Tuesday, June 25, 2024

Levels of Prevention and Preventive Screenings by Age, Sex, and Risk Factors

 

In the realm of healthcare, prevention is a cornerstone for maintaining optimal health and well-being. Prevention can be broadly categorized into three levels: primary, secondary, and tertiary. Each level plays a crucial role in safeguarding our health by addressing potential health issues at different stages—from preventing diseases before they occur to managing chronic conditions to avoid further complications.

However, the effectiveness of these preventive measures relies heavily on compliance with recommended screenings and interventions. Preventive screenings are essential tools in the early detection and management of diseases. They help identify health issues at an early stage when treatment is often more effective and less costly.

In this article, we will delve into the three levels of prevention, exploring the various strategies employed at each stage and their significance in the healthcare continuum. Additionally, we will highlight the critical importance of adhering to recommended preventive screenings. By understanding and complying with these recommendations, we can take proactive steps towards a healthier future, reduce the burden of disease, and improve overall quality of life. 


The three levels of prevention are: primary, secondary, and tertiary.

Primary Prevention: This level aims to prevent a disorder from occurring in the first place. Methods include:

  • Vaccinations
  • Counseling to modify high-risk behaviors
  • Occasionally, chemoprevention

Secondary Prevention: This involves early detection and treatment of disease, often before symptoms arise, to reduce serious outcomes. Methods include:

  • Screening programs (e.g., mammography for breast cancer, DXA for osteoporosis)
  • Contact tracing and treatment for partners of individuals with sexually transmitted infections to control disease spread

Tertiary Prevention: This level focuses on managing chronic diseases to prevent complications or further damage. Methods include:

  • For diabetes: Blood sugar control, good skin care, regular foot exams, and exercise to prevent cardiovascular issues
  • For stroke survivors: Taking aspirin to prevent another stroke
  • Providing rehabilitative services to prevent deterioration and enhance quality of life, such as rehab after injuries, heart attacks, or strokes
  • Preventing complications in those with disabilities, such as avoiding pressure sores in bedridden patients.


In the United States, preventive screening tests are recommended based on age, sex, and risk factors. The following are common preventive screening tests recommended by health organizations such as the U.S. Preventive Services Task Force (USPSTF):

For Adults:

General Health:

  • Blood Pressure Screening: Regular checks for hypertension, starting at age 18.
  • Cholesterol Screening: Men aged 35 and older, and women aged 45 and older, or younger if at high risk for coronary heart disease.
  • Diabetes Screening: Adults aged 35 to 70 who are overweight or obese, or earlier if at increased risk.
  • Body Mass Index (BMI): Regular checks for overweight and obesity.


Cancer Screening:

  • Colorectal Cancer: Screening for adults aged 45 to 75 using fecal occult blood testing, sigmoidoscopy, or colonoscopy.
  • Breast Cancer: Mammography every 1-2 years for women aged 50 to 74, or earlier based on risk factors.
  • Cervical Cancer: Pap smear every 3 years for women aged 21 to 65, or every 5 years with HPV testing for women aged 30 to 65.
  • Lung Cancer: Annual screening with low-dose CT for adults aged 50 to 80 who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years.
  • Prostate Cancer: PSA-based screening for men aged 55 to 69 based on individual decision-making.

Bone Health:

  • Osteoporosis: Bone density testing for women aged 65 and older, and younger women at increased risk.

Infectious Diseases:

  • HIV Screening: Routine screening for adolescents and adults aged 15 to 65.
  • Hepatitis C: One-time screening for adults aged 18 to 79.
  • Sexually Transmitted Infections (STIs): Screening for chlamydia, gonorrhea, syphilis, and other STIs based on age and risk factors.


Other Screenings:

  • Abdominal Aortic Aneurysm: One-time screening for men aged 65 to 75 who have ever smoked.
  • Depression: Regular screening for all adults.
  • Vision and Hearing: Periodic screening for older adults based on risk factors and symptoms.

For Children and Adolescents:

General Health:

  • Newborn Screening: Blood tests for genetic, metabolic, and endocrine disorders.
  • Growth and Development: Regular checks of growth and developmental milestones.
  • Vision and Hearing: Screening at regular intervals.

Infectious Diseases:

  • HIV Screening: For adolescents at increased risk.

Other Screenings:

  • Lead Screening: For children at risk of exposure.

For Pregnant Women:

  • Blood Pressure Screening: At each prenatal visit.
  • Gestational Diabetes: Screening at 24 to 28 weeks of gestation.
  • Hepatitis B: Screening at the first prenatal visit.
  • HIV Screening: At the first prenatal visit.
  • Syphilis Screening: At the first prenatal visit.
  • Rh(D) Incompatibility: Blood typing and antibody testing for Rh(D) negative women.


These recommendations may vary based on individual health conditions and risk factors, so it is important to consult healthcare providers for personalized screening schedules. 

 Whether you are seeking to prevent illness, detect issues early, or manage an existing condition, knowledge and action are your best allies in maintaining good health.

 

Source:

 Tools of Prevention - Fundamentals - Merck Manual Consumer Version (merckmanuals.com)

Recommendation Topics | United States Preventive Services Taskforce (uspreventiveservicestaskforce.org)



Tuesday, June 11, 2024

Enhance Your Garden with This Edible Flower: A Haven for Bees and Beauty

Did you know that planting calendula can increase the presence of bees and other pollinators in your garden? Also known as pot marigold, this vibrant and cheerful flower not only adds aesthetic appeal to your outdoor space but also provides an essential food source for these crucial insects. Discover how this adaptable plant can transform your garden into a thriving pollinator hub.



