Health care dana bartlett, bsn, msn, ma, cspi
Dental And Periodontal Disease And Oral Cancer
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- All adults be screened for hypertension
Dental And Periodontal Disease And Oral CancerRegular examinations and periodic cleanings by a dental hygienist clearly help prevent dental caries and periodontal disease. In addition, there is evidence that dental caries and periodontal disease are associated with systemic illnesses. The American Dental Association recommends that the frequency of dental visits and professional cleanings be determined on a case-by-case basis. People who have risk factors that increase the chances of developing dental caries and periodontal disease.Oral cavity and oropharyngeal cancers are a serious pathology. The American Cancer Society estimates that in 2016 approximately 48,000 Americans will develop oral cavity or oropharyngeal cancer and approximately 9,500 will die from one of these cancers.24Most of these cancers are not detected in the early stages and the five-year survival rate is 80% if they are detected when still in Stage I or Stage II.25 The primary risk factors for these cancers are alcohol use, tobacco use, and HPV infection.Although screening is recommended by many dental associations and dental professionals, unfortunately there is a lack of evidence to support the effectiveness of screening for oral cancer.25 By example, “The USPSTF found inadequate evidence on the diagnostic accuracy, benefits, and harms of screening for oral cancer. Therefore, the USPSTF cannot determine the balance of benefits and harms of screening for oral cancer in asymptomatic adults.”5 The American Dental Association in 2010 published guidelines about oral cancer screening. In brief, these guidelines noted that oral inspection and tactile palpation were the recommended screening tools. These guidelines also noted that the use of devices that rely on auto-fluorescence or tissue reflectance to detect oral cancers do not appear to be superior for this purpose when compared to conventional visual inspection and tactile palpation.26Coronary Heart Disease Coronary heart disease and its associated conditions are the leading cause of death in the U.S. Risk factors for the development of coronary heart disease includes those that are modifiable and non-modifiable. Modifiable risk factors include cigarette smoking, diabetes, diet, elevated serum lipids and cholesterol, hypertension, obesity, and sedentary life style. Non-modifiable risk factors are age, gender, and family history of coronary heart disease. The USPSTF does not recommend specific screening for coronary heart disease for asymptomatic adults who do not have coronary heart disease or diabetes.5 The USPSTF does recommend that people be screened for the presence of the risk factors for coronary heart disease and counseled on smoking cessation, diet, exercise and management of diabetes and hypertension. The American Heart Association’s specific guidelines for coronary heart disease risk factor screening are outlined below.
Starting at age 20, blood pressure measurement at each regular healthcare visit or at least once every two years if blood pressure is < 120/80 mm Hg.
Starting at age 45, measure blood glucose every three years.
Starting at age 20, measure total cholesterol, HDL and LDL cholesterol, and triglycerides every four to six years for normal people, more often if someone has an elevated risk for heart attack or stroke.
The American Heart Association’s specific guidelines for coronary heart disease risk factor screening may be found on its website.23 Hypertension Hypertension is one of the most important preventable causes of cardiovascular disease, diabetes, stroke, and renal failure.59, 60 Approximately 72 million Americans have hypertension, more than half are undiagnosed, and of those that are diagnosed, control of the disease has been described as suboptimal.60,61 Risk factors for the development of primary hypertension (the most common form of the disease) include but are not limited to the factors are listed in the table below.60
Hypertension is defined as a blood pressure of 140/90 mm Hg or higher.59 The USPSTF screening recommendations, derived from the the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure - JNC 7 Report, include the following.5
