LEIK Health Screening and Health Promotion

USPSTF recommends for Pancreatic Cancer?

Against Routine screening

Leading Cause of Mortality 45-64

Cancer

Per US Task Force what is the guidelines for cervical screening for those under the age of 21-65?

Baseline at age 21 years. Screen every 3 years.

Leading cause of death in all age groups and gender:

1. Heart disease (or diseases of the heart) 2. Cancer (or malignant neoplasms) 3. Chronic lower respiratory diseases (i.e., chronic obstructive pulmonary disease [COPD])

Sensitivity

A sensitive screening test is very good at identifying/detecting those people who have the disease (true positive). An easy way to remember is to think of "sensitivity—rule in" or "SSIN or SIN."

Specificity

A specific screening test is very good at identifying/detecting those people without the disease (true negative). An easy way to remember is to think of "specificity—rule out" or "SPOUT."

Per the US Task Force screening for Ovarian Cancer Include?

Grade D: Routine screening is not recommended. Very high-risk women with BRCA1/BRCA2 mutations: Refer to specialists. If ovarian cancer screening is done, transvaginal ultrasound with serum cancer antigen (CA-125) is ordered. The screening starts at age 30 years (or 5-10 years before earliest age of first diagnosis of ovarian cancer in family). Some experts recommend bilateral salpingo-oophorectomy (BSO) between age 35 to 40 years (after childbearing is complete). BSO has a significant effect in reducing ovarian cancer risk in at-risk women. High-risk women: Refer for genetic counseling. Look for family history of having two or more first- to second-degree relatives with a history of ovarian cancer or a combination of ovarian cancer; women of Ashkenazi Jewish ethnicity with first-degree relative (or second-degree relatives on the same side of the family) with breast or ovarian cancer.

Can any person who has never had chickenpox develop shingles?

No, they cannot.

Pneumococcal conjugate vaccine (PCV 13)

One dose lifetime for adults; give at age 65 followed by PPSV23

Seasonal Influenza Vaccine

Start giving the influenza injection at the end of October of each year (fall to winter season). It takes 2 weeks after the shot for a person to develop antibodies. As long as influenza viruses circulate, vaccination should continue to be offered, even into January or later. Most seasons, influenza activity peaks in January or later (CDC, 2017). Health care personnel who work with patients older than 50 years should be vaccinated. If a person with an egg allergy only experiences hives, an influenza vaccine can be administered. Pregnant women may receive any licensed, recommended, and age-appropriate flu vaccine.

Preferred Method of TB blood test

TB blood tests (IGRA) are preferred method of TB testing for people who have received the BCG vaccine.

Special Considerations for Cervical screening?

These recommendations do not apply to women who are immunocompromised (i.e., Hiv infection), had in utero exposure to diethylstilbestrol (DES), or have a diagnosis of high-grade precancerous cervical lesion or cervical cancer.

Bacillus Calmette-Guerin (BCG)

Bacillus Calmette-Guérin (BCG) is a vaccine against tuberculosis (TB) infection. BCG is made from live attenuated (or weakened) Mycobacterium tuberculosis. Vaccination with BCG can produce a false positive with the TB skin test (Mantoux).

Per the US Task Force Breast Cancer Screening should begin at?

Baseline mammogram: Start at age 50 years and repeat every 2 years until the age of 74 years Age 75 years or older: Insufficient evidence for routine mammogram **Does not apply to women with known genetic mutations (BRCA1 or BRCA2), familial breast cancer, history chest radiation at a young age or previously diagnosed with high-risk breast lesion who may benefit from starting screening in their 40s

Per the US Task Force screening for Colo-rectal Cancer include?

Baseline: Starting at age 50 years until the age of 75 (older age is the most common risk factor) Age 76 to 85 years: Against routine screening but "there may be considerations"; individualize screening as needed Older than age 85 years: Screening for colorectal cancer bot recommended

Screening Considerations:

*Decision to screen is based on risk factors, life expectancy (>10 years), risk versus benefits.FOBT, fecal occult blood test; GDM, gestational diabetes mellitus; PCOS, polycystic ovary syndrome.

