Preventative med 2

Which state has an adult obesity prevalence of <20%?

None.

How many states have an obesity prevalence of 35% or greater?

4 states

What geographical region has the highest prevalence of obesity at 31.2%? And second at 30.7%? And third at 26.4%? And fourth at 25.2%?

US south.

Midwest

Northeast

West.

What are the etiologies of obesity?

Genetics. 30-40% risk

Environment

Metabolic

Behavioral issues.

How much has the prevalence of obesity increased in the last 10 years?

by 40%.

What are the major obesity related comorbidities?

CVD

T2DM

Hypertension

Dyslipidemias- last to change with weight loss.

What percent of T2DM patients are obese?

80%

BMI >31 increases the risk of T2DM in women by how much?

40 fold increase. (100-4000)

BMI >35 increases the risk of T2DM in men by how much?

40 fold increase

What is the obesity prevalence in African American women and men, and Hispanic women and men?

African American women: 57%

African American men: 37%

Hispanic women: 47%

Hispanic men: 36%

What BMI percentile characterizes a child being overweight?

85% percentile

What BMI percentile characterizes a child being obese?

95% percentile

What are the components of a nutrition assessment?

Anthropometric (weight, height, BMI, pinching fat, recent weight loss- intentional or non intentional)

Biochemical- labs (fasting)

Clinical/history

Dietary evaluation (24 hour recall, food frequency, food diary, diet/nutrition history)

The state of being created by the interaction between nutrition and physical activity is defined as?

Physical Fitness.

What are the four sub-domains of Physical Fitness?

Cardiovascular endurance. (Cardiorespiratory.)

Musculoskeletal fitness.

Flexibility.

Optimal Body Composition.

Muscle movement that increases energy expenditure is

Physical activity.

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

Heart disease.

Stroke

HTN

T2DM

Falls/hip fractures

Osteoperosis

Early Mortality.

What percent of US adults perform the recommended amount of physical activity?

<50%

What percent of US adults admit to doing no leisure time physical activity at all?

25%

What percent of high school students participate in at least 60minutes of physical activity per day?

<30%

Epidemiology of physical activity.

Lower in southern states.

Higher in western states.

Lower in black adults.

Highest in white adults.

Lower in older adults.

Higher in younger adults.

Lower in less educated.

Lower in decreased SES.

What are the physical activity recommendations for children and adolescents?

At least 60 minutes of physical activity per day. (muscle strengthening and bone strengthening at least 3 days per week)

What are the physical activity recommendations for adults?

150 minutes of moderate-intensity aerobic activity every week.

Muscle strengthening activities on 2 or more days a week that work all major muscle groups.

What are the varying factors in an individual fitness program?

Trying to maintain or improve overall health.

Trying to significantly improve physical fitness.

Training for an athletic competition.

Advise related to training injuries.

Guide on recuperation is key.

Refers only to the instrument used to assess health risk?

Health risk appraisal.

The severity or likelihood of an adverse health outcome due to an exposure to environmental, biological, or social condition.

Health risk.

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

Health risk assessment.

What are the uses of an HRA?

Provide baseline to track health improvements in a population.

Identify behavioral and environmental health risks in individuals.

Reduce healthcare costs.

Has a significant impact on direct healthcare spending within 5 years.

Foster a healthy quality of life culture.

Examples of baseline data HRAS provide to track health improvements in a population?

Smoke, ETOH consumers, elevated BMI, text while driving, no seat belts, risky behavior.

Examples of individual behavior and environmental risks HRAS provide?

Worksite stress, unprotected sex with multiple, short term partners, use of illicit drugs or abuse prescription meds.

These can be a wake up call for patients when they receive the results and allows the provider an opportunity to broach sensitive topics.

What is the relationship between cost age and risk level?

The older a patient is, the greater the cost, the higher risk the patient is, the greater the cost. So young, low risk patients cost the least. Older, high risk patients cost the most.

What are the 6 goals of HRAs?

• Address underlying determinants of health.

• Tailor approaches to each individual's unique environment and circumstance.

• Transfer day to day responsibility for personal healthcare management to the patient.

• Emphasize ongoing communication and education.

• Normalize healthy behavior. (Change attitudes.)

• Promote healthy environments. (healthy eating options/exercise. ect)

Ideas to make use of HRAs.

Use them to make your work more efficient and effective. (staff should execute)

Select the right tool for the right job. (use age appropriate HRA)

Know the advantages and limitations of self-reported data.

HRA does not equal a clinical evaluation.

Note ethical considerations. (HIPPA, domestic violence.)

What are the 5 types of HRAs?

Lifestyle assessment.

Disease/Condition specific.

Age-based.

Gender-based.

Environmental (chemicals, biological, insects.)

How do smokers tend to die?

32% ischemic heart disease and stroke.

29% lung cancer

21% COPD

8% other cancers

10% other causes.

What are the 2 types of COPD?

Chronic bronchitis. Blue bloaters, tend to take deeper breathes but cannot secure the optimal level of O2.

Empysema. Pink puffers, thin rapid breathing, pursed lip breathing.

