Economic stability Neighboorhood/Built Environment

According to the USPSTF, BOTH MEN AND WOMEN would get moderate benefit from screening for what at ALL AGES IF AT INCREASED RISK?

Hep B STIs Diet/Activity for CVD prevention if overweight or obese and with additional CVD risk

According to the USPSTF, ALL PPL BOTH MEN AND WOMEN would get significant benefit from screening for what at ALL AGES?

Hypertension Tobacco use and cessation HIV infection

When to screen for folic acid supplementation?

If a woman can conceive

Primary prevention of breast cancer begins when for women?

If at increased risk and only after shared decision making for all ages.

When should a woman be screened for intimate partner violence?

If she is at child bearing age (<50)

What is tertiary prevention?

If the disease is present, we are just trying to limit its harm ex. BG levels in diabetics Control BP in HTN to prevent stroke, heart and kidney disease exercise for arthritis

What is the difference between incidence and prevalence?

Incidence- # of NEW cases in a given time. The RATE. Prevalence- # of people who HAVE the disease at a given time.

Which vaccinations are ALWAYS given annually?

Influenza 1 dose annually both men and women all ages

What is primary prevention? Give some examples.

Interventions to prevent disease or injury from happening in the first place. Ex. helmet, seatbelt, lifestyle changes (which can also be tertiary), immunizations

When should we screen for aspirin for CV risk?

MEN ONLY= 40 and over if the benefit of aspirin > risk WOMEN ONLY= 50 and over if the benefit of aspirin > risk

What are the differences in age and sex for screening for lipid disorders?

Men- Under 30 only screen for CHD if at increased risk. >30, always screen for CHD Women- Only screen if at increased risk. At age ~40, will get moderate benefits, over that age, will get significant benefits.

For both sexes, should we always screen for lung cancer?

No. Only if 55-74 and if they have had a 30 year/pack history. If they are a former smoker within the last 15 years, or if they are a current smoker .

In the winter, flu tests have a higher _ _ _ than in the summer

PPV

When we evaluate a test, which factors should we use?

PPV, NPV, specifity and sensitivity

men have lower _ _ _ than a group of women on a positive pregnancy test.

PPV. The number of men who have positively and correctly identified as being pregnant is MUCH less than the number of women positively and correctly identified as being pregnant.

Give an example of primary prevention of cancer and an example of secondary prevention of cancer.

Primary prevention aims to prevent an illness from occurring. Reducing or abstaining from tobacco use, including vaping and chew, is an example of primary prevention of lung, mouth and throat, pancreatic, and kidney cancers. Fortunately, smoking is a modifiable behavior, so one has some control over his or her susceptibility to these cancers. Secondary prevention aims to alleviate or prevent disease progression. Screening for cervical and colorectal cancers are examples of secondary prevention with success.

When should we screen for prostate cancer?

Recommend men 55-69 about benefits/harm of screening for PSA (prostate specific antigen). don't do it to the poor dude if he's over 70 for routine PSA.

Why does the CDC say that chronic disease is the public health challenge of the 21st century?

Responsible for 75% of US health care spending and 7/10 deaths in the US Almost 50% adults in US had one or more chronic illness Approximately 25% of people with chronic conditions have some daily activity limitation

When should we use secondary prevention?

Screening should only be done if the disease is common and if the problem is really bad, if it lasts a long time without symptoms, if the test is valid, if early treatment makes a difference, if treatment is available, and if the benefits outweigh risks.

What is the difference between sensitivity and specificity?

Sensitivity- does this test get everyone who has the disease? It doesn't miss people, does it? Specificity- Does the person ACTUALLY have the disease?Like its not just a false positive.

When to screen for colon cancer?

Start age 50 until age 75. OR IF FAMILY HISTORY/AT RISK 1. Flex. sigmoidoscopy every 5 years OR 2. Colonoscopy every 10 years OR 3. Dbi contrast BE every 5 years OR 4. CT scan every 5 years OR 5. annual FOB/FiT OR 6. Stool DNA test every 3 yrs

When should a woman be screened for breast cancer?

Starting age 50 with mammography every 1-2 years. ACS says 45. individualized screening for those women at risk of developing breast cancer.

When should we vaccinate for Tetanus, diphtheria, pertussis (Td/Tdap)?

Substitute Tdap for Td once, then a Td booster every 10 years Unless woman is pregnant (Where she will get 1 dose each pregnancy)

What is a positive predicted value?

The ratio of CORRECTLY identified patients with a disease/ everyone listed as having the disease, this denominator includes false positive. ARE WE SURE THAT THE POSITIVES ARE REAL?

What is negative predictive value?

The ratio of correctly identified NEGATIVES/Total # of reported people without a disease. IS IT ACTUALLY NEGATIVE?

