HPPM Cards from Outline (7-12-26)

What are the top causes of death in America?

Heart disease, cancer, unintentional injury

Health Promotion

encourages well-being and is oriented toward the actualizing of human potential and thus is positive/attractive to the client

Health Protection

directed toward a desire to actively avoid illness, to detect it early, or to maintain function within the constraints of illness

Disease Prevention

similar to health protection in that one is taking action to thwart the disease process by finding ways to modify the environment, behavior, and bodily defenses so that the disease processes are eliminated, slowed, or changed

What did the WHO rank the US for overall health system performance?

37th out of 191 countries

What did the WHO rank the US for level of health?

72nd out of 191 countries

What are the criteria the ranking countries by the WHO?

Equity of distribution, preventable deaths, utilization of existing health resources

Risk factors

personal characteristics, physiological parameters, symptoms, or preclinical disease states that increase the likelihood that an individiaul has or will develop a particular disease

Frequency

measured in terms of incidence or prevalence

Severity

measured by morbidity, mortality, survival rates, quality of life, functional status, overall well-being

Relative Risk

ratio between the risk of disease among persons with the risk factor and the risk among those without the risk factor

(Ex: those who smoke and get lung cancer vs those who don't smoke and get lung cancer)

Absolute Risk

actual proportion of persons with the risk factor who will develop the disease

(Ex: All people who develop lung cancer vs entire population)

Population-Attributable Risk

proportion of the population affected due to exposure

(ex: those who smoked and developed lung cancer vs everyone who developed cancer)

Sensitivity

a test's ability to designate an individual with disease as positive

Specificity

a test's ability to designate an individual who does not have disease as negative

Positive predictive value

probability that a patient with a positive/abnormal test result actually has the disease

Negative predictive value

probability that a person with a negative/normal test result truly is disease-free

What are the potential consequences of a false positive test result?

Cause unecessary worry for the patient, patient undergoes unecessary testing/treatment, extra healthcare costs, time

What are the potential consequences of a false negative test result?

Patient doesn't get the necessary treatment and this could cause death or false sense of security

Communicable disease

illness caused by an infectious agent or its toxins that occurs through the direct or indirect transmission of the infectious agent or its products from an infected individual or via an animal, vector, or inanimate environment to a susceptible host

Non-Communicable Disease

disease that are not spread through infection or other people but are usually caused by unhealthy behaviors

Explain why non-communicable diseases are a community health concern

NDCs are the leading cause of death and disability globally and kill more than 3/5 people worldwide. Responsible for more than half of the global burden of disease

Nosocomial infection

aka Healthcare Associated Infections (HAIs). infections acquired while receiving healthcare that was not present at the time of admission

Community Acquired Infection

infection acquired outside a hospital or diagnosed within 48 hours of admission without any previous healthcare encounters

Common types of healthcare associated infections (HAIs)

C. Diff, catheter-associated urinary tract infection (CAUTI), cenral line-associated bloodstream infection (CLABI), MRSA, surgical site infections, ventilator associated pneumonia

Modes of transmission for HAIs

- Contact (direct or indirect)

- Respiratory droplets

- Airbone Spread

- Common vehicle

High risk populations for HAIs

very young people, very old people, those with weakened immune systems, patients who had surgery, patients with long hospital stays

What is a health maintenance schedule?

- a protocol that describes the preventive services a practice intends to offer and a system to ensure that the schedule is implemented

- defines goals of a given practice for delivering preventive services

What are the benefits of a health maintenance schedule?

- common statement of minimum standards of preventive care

- ensures patients are consistently being provided with preventive health care

- alignment among clinicians on the importance of preventive medicine

Developing a health maintenance schedule

1. Plan for offering preventive services

2. Clinician reminder plan

3. Patient reminder plan

4. Plan for engaging patients

5. Incentive process

6. Audit/evaluation process

Barriers to implementing preventive sesrvices

- lack of time

- uncertainty about the value of preventive services

- conflict among recommendations

Immunization for adults

COVID-19

Diptheria

Influenza

Pneumonia

Pertussis

Shingles

Tetanus

Cons of live/attenuated vaccines

- can have side effects and allergies

- not recommended for pregnant woman

- not recommended for those who are immunocompromised

Tetanus

- causes painful muscle tightening and stiffness, usually all over the body

- can lead to tightening of muscles in the head and neck so you can't open your mouth, swallow, or breathe

- kills 1/10

- enters the body through cuts, scratches, or wounds

Diphtheria

- can cause a thick coating to form in the back of the throat

- can lead to breathing problems, heart failure, paralysis, and death

Pertussis

AKA Whooping Cough

- caues severe coughing spells, which can cause difficulty breathing, vomiting, and disturbed sleep

- can also lead to weight loss, incontinence, and rib fractures

- complications can lead to hospitalization, pneumonia, or death

TD/TDAP immunization schedule

1 dose of Tdap, then TD booster every 10 years

For pregnancy, 1 dose of Tdap during each pregnancy, preferably in early gestional weeks

Shingles (Herpes Zoster)

- reactivation of Varicella Zoster

- painful rash appears unilaterally on the face or body and heals within a few weeks

- post herpetic neuralgia

- can cause blindness: Herpes Zoster Opthalmicus

- risk increases with age

What cranial nerve is affected by Shingles?