Symptoms of chronic bronchitis (blue bloater).

Chronic, productive cough.

Purulent sputum.

Hemoptysis.

Mild dyspnea initially.

Cyanosis.

Peripheral edema.

Crackles, wheezes.

Prolonged expiration.

Obesity.

Symptoms of emphysema (pink puffer)

Dyspnea.

Minimal cough.

Increased minute ventilation.

Pink skin, pursed lip breathing.

Accessory muscle use.

Cachexia.

Hyperinflation, barrel chest.

Decreased breath sounds.

Tachypnea

What are the populations that still have high cigarette smoking habits?

Low education.

Males.

Young adults.

South and midwest.

LBGTQ.

Below poverty level.

Disabled.

Certain races/ethnicities.

What is the average cigarette price in the US and at what price percentage increase will reduce overall cigarette consumption by 3-5%?

$8-9 per pack.

10% increase.

How many years does a lifespan increase after quitting tobacco? Ages 30, 40, 50, 60.

30: 10 year increase

40: 8 year increase.

50: 6 year increase.

60: 4 year increase.

It's never too late.

Why do people smoke?

Nicotine is highly addictive. Euphoria, reaches the brain quickly, cravings.

What are the withdrawal symptoms of cigarettes? (develop in 3 days, peak in 3-7 days, wane by 7-14 days)

Dysphoria or depressed mood.

Insomnia.

Irritability, frustration, anger.

Anxiety.

Difficulty concentrating.

Restlessness.

Decreased heart rate.

Increased appetite or weight gain.

What can we do as providers for smokers? (5 As)

• Ask about smoking- every patient at every visit. Include in vital signs (3xs greater change of discussion)

• Advise about smoking.

• Assess their willingness to quit.

• Assist those who are willing to quit.

• Arrange for follow up.

Pharmacotherapy for smoking cessation. (First line and second line)

First line: nicotine delivery systems/ Bupropion (Wellbutrin)/Varenicline (Chantix)

Second line: Clonidine/Nortriptyline.

What is the goal of nicotine therapy and how is it applied?

Treatment focus is to provide steady nicotine levels to eliminate withdrawal and reinforcing hits.

Five forms: patch, gum, lozenge, inhaler, nasal spray. 8-12 weeks, decrease in increments.

"All healthy people between 40-60 should have an annual EKG or exercise stress test" Why is this wrong?

Low risk person could be 10x more likely to get a false positive.

Leads to unnecessary procedures such as heart catheterization.

Despite this data, approximately 39% of asymptomatic people in this age group had an EKG over the previous 5 years.

"All male over age 40 should have a PSA test to screen fro prostate cancer". Why not?

In med with usual risk and no sx, the test may cause more harm than benefit. 75% turn out to be false alarms.

False positives lead to unneeded ultrasounds, repeat lab tests and biopsies.

Consider only for 55-69 years old.

PSA test should not be done in asymptomatic individuals that are expected to live less than 10 years.

"Adults with memory issues should have a pet scan to screen for alzeimers disease" Why not?

Effectiveness of the test in diagnosis Alzheimer in a clinical setting is nebulous at best. Test has low validity and is unable to predict which individuals with plaques will develop the disease.

"Adult women should have an annual Pap test to screen for cervical cancer" Why not?

Women of average risk only need to test ever 3 years.

Women with negative test for HPV only need Pap test along with HPV test every 5 years.

Women over 65 who have normal pap smears in a row can discontinue testing.

"Women between the ages of 50 and 65 should have a bone density scan to screen for oseopenia and osteoporosis" Why not? Focus on agees.

Testing and treatment for women between 50-65 with mild osteopenia may not be cost effective. Risk of fracture low and risk for ADR is high. NO evidence that medication provide much benefit.

"Colonoscopy should be part of routine screening for 75 year olds" Why not?

People with normal risk should begin screening at 50 and repeat every 10 years if the test is normal.

If all tests are normal, at 75, no additional testing needed. ADR outweighs benefit.

"Annual checkup" Why not.

Little evidence that annual check ups keep healthy people healthy.

Results of specific tests should be used to determine frequency of visits.

"Adults with lower back pain should have an x-ray, CT scan or MRI" Why not?

Imaging technology is often inadequate at determining the cause of back pain.

Majority of LBP goes away in a month without treatment.

Imaging tests often lead to expensive procedures that often do not help recovery.

What was the decrease in stroke rate and heart disease in the participants of the DASH diet?

27% less stroke rate.

15% decrease in heart disease.

What was the beautiful outcome of the fruit and vegetable diet?

Decease in systolic and diastolic blood pressure in both groups and in the hypertensive subgroup.

What was the outcome of the combination diet ? Where was the greatest drop?

Significant decrease in both systolic and diastolic blood pressure in both groups. The greatest drop was in systolic BP in hypertensive group.

What were the 3 arms of the Dash Study?

Control -average US diet.

Fruits and Veggies- increased to 8.5 servings.

Combo- Add 2-3 servings low fat dairy to fruit and veggie diet.