The diagnosis of hypertension cannot be confirmed until an elevated blood pressure is present on several occasions. Blood pressure can be measured in a physician’s office, by using ambulatory blood pressure monitoring, or using home blood pressure monitoring.60Diabetes Approximately 21 million Americans have diabetes and 37% percent of the population 20 years of age or older have pre-diabetes.35 Approximately 27.8% of people who have diabetes are undiagnosed, and almost half of Asian Americans and Hispanic Americans who have diabetes are undiagnosed.35,36 The prevalence of diabetes is increasing,37 and diabetes is the primary cause of, or a major contributing factor in, the development of many serious diseases such as blindness, heart disease, and kidney failure. There is evidence that suggests screening for and early treatment of diabetes can be beneficial.38-41 The American Diabetes Association (ADA) has recommendations for testing for diabetes or pre-diabetes in asymptomatic adults as set forth in the following table. Testing for Diabetes/Pre-diabetes in Asymptomatic Adults Testing should be considered in all adults who are overweight (BMI ≥25 kg/m2 or ≥23 kg/m2 in Asian Americans) and have additional risk factors, as outlined below.42
USPSTF Screening Recommendations The USPSTF screening recommendations for symptomatic adults with sustained blood pressure greater than 135/80 mmHg are recommended to screen for type 2 diabetes mellitus. These recommendations apply to adults with no symptoms of type 2 diabetes mellitus or evidence of possible complications of diabetes.5 Blood pressure measurement is an important predictor of cardiovascular complications in people with type 2 diabetes mellitus. The first step in applying this recommendation should be measurement of blood pressure (BP). Adults with treated or untreated BP >135/80 mm Hg should be screened for diabetes. The American Diabetes Association recommends screening with fasting plasma glucose (FPG), and defines diabetes as FPG ≥ 126 mg/dL; and, recommends confirmation with a repeated screening test on a separate day. The optimal screening interval is not known. The ADA, on the basis of expert opinion, recommends an interval of every 3 years. To determine whether screening would be helpful on an individual basis, information about 10-year coronary heart disease (CHD) risk must be considered. For example, if CHD risk without diabetes was 17% and risk with diabetes was >20%, screening for diabetes would be helpful because diabetes status would determine lipid treatment. In contrast, if risk without diabetes was 10% and risk with diabetes was 15%, screening would not affect the decision to use lipid-lowering treatment. The diagnostic criteria for diabetes are outlined below.42
Screening for medical complications that are caused by or associated with diabetes is very important. The following recommendations are from the ADA, Standards of Medical Care in Diabetes - 2016.43
Patients who are at risk for, or who have diabetes, should be screened for hypertension and blood pressure should be measured at every routine visit. A systolic blood pressure of ≤ 140 mm Hg or a blood pressure of < 140/90 m Hg is desirable. These levels have been associated with a reduction in CVD, nephropathy, and stroke in patients who have diabetes.
The Standards recommend that “... it is reasonable to obtain a lipid profile at the time of diabetes diagnosis, at an initial medical evaluation, and every 5 years thereafter, or more frequently if indicated.”43
Measure urinary albumin level and eGFR at least once a year in patients who have had type 1 diabetes ≥ 5 years, in all patients who have type 2 diabetes, and in all patients who have diabetes and hypertension.
Adults who have type 1 diabetes should have a dilated and comprehensive eye examination within five years of the time of diagnosis. Patients who have type 2 diabetes should have a dilated and comprehensive eye examination at the time of diagnosis. If the patient does not have retinopathy after one or more yearly examinations, then biennial examinations may be considered. If any level of retinopathy is discovered then dilated retinal examination should be done at least every year and if the retinopathy is progressing, more frequent examinations may be needed. For pregnant women who have diabetes, an eye examination should be done before pregnancy or in the first trimester. Subsequently, patients should be monitored each trimester and for one year, post-partum, as indicated by the degree of retinopathy.
Patients who have type 1 diabetes should be assessed for the presence of diabetic five years after the diagnosis is made. For patients who have type 2 diabetes, this assessment should be done at the time the diagnosis is made. The assessment should include a patient history, 10-g monofilament testing, and at least one of the following tests: pinprick, temperature, or vibration sensation.
A comprehensive foot evaluation should be done every year. The examination should include inspection of the skin, assessment of foot deformities, and a neurological assessment including 10-g monofilament testing and pinprick or vibration testing or assessment of ankle reflexes. The pulses in the feet and legs should be checked, as well.
