Exam #2: Screening for High Risk Populations Flashcards
What makes someone part of a high risk population?
- Biology and genetics
- Culture
- Health disparity
Culture refers to differences in actions, customs, beliefs, and values between different groups of people.
What are the reasons for health disparity?
- Provider/patient relationship
- Provider bias/discrimination
- Patient mistrust of the healthcare system
- Refusal of treatment
- Limited English/literacy
- Access to healthcare
What group has the highest risk for colorectal cancer?
Black/ African American
What are the risk factors for colorectal cancer? What is the protective factor?
- Obesity
- DM
- Red and processed mets
- Alcohol consumption
- Tobacco
- SES (socioeconomic status)- i.e. less and later screening for cancer
The protective factor for colorectal cancer is physical activity.
What is the screening recommendation for colorectal cancer in blacks?
- Same as gen. pop, age 50
*****Unless hx of Crohn’s or family hx of colorectal cancer
Why is there health disparity in the African American community in regards to colorectal cancer i.e. why has the technology improved to screen, but their death rates are not falling as fast as the general population?
- Late stage diagnosis
- Lack of access
- Less aggressive treatment (offered/ receive)
What population has the highest incidence of prostate cancer?
African American and Jamacians (genetic)
- 1/5
- 1/3 w/ 1st degree relative
What are the prostate cancer screening recommendations for African Americans?
- AA are all “high risk”
- Screen at 45 y/o
**IF family hx, 40 y/o
How does the incidence of breast cancer differ from African American and white women?
- Higher incidence in AA women under 40
- Higher incidence in white women over 40
Mean age of diagnosis is lower in AA women; mortality rates are higher*
What is the major non-modifiable risk factor contributing to mortality of breast cancer in AA women?
More aggressive cancer
What are the major modifiable risk factors for breast cancer?
- Breast feeding for more than a year is protective
- Treatment aggressiveness
- Prompt follow-up after abnormal screening
What are the breast cancer screening recommendations in AA women?
American Cancer Society
- Mammography after 40
- CBE in 20s
USPSTF
- Mammography q2 50-79
- No CBE
- Discuss mammography at 40
What is the incidence of infant mortality among African Americans?
- More than 2x the national average (12.67 vs. 6.61)
- 2.3x more likely to have an infant die
What are the risk factors for infant mortality?
- Maternal age less than 20 and greater than 35
- Unmarried mothers
- Smokers
- Low income
- Inadequate prenatal care
What is the most risky behavior for HIV/AIDS acquisition?
Anal sex
What is the major risk factor contributing to AIDS/HIV?
- Residing in an urban poverty area (where blacks are more common)
- Income less than 10,000
This is a POVERTY disparity, NOT a RACIAL disparity
What is the brotherhood project?
12 hour course for barbers to promote healthy lifestyle
What diseases are the Hispanic population more prone to?
DM
- End stage renal disease
- More likely to die from
- More DM retinopathy
Cancer caused by infectious disease
What are the risk factors for DM?
Genetics Overweight/ obese Sedentary lifestyle Access to care Lower SES
What are the screening recommendations for DM in the Hispanic populations?
Same for gen. pop
What cancers are most common in the Hispanic population?
1) Stomach- H.pylori
2) Liver- Haptitis B and C
3) Uterine/ cervix- HPV
*****All related to infectious disease
What are the screening recommendations for the Hispanic population for cervical cancer?
Same as gen. pop
What are the major health disparities seen in Indian and Alaska Natives?
Suicide
Substance Use (leaded to accidental death)
Fetal Alcohol Spectrum Disorders
When are the native populations more likely to commit suicide?
Young age
How many times more likely are the natives to die from alcohol-related death compared to gen pop?
5x
What are the disparities affecting the Asia/Pacific islander population?
Osteoporosis
TB
Why are is the pacific islander population more prone to osteoporosis?
- Small frame
- Lower BMI
- Less Ca++
What are the screening recommendations for TB in the asian/pacific islander population?
Screen high-risk populations
- BCG vaccine
- injection drug users
- Homeless residents/workers
- Former prisoners
- Recent arrivals
- High risk of conversion from latent to active TB
What countries do NOT have a high TB rate?
Western Europe
Australia
Canada
Who is at risk for conversion from latent to active TB?
Immune compromised
DM
Don’t forget about rheumatoid arthritis meds. as immunocompromising
What test should you order for individuals with BCG vaccine?
QantiFERON Gold
Also do this in people that you think are going to be non-compliant
What does depression increase the risk of?
Rates of morbidity and mortality of chronic disease
What are the screening recommendations for depression?
Screen ALL adults
What are the major common coping responses to trauma that you should be watchful for?
- Disturbance of eating or sleeping patterns
- Substance abuse
- Depression
- Suicide
- PTSD
What is the most important thing you can do about domestic violence as a physician?
ASK
What are the common health disparities seen in the LGBT community?
Substance abuse
Suicide
Homelessness
What causes the increase in substance abuse in the LGBT community?
Reaction to:
- Homophobia
- Discrimination
- Violence
What trend is seen among the LGBT community with each episode of victimization?
Each episode increases likelihood of self-harm by 2.5x
