Cards Straight Outta the Review

Remember this in the course eval guys

20%

No state has an adult prevalence less than

4 (louisiana, alabama, mississippi, west virginia)

How many states had an obesity prevalence over 35%

US SOUTH, 2ND Midwest (30.7%), Northeast (26.4%), West (25.2)

Highest geographical prevalence of obesity (31.2%)?

Genetics (30-40% of risk), Environment, Metabolic, Behavioral issues

Etiology of obesity

40%

Prevalence of obesity has increased __ in the last ten years

CVD, Type II DM, Hypertension, Dyslipidemias

The major obesity-related comorbidities are:

Dyslipidemias

Which obesity related comorbidity is the last to change with weight loss?

80%

__ of type II Diabetics are obese?

40x

BMI > 31 INCREASES risk of Type II DM in women by What ?

40x

BMI > 35 in Men INCREASES risk of Type II DM in men by What

57%, 37%

Obesity prevalence in African American Women? Men?

47%, 36%

Obesity prevalence in Hispanic women? Men

Weight, Height, BMI, pinching fat, Recent weight loss (Intentional or not), Labs (fasting etc), Clinical/History, Dietary Evaluation, 24 hr recall, Food frequency, Food diary, Diet/Nutrition history

What are the components of a nutrition assessment?

Physical fitness

a state of being created by the interaction between nutrition and physical activity

Cardiopulmonary fitness, MSK fitness, Flexibility, Optimal Body composition

4 Domains of physical fitness

physical activity

muscle movement that increases energy expenditure

Heart disease, Stroke, HTN, Diabetes II, Falls/Hip fractures/Osteoporosis, Early Mortality, decreased risk of endometrial and colorectal cancer

A lifestyle of physical activity has been shown to independently decrease which common morbidities?

1/4

In spite of the benefits what percentage of US adults admitted to no leisure activity

less than 50%

In spite of the benefits what percentage of US adults perform the recommended amount of physical activity

30%

In spite of the benefits what percentage of US adolescents participate in at least 60 min per day (data suggest this number is increasing)

usually yes

If you lack exercise as a teen, does this trend continue as an adult

West (colorado, cali, oregon) Highest, South lowest

Rates of physical activity based on states

Lowest in non-hispanic black adults, highest in white adults

Rates of physical activity based on ethnic groups

Lower in those with less education, Lower in those living at the poverty level

Rates of physical activity based on education and SES

60 minutes a day - muscle strengthening 3x/week and Bone strengthening 3x/week

Exercise recommendations for Children and teens

150 minutes/week of moderate intensity exercise every week - 2 or more days of muscle-strengthening

Exercise recommendations for adults

Trying to maintain or improve overall health, Trying to significantly improve physical fitness, Training for athletic competition, Advise related to training injuries (Strains, Inflammation, etc.), Guide on recuperation is key

An individual’s fitness program will be different if they are?

Health risk

the severity or likelihood of an adverse health outcome due to an exposure to environmental, biological, or social conditions

Health risk appraisal

refers only to the INSTRUMENTS used to assess health risk

Health risk assessment

refers to the overall process in which the health risk appraisal instruments are used

Health improvements in a population, Reduce healthcare costs, Has a significant impact on direct healthcare spending within 5 years, Want to move them from high to low risk, Foster a healthy quality of life culture, Smoke, ETOH consumers, elevated BMI, Text while driving, no seat belts, Risky behaviors

HOW DO HRAS PROVIDE BASELINE DATA TO TRACK HEALTH IMPROVEMENTS IN A POPULATION

Worksite stress, Unprotected sex with multiple, short-term partners, Use illicit drugs, or abuse prescription medications, Can be a wake up call for the patients when they receive the results, Allows you as the healthcare provider an opportunity to broach sensitive topics

HOW DO HRAS PROVIDE BASELINE DATA TO TRACK HEALTH IMPROVEMENTS IN A POPULATION

the sooner we lower the risk the cheaper it is

Sum up this chart

Address underlying determinants of health, Tailor approaches to each individual’s unique environment and circumstances, Transfer day-to-day responsibility for personal healthcare management to the patient, Emphasize ongoing communication & education, Normalize healthy behavior, Change attitudes, Promote healthy environments (Healthy eating options/exercise etc.)

Uses of HRAs

Do use them to be more efficient and effective, Do select the right tool, Do realized advantages and limitations, Don’t assume HRA equals clinical eval (patients may lie), Don’t neglect the ethics (HIPAA, DV)

Dos and Don’ts of HRAs

32% Heart disease and stroke, 29% from lung cancer, 21% from COPD, 8% other cancer (renal, esophageal, oral), 10% other causes

How do smokers die?