Trigeminal nerve (5th), ophthalmic branch

How could you get Shingles from another person?

You can't catch Shingles from someone else, however, if you've never had Chickenpox or the Chickenpox vaccine, you could get Chickenpox from someone with Shingles

What are the two types of the Herpes Zoster vaccine?

Recombinant (dead) shingles vaccine: RZV- Shingrix

Live Shingles Vaccine: ZVL Zostavax

Herpes Zoster vaccine schedule

Two doses 2-6 months apart are recommended for adults 50 and older

What Herpes Zoster vaccine is more effecetive in preventing Shingles?

Recombinant shingles vaccine is more than 90% effective

Pneumococcal pneumonia

- caused by bacteria that can spread from person to person

- can cause ear infections and can lead to pneumonia, bacteremia, or meningitis

What groups are most at risk for pneumococcal pneumonia?

children under 2 years of age, adults 65 years and older, people with certain medical conditions, cigarette smokers

Pneumonia vaccine recommendations

If patient is healthy at age 65, 1 dose of PCV20 (Prevnar 20) OR 1 dose of PCV15 followed by a dose of PPSV23 given at least 1 year after the PCV15 dose

Cut off values for A1C

Normal: less than 5.7

Prediabetic: 5.7-6.4

Diabetic: 6.5 and greater

Antigenic drift

small mutations over time when replicating

Antigenic shift

abrupt, major change in the influenza A viruses, resulting in new hemagglutinin (H) and/or new hemagglutinin and neuraminidase (N) proteins in influenza viruses creating a novel virus

What is another name for the H1N1 Pandemic of 1918?

Spanish Flu

What is another name for H5N1?

Avian Flu

- high virulent

- mortality rate is 60%

What is Type B Influenza?

Seasonal flu

Trivalent influenza vaccine

2 influenza A (H1N1 and H3N2) and an influenza B virus

Quadrivalent influenza vaccine

protects against the same viruses as the trivalent vaccine and an additional B virus

What ages is recommended to take the inactivated influenza vaccine (IIV)?

6 months to 64 years old

FluMist (LAIV)

Quadrivalent, live flu virus for 2 year-64 year olds

What populations are contraindicated to get FluMist?

pregnant women and immunocompromised

FluZone High Dose

double the standard dose for ages 65 years of age and older

FLUAD

Adjuvant (an ingredient of a vaccine that helps promote a better immune response) for ages 65 and older.

Why do you stop screening?

- short life expectancy

- when the patient decides they will not treat if something was found

- when the patient refuses

Screening test

- method for detecting disease or body dysfunction before an individual would normally seek medical care

- asymptomatic patients

Diagnostic tests

confirm or rule out a medical condition in an individual with concerning symptoms or an out-of-range screening result

What patient population should be screened for blood glucose?

- adults aged 40-70 years old who are overweight or obese

- earlier screening in those with higher risk: family hx of diabetes, personal hx of gestational diabetes or PCOS

What certain racial and ethnic groups are at higher risk for developing diabetes and should be screened earlier?

Afrian American, American Indians, Alaska Natives, Asian Americans, Hispanics/Latinos, Native Hawaiians or Pacific Islanders

What is the interval for blood glucose testing when patient's have had a normal test?

every 3 years

Types of blood glucose screening tests

- Fasting Plasma Glucose (FPG) test

- Hemoglobin A1C

- 2 hour post load plasma glucose (2 hr PG)

What does a fasting lipid profile consist of?

total cholesterol

LDL-C (bad fat)

HDL-C (good fat)

triglyceride (food fat/stored in fat cells)

What is the recommendation/screening guideline for total cholesterol and lipid profiles?

all adults 20 years and older should have a FASTING LIPID PROFILE

What is the screening interval for total cholesterol and lipid profiles?

- at least every 5 years as part of an assessment for cardiovascular risk

- shorter intervals may be needed for those who are close to warranting therapy based on CVD risk

- longer intervals may be acceptable for those who don't have increased CVD risk and have repeatedly normal levels

What patient population should get a total cholesterol and lipid profile?

all adults aged 20 years and older

What are the USPSTF guidelines for total cholesterol and lipid profile testing?

- for adults aged 40-75, the focus from determining populations to be screened for dyslipidemia to populations who should be prescribed statin therapy based on CVD Risk

- from 21-39 years, clinicians should use clinical judgement

What are the ACOG guidelines for screening women for total cholesterol and lipid profiles?