NONE of the three were sodium restricted.

What were the elements of the DASH diet?

7-8 servings of grains and grain products.

4-5 servings of veggies

4-5 servings of fruits

2-3 servings of low fat dairy products.

2 or less servings or meat, poultry, and fish.

2-3 servings of fats and oils.

Nuts, seeds and dry beans 4-5 times per week.

Limited sweets low in fat.

Source of C. Botulinum

Home canned foods

Source of Campylobacter

Poultry, raw milk.

Source of Cyclospora

Imported berries.

Source of E. Coli

Ground beef, produce, water, animal contact.

Source of Listeria monocytogenes

Ready to eat meats, pate, soft cheeses.

Source of Norovirus.

Ill food handlers, produce, shellfish.

Source of Toxoplasmosis

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

Source of Salmonella.

Meat, eggs, raw milk, animal contact.

Source of Vibrio

Shellfish.

Source of Yersenia

Port products (chitterlings)

Source of Shigella.

contaminated food and fecal-oral person to person contact.

Source of Hepatitis A.

Foodborned.

Bacterial illness Shigella. What is the tx, where do outbreaks typically occur, and how can this best be prevented?

Tx: fluids, azithromycin.

Outbreaks are common in daycare and school settings.

Hand washing can help prevent.

Bacterial illness, Salmonella, characterized by diarrhea, abdominal cramps, tenderness, nausea/vomiting and fever. What is the treatment in adults and children, and what are the reptile precautions that should be observed?

Tx: IV fluids, floroquinolones for adults and azithromycin for kids.

Incubation 8-12 days post consumption, 12-36 hours (range 6 hours-7 days)

Prohibit sale of pet turtles, and sale of other reptiles should be restricted.

What is the treatment for campylobacter?

Fluids, azithromycin or ciprofloxacin.

What is the most common cause of bacterial gastroenteritis in the U.S.?

Campylobacter.

What is the number one cause of travelers diarrhea?

E. coli.

What are the symptoms and treatment for e.coli?

Diarrhea (often bloody) and cramps.

Tx. fluroquinolones or azithromycin.

What is a classic sign of listeria monocytogenes? What are the treatments?

Still neck, muscle aches, fever, headache.

Tx: ampicillin, gentamicin.

How can Listeria affect pregnant women? When are most diagnosis made?

Septic abortion, stillbirth, neonatal sepsis/meningitis.

3rd trimester of pregnancy.

Viral infection with fever, fatigue, malaise, loss of appetite, nausea, abdominal pain, dark urine, and jaundice. What is it? What is the treatment? Who is it common among?

Hepatitis A.

Tx: none. goes away on it's own.

School age children and young adults. Also frequent in day care centers with diapered children.

How many diseases can be caused by contaminated foods?

more than 250.

What are the main ways a person might contract a disease? (speaking about FBI)

Food, water, animal contact, contact with other ill person.

How can you definitively know the source of an infection?

You might not. For many illnesses it is often impossible to know the source.

What provides the best opportunity to learn the specific source of infection?

Outbreak.

What is the generic chain production from farm to table and what measures are taken at each step to ensure safety of the food?

Production: on farm sanitation, safety of animals food and water biosecurity, and other good agriculture practices.

Processing: Factory sanitation, quality control HACCP, inspection and other good manufacturing processes.

Pathogen killing step. Pasteurization, retort canning.

Final preparation and cooking- foodhaldler certification, consumer education, restaurant inspection.

what are the ATP III risk factors that modify LDL goals?

Cigarette smoking.

Hypertension >140/90 or on meds.

Low HDL-C (<40 mg/dl)

Family history of premature CHD (male first degree relative <55, female <65)

Age (men >45, women >55)

What is the recommendation regarding antioxidant supplements?

Potential harm with antioxidant supplements (I.e. higher risk of lung cancer with beta-carotene supplements in smokers, and increase risk of heart failure and total mortality from high dose vitamin E supplements)

Supplements not recommended, food sources of antioxidant nutrients are.

AHA on soy protein.

Minimal evidence of a direct cardiovascular health benefit from consuming soy protein. Some benefit is soy protein is used to replace animal and dairy products that contain SFA and cholesterol.

AHA on fish oil supplements.

Fish intake is associated with decreased risk of CVD. Pts without documented CHD eat fish, preferable oily, 2x weekly.

Pts with documented CVD should consume 1 gram per day, preferable oily fish, though supplements can be considered with physician input.

Mediterranean Diet.

High in fat, especially MFA (olive oil), fish, nuts, low in red meat, associated with decreased risk of CVD.

Emphasizes fruits, root veggies, flax, and canola.

AHA states that high fat diets should be used with caution.

What are the lifestyle change recommendation for CVD Risk Reduction?

Balance calorie intake and physical activity.

Consume diet rich in veggies and fruits.

Choose whole grain, high fiber foods.

Consume fish (oily preferred) at least 2x weekly.

Minimize intake of beverages and foods with added sugars.

Choose and prepare goods with little or no salt.

If you must imbibe, do so in moderation.