Men's Preventive Health

Question 1

What pop groups are less likely to utilize health care system?

Answer 1

• men
• American men are less likely to carry health insurance, less likely to have seen physician in previous year and more likely to delay seeking healthcare than American women
• especially poor among African-American and latino men
• Minority men ages 18-64 (Black and Hispanic) in all income brackets were found to be 2x as likely to have had no physician contacts in past year when compared with minority women
• rate of doctor visits for such reasons as annual exams and preventive services was 100% higher for women than men

Question 2

Ways to increase male participation?

Answer 2

• health fairs held on weekends
• basic health screenings to workplace
• screenings where men usually gather: barbershops, sporting events
• gender specific programs targeting males needed to help keep young males engaged in health care after pediatric age

Question 3

RFs for prostate cancer?

Answer 3

• age: 50-70
• family hx (1st degree relative)
• African American
• screening when life expectancy is less than 10 yrs isn’t appropriate
• ultimately pt’s decision for screening

Question 4

Testicular cancer: predisposing factors, RFs, what can pt do? Prognosis?

Answer 4

• predisposing factors: cryptorchidism, Klinefelter syndrome
• RFs: natural exposure to intrapartum estrogens, exposure to insecticides, prior hx of tumor isn’t a known precipitant
• excellent prognosis if discovered early

Question 5

Colorectal cancer screening guidelines? Predisposing factors? Risk factors? When do sxs show up?

Answer 5

• start at 50 with colonoscopy
• if family hx + - 10 yrs prior to onset of family member
• occurs much more in societies where low fiber high fate diets predominate (America)
• predisposing factors:
  ulcerative colitis, unsure if assoc w/ crohns, FAP (risk for cancer is about 50% by 40)
• RFs: advancing age, family hx, family hx of adenomatous polyps, pt with benign adenomatous polyps
• sxs: occur late in course of growth of cancer (duration of asx detectable period is estimated to be several yrs)

Question 6

Screening tests for colorectal cancer?

Answer 6

• DRE: only 10% of CRCs w/in reach of examining finger
• serial sampling of stools for occult blood: guaiac testing
• sigmoidoscopy: flex sig can only detect 50% oc CAs, not well tolerated, if seeing polyp - need a colonoscopy
• colonoscopy: able to visualize entire colon and therapeutic - can remove polyps
• double contrast barium enemas
• can use virtual colonoscopy

Question 7

STI education for pt?

Answer 7

• infrom that it is possible to have STD and have no sxs
• no protection method is 100%
• condom won’t prevent many lesional STDs such as herpes and syphilis b/c lesion won’t be covered by condom

Question 8

Smoking education for pt?

Answer 8

• screen for use and provide tobacco cessation intervention as appropriate
• educate pts about harmful effects of 2nd hand smoke, especially to kids
• 2 big cancers: lung and bladder?

Question 9

Who should get flu shots?

Answer 9

• annually for anyone with any kind of chronic CV or pulm. system disorder as well as host of other problems such as DM
• annually for anyone at increased risk for acquring flu
• anyone who wants to be vaccinated
• anyone over 50
• educate that: Flu shots don’t cause the flu

Question 10

Who is Pneumovax for?

Answer 10

• anyone over 65
• look it up for revaccination
• anyone less than 65 with chronic disorders of pulm system, CV diseases, DM, and other disorders
• educate pt that is isn’t annual shot, for pneumonia not flu

Question 11

Who should get Td or Tdap?

Answer 11

• Td booster q 10 yrs
• one Tdap should be substitued from 19-65 (cover pertussis)
• don’t forget to ask pt who comes in with laceration or puncture wound when their last tetanus shot was, if unsure - give booster

Question 12

WHo should get Zostavax and why?

Answer 12

• 60 and older: live attenuated vaccine - assoc with reduction of incidence and burden of illness of zoster and morbidity assoc with postherpetic neuralgia
• incidence and severity of herpes zoster and postherpetic neuralgia increase with age in assoc with progressive decline in cell mediated immunity to VZV
• complications of zoster occur in almost 50% of older persons include myelopathy, vasculopathy, and postherpetic neuralgia