Community and Preventative Medicine

Community and Preventative Medicine Preventative Medicine 

1° prevention includes disease prevention measures, such as counseling for at-risk behaviors, immunizations, and chemoprevention, that are taken before the disease develops  2° prevention is defined as early detection and treatment of asymptomatic disease, including risk assessment  3° prevention is management of chronic diseases to prevent or minimize complications: Eg: insulin, chemo,  Characteristics that make a disease appropriate for screening are: dz leads to morbidity and mortality, dz detectable in the asymptomatic period, effective treatment available, testing is accurate and simple, tx in asymptomatic period yields a better outcome than tx in the sx period.  Characteristics of appropriate risk factors for screening are as follows: high prevalence of the risk factor in population, large % of those with the risk factor are unidentified, associated disease should have a high incidence in the population, dz have serious consequences, tx that can modify the risk factor should be readily available, Risk modification should ↓ disease incidence. Adult Immunization  Tetanus, diphtheria,pertussis: Give complete primary series if pt not previously vaccinated. First dose: Tdap; second dose: Td in 4 wk,       



3rd dose: Td in 6 mo . Tdap can replace for only 1 of the 3 Td doses in the series. Booster Td given every 10 years thereafter. Human papillomavirus: vaccination females 9–26 years of age with either HPV2 or HPV4 (3 doses).HPV4 licensed for use in males in 2009. Varicella: If pt w/ hx of chickenpox, consider immuned. Otherwise, vaccinate with 2 doses given 1–2 months apart. Zoster: Single dose recommended for adults 60 years of age regardless of whether they report a prior episode of herpes zoster. Measles, mumps,rubella: pt born before 1957, consider immuned. If born after 1957, 2 doses given at least 1 month apart.For rubella ensure childbearing female potential have immunity Influenza Routine annual influenza vaccination recommended for all persons aged 6 months, including all adult Pneumococcal(polysaccharide):give all pts > 65 years of age. immunocompromised or who have chronic diseases. Revaccinate pts>65 years if 1° vaccine > 5 years ago or are at high risk. Hepatitis A Vaccinate any person seeking protection or people of the following indications: MSM (men having sex w other men), chronic liver dz, persons traveling or working in endemic areas (Central or South America, Mexico, Asia (except Japan), Africa, and

eastern Europe. . Two doses should be given at least 6 months apart Hepatitis B Vaccinate any person seeking protection or people of the following indications: persons at high risk for STDs, health care personnel, end-stage liver disease patients, HIV-infected patients, chronic liver disease patients. Three dose series of Hep B should be given.

 Meningococcal Give to adults with asplenia, first-year college students in dormitories, military personnel. Cancer Screening  Skin Cancer: The USPSTF concluded insufficient to assess the balance of benefits and harms of using a whole-body skin examination or patient skin self-examination for the early detection of cutaneous melanoma, basal cell cancer, or squamous cell skin cancer  Cervical Cancer : screen for cervical cancer with Pap smear all women > 21years of age who sexually active and have a cervix (strongly recommended). Repeat screening at least every 3 years. Routine screening is not recommended for women > 65 years of age with a hx of adequate screening and not at high risk. Insufficient evidence to use HPV testing for screen for cervical cancer  Ovarian Cancer: not routinely screen Although the specificity for screening strategies is high, the positive predictive value is low because of the low prevalence of ovarian cancer in the general population. Risk outweighs benefit  Breast Cancer: Yearly mammograms are recommended starting at age 40 and continuing for as long as a woman is in good health. Clinical breast exam (CBE) about every 3 years for women in their 20s and 30s and every year for women 40 and over. Breast self-exam (BSE) is an option for women starting in their 20s  Prostate Cancer: screening men > 50 yoa, if pt expected to live at least 10 yrs. Screen earlier age if pts at increased risk (eg, AfricanAmerican men or those with a first-degree relative with prostate cancer).n No screen > 75 yoa  Colon Cancer: 50 years of age for colon cancer w/ annual fecal occult, sigmoidoscopy q 3–5 yrs, or colonoscopy every 10years (strong recommendation). Screen earlier if increase risk for colorectal cancer— it ptw/ personal or strong fhx of colorectal cancer, adenomatouspolyps, or a family history of a hereditary syndrome (familial adenomatouspolyposis, hereditary nonpolyposis colon cancer).n Do not screen for colorectal cancer in adults > 85 Adult health Maintenance: Age >18: Accidental injury (counsel), Alcohol misuse (screen and counsel), CAD (aspirin for men 45–79 years of age and women 55–79 years of age when the potential benefit due to reduction in MIs outweighs the potential harm due to an increase in GI bleeding. No screen >80), DM2( screen asx pt with BP>135/80), depression (screen), HTN (screen), Obesity (screen, counsel, behavioral intervention), Physical Activity (advise), Healthy diet (counsel pt with hyperlipidemia, risk factor of CVD or diet related chronic dz), second hand smoke( counsel),