Live Attenuated Inactivated Virus (LAIV)

For the 2017 to 2018 influenza season, there is a CDC and Advisory Committee on Immunization Practices (ACIP) recommendation against use of LAIV vaccine for all age groups. Only for healthy persons aged 2 to 49 years Some antivirals (amantadine, rimantadine, zanamivir, or oseltamivir) should be avoided 48 hours before and 14 days after vaccination because they interfere with antibody production. Do not give aspirin to children within the 4 weeks following vaccination.

USPSTF recommends for Depression?

General adult population Include pregnant and Postpartum women; use beck depression inventory

If a person is vaccinated before the age of 65 with Pneumovax, what is recommended?

Give a booster dose of Pneumovax 5 years after the initial dose

. What age group should receive the shingles vaccine?

Give a one-time dose at the age of 60 years or older (even if patient has already had shingles). A person with a history of shingles can be vaccinated with shingles vaccine (unless there is a contraindication). The youngest age that Zostavax can be given is 50 years of age.

Tetanus Vaccine

Give every 10 years for lifetime Boosters: For "dirty"/contaminated wounds, give a booster if the last dose was more than 5 years prior Infancy and children younger than age 7 years: Use DTaP form Age 7 years and older: Use only tetanus and diphtheria (Td); and tetanus, diphtheria; or the tetanus, diphtheria, acellular pertussis (Tdap) forms of the vaccine; give one Tdap dose (lifetime) to replace one Td dose DTaP: Give by IM route to infants and children younger than age 7 years Td: Give by IM route. Start using this form at the age of 7 years Tdap: Give by IM route Safety Issue History of Guillain-Barré syndrome within 6 weeks of previous dose. Be careful with pertussis component if progressive or unstable neurological disorder, uncontrolled seizures.

Leading Cause of Mortality 65 and older

Heart disease

Breast Cancer Risk Factors

Older age: Age 50 years or older (most common risk factor) Previous history of breast cancer Two or more first-degree relatives with breast cancer Early menarche, late menopause, nulliparity (longer exposure to estrogen) Obesity (adipose tissue can synthesize small amounts of estrogen)

Routine screening is not recommended by the USPSTF for the following conditions:?

Ovarian cancer Oral cancer Prostate cancer Testicular cancer

Lung Cancer

Screening for persons who smoke (30 pack-years) or have quit in the past 15 years Age 55 to 80 years: Annual screening with low-dose CT (LDCT) Discontinue screening once person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery

Secondary Prevention (Early Detection of a Disease to Minimize Bodily Damage)

Screening tests (Pap smears, mammograms, CBC for anemia, etc.) Screening for depression (interviewing a patient about feelings of sadness, hopelessness) Screening for sexually transmitted infections (STIs; asking about sexual history, partners, signs and symptoms) Screening for alcohol abuse (interviewing a patient using the CAGE questionnaire) Testing for hepatitis C virus infection in a person with risk factors Having a person with a history of MI, TIA, or stroke take an aspirin or statin daily (to prevent a future stroke or MI)

USPSTF recommends BP Screening in adults?

Start at age 18 years or older Recommends obtaining measurements outside of clinical setting for diagnostic confirmation before starting treatment

USPSTF recommends for Colon Cancer screening:

Start at age 50 years and continue until age 75 years High sensitivity Fetal occult blood test (FOBT) annually sigmoidoscopy Q 5 years Colonoscopy Q 10 years ** Age 76-85 years individualize and older than 85 Stop Screening

USPSTF recommends for Obesity?

Start at age 6-18 years Offer or refer for intensive behavioral interventions

USPSTF recommends for Osteoporosis?

Start at age 65 years or older; May start earlier if younger women has a fracture risk equal or greater than that of a 65 year old white woman ie... chronic steroids

USPSTF recommends for STI's?

Start at the onset of sexual activity High intensive behavioral counseling for sexually active adolescents and adults at high risk for STI's

Tertiary Prevention (Prevention of Disease Progression, Rehabilitation, Support Groups, Education on Equipment)

Support groups: Alcoholics Anonymous (AA), breast cancer support groups, Hiv support groups Education for patients with preexisting disease (i.e., diabetes, hypertension): Avoidance of drug interactions, proper use of wheelchair or medical equipment, others Rehabilitation: Cardiac rehabilitation, physical therapy (PT), occupational therapy (OT) Treatment of a person with hepatitis C virus infection Treatment of a person who has already had a heart attack with daily aspirin (to prevent another heart attack)

What is the follow-up if a person with a history of BCG immunization has a positive purified protein derivative (PPD)?

