Discussion: Significance of nutrition and obesity
Define the characteristics of a good screening test. Describe the recommendation for cancer screening for common cancers for an adult male patient (e.g., lung, colorectal, and prostate). Describe the significance of nutrition and obesity in health promotion and disease prevention. Propose an exercise program for a sedentary patient. Formulate timely vaccinations based on age, medical conditions, lifestyle, and environment. Perform smoking cessation counseling for patients who smoke. Describe principles that guide behavior change counseling.
RISE Mnemonic for Preventive Visits
Risk factors: Identify risk factors for serious medical conditions during history and physical exam. Immunizations: Provide recommended immunizations/chemoprophylaxis. Screening tests: Order appropriate screening tests. Education: Educate patients on ways to live healthier while reducing risks for disease.
Most Frequent Causes of Death for a 55-Year-Old Male in the U.S.
malignant neoplasm heart disease unintentional injury (accident) chronic lower respiratory disease diabetes mellitus chronic liver disease and cirrhosis CVA
Risk Factors for CVD and ASCVD
Most of a person’s risk for CVD and for stroke (together called atherosclerotic cardiovascular disease, or ASCVD) can be determined by a limited set of major risk factors. Major risk factors:
hypertension high cholesterol diabetes tobacco use
Other minor risk factors are only helpful if they adjust a patient’s risk category from that determined by the major risk factors. sedentary lifestyle stress premature family history excess alcohol use and many more (e.g. obesity, poor diet, high homocysteine levels, etc.)
American College of Cardiology/American Heart Association (ACC/AHA) guidelines recommend assessing major ASCVD risk factors every four to six years in adults age 20 to 79 who are free from ASCVD. For more required information about risk factors for ASCVD, read the Aquifer Cholesterol Guidelines Module. Although a complete review of systems should always be asked, symptoms related to cardiovascular disease should definitely be included:
Leg pain with activity may indicate claudication, a manifestation of peripheral atherosclerotic disease.
© 2020 Aquifer 1/11
Chest pain with activity may indicate angina pectoris, a manifestation of coronary artery atherosclerosis.
Effects of Alcohol
The effect of alcohol on health is complex. For some people, even mild alcohol use carries major risks. For others, moderate alcohol use may offer a degree of protection. At this time, there is no consensus about whether one form of alcohol is better or worse than another. Regardless of type of alcohol, drinkers should drink in moderation: up to one drink per day for women; up to two drinks per day for men. Effects of moderate alcohol intake: The best-known effect of moderate alcohol intake is a small increase in HDL cholesterol. However, regular physical activity is another effective way to raise HDL cholesterol, and niacin can be prescribed to raise it to a greater degree. Alcohol or some substances such as resveratrol found in alcoholic beverages may prevent platelets in the blood from sticking together. That may reduce clot formation and reduce the risk of heart attack or stroke. (Aspirin may help reduce blood clotting in a similar way.) How alcohol or wine affects cardiovascular risk merits further research, but right now the American Heart Association does not recommend drinking wine or any other form of alcohol to gain these potential benefits. Effects of red wine: Over the past several decades, many studies have been published about how drinking alcohol may be associated with reduced mortality due to heart disease in some populations. Some researchers have suggested that the benefit may be due to wine, especially red wine. Others are examining the potential benefits of components in red wine such as flavonoids and other antioxidants in reducing heart disease risk. The linkage reported in many of these studies may be due to other lifestyle factors rather than alcohol. Such factors may include increased physical activity, and a diet high in fruits and vegetables and lower in saturated fats. No direct comparison trials have been done to determine the specific effect of wine or other alcohol on the risk of developing heart disease or stroke. Effects with certain chronic diseases: Patients with heart failure, cardiomyopathy, diabetes, hypertension, arrhythmia, obesity, hypertriglyceridemia, or who are taking medications may have adverse effects from alcohol ingestion. It is not always possible to identify those who will develop alcoholism, therefore screening all adult primary care patients to identify at-risk people and counseling is recommended as a preventive strategy. The Alcohol Use Disorders Identification Test (AUDIT) is the most widely validated screening tool. It consists of 10 items and takes two to three minutes to complete, and longer to score. AUDIT-C is a brief version of the AUDIT comprising three questions scaled 0 to 12: Discussion: Significance of nutrition and obesity
“How often do you have a drink containing alcohol?” “How many standard drinks containing alcohol do you have in a typical day?” “How often do you have six or more drinks on one occasion?”
A score of 4 in men and 3 in women is considered positive. An even briefer screening test, the Single-Item Alcohol Screening Questionnaire (SASQ), has been shown to be highly effective in primary care. “How many times in the past year have you had X drinks in a day (X = 4 for women, 5 for men). Any answer above zero is considered a positive screen. The American Heart Association cautions people to NOT start drinking if they do not already drink alcohol.
Adult Immunization Recommendations
CDC website and free immunizations app (called “Shots”) from The Society of Teachers of Family Medicine. Relevant immunization recommendations:
Influenza is recommended annually. Current recommendations recommend substituting a one-time dose of Tdap for Td booster (tetanus and diphtheria) for ages 11 to 64 to provide additional pertussis protection, then boost with Td every 10 years. Adults who smoke should receive a pneumococcal 23-valant polysaccharide vaccine (PPSV23). The CDC now recommends the recombinant zoster vaccine (Shingrix) be given to every adult at age 50. This is a two- vaccine series given two to six months apart. Adults over 60 who previously received the live zoster vaccine (Zostavax) should be re-vaccinated with the recombinant vaccine.
Live vaccines, like Zostavax (also MMR, OPV, and Varicella), should not be administered to immunocompromised patients, their close contacts, or to pregnant women.
Characteristics of a Good Screening Test
Medical screening should be considered for conditions that are important health problems that can be treated and have a latent phase of a disease enabling early detection and more timely treatment, impacting the outcome of the disease. The screening test should be acceptable to patients at reasonable cost. Since patients without symptoms are being screened, the overall prevalence of the condition in the population will be low. The goal is to identify cases at an early stage; thus, an effective screening test should have very good sensitivity (identify most or all potential cases) and high specificity (label incorrectly as few as possible as potential cases). Remember that even a test with a specificity of 95% will lead to many false positives when the prevalence of the condition is very low. Discussion: Significance of nutrition and obesity
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