Medical Science- Preventive Health

Primary Preventive Medicine

Remove or reduce disease risk factors

Secondary Preventive Medicine

early detection of disease

Tertiary Preventive Medicine

limit impact of established disease

Top 3 leading causes of death in the US

Heart disease, cancer, unintentional injuries

Functions of History and Physical Exam Step 1

collect information

Functions of History and Physical Exam Step 2

Determination of patient values

Functions of History and Physical Exam Step 3

Assessment and communication of prognosis

Functions of History and Physical Exam Step 4

Establishment of therapeutic relationship

Functions of History and Physical Exam Step 5

Discussion of diagnostic testing and therapeutic options

Functions of History and Physical Exam Step 6

Counseling, education and motivation for behavioral changes

Patient Adherence

extent patient corresposnd with clinical advice in the longterm

Patient centered

behaviors

Patient Compliance

extent patient coincides (agrees) with clinical advice

provider centered

understand and follows agrees to directions/instructions in the short term

How to improve adherence

better education

clinician- patient goals agreement

simple treatment regimens

reminders

monitoring

support system

Screening tests

a way to identify a disease/condition in a seemingly well person

Screening test determination

burden of disease sufficiency (presence)

test is high quality

evidence shows screening can decrease morbidity and mortality

risk of harm

USPSTF Standardized system Grade A

recommends service with high certainty

USPSTF Standardized system Grade B

recommends service with moderate certainty

USPSTF Standardized system Grade C

selective recommends with small/low benefit

USPSTF Standardized system Grade D

Recommends against service

USPSTF Standardized system Grade I

not enough evidence

Prevention of Infectious disease immunization scheldules

Pediatric

adult

travel recommendations

Prevention of Obesity in Adults, amount of exercise

Minimum of 150 min of moderate-intensity aerobic activity + muscle strengthen activity (twice a week)

Benefits of physical activity

weight management

decreased risk for chronic health conditions

improved quality of life

Components of Physical Fitness

cardiorespiratory

musculoskeletal

flexibility

balance

speed

Risks for physical activity

the “weekend warrior”

injury prevention

What is single most significant risk factor for disability and premature death

Diet

Dietary Patterns

DASH (Dietary Approaches to Stop Hypertension)

Mediterranean diet

2015 Dietary Guidelines for Americans (My Plate)

Vegetarian/vegan

some of the most significant causes of morbidity and mortality in developed countries

coronary heart disease

cerebrovascular accident

Cigarette Smoking

•SIGNIFICANT cause of preventable morbidity and mortality

•Increases the risk for (almost) EVERYTHING!

•Active vs passive smoking

•Quitting at ANY age can increase life expectancy

Ways to prevent cancer

UV light restriction/sunscreen

smoking cessation

vaccines

diet and physical activity

screenings and early detection

Most important casue of loss potential years of life before 65

injury prevention through PATIENT EDUCATION

Intimate Partner Violence

unrecognized and under addressed worldwide

escalation in frequency and severity over-time

Forms of Intimate Partner Violence

Physical

emotional

sexual

financial abuse

stalking

verbal

all by current/former partner

Effects of Intimate Partner Violence

Physical Effects = direct to the abuse and development of chronic medical conditions

Psychological Effects= anxiety, depression, PTSD, sleep disorders, low self- esteem

When to screen for Intimate Partner Violence

• patients with suspicious or physical signs of violence

• pregnant women

• initial primary care and OB/Gyn visits

• all ED visits

• all hospital admissions

How to screen for Intimate Partner Violence

Avoid using harsh terms (use hurt, frightened, treated badly or mirror patient word choice) never say victim, abused or violence

Tools

HITS (Hurt, Insult, Threatened, Scream), STAT (slapped, Threatened and Throw), WAST (Women Abuse Screening Tool), HARK (Humiliation, Afraid, Rape, Kick), OVAT (Ongoing Violence Assessment Tool)

must assess for risk of immediate significant harm

Substance Use Disorder

medical illness caused by repeated misuse of a substance or substances

impairs health, social, occupational, and relationship

Substance Use

any use EVER (once or more) of any psychoactive

substances like alcohol, opioids, tobacco ect

Substance Misuse

Use of any substance in a manner situation, amount or frequency that can cause harm to user or others