Asymptomatic patients should not be screened for cardiovascular disease but cardiovascular risk factors should be assessed annually, at least. These risk factors include dyslipidemia, hypertension, family history of premature cardiovascular disease, presence of albuminuria, and smoking. Lipid Disorders The lipid disorders of elevated cholesterol and elevated triglycerides are an important factor in the development of atherosclerosis. Atherosclerosis contributes to the development of coronary heart disease, it is a risk factor for stroke, and it is considered to be the major cause of premature death in developed countries.72 Libby (2015) writes: “Abnormalities in plasma lipoproteins and derangements in lipid metabolism rank among the most firmly established and best understood risk factors for atherosclerosis.”72 The USPSTF advises that the benefits of lipid screening definitely outweigh the risks and that these populations should be screened for lipid disorders:5
Increased risk would be the presence of atherosclerosis or coronary heart disease, diabetes, family history of coronary heart disease, hypertension, obesity and smoking. Fasting total serum cholesterol, high-density and low-density cholesterol should be measured. The optimal interval for screening is not certain, but lipid measurement every five years in patients who are below the treatment threshold, and measurement at shorter intervals for people who have lipid levels that are close to those requiring therapy is recommended as a reasonable approach.5 Screening can be done at longer intervals if someone has no risk factors and repeated lipid measurements are normal. Obesity Obesity is a significant public health problem worldwide and in the United States. The prevalence of obesity in the U.S., has been estimated to be 35% for men and 40.4% for women.76 Obesity is a contributing factor for the development of many diseases, and people who are obese have an increased risk for cancer, coronary heart disease, depression, type 2 diabetes, gallbladder disease, osteoarthritis, respiratory problems, sleep apnea, and stroke.77 Screening for obesity is recommended5,78 and the USPSTF advises that adults age 18 and older be screened by using body mass index (BMI) and anyone with a BMI ≥ 30 kg/m2 “… should be offered or referred to intensive, multi-component behavioral interventions.”5 Additionally, “Screening combined with interventions can improve glucose tolerance and decrease risk factors for cardiovascular disease and the harms of this approach are considered to be small.”5 It should be noted that body mass index (BMI) is calculated by dividing weight in kilograms divided by the square of height in meters. Body mass index may not always be the most accurate way to determine whether or not someone is obese and in some circumstances measuring weight circumference is preferable. Osteoporosis Osteoporosis is a skeletal disorder that is characterized by decreased bone mass. Osteoporosis is very common, especially in the elderly. It is more common in women than in men, although with advancing age, many men develop osteoporosis as well. The National Osteoporosis Foundation estimates that 54 million Americans have osteoporosis/low bone mass,79 and the health consequences of this disease are significant. Osteoporosis does not produce symptoms, but there are estimated 1.5 million fragility fractures that happen in the United States every year, and one out of every two women and one out of every four men 50 years old or more will have a fracture caused by osteoporosis.79,80 Risk factors for osteoporosis are outlined below as:80
The USPSTF recommendations for osteoporosis screening5 state that dual-energy x-ray absorptiometry of the hip and lumbar spine should be done for the following groups of women.
Hepatitis B And Hepatitis C Hepatitis B is a viral infection of the liver. Hepatitis B is transmitted primarily by contact with infected blood, and it can also be transmitted through other body fluids, by sexual contact, and from mother to child. The risk of developing a chronic infection after an exposure is approximately 2%-6%, and the Centers for Disease Control and Prevention (CDC) estimates that there are between 850,000 to 2.2 million Americans who are chronically infected with the Hepatitis B virus.52 Factors that increase the risk of being infected with Hepatitis B include intravenous drug use, hemodialysis, a healthcare occupation, men who have sex with men, unprotected sex with multiple partners, or travel to an area where there is a high infection rate of Hepatitis B. The signs and symptoms of a Hepatitis B infection are temporary and for the most part, non-specific. The CDC recommends screening the following groups for Hepatitis B by testing for the presence of Hepatitis B surface antigen (HBsAg):53