Bluish- colored skin and lips, Tend to take deeper breaths but cannot secure the optimal level of O2

Describe a blue bloater (chronic bronchitis)

Thin, breathing rapidly, and is pink, Pursed lip breathing

Describe a pink puffer (emphysema)

low education, males, young adults, south and midwest, LGBTIAQ+, below poverty level, disabled, certain races/ethnicities

Smoking remains high among which population

3-5%

A 10% increase in cigarette has reduced overall consumption

young adults (2-3x)

A price of cigarette affects which populations smoking choices?

10 years

If you quit at 30 y/o this increases your lifespan by

8 years

If you quit at 40 y/o this increases your lifespan by

6 years

If you quit at 50 y/o this increases your lifespan by

3-4 years

If you quit at 60 y/o this increases your lifespan by

Nicotine is highly addictive, causes euphoria, reaches the brain quickly, cravings, becomes a pavlov response

Why do people smoke

Dysphoria/depressed mood, Insomnia, Irritability, frustration, or anger, Anxiety, Difficulty concentrating, Restlessness, Decreased heart rate, increased appetite/weight gain

Big time withdrawal symptoms of smoking

Ask about smoking, Advise about smoking, Assess their willingness to quit, Assist those are willing to quit, Arrange for follow up

5As of smoking

Every patient, every visit, every H&P, Include in vital signs, Congratulate never smokers, encourage former smokers, advise current to quit

Ask about smoking includes:

First Line -Nicotine delivery systems, Bupropion (Wellbutrin), Varenicline (Chantix); Second line - Clonidine, Nortripyline

Pharm therapy for smoking

treatment focus is to provides steady nicotine levels to eliminate withdrawal and reinforcing "hits” (Patch, gum, lozenge, inhaler, nasal spray) - 8-12 weeks (if smoking >10 cigs/d, apply highest dose patch daily Q 6 wks, then titrate to lower doses Q 2 wks each sequentially)

Tell me about nicotine therapy

low risk for heart disease could be 10x more likely to a false positive, Could lead to an unnecessary cath (approximately 39% of asymptomatic have had an EKG despite this)

Should Healthy and 40-60 → EKG or stress test (ER VISITS DO NOT COUNT)

if there’s no symptoms there’s no benefit, 75% of tests that reveal a high PSA level turn out to be false alarm, False postive leads to stupid unneeded stuff, CONSIDER 55-69 y/o, Don’t test if they are going to die in 10 years

Should Males over 40 → PSA

This is radioactive, Find the protein in 30-40% of people who are asymptomatic, Unable to predict which individuals with plaques will develop the disease

If you have a memory issue → PET

Only needed every 3 years, With 1 negative HPV test → only HPV test every 5 years, Over 65 y/o with normal pap smears → you can discontinue testing

All adult women → Pap smear

Mild osteopenia may not be cost effective, risk of fracture is low and the risk for significant side effects, no evidence that the medications provide much benefit

Women 50-65 → DEXA (osteopenia, osteoporosis)

Peeps with normal risk should begin screening at 50 and repeat every 10 years, If normal at 75 → never again

Over 75 → colonoscopy

Little evidence that annual check up keeps people healthy, Results of specific tests should be used to determine frequency, schedule based on need

All adults → annual checkup

Best imaging technology in the world is often inadequate at determining the cause of back pain, Most will go away in a month, imaging tests often leads to expensive procedures

Lower back pain →Xray, CT, MRI

DASH

A diet rich in fruits, veggies, and low fat dairy foods, can substantially lower bp in individuals with HTN and high normal bp. The greatest potential is in African Americans and the elderly

Decrease in systolic and diastolic in ENTIRE study group

Increased fruits and veggies to 8.5 servings

Significant decrease in systolic and diastolic bp in both groups, greatest drop was in systolic in HTN group (11.4 mmhg)

Combination - add 2-3 servings of low fat dairy to fruit and veggie diet

Linked to 27% less strokes, 15% decrease in heart disease

Study outcomes for DASH - 10 year follow up period

No (just eat them)

Are antioxidant supplements recommended?

MAY help with cholesterol level if use to replace animal products (minimal otherwise)

Benefits of Soy proteins

associated with decreased risk of CVD (use with caution as it is high fat)

Benefits of mediterranean diet

Control Macros and fiber, Increased fruits and veggies to 8.5 servings, Combination - add 2-3 servings of low fat dairy to fruit and veggie diet

DASH arms → not sodium restricted

7-8 servings of grains, 4-5 servings of veggies, 4-5 servings of fruit 2-3 servings of low fat dairy, 2 (or less) servings of meat, poultry, fish, 2-3 servings of fats and oils, limit sweets, nuts, seeds, and dry beans 4-5 times/week

The DASH diet includes

Cigarette smoking, Hypertension >140/90 mmHg or on medication, Low HDL-C (<40 mg/dl), Family history of premature CHD (male first degree relative<55; female<65), Age (men >45 years, women 55 years)