TB blood testing (QuantiFERON, T-SPOT) is preferred. Most people with a positive TB blood test have latent TB infection. TB blood tests (interferon-gamma release assays [IGRAs]), unlike the TB skin test, are not affected by prior BCG vaccination.

When can the Tdap be used as a booster in adolescents and adults?

The Tdap can be substituted for a single dose of Td (once in a lifetime) starting at age 11 to 12 years

Prostate cancer

The USPSTF recommends against prostate-specific antigen (PSA) screening for prostate cancer. The recommendation "applies to men in the general U.S. population, regardless of age." Grade D: The benefits of PSA-based screening for prostate cancer do not outweigh the disadvantages.

Abdominal Aortic Aneurysm Screening?

The USPSTF recommends one-time screening for abdominal aortic aneurysm by ultrasonography in men ages 65 to 75 years who have ever smoked.

Breast cancer screening according to the USPSTF?

The USPSTF recommends screening mammography for women at age 50 Start at age 50 years Mammogram every 2 years (biennial) until 74 years of age Age 75 years or older- Stop routine screening. Individualized

The National Vaccine Injury Compensation Program (VICP)

The VICP is a federal program created to compensate people who have been injured by certain vaccines. Call 1-800-338-2382 or visit the VICP website at www.hrsa.gov/vaccinecompensation.

Which vaccine, the shingles vaccine or the varicella vaccine, contains more varicella zoster virus (VZV)?

The shingles vaccine (Zostavax) contains about 14 times more VZV compared with the varicella vaccine (Varivax).

Most common type of skin cancer

basal cell carcinoma however melanoma causes the majority of skin cancer deaths

Shingrix

herpes zoster vaccine (inactivated) (herpes zoster/shingles virus vaccine)

Most Common Cancer

skin cancer

Varicella Safety Issues

Safety Issues Avoid giving to pregnant patients, patients with immunosuppression or on drugs that affect the immune system (steroids, biologics such as Humira, Enbrel), patients having radiation treatment or with any type of cancer.

Leading cause of Death in Adolescents:

1. Accidents/ unintentional injuries (39.5%); the most common cause is motor vehicle crashes (risk is highest from 16 to 19 years of age) 2. Suicide (16.8%): Watch teens for signs of depression, excess stress, and suicidal behavior; open communication between the adolescent and the parents/caregivers (or persons they trust) is extremely important in preventing teenage suicide 3. Homicide (14.3%): Nonfatal and fatal violence are much higher among young people compared to any other age group.

Leading cause of death in women:

1. lung cancer 2. breast cancer 3. colorectal cancer

Leading Cause of Cancer death in men

1. lung cancer 2. prostate cancer 3. colorectal cancer

Most common cancer among all children:

Acute lymphoblastic leukemia (ALL; 34% of all cancers in children)

What is done if a patient has a tetanus-prone wound and vaccination status is unknown?

Administer immediate dose of Td/Tdap vaccine and the tetanus immunoglobulin (TIG) injection as soon as possible

What vaccine is recommended for persons who are 65 years of age?

Adults 65 years or older (who never received Pneumovax): Give Prevnar (PCV13) initially, followed at 12 months with Pneumovax (PPSV23); if person has already had PPSV23 previously, wait 12 months to give PCV13

USPSTF recommends for Ovarian Cancer?

Against Routine screening; Do not screen except high risk

Special Considerations for Breast Cancer Screening?

Age 40 to 49 years (individualize based on risk factors, if done). The American Cancer Society recommends starting routine screening at age 40 years.

USPSTF recommends for DM type 2?

