Preventive Medicine, Screening, and Lifestyle Recommendations in Healthcare

Primary prevention, secondary prevention, and tertiary prevention

What are the 3 categories of preventive medicine?

primary prevention

Removing or reducing disease risk factors before disease occurs.

secondary prevention

Early detection of disease

tertiary prevention

Limiting the impact of an established disease

heart disease, cancer, unintentional injuries

What are the three leading causes of death in the U.S. listed in the lecture?

tobacco smoking

What is the leading preventable risk factor contributing to deaths from all causes?

Hypertension, overweight/obesity, physical inactivity, hyperglycemia, and high LDL cholesterol

Which major risk factors were listed after tobacco smoking?

main functions of the history and physical exam

- Information collection

- determination of patient values

-assessment/communication of prognosis

- establishment of a therapeutic relationship - discussion of diagnostic testing and treatment options

- counseling, education, and motivation for behavior change.

determination of patient values

Which function of the H&P focuses on understanding a patient's priorities and preferences?

compliance

behavior coinciding with clinical advice

adherence

- The extent to which a patient's behavior corresponds with agreed recommendations from a healthcare provider

- behavior corresponding with agreed recommendations between patient and provider.

forgetfulness, busy schedule, changing routine, being away from home

list the main reasons for poor adherence

additional causes of poor adherence

Psychiatric disorders, uncertainty about treatment effectiveness, lack of knowledge of consequences, treatment side effects, cost

adherence improvement

Goal agreement, education, convenient care, simplified regimens, reminders, monitoring, support systems.

screening test

To identify disease in a seemingly well person.

criteria for screening test

Significant disease burden, high-quality test, evidence of decreased morbidity/mortality, acceptable risk of harm

USPSTF

United States Preventive Services Task Force.

high, moderate, and low certainty

What three levels of certainty does USPSTF use?

USPSTF Grade A recommendation

Recommended service with high certainty of substantial net benefit.

USPSTF Grade B recommendation

Recommended service with moderate certainty.

USPSTF Grade C recommendation

Selective recommendation because benefit is small

USPSTF Grade D recommendation

Recommends against the service.

USPSTF Grade I recommendation

Insufficient evidence.

major preventative methods for infectious disease

Immunizations, travel recommendations, and improving vaccination rates.

travel related vaccines

Cholera, Japanese encephalitis, meningococcal meningitis, polio, rabies, typhoid, yellow fever, tick-borne encephalitis, tuberculosis.

adult physical activity recommendation

At least 150 minutes of moderate-intensity aerobic activity plus muscle-strengthening activities at least 2 days/week.

physical activity benefits

Weight management, lower chronic disease risk, and improved quality of life.

components of physical fitness

Cardiorespiratory fitness, musculoskeletal fitness, flexibility, balance, and speed.

"weekend warrior"

Accumulating exercise primarily on weekends.

diet

SINGLE MOST SIGNIFICANT risk factor for disability and premature death

dietary patterns

DASH, Mediterranean, MyPlate, Vegetarian/Vegan

dietary approaches to stop hypertension

DASH

benefits of DASH

Decreases BP, CVD risk factors, obesity risk, and type 2 diabetes risk.

mediterranean diet

Fish, olive oil, fruits, vegetables, whole grains, legumes/nuts.

benefits of mediterranean diet

Reduced risk of type 2 diabetes, cancer, cognitive decline, obesity, CVD, and mortality.

vegan/vegetarian diet

Plant-based foods including grains, oils, nuts, seeds, legumes, fruits, and vegetables

vitamin B12, iron, calcium

Which vitamin and mineral deficiencies are concerns in vegetarian/vegan diets?

½ cup or 1 medium fruit

What is a serving size of fruit?

¼ cup (1 oz)

What is a serving size of nuts?

1 tbsp

What is a serving size of oils/fats?

Coronary heart disease and cerebrovascular accident

What are two major causes of morbidity and mortality in developed countries?

modifiable and nonmodifiable

What two broad categories of cardiovascular risk factors exist?

cigarette smoking

It is a major preventable cause of morbidity and mortality and increases risk for nearly everything.

yes

Does quitting smoking help if done later in life?

men age 65-75 who have never smoked

Who should receive one-time AAA screening?

adults 18 and older

Who should receive universal blood pressure screening?

adults 40-75

What age group should undergo routine lipid screening?