The USPSTF recommends that at the first prenatal visit, all pregnant women should be screened for Hepatitis B by checking for HBsAg.5 The USPSTF also recommends rescreening women with unknown HBsAg status or new or continuing risk factors at admission to hospital, birth center, or other delivery setting. Hepatitis C is a viral infection of the liver. Hepatitis C is primarily transmitted by contact with infected blood, and infection after contact with other body fluids and from sexual contact is also possible. Approximately 85% of people who have an acute infection with Hepatitis C will develop a chronic Hepatitis C infection,54 and the CDC estimates that 2.7-3.9 million people in the U.S., have chronic Hepatitis C.55 Hepatitis C is one of the most common indications in the U.S., for liver transplantation.54 Factors that increase the risk of being infected with Hepatitis C include the following: 1) current or former IV drug users, 2) hemodialysis patients, 3) healthcare workers who are exposed to blood or body fluids, 4) anyone who was given clotting factors before 1987, 5) anyone who received a blood transfusion or a sold organ transplant prior to July of 1992, 6) persons infected with HIV, and 7) children born to mothers who are infected with Hepatitis C. The signs and symptoms of a Hepatitis C infection are temporary, for the most part non-specific, and the patient often has no signs or symptoms. Hepatitis C Screening The USPSTF recommendations for hepatitis screening are highlighted here.5
The CDC’s recommendations for Hepatitis C screening are essentially the same as the USPSTF but are more specific about who should be screened.52 CDC Recommendations for Hepatitis C Screening
injected only once many years ago
July 1992
after needle sticks involving HCV-positive blood or recipients of blood or organs from a donor who later tested HCV-positive
enzyme tests
antibody; these children should not be tested before age 18 months)
Infection with the human immunodeficiency virus (HIV) can cause acquired immunodeficiency syndrome (AIDS). An acute infection with HIV after exposure may produce mild, non-specific signs and symptoms or the infected person may feel fine. The acute infection period lasts approximately two weeks and then the virus enters the dormant phase. During this time HIV is reproducing at a slow rate and the infected person is asymptomatic.
Younger adolescents and adults considered to be at increased risk include:5
A one-time screening test is sufficient unless risk factors are present and then screening should be done once a year, or in some cases, every three to six months.55 Screening for HIV is done by testing blood for HIV antibodies and HIV antigen. Rapid HIV testing can be done (results within 5-40 minutes) and over-the-counter HIV testing products are available, but when these methods are used formal laboratory testing is required to confirm the results.5,58 Illicit Drug And Prescription Drug Use Illicit drug use is a significant public health problem. The USPSTF advises that clinicians should be aware of, and alert to the signs and symptoms of illicit drug use but that “… the evidence is insufficient to determine the benefits and harms of screening for illicit drug use.”5 An area of increased concern is the rise of prescription drugs as sources of illicit drug use and addiction. This has become a serious health and social concern within all age groups where the use of prescribed controlled substances have led to heightened monitoring requirements by providers when reviewing patient history of use and exposure to controlled substances in the home. The American College of Preventive Medicine defines the term abuse of a controlled substance as “the self-administration of substances to alter one’s state of consciousness and an intentional and maladaptive pattern of using a medication leading to significant impairment or distress.”141 An individual noted to be abusing controlled substances is using a drug in a detrimental way to one’s health and wellbeing. Health providers as well as many employer policies for workers may receive special training on how to recognize impaired individuals in a health agency or workplace, and are guided on steps to report impairment as a public safety concern. Prescription drug abuse has been identified as a very real threat to society and the numbers of patients abusing these types of drugs has increased dramatically in recent decades. In 2011, the CDC declared that prescription drug abuse is a nationwide epidemic.142 Without keeping restraints on controlled substances, including those that are prescribed for medical use, the potential for misuse and abuse of these drugs continues to increase. The risk factors for developing addiction to controlled substances may vary depending on the age of the patient, life circumstances, medical history, and physical health. While prescription drug abuse and the numbers of overdoses that occur every year is not necessarily consistent with one particular age group, there are differences between social, physical, and environmental factors that can increase the risks of abuse and addiction more for some age groups. According to the National Council on Drug Abuse, risk factors can affect people at different stages of their lives; however, with each risk, there are preventive measures that can change the gravity of the risk through intervention.143 Health providers can identify a potential problem relative to an individual’s level of exposure and risk to develop a substance use and addiction disorder, and can educate about the risk factors involved to abuse prescription medication. For