Age 40-70 years if overweight or Obese Applies to adults in PCP settings who are not high risk; DM patients with risk factors (certain ethnicities, PCOS, GDM, etc.) **Can undergo screening at younger age

Per US Preventative Task Force What is the recommendation for Aspirin Use to Prevent Cardiovascular Disease and Colorectal Cancer (April 2016)

Age 50 to 59 years with equal or more than 10% risk (10-year cardiovascular disease risk) Initiate low-dose aspirin use for primary prevention of cardiovascular and colorectal cancer (in patients who are not at increased risk for bleeding) with life expectancy of at least 10 years and who are willing to take low-dose aspirin daily for at least 10 years)

Prostate Cancer Risk Factor

Age 50 years or older African ancestry First-degree relative with prostate cancer

USPSTF recommends for Lung Cancer?

Aged 55-80 with history of smoking and currently smokes with 30-pack year history or quin in previous 15 years then low dose CT recommended

Per US Task Force what is the guidelines for cervical screening for those under the age of Age 30 to 65 years?

Another option starting at age 30 years is to screen with combination of cytology plus human papillomavirus (HPV) testing every 5 years.

USPSTF recommends for Latent TB?

Asymptomatic adults who are at an increased risk for infection

What is the youngest age at which influenza vaccine (injection) can be given?

At the age of 6 months

Average Life Expectancy

Average life expectancy is 78.6 years (a decrease of 0.1 year from 2015; National Center for Health Statistics. Mortality in the United States, 2016.

Most common cancer by gender (prevalence) in women

Breast cancer In women, there are more cases of breast cancer (prevalence), but the cancer that causes the most deaths (mortality) is lung cancer

Leading Cause of mortality in Birth- 12 months

Congenital malformations (20.3%)

If a patient had only one dose of hepatitis B vaccine, what is recommended?

Do not restart the hepatitis B series again. If only one dose, give the second dose. Catch up until the three-dose series is completed.

Per US Task Force what is the guidelines for cervical screening for those under the age of 20?

Do not screen (even if sexually active with multiple partners). Cervical cancer is rare before age 21 years.

Per US Task Force what is the guidelines for cervical screening for those Women older than 65 years who had adequate prior screening?

Do not screen if history of adequate prior screening and is otherwise not at high risk for cervical cancer.

Influenza Deaths

During recent influenza seasons, between 80% and 90% of influenza-related deaths occurred in people aged 65 years or older. Remind older patients to get the influenza vaccine starting in the fall season.

Most flu vaccines (including nasal spray) are manufactured using egg-based technology. What are the implications for patients?

Egg allergy affects 1.3% of children but only 0.2% of

What is the follow-up if a person has a positive TB skin test or TB blood test?

Evaluate the person for signs and symptoms of TB. Rule out latent or active TB infection. Order a chest x-ray and check for signs and symptoms of TB such as a "chronic" cough, weight loss, and night sweats. Preferred treatment for latent TB infection is isoniazid daily orally for 9 months. According to the CDC, there are four treatment regimens for latent TB infection (April 2016). Consult or refer to TB specialist if the source has drug-resistant TB.

Contraindications (all types of influenza vaccine)

Infants age 6 months or younger People with severe, life-threatening allergies to components of the influenza vaccine (gelatin, gentamicin, preservative), which is not related to an egg allergy, should not be given influenza vaccine (egg-allergy-related reactions are discussed in the text that follows).

Colorectal Cancer Risk Factor

History of familial polyposis (multiple polyps on colon) First-degree relative with colon cancer Crohn's disease (ulcerative colitis)

Per US Task Force what is the guidelines for cervical screening for those who had hysterectomy with removal of cervix?

If hysterectomy with cervical removal was not due to cervical intraepithelial neoplasia (CIN grade 2) or cervical cancer, then can stop screening.

Flu Vaccination Safety Issues

If severe reaction (hypotension, wheezing, nausea/vomiting, reaction requiring epinephrine or emergency medical attention) occurs after eating eggs or food containing eggs, vaccine should be administered in an inpatient or outpatient medical setting (clinics, hospitals, health departments, physician offices) under the supervision of a health care provider who is able to recognize and manage severe allergic conditions. If patient experienced only hives previously, he or she can receive the influenza vaccine. People with egg allergies no longer need to be observed for an allergic reaction for 30 minutes after receiving the flu vaccine (CDC, 2016; Committee on Infectious Diseases, 2017). Age-appropriate recombinant (Riv) or cell cultured flu vaccines are an option for patients who refuse egg-based influenza vaccine. Use caution or avoid influenza vaccine if history of Guillain-Barré syndrome within 6 weeks of previous vaccination.