Overweight/obese adults ages 40-70

Who should be screened for diabetes according to the slide?

primary cancer prevention

Smoking cessation, UV protection, diet/physical activity, vaccines, screening, and early detection.

annual mammogram

Breast cancer screening recommendation for women ages 40-54?

biennial mammogram

Breast cancer screening recommendation for women 55+?

PAP smear every 3 years

Cervical cancer screening for women 21-29?

PAP smear plus HPV testing every 5 years

Cervical cancer screening for women 30-65?

45-75

Colorectal cancer screening age range?

every 10 years

What is the colorectal cancer colonoscopy interval listed?

30 pack years

What defines a smoker for lung cancer screening in this lecture?

injuries

What is the most important cause of loss of potential years of life before age 65?

patient education

What is the most important intervention for injury prevention?

injury prevention counseling

Seat belts, smoke detectors, CO monitors, poison control, sunscreen, helmets, texting while driving, gun safety.

intimate partner violence

Physical, emotional, sexual, or financial abuse by a current or former partner

Escalation in frequency and severity over time

What important pattern is seen with IPV?

4 types of IPV

Physical violence, sexual violence, stalking, psychological aggression

Verbal/nonverbal communication intended to mentally/emotionally harm or control another person

psychological aggression

Greater severity correlates with greater physical and mental health impact

What relationship exists between abuse severity and health outcomes?

psychological effects of IPV

Anxiety, depression, substance abuse, eating disorders, PTSD, sleep disorders, low self-esteem, fear of intimacy

IPV screening times

Suspicious symptoms, pregnancy, initial primary care/OB visits, ED visits, hospital admissions

Domestic violence, victim, abused, battered

During IPV screening, what words should be avoided?

IPV screening tools

HITS, STAT, WAST, HARK, SAFE, OVAT

Assess for immediate significant harm

What is the first priority if IPV screening is positive?

the heart

Which organ does cardiovascular disease damage?

the pancreas

Which organ is impaired in diabetes mellitus?

brain

What does a substance use disorder "hijack"?

SUDs are medical illnesses

Why is "just say no" not enough?

substance use disorder

A medical illness caused by repeated misuse of substances causing significant impairment in health, function, or relationships.

substance use

Use, even once, of any psychoactive compound

substance misuse

Use of a substance in a manner, amount, situation, or frequency that can cause harm

recovery

A process of change through which individuals improve wellness and strive to reach their full potential

10 DSM-5 subcategories

Alcohol, caffeine, cannabis, hallucinogens, inhalants, opioids, sedatives/hypnotics/anxiolytics, stimulants, tobacco, other/unknown substances

intoxication

A reversible set of symptoms caused by recent substance use or exposure.

withdrawal

Behavioral, physical, and cognitive symptoms occurring after abrupt reduction or cessation of use

DSM-5

How are SUDs diagnosed?

moderate drinking

Up to 1 drink/day for women and 2 drinks/day for men.

low risk drinking for women

≤3 drinks/day and ≤7 drinks/week.

low risk drinking for men

≤4 drinks/day and ≤14 drinks/week

binge drinking

Men ≥5 drinks or women ≥4 drinks on one occasion (about 2 hours).

heavy drinking

Binge drinking on 5 or more days within the past month.

alcohol screening test

Amount, frequency, context, age at first use, last use, past/current use.

alcohol screening

CAGE, TACE, AUDIT.

drug screening

Modified CAGE and DAST-10

SDOH

Contextual environmental factors that can produce health inequities.

SDOHs

Poverty, education quality, food insecurity, transportation access, housing, unemployment, utilities, violence, public safety.

SDOH screening tools

PRAPARE, AAFP Social Needs Screening Tool, AHC-HRSN Screening Tool

newborn screening topics

Congenital heart disease, genetic/metabolic disorders, hearing impairment, hyperbilirubinemia

school-aged child screenings

Depression, dyslipidemia, hearing, hypertension, obesity, scoliosis, SDOH, vision.

food insecurity

What is the Hunger Vital Sign screening question used to assess?

unintentional injury

What is the leading cause of death among school-age children in the U.S.?

10-24 years

What age range is traditionally considered adolescence?

adolescent visits

Mental health, substance use, sexual health, teen dating violence, diet/exercise/eating disorders, and safety.

teen screening tools

PHQ (depression), CRAFT+N (substance use), and SCOFF (eating disorders)

depression

PHQ