Adult Treatment Panel III (ATP III) targets LDL goals what can impede this

Beta Carotene → Higher risk of lung cancer in smokers taking this

Antioxidants and smoking

C. Botulinum

Home canned foods

campylobacter

Poultry, raw milk

Clyclospora

Imported berries

E. coli

Ground beef, produce, water, animal contact

listeria monocytogenes

Ready to eat meats, soft/pale cheeses

norovirus

Ill food handlers, produce, shellfish

★ M/C cause of viral gastroenteritis

salmonella

Meat, eggs, raw meat, animal contact

toxoplasmosis

cat feces, raw meat (pork, lamb, venison)

vibrio

Shellfish

yersinia

pork products (chitterlings)

final prep and cookin

What point in the chain of production of farm to table do we target?

ingestion of undercooked meat, contaminated food or water, contact with infected animals

Clin. Pres.: diarrhea, cramps, malaise, fever, N/V

TX: fluids + azithro (kids) or cipro (adults)

No risk to pregnancy

High burden in infants, especially <1 y.o.

★ M/C cause of bacterial gastroenteritis

Campylobacter quirks

#1 Cause of Traveler’s Diarrhea

Characterized by bloody diarrhea and cramps but can be ASx

cattle/deer via contaminated food/water or infected person to person

Unpasteurized dairy/undercooked ground beef

prevention=improved sanitation, personal hygiene, and avoid undercooked ground beef/unpasteurized dairy/fruit juices

TX: FQ for adults & azithro for kids

★ 6% of cases progress to HUS (hemolytic uremic syndrome)

E.Coli quirks

Acute viral infection

CP: fever, fatigue, dark urine, +/- jaundice, nausea, anorexia, abd pain or asymptomatic

Reservoir = humans

Resolves on its own, but very infectious viral infection

Primarily Foodborne transmission. Can be sexual transmission

Incubation 28-30 days

Children at high risk, vaccine available for 2+ y.o.

Typically seen in daycares and schools typically seen in school age kids and young adults

Hep A quirks

Parasite

Infections mild and symptoms include malaise, fever, fatigue, and

lymphadenopathy

Reservoir: cats and other felines (others=swine, cattle, sheep, goats, rodents, and birds)

Infections in immunocompromised are severe

TX: Sulfadiazine or Pyrimethamine

Ingestion of undercooked meat, Ingestion of oocytes passed in feline feces through contact w/ litter or soil, Vertical transmission

Toxoplasmosis Quirks

Bacterial Illness

Diarrhea, abd cramps, tenderness, N/V, and fever or ASx

2 types: Typhi and Non- typhi (m/c in US)

Serotypes: Contaminated egg products (enteritidis), beef (Newport), poultry (typhi)

TX: IV fluids + FQ for adults and azithromycin for kids

Infectious throughout course of infection

Amphibians/reptiles carry it

Children increased risk due to immature immune systems and hand-to-mouth contact

Quirks of salmonella

145

Cook steaks and roast to →

180

Cook whole poultry to →

160

Cook ground meat to →

165

Heat leftovers to →

40 or less

Refrigerate foods at →

Many different diseases are caused by contaminated foods (250+), For many of these, the source might be food, water, animal contact, or contact with ill people, For an individual case of illness, it is often impossible to know the source of the infection, Outbreaks let us learn specific course of infection, Individual cases are tracked regardless of whether or not they may be from food or other sources, Outbreaks of foodborne diseases, regardless of which microbes caused them (source-specific surveillance)

Core concepts in surveillance of food-borne outbreakes

17%

Obesity in children

start with 5 to 10 % of initial body weight

Guidance for obesity

Recent data suggest this may be better to estimate central adiposity, Correlates strongly with type II DM, CVD, HTN, and dyslipidemia risk (35” in women, 40” in men)

Waist Circumference

Weight loss has been shown to lower bp (independent of Na+ restriction), Weight loss from diet alone reduced both LDL cholesterol and triglycerides, Weight loss from a combination of diet and exercise decreased total cholesterol and increased HDL cholesterol

weight loss and chronic diseases

kg/height (meters) (25-29.99= overweight, 30 = obese, 40+ = extremely obese)

BMI formula

Osteoartritis really benefits from weight loss, Modest wt loss has been shown to improve both glucose tolerance and type II DM, lower BP

Benefits of weight loss

Lifestyle assessment (eating behavior, stress management, fitness assessment, work style) Disease/condition specific (Bronchitis and COPD, Pain, menopause, depression, PTSD, insomnia, skin cancer, heart disease, diabetes, osteoporosis), Age-based (adolescents, young adults, older adults, seniors), Gender-based (Cancers, Bone density loss, Depression, STI), Environmental (chemicals, biologicals, insects–safety, lead contamination, sports safety, hurricane prep, depleted uranium exposure, asthma triggers)

Types of HRAs

1. Don’t be afraid to address underlying determinants of health

2. Tailor approaches to each individual's unique environment and circumstances

3. Use shared decision making

4. Transfer day-to-day responsibility for personal healthcare management to the patient

5. Emphasize ongoing communication and education

Engaging and powering