What is Calendula & Why Should You Grow It?

Calendula, a low-maintenance annual flower from the daisy family, features bright orange and yellow blooms that are popular for their vivid colors and ease of cultivation. Often referred to as the “poor man’s saffron,” calendula’s edible fresh petals can add color and flavor to salads, while dried petals can impart a golden hue to cheeses or act as a tasty, cost-effective saffron substitute. Growing calendula not only brings a burst of freshness to your meals and elegance to your garden but also supports local pollinators.



How Calendula Attracts Bees & Other Pollinators

Calendula flowers are rich in nectar and pollen, which attract bees and other pollinators. The bright colors of the flowers serve as visual signals to pollinators, enticing them to gather these valuable resources. The shape and structure of the calendula flowers provide easy access to nectar and pollen, making them an ideal nutritional source for pollinators. Planting calendula helps create a welcoming environment for bees and other pollinators.



The Role of Calendula Flowers in Bee Nutrition & Health

Calendula flowers offer bees a vital source of nutrition, supplying them with ample nectar and pollen. These flowers provide essential nutrients, including antioxidants and other beneficial compounds, supporting bee health. By consistently providing calendula flowers, you contribute to the overall well-being of local bee populations.



Additional Benefits of Calendula

Beyond attracting bees, calendula brings numerous advantages to your garden. The flowers act as a natural pest repellent, deterring aphids and other unwanted pests. Calendula also has medicinal properties, making it a popular choice for herbal remedies. Additionally, the plant’s leaves and stems can be used as natural dyes, adding a bright touch to your garden. Incorporating calendula into your garden allows you to enjoy a wide range of benefits beyond just attracting pollinators.


Sources: (PDF) Evaluation of Selected Ornamental Asteraceae as a Pollen Source for Urban Bees (researchgate.net)

 Public domain | Free High-Resolution CC0 Art, Photos & Illustrations - rawpixel

Monday, June 3, 2024

Medication Safety for the Elderly

 Medication Safety for the Elderly


If you are taking care of an elderly parent or a practitioner taking care of geriatric patients, please read this for safe medication administration.

Polypharmacy, typically described as the use of five or more medications, is more prevalent among older adults than other age groups. This practice often leads to adverse drug reactions due to errors associated with polypharmacy and frequently results in emergency department visits by older adults. 

The Beers Criteria is a tool designed to identify medications that pose a high risk to older adults, aiming to discontinue those that may cause adverse drug events. This approach promotes better medication selection and quality of care while reducing unnecessary drug costs. 

The American Geriatrics Society updates the Beers Criteria list every three years. Below is a summary of the 2023 Beers Criteria updates: 

DOACs- direct-acting oral anticoagulants such as dabigatran (Pradaxa), rivaroxaban (Xarelto), apixaban (Eliquis), edoxaban (Savaysa), and betrixaban (Bevyxxa).

Sulfonylureas are oral type 2 anti diabetic pills that help to lower blood sugar levels by stimulating the pancreas to create more insulin. Examples are glipizide, glimepiride, and glyburide.

Examples of proton pump inhibitor are esomeprazole (Nexium), pantoprazole (Protonix), lansoprazole (Prevacid) and omeprazole (Prilosec).

HFrEF means Heart failure with reduced ejection fraction.


Sodium-Glucose Transport Protein 2 inhibitors (SGLT2i) examples are Dapagliflozin (Forxiga), Empagliflozin (Jardiance), and Ertugliflozin (Steglatro).

Prasugrel is a platelet inhibitor used to prevent formation of blood clots. 
Trimethoprim-Sulfamethoxazole or Bactrim is an antibiotic used to treat ear infections, urinary tract infections, bronchitis, and pneumonia. 

ARNI (angiotensin receptor/neprilysin inhibitor) are medications used to treat heart failure. Sacubitril/valsartan is the only ARNI drug available now in the US.

                                          
Some examples of anticholinergic agents are atropine, scopolamine, ipatropium, tiotropium.

Due to their potential to cause central nervous system (CNS) depression, skeletal muscle relaxants included on the Beers list are carisoprodol, chlorzoxazone, cyclobenzaprine, metaxalone, methocarbamol, and orphenadrine.

ARBs or angiotensin receptor blockers are antihypertensive drugs like losartan, valsartan, candesartan, olmesartan.

SSRI or selective serotonin reuptake inhibitors are antidepressants such as Citalopram (Celexa), Escitalopram (Lexapro), Fluoxetine (Prozac), Paroxetine (Paxil, Pexeva), Sertraline (Zoloft).

Baclofen is a muscle relaxant that may cause drowsiness or dizziness. People with low eGFR or glomerular filtration rate or with kidney disorders should avoid use.

NSAIDs or non-steroidal anti-inflammatory drugs are added to the medications to be avoided for renal patients or use renal or lower dose.


Note: Please consult your doctor before discontinuing any medications. 




Source: Beers Criteria Updates Handout (ashp.org)

American Geriatrics Society 2023 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults (sbgg.org.br)

What are Direct-Acting Oral Anticoagulants (DOACs)? (heart.org)

Levels of Prevention and Preventive Screenings by Age, Sex, and Risk Factors

  In the realm of healthcare, prevention is a cornerstone for maintaining optimal health and well-being. Prevention can be broadly categori...