Addiction

old term used for severe SUD

Recoverey

a process of change through which individuals improve their health and wellness

Substance Use Disorders

Dependence Syndromes

Substance Induced Disorders

Intoxication syndromes (when substance is present) , withdrawal syndromes (lack of substance sue to reduction or cessation), mental disorders

DSM used to diagnose

Alcohol use types

Moderate= 1 drink/day for women, 2 drink/day for men

Low risk= women no more than 3 drinks for women, and 7 drinks for men a week

Binge= consuming excessive amount of alcohol on a single occasion (in 2 hours). 5+ men, 4+ for women

Heavy= bindge drinking on 5+ days or more in the past month

Screening for Alcohol Use Disorder

Need to know amount, frequency, context, age of first use, last time used

tools

CAGE/Tace an AUDIT (Alcohol Use Disorders Identification Test)

Screening for Illicit Drigs

Includes “street drugs” and prescription drugs used incorrectly

need to knows:

amount

type

route

frequency

context

age of first use

Tools

CAGE

Social Determinants of Health

Types:

Poverty

education

food insecurity

access to transportation

unemployment

maintenance of basic utilities

violence

safety

Screening in Infants and Young Children

Catch medical problems and psychosocial concerns

anticipatory guidance/health promotion

Methods

Newborn screening test

monitoring the growth and development

Considerations in tests

–Speech & language

–Autism

–Developmental delay

–Lead levels

–Maternal depression

–Psychosocial concerns

Health maintenance and screening school-age children

goals:

health promotion

disease detection

patient education

considerations:

psychosocial review

developmental surveillance

school performance/chronic absences

Leading cause of death school-age children

unintentional injury

prevention:

education of safety precaution

tell parents to act as role models

Age of Adolescents and Young Adults

10-24 years

more likely to access healthcare and have favorable attitude to clinicians when confidentiality is assured

-60% of young adults don’t get private discussion time

Risks/ risks behaviors in Adolescents

Motor Vehicle Accidents (22%)

unintentional injuries (20%)

suicide (15%)

50% of STI’s occur in adolescents

Improtant topics to cover with adolescents

mental health (depression/anxiety) - self injury

sexual health (opportunity to address sexual orientation, gender identity, and safe sexual practices)

substance use

teen dating violence (different than Intimate partner violence)

diet/exercise, and eating disorders (healthy diets for growth/appetite surge, consideration for athletes, screen for risky eating patterns obesity, eating disorders- anorexia nervosa, avoidant-restrictive food intake disorder

safety (violence, sports related concussion, social media)

Screening tools for eating disorders

SCOFF

make yourself SICK

no CONTROL of eating

ONE or more times or being preoccupied by fat

think you FAT

does FOOD dominate your life

Dual Reasoning Processes

used for diagnostic process System 1 of reasoning and System 2 reasoning

Diagnostic Errors

faulty knowledge, faulty data, faulty information processing

Diagnostic Process Step 1

Identify the problem

Diagnostic Process Step 2

Frame Differential Diagnoses (possible conditions/diseases)

Diagnostic Process Step 3

Organize possible differential diagnoses

Diagnostic Process Step 4

Limit Differential diagnoses (use pivotal point to eliminate less possible diagnoses)

Diagnostic Process Step 5

Explore Diagnoses using Patient Physical and History findings

Diagnostic Process Step 6

Rank Differential Diagnoses by approaches

Diagnosis approach

Possibilistic approach= All possible diseases

probabilistic approach= how probable each disease is

prognostic approach= long term plan with diagnosis

pragmatic approach= solve diseas aliment in present time

Diagnostic Process Step 7

Test hypotheses using testing and screening

Diagnostic Process Step 8

re-rank differential diagnoses with new data from tests

Diagnostic Process Step 9

re-test new hypothesis with new particular diagnosis ideas