- begin at 45 years old

- screening for ages 19-44 should be based on risk factors

What are the AHA guidelines for total cholesterol and lipid profiles?

all adults 20 years and older have a fasting lipid profile assessed every 4-6 years and CVD risk

Types of screening tests for HIV

- Initial ANA screening: Enzyme-Linked Immunosorbent Assay (ELISA)

- Standard test for diagnosing: Repeatedly reactive enzyme immunoassay HIV-1 EIA

- Confirmatory test: Western Blot OR immunofluorescent assay

What test identifies those with HIV?

a positive result on both the enzyme assay and confirmatory test

Patient population at increased risk for HIV infection

- men who have had sex with men after 1975

- men and women having unprotected sex with multiple partners

- past or present injection drug users

- sex workers

- individuals whose past or present sex partners were HIV-infected, bisexual, or injection drug workers

- trans women

- persons being treated for STIs

- persons with a history of blood transfusion between 1978-1985

USPSTF guidelines for HIV testing

- sexually active adolescents and adults aged 15 to 65 years

- all individuals at risk for HIV

- those who receive medical care in high-risk settings (STI clinics, correctional facilities, homeless shelters)

- pregnant women in first trimester

- rapid screening for those women who present in labor with unknown HIV status

- annually

Types of screening tests for Syphilis (bacterium Treponema pallidum)

- Venereal disease research laboratory (VDRL) or Rapid Plasma Reagin (RPR) tests

- followed by a confirmatory fluorescent treponemal antibody absorption assay (FTA-ABS) or Treponema pallidum particle agglutination (TP-PA) test

What identifies individuals with Syphilis?

positive results on the confirmatory FTA-ABS pr TP-PA

What patient populations are at increased risk for Syphilis infection?

- men who have sex with men (MSM) and engage in high-risk sexual behavior

- commercial sex workers

- persons who exchange sex for drugs

- adults in correctional facilities

What are the recommendation/screening guidelines for Syphilis?

- all asymptomatic high-risk adolescents and non-pregnant adults

- MSM or persons living with HIV at 3 months intervals

- all pregnant women: at first prenatal visit and repeat screening early in the third trimester and at delivery for all high-risk women

Patient populations that are recommended to get screened for Gonorrhea and Chlamydia

- all sexually active women aged 24 years and younger, women at high risk, and pregnant women

- annually for non-pregnant women

- screening of pregnant women should be offered in the first trimester, followed by repeat screening in third trimester for those at high risk

Is routine gonorrhea and chlamydia screening recommended for men?

Not recommended except in adolescents and young adult males who have sex with males and engage in high-risk behaviors or who are in high-risk settings

Types of screening tests for gonorrhea and chlamydia

culture, nucleic acid amplification tests, nucleic acid hybridization tests (nucleic acid probes)

How are cultures collected to screen for gonorrhea and chlamydia?

endocervical swabs or cervical swabs in women and urethral swabs in men

- urine specimen can be used for both

Based on patient sexual behaviors, what other types of swabs can be used for gonorrhea and chlamydia?

Posterior nasopharynx tonsillar arches, and anal samples

Patient populations that are at high risk for TB

- those with HIV

- close contacts of persons known or suspected of having TB

- persons with medical conditions that increase the risk of infection (immunocompromised pts)

- immigrants from countries with high prevalence of TB

- medically underserved or low income

- alcohol abuse, injection drug uses

- residents of long-term institutions like nursing homes

- healthcare providers

Tuberculin Skin Testing

- most commonly performed using the Mantoux test (known quantity of purified protein derivative (PPD), which is injected intradermally

Describe the Mantoux Test

- tuberculin syringe is used to inject 0.1 mL of five tuberculin units of PPD intradermally on the volar surface of the forearm

- injection should produce a skin wheal measuring 6 to 10 mm

When should the patient return to the clinic after the Mantoux/Tuberculin skin testing and how is the injection site examined?

- patient should return to the clinic in 48-72 hours

- site is inspected for induration (erythema alone is insignificant)

- measure diameter of induration

What are the parameters for a positve TB skin test?

- positive test: diameter of induration is 5mm or more in HIV+ patients, recent contacts of people with infectious TB, organ transplant recipients, immunosuppressed patients, people with CXR findings suggestive of TB

- positive test: 10mm or more in patients from countries where TB is common, people who misuse drugs and alcohol, people who live and work in high risk settings, kids younger than 5, infants, adolescents exposed to adults in high-risk categories

- 15mm or more in all patients

What is the QuantiFERON-TB Gold Test?

- requires serum blood sample

- enzyme-linked immunosorbent assay test that detects the release of interferon-y in fresh heparinized whole blood from sensitized persons

What is the T-Spot.TB test?

- requires serum blood sample

- detects and enumerates effector T Cells that have been specifically activated by Mycobacterium tuberculosis antigens

What are the type of screening test for abdominal aortic aneurysm (AAA)?

Abdominal ultrasonography

An AAA is present when the infrarenal aortic diameter exceeds what?

3 cm

At what diameter is an AAA considered at increased risk for rupture?

larger than 5cm

Screening guidelines for abdominal ultrasound for AAA

males between ages 65-75 years with a current past history of smoking should be offered one-time screen

What are the recommendations for one-time AAA screening per the Society for Vascular Surgery

- men 55 years or older with family history of AAA

- all men 65 years or older

- women 65 years or older who have smoked or have a family history of AAA

Prediabetes

blood glucose levels are higher than normal but not high enough to be diagnosed as diabetes

Prediabetes usually occurs in people who already have what?

Insulin resistance or whose beta cells in the pancrease aren't making enough insulin to keep blood glucose in normal range