When should women get screened for the BRCA gene?

There is a moderate risk if she has appropriate family history at all ages

When do we screen for Hep C?

This is a weird one. For both men and women, only if increased risk up to age 49. Born between 1945 and 1965, ALWAYS SCREEN FOR HEP C FOR BOTH SEXES, and again, after 1965 only if increased risk.

Which injury prevention measures should be taken for infants?

Traffic safety- car seat placement burn prevention fall prevention- gates stairs. no infant walkers. choking- small parts drowning- buckets and bathtubs. safe sleep- supine in crib. no soft surfaces. no bumper pads when baby starts to stand. keep crib walls up cpr

When do we screen for skin cancer prevention?

WOMEN AND MEN IF FAIR SKINNED AGES UP TO 25. Patients with history of skin cancer or suspicious moles AADA says pt with increased risk of melanoma

At what age is Pneumococcal 13 talent conjugate (PCV 13) only recommended if you have a risk factor?

all sexes until 65, msm of any age, heart disease, chronic lung disease, chronic alcoholism, chronic liver disease, diabetes, and healthcare profession

What are the main cancers we screen for? Please indicate whether there is any disagreement about whether or not to screen for this cancer routinely

he main cancers screened are: Breast Cancer- while self exams are not currently recommended, the data regarding clinical breast exams is inconclusive. However, biennial mammograms should be conducted for women of 50-74 years of age. USPSTF states that women under 50 should have a choice in mammography screening, beginning biennially at age 40. Cervical Cancer/HPV- clinicians should screen women 21-65 every three years for cervical cancer, and should include a cytology via a Pap smear. Another option is to combine cytology screening for cervical cancer and human papillomavirus to get a longer interval period of five years in women 30-65 years old. USPSTF does not recommend screening women under 21 or in women over 65 that arent at risk of developing cervical cancer with previous screening. It also advises against screening women without previous high-grade, precancerous lesions and with a history of hysterectomy with removed cervix or cervical cancer. Women 30 or younger are not recommended for alone or combined cytological cervical cancer/HPV screening. Colorectal Cancer (CRC)- At age 50 and above, colorectal cancer screens should be performed. However, in ages 76-85, patients have autonomy in colorectal screening but should concern health status and previous screening in this consideration. Fecal occult blood tests (gFOBT) and FIT should be conducted yearly. FIT-DNA should be done every 1-3 years. CT colonography and flexible sigmoidoscopy screening should be done every 5 years. A colonoscopy tested every 10 years, while a flexible sigmoidoscopy screening every 10 years with FIT each year. Lung Cancer- screened annually using low-dose CT in current smokers ages 55-80 with a history of 30 packs/year or in former smokers that have quit within the last 15 years. Screenings cease when patient has not smoked for 15 years or more or in the presence of a life threatening disease. Prostate Cancer- screening for prostate cancer shouldn't be based on prostate specific antigen PSA tests. Testicular Cancer- Against screens for testicular cancer in adolescent/adult males.

When to screen for an abdominal aortic aneurosym?

only men only if ever smoker only at ages 55-75

What are the 4 key modifiable health behaviors?

physical activity nutrition tobacco alcohol

When is zoster vaccination contraindicated?

pregnancy, immunosuppression, HIV <200 CD4+

When is MMR contraindicated?

pregnancy, immunosuppression, and HIV CD4+ <200

According to the USPSTF, BOTH MEN AND WOMEN would get significant benefit from screening for what at ALL AGES IF AT INCREASED RISK?

syllphilis

Which injury prevention measures should be taken for pre-schoolers?

traffic safety- forward car seat. back seat. don't cross streets alone. helmet burn prevention- smoke alarm. outlet covered. fall prevention- protect from stairs, windows, heavy moveable furniture poison- kids get into everything. hide medications call poison control drowning- fenced in pools, adults stay with kids younger than 5 "touch" rule in pool firearm- keep guns hidden locked out of reach. guns should be out of home or locked away

Which injury prevention measures should be taken for school aged kids?

traffic safety- reach top weight car sear, ride booster seat until seatbelt can lie across kids chest, lap belt low and snug across upper thighs, legs bent at knees against seat. helmets water- 5> taught to swim. swim not alone. life jackets boating sports- safety equipment firearm- ask homes where kids visit to ensure no guns. keep guns safe place. guns should be out of home or locked away

Which injury prevention measures should be taken for teens?

traffic safety- seat belt. alcohol/drug driving. limit distracted driving. reckless driving. helmet water- don't swim in remote places. alcohol/drugs and swimming. feet first entering. life jackets sports- safety equipment. firearm- high risk. guns should be out of home or locked away