instance, an adolescent who witnesses misuse of prescription sedatives by a parent to aid in sleep may be more likely to develop a substance use disorder with a similar type of controlled substance as well. Not enough has been said about the effect of prescription drug abuse on children and adolescents however a recent retrospective nationwide study focused on admissions to emergency departments from 2006 to 2012 found that “poisonings by prescription opioids largely impact both young children and adolescents,” and that future screening and preventive strategies need to focus on this age group.144 Glaucoma More than 2 million Americans 40 years and older have glaucoma. It is estimated that more than one-half of these people have not been diagnosed or are not being treated.44,45 Common risk factors for the development of glaucoma include:45,46 1) African-American or Hispanic heritage, 2) age > 40, 3) Asian heritage, 4) circulatory problems, 5) corneal thinness, 6) diabetes, 7) family history of glaucoma, 8) myopia, 9) history of an eye injury, 10) hypertension or hypotension, 11) migraine headache, 12) obstructive sleep apnea, and 13) smoking. The USPSTF has no recommendation for glaucoma screening, and the 2014 Guidelines state: “Evidence on the accuracy of screening tests, especially in primary care settings, and the benefits of screening or treatment to delay or prevent visual impairment or improve quality of life is inadequate. Therefore, the overall certainty of the evidence is low, and the USPSTF is unable to determine the balance of benefits and harms of screening for glaucoma in asymptomatic adults.”5 Jacobs (2016) writes that: “It remains controversial which (if any) populations should be screened, what screening tests should be performed, and with what frequency.”47 On the other hand, the American Academy of Ophthalmology provides these guidelines for screening.46
Hearing Impairment Hearing loss or hearing impairment is common in older adults, and advancing age is one of the primary risk factors for decreased hearing ability.5 Other risk factors for hearing loss are diabetes, genetic susceptibility, exposure to loud noise, exposure to ototoxic drugs, and recurrent ear infections.5 The USPSTF does not recommend routine screening for hearing loss in asymptomatic adults 50 years and older, noting that there is no convincing evidence to determine the benefits and harms of screening in this population.5 The USPSTF does recommend universal hearing screening for all infants before one month of age, and infants who do not pass the screening test should have audiologic and medical evaluation before 3 months of age.5 Hearing loss is the most common congenital condition in the U.S. Each year approximately three in every 1,000 infants born in the United States will have moderate, severe, or profound hearing loss48 and half of these children have no identifiable risk factors.49 Common causes or risk factors for childhood hearing loss include (but are not limited to) congenital anomalies, infection, trauma, and the use of ototoxic drugs like aminoglycosides and platinum antineoplastics.50 Hearing loss in the first few years of life can cause delays in cognitive, language, and speech development, but early identification of hearing impairment can prevent these.50 Hearing testing for newborns is mandatory in all 50 states. For the specific regulations of each state the American Academy of Pediatrics web link may be used,51 or the website of the American Academy of Pediatrics may be accessed to search for State Early Hearing Detection and Intervention (EHDI) Laws and Regulations, 2016. Genitourinary Infections And Sexually Transmitted Diseases Bacteriuria Asymptomatic bacteriuria is defined as the presence of at least 105 colony forming units of bacteria per 1 mL of urine.90 Asymptomatic bacteriuria has been reported to occur in 2%-10% of pregnant women and can result in pyelonephritis, low birth weight, and pre-term birth.90,91 The USPSTF recommends that all pregnant women be screened for asymptomatic bacteriuria.5 This should be done by obtaining a mid-stream, clean catch urine sample at 12-14 weeks of the pregnancy or if later than that, at the first prenatal visit. The USPSTF 2014 Guidelines note that there are adverse effects from antibiotics and the possibility of developing antibiotic resistance but “… detection and treatment of asymptomatic bacteriuria with antibiotics significantly reduces the incidence of symptomatic maternal urinary tract infections and low birthweight.”5 Chlamydial Infection Chlamydia trachomatis is bacteria that can cause many types of infections, but it is most often a sexually transmitted disease.92 Chlamydia is the most common sexually transmitted disease in the United States93 and it can be transmitted by anal, oral and vaginal sex. Signs and symptoms of a sexually transmitted chlamydial infection may include vaginal discharge and pain when urinating. Sexually transmitted chlamydial infections are much more common in women than men93 and a genital infection with C trachomatis can cause pelvic inflammatory disease (PID) and PID can result in chronic pain and/or infertility and pre-term birth. Transmission of the C trachomatis infection