Cervical Cancer Risk Factor

Multiple sex partners (defined as greater than four lifetime partners) Younger age onset of sex (immature cervix easier to infect) Immunosuppression and smoking

Primary Prevention

Individual actions (healthy individuals): Eat a nutritious diet, exercise, use seatbelts and helmets Gun safety: Use safety locks for guns; keep guns out of reach of children/teens National programs: Federal health-promotion/disease-prevention programs include immunizations, the Occupational Safety and Health Administration (OSHA)'s job safety laws, and Environmental Protection Agency (EPA) laws. Programs promote a healthy lifestyle for youth (healthy diet, exercise, etc.) Building a youth center in an urban high-crime area or a Habitat for Humanity (shelter). Aspirin prophylaxis for primary prevention of CVD and colon cancer in adults aged 50 to 59 years who have a 10% risk or higher.

STD Risk Factors

Multiple sexual partners Earlier age onset of sex New partners (defined as <3 months) History of STD Homelessness

Leading cause of cancer death

Lung cancer

MCV4

Meningococcal vaccine; preteens, teens, start at age 11-12; especially first year students living in dorms they are at higher risk

Pneumonia vaccination

Pneumococcal polysaccharide vaccine (PPSV23 or Pneumovax): All adults age 65 years or older or if high risk for pneumococcal disease (ages 2-64 years) PPSV23: 50% to 85% effective Pneumococcal conjugate vaccine (PCV13 or Prevnar): All children younger than 5 years of age or at high risk for pneumococcal disease; PCV13 is also recommended for all adults age 65 years or older Age 65 years or older: CDC recommends giving PCV13 first (if never had PPSV23); then 12 months after PCV13, administer PPSV23 (better immunogenic response) Highest risk (of fatal pneumococcal infection): Chronic diseases (alcoholism, diabetes, cerebrospinal fluid [CSF] leaks, asthma, chronic hepatitis) Anatomical or functional asplenia (including sickle cell disease) If immunocompromised or on medications causing immunocompromised state Generalized malignancy or cancers of the blood (leukemia, lymphoma, multiple myeloma) Renal diseases (e.g., chronic renal failure, nephrotic syndrome) History of organ or bone marrow transplant

PPSV23

Pneumovax 23; one dose at age 65 years or older *if given before the age of 65 give a booster in 5 years

LAIV Contraindications- Live attenuated influenza virus

Pregnancy, chronic disease (i.e., asthma, COPD, renal failure, diabetes, immunosuppression) Contraindicated in children on aspirin therapy (ages 2-17 years)

Most common cancer by gender (prevalence) in Men

Prostate cancer In men, there are more cases of prostate cancer (prevalence), but the cancer that causes the most deaths (mortality) is lung cancer

Which wounds are considered at highest risk for tetanus infection?

Puncture wounds, wounds with devitalized tissue, soil-contaminated wounds, crush injuries, and others are at high risk for tetanus infection

Per the US Task Force Skin Care Counseling Includes?

Recommended for children, adolescents, and young adults (ages 10-24 years) with fair skin Education includes avoidance of sunlight from 10 a.m. to 4 p.m., use of SPF 15 or higher sunblock, protective clothing, wide-brim hats

USPSTF recommends for Skin cancer?

Routine screening is not recommended; Individualize recommendation

How long are persons with shingles contagious?

Shingles is infectious until all the skin lesions are dry and crusted. Follow contact precautions. About half of cases of shingles occur in persons aged 60 years or older.

Health Care Personnel Vaccination Recommendations

These recommendations also apply to students who are in training to become health care providers. Td or Tdap Give one-time dose of Tdap for all health care personnel who have not received the Tdap when due for a tetanus booster. Continue giving Td boosters every 10 years for a lifetime. MMR Proof of immunity is necessary (born before 1957, laboratory confirmation such as positive titers). If not vaccinated for MMR, two doses are needed (at least 28 days apart). Varicella Proof of immunity is necessary (positive varicella titer, documentation of two doses of varicella vaccine or diagnosis of varicella by physician/health care provider). Hepatitis B If incomplete hepatitis B series (fewer than three doses), complete the series (do not restart). If job involves blood or body fluids, obtain anti-HBs serological testing 1 to 2 months after dose 3. If anti-HBs is less than 10 mIU/mL, three additional doses should be administered on the regular hepatitis B schedule followed by anti-HBs testing in 1 to 2 months. Influenza All health care personnel should have an annual influenza shot during the fall/winter.

