Health care dana bartlett, bsn, msn, ma, cspi

PHQ-9 Screening Tool

The thyroid hormone tri-iodothyronine (T3) is essential for normal childhood growth and development, especially in the first few years of life.¹¹¹ During the first trimester the fetus is dependent on maternal thyroid hormones and maternal thyroid hormone requirements are increased at this time, as well.^111,112 An increased maternal need, dependency of the fetus on maternal thyroid function, and hypothyroidism in a pregnant woman can cause serious consequences: impaired cognitive functioning in the child and complications of pregnancy such as low birth weight, miscarriage, preterm birth, and preeclampsia.¹¹²

The prevalence of obesity in children and adolescents in the United States is approximately 17% and it is expected to increase.^116,117

The USPSTF recommends that children and adolescents age 6 to 18 be screened for obesity.⁵ Obesity is defined as an age and gender specific BMI ≥ 95^th percentile.⁵


Phenylketonuria

Phenylketonuria (PKU) is a relatively common inborn error of metabolism. People who have PKU do not have normal activity of the liver enzyme phenylalanine hydroxylase. Phenylalanine is an amino acid, a breakdown product of many proteins. Accumulations of phenylalanine can cause mental retardation, seizures, and other serious neurological problemns.¹¹¹

Sickle cell disease is an inherited hematologic disorder. People who have sickle cell disease have hemoglobin S and when oxygen binds to hemoglobin S, red blood cells form an abnormal shape (the sickle shape) and they hemolyze, causing an anemia that deprives the tissues of oxygen and blocking blood vessels. Sickle cell disease primarily affects African Americans, and approximately 1 in every 365 African Americans has the disease.¹¹⁸

Children ages 3 to 5 years should be screened for ambylopia. Ambylopia, often called lazy eye, is defined as decreased vision in one eye. The term lazy eye is used because the affected eye often is fixed to the lateral or medial side. Ambylopia can result from an imbalance in the muscles that move and position the eyes or from neurological abnormalities and if it is untreated it can cause permanent vision loss. Effective treatments for ambylopia are available so early detection is critical. The USPSTF recommends that children three to five years of age have vision scrrening.⁵

Amblyopia is defined as a functional reduction in visual acuity that is caused by abnormal visual development during childhood. Amblyopia is the most common cause of visual impairment in children^116,117 with a reported prevalence of 1%-4%.^116-119 Ambylopia develops during a critical period of three months to eight years when the vision is maturing. Risk factors for ambylopia include having a first-degree relative with amblyopia; neurodevelopmental delay; premature birth; and, small size in relation to gestational age.¹¹⁶ Amblyopia affects boys and girls equally.
The USPSTF recommends that children age three to five have vision screening⁴ and screening for, and early detection of amblyopia can improve the prognosis for normal visual development.^116,120,121 Screening is also important because amblyopia is an asymptomatic condition; certain types of amblyopia are characterized by an obvious lateral deviation of one eye (commonly called lazy eye) but some are not; and, the treatments for amblyopia are most effective when they are used early.¹²¹

Children who are pre-verbal are screened by using the fixation reflex test or the objection to occlusion test.¹¹⁶ Children who are three years of age or older can have their visual acuity checked by using the Snellen chart (the classic eye chart with letters and number, viewed from 20 feet away) or by using Allen figure cards.¹¹⁶

Intimate partner violence is defined by the CDC as physical violence, sexual violence, stalking and psychological aggression (including coercive acts) by a current or former intimate partner.⁶² Breiding, et al., (2014, 2008) noted that a substantial number of American women and men have suffered from one or more types of intimate partner violence (as many as one in four women and one in seven men)^63,64 and intimate partner violence is often unreported and undiagnosed.⁶³

The USPSTF recommends that asymptomatic women of childbearing age be screened for intimate partner violence and that screening and interventions provide a moderate benefit.⁵ There are many screening tools that can be used to detect intimate partner violence but there is no agreement as to which one is best.^63,64 A recent (2016) survey⁶⁵ of intimate partner violence screening tools found that the Women Abuse Screen Tool (WAST), Abuse Assessment Screen (AAS) and Humiliation, Afraid, Rape and Kick (HARK) are particularly useful.^66,67 The WAST screen is provided below as an example.

Elder abuse is a common problem in the United States and elsewhere. As with intimate partner violence, elder abuse is underreported but several studies have found a prevalence of 7.6% to 10%.⁶⁸ Elder abuse has been defined and classified into five categories.⁶⁸

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  Physical abuse or acts carried out with the intention to cause physical pain or injury
  
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  Psychological or verbal abuse
  
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  Sexual abuse, i.e., non-consensual sexual contact
  
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  Financial exploitation
  
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  Neglect
  

Risk factors for elder abuse include dementia, isolation, low income, poor social support, a shared living situation with a large number of relatives, and perpetrator characteristics such as alcohol use, mental illness, and exposure to violence as a child.^69-71

screening for or inquiry about elder abuse is recommended by organizations such as the National Center on Elder Abuse, the National Academy of Sciences, and the American Academy of Neurology and the American Medical Association recommend routine screening.⁷¹

Counseling is a vital component of preventive medicine. Screening tests detect health problems and identify people at risk. But screening tests should be followed by counseling and patient education if the patient has, or is at risk for a specific disease or disorder. The USPSTF recommends that when appropriate, adult patients should be counseled about the following.⁵

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  Alcohol misuse
  
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  Breastfeeding
  
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  Falls
  
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  Healthful diet and physical activity
  
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  Motor vehicle occupant restraints
  
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  Obesity
  
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  Sexually transmitted infections
  
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  Skin cancer
  
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  Tobacco use
  

Children and adolescents should be counseled, when appropriate, about:⁵

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  Alcohol misuse
  
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  Illicit drug use
  
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  Motor vehicle occupant restraints
  
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  Obesity
  
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  Sexually transmitted infections
  
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  Skin cancer
  

Vaccinations are a critically important part of preventive medicine. The vaccination schedules presented here are the recommendations of the CDC.

Vaccine	Age Group	19-21 years	22-26 years	27-49 years	50-59 years		60-64 years	≥ 65 years
Influenza 2,		←1 dose annually→
Tetanus, diphtheria, pertussis (Td/Tdap) 3,		Substitute 1-time dose of Tdap for Td booster; then boost with Td every 10 yrs
Varicella 4,		←2 doses→
Human papillomavirus (HPV) Female 5,		←3 doses→
Human papillomavirus (HPV) Male 5,		←3	doses→
Zoster 6							←1 dose→
Measles, mumps, rubella (MMR) 7,		←1 or 2 doses→
Pneumococcal 13-valent conjugate (PCV13)8,		←1 dose→
Pneumococcal polysaccharide (PPSV23)9,10		←1 or 2 doses→						←1 dose→
Meningococcal 11,		←1 or more doses→
Hepatitis A 12,		←2 doses→
Hepatitis B 13,		←3 doses→
Haemophilus influenzae type b (Hib)14,		←1 or 3 doses→