to an infant can cause conjunctivitis and/or pneumonia.94 Genital chlamydial infections in women are very common. The infections may not produce symptoms and the consequences of an untreated genital chlamydial infection can be quite serious. For these reason and because screening is simple (either a urine sample or a cervical swab is used) and essentially has no risks, the USPSTF recommends screening women for chlamydial infections.5 USPSTF Screening Recommendations The USPSTF screening recommendation for women 24 years and younger, including adolescents, and for women 25 years and older and at increased risk, is to be screened for chlamydial infection. This recommendation also applies to women who are pregnant. Increased risk is considered to exist for women who have had a previous chlamydial infection or other sexually transmitted infections, had new or multiple sexual partners, do not consistently use condoms, or are in sex work. In non-pregnant women the optimal interval for screening is not known, but the CDC recommends that women at increased risk be screened at least annually. In pregnant women ages 24 years and younger and older women at increased risk, screening should be provided at the first prenatal visit. For patients at continuing risk, or who are newly at risk, screening should be offered in the 3rd trimester. Gonorrhea Gonorrhea is a common sexually transmitted disease caused by infection with the Neisseria gonorrhoeae bacterium. Gonorrhea infections can occur after anal, oral, or vaginal intercourse, and the infection can be transmitted from a pregnant woman to her child. There were 350,062 reported cases of gonorrhea in the United States in 2104, but this number is considered to be far less than the actual incidence of the disease.95 High rates of gonorrhea infection are especially common in adolescents and young adults aged 15-24 and in non-Hispanic blacks.94 In women the signs and symptoms of gonorrhea are non-specific, they are often mild, and a large majority of women with a gonorrhea infection are asymptomatic.95 Untreated gonorrhea can have serious consequences for women.96,97 Between 10%-20% will develop PID95 and fallopian tube infection and scarring and infertility are relatively common sequelae of PID.95 The USPSTF recommendations for gonorrhea screening women are outlined below.5 Testing is done by obtaining a cervical swab or a urine sample. USPSTF Screening Recommendations Sexually active women, including pregnant women, should be screened when at risk for gonorrhea infection. Risk factors for gonorrhea include a history of previous gonorrhea infection, other sexually transmitted infections, new or multiple sexual partners, inconsistent condom use, sex work, and drug use. Screening is recommended at the first prenatal visit for pregnant women who are in a high-risk group for gonorrhea infection. For pregnant women who are at continued risk, and for those who acquire a new risk factor, a second screening should be conducted during the third trimester. The optimal interval for screening in the non-pregnant population is not known. The USPSTF concluded that the benefits of screening women at increased risk for gonorrhea infection outweigh the potential harms. Syphilis Syphilis is a sexually transmitted disease caused by the Treponema pallidum bacterium. Syphilis can be transmitted by anal, oral, or vaginal intercourse. In its early stages a syphilis infection does not cause dramatic or highly specific signs or symptoms but a late stage syphilis infection may cause severe cardiovascular, dermal, and neurological complications.
Iron deficiency anemia is relatively common in pregnant women. Older data indicated that the prevalence of anemia in pregnant women was 18.6%99 and pregnant women are much more likely to be anemic than non-pregnant women.100 Anemia during pregnancy can cause, or has been associated with increased maternal mortality, premature birth, spontaneous abortion, fetal death, low birth weight, and in utero abnormalities.101-104 Causes of iron deficiency anemia during pregnancy include poor intake, poor nutrition, gastrointestinal disease, vegetarian diet, medications that interfere with iron absorption, and multiple pregnancies.99,105,106 The USPSTF recommends that all asymptomatic pregnant women be screened for iron deficiency anemia by measuring hematocrit and hemoglobin levels.5 Directory: Tests -> Materials Tests -> Section I: Questions about Canada Aboriginal Peoples Tests -> Introducing the united states transportation command Tests -> Introducing the united states transportation command Materials -> Inhalant use disorder dana bartlett, rn, bsn, msn, ma Tests -> Reading Section Directions Tests -> Compatibility This section shows pages that exhibit browser-specific behavior, or trigger browser bugs. Internet Explorer Some pages misbehave in Internet Explorer Tests -> Compatibility This section shows pages that exhibit browser-specific behavior, or trigger browser bugs. Internet Explorer Some pages misbehave in Internet Explorer Tests -> Usnei international Affairs Office, U. S. Department of Education Feb 2008 Download 0.53 Mb. Share with your friends:
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