Per the US Task Force screening methods for Colo-rectal Cancer include?

These three methods are all acceptable for colorectal cancer. The screening intervals of each method differ: High-sensitivity fecal occult blood test (gFOBT) for three consecutive stool samples annually (high-sensitivity version such as Hemoccult SENSA superior to older Hemoccult ii test) Flexible sigmoidoscopy or CT colonography every 5 years Colonoscopy every 10 years

Per the US Task Force screening Lipids include?

Total lipid profile after a 9-hour (minimum) fast The USPSTF recommends the use of low- to moderate-dose statin when all of the following criteria area met: Aged 40 to 74 years The patient has one or more CVD risk factors (i.e., dyslipidemia, DM, hypertension, smoking) The patient has a calculated 10-year risk of a cardiovascular event of 10% or greater Age 76 years and older without history of heart attack or stroke (insufficient evidence)

Hepatitis B Vaccine

Total of three doses (0, 1, 6 months). First vaccine given at birth (monovalent hepatitis B vaccine). Need a minimum interval of 4 weeks between doses one and two. If series is not completed, catch up until three-dose series is completed. The Centers for Disease Control and Prevention (CDC) does not recommend a restart of the hepatitis B series.

Formulations Inactivated and Recombinant Influenza Vaccines (Injectable)

Trivalent influenza vaccine or quadrivalent vaccines given by intramuscular (IM) injection in the arm preferred. There are intradermal and nasal forms of these vaccines. High-dose trivalent influenza vaccine for people age 65 years or older (Fluzone High-Dose) Recombinant trivalent influenza vaccine that is egg-free approved for persons age 18 years and older (Flublok) Quadrivalent influenza vaccine: protects against four types flu virus (broader protection). Age 4 years or older.

Leading cause of Mortality ages 1-44 years

Unintentional injuries

Varicella Vaccine

Varicella live attenuated virus (Varivax): Given by SC route. Need two doses. First dose given in infancy: 12 to 15 months (do not give to infants younger than 12 months). Advise women not to get pregnant for 1 month after getting vaccine. A new combination vaccine called the MMRV (ProQuad) contains both chickenpox and the MMR vaccines (only for ages 12 years or younger). Postexposure prophylaxis: Ideally, vaccine should be given within 72 hours postexposure but may be given up to 5 days (120 hours) after incident (healthy, previously unvaccinated). Reactions: Mild rash or several small chickenpox rashes can occur after vaccination (contagious, avoid immunocompromised people). Acceptable proof of varicella immunity: Documentation of two doses of varicella vaccine Written diagnosis of chickenpox or shingles based on health care provider diagnosis Positive laboratory varicella titer (IgG ELISA) Do not administer the varicella vaccine to a person born in the United States before 1980. Safety Issues Avoid giving to pregnant patients, patients with immunosuppression or on drugs that affect the immune system (steroids, biologics such as Humira, Enbrel), patients having radiation treatment or with any type of cancer.

Shingles Vaccine

Zoster vaccine (Zostavax) is a live attenuated virus vaccine. Age 60 years: Give one-time dose by subcutaneous (SC) route. A past history of shingles is not a contraindication for receiving the shingles vaccine. The shingles vaccine can be administered to persons even if they never had a chickenpox infection. However, even if a person has had shingles before, the CDC still recommends the vaccine. Certain antivirals (acyclovir, famciclovir, valacyclovir) can decrease immunological response if taken 24 hours before or 14 days after vaccination. May cause exacerbation of asthma and polymyalgia rheumatica (PMR). Risk factors (shingles): Older age (60 years or older), immunocompromised (Hiv, steroids, chemotherapy) Leukemia, lymphoma Contraindications: Pregnancy and breastfeeding Leukemia, lymphomas, or other malignancies of the bone/bone marrow Immunocompromise (high-dose steroids >2 weeks, antitumor necrosis factor medications such as etanercept)