Risk Factor Assessment and Screening Procedures Flashcards
Common modifiable risk factors:
PUT
Physical inactivity
Unhealthy diet
Tobacco and alcohol use
Intermediate modifiable risk factors:
ROAR
Raised blood sugar
Raised BP
Abnormal blood lipids
Overweight/obesity
Common risk factors of major NCDs
Raised BP
Raised Bld sugar
Abn blood lipids
Overweight/obesity
Smoking
Unhealthy diet
Physical inactivity
Stress
Raised BP Prevalence
25.4%
- Single BP determination of 140/90
- Questionnaire if there was previous diagnosis
Raised Blood Sugar Prevalence
7.1%
- High levels of FBS
OR - 2H-PPBS
OR - Diabetes Questionnaire
Abnormal blood lipids prevalence
Lipid profile:
- high T-CHOL (>240mg/dL) 10.2%
- high LDL (>160mg/dL) 11.8%
- high TAGs (>200mg/dL) 14.6%
- low HDL (<40mg/dL) 64.4%
Overweight/obesity prevalence
BMI:
3.2% in men
6.6% in women
Waist-hip ratio (WHR):
12.1% in men
54.8% in women
What is defined as a waist-to-hip ratio (WHR) of 1.0 and over in men, and 0.85 in women?
Central obesity
How do you assess the use of tobacco or smoking?
- Smoking status (smoker or non-smoker)
- Trend in client’s smoking practice
- Exposure to secondhand smoke
Comprehensive assessment of unhealthy diet:
- Detailed food recall
- Extensive questionnaire on food frequency
- Estimation of food nutrients using Food Composition Table and Food Exchange List
Ask about amount and frequency of food eaten s/a veggies, fruits, fat, Na, sugar or simple CHO.
How do you assess physical inactivity?
- Occupation
- Transportation
- Leisure (sports or formal exercise)
What are the 8 risk factors associated with the likelihood of developing a CVD?
Smoking
Physical inactivity
Obesity
Nutrition/diet
Alcohol use
Raised BP
Inc blood lipids
Inc bld sugar
WHO STEPwise approach to surveillance
Step 1: q based info about diet and physical activity, tobacco use, and alcohol consumption
Step2: standardized physical measurements on BP, ht and wt
Step3: blood samples for lipids and glucose status
What is the most sensitive indicator of adiposity?
Waist circumference
It is determined by using a non-extensible/non-stretchable tape measure placed around the waist.
Waist circumference
What are the 2 suggested points for waist measurement?
- Level of umbilicus
- Midway or between the last rib and supra iliac crest
This method, in very overweight people, the umbilicus level is what?
Low
Preferred because of more stable landmarks
Between last rib and supra iliac crest
feet to m
feet / 3.28
This is obtained by dividing the waist circumference at the narrowest point by the hip circumference at the widest point.
Waist-hip-ratio (WHR)
WHR =
Waist circumference (cm)/Hip circumference (cm)
What is a service component towards promoting healthy lifestyle and preventive interventions?
Screening
What is an important component of screening procedures?
Risk factor assessment
Collect minimum amount of info about diet and physical activity, tobacco use, and alcohol consumption and obtaining data on physical measurements such as BP and anthropometric measurements.
Risk factors assessment
What is the presumptive identification of unrecognized disease or defect by application of tests, examination or other procedures which can be applied rapidly?
Screening
What refers to the testing applied to one person considered to be at high risk for a dse or condition (e.g. Pap smear for possible cervical cancer, digital rectal exam for possible prostate cancer, etc.)?
INDIVIDUAL SCREENING
This refers to tests applied to a segment of population which portray any of the following situations:
- an increased incidence of a condition;
- a significant prevalence of the condition; and
- a recognized element of high risk within the group
GROUP OR MASS SCREENING
Disease-specific
Screening
A sustained elevation in mean arterial pressure which results from changes in the arterial wall s/a loss of elasticity and narrowing of BV, leading to obstruction in blood flow that can damage the heart, kidney, eyes, and brain.
Hypertension
200-239mg/100mL
Elevated may be at risk
> /=240mg/100mL
Elevated at risk
Characterized by airflow limitation that isn’t fully reversible.
COPD
Progressive and associated with abnormal inflammatory response of the lungs to noxious particles or gases.
COPD
An inflammatory disorder characterized by increased airway hyper-responsiveness manifested by a widespread narrowing of air passages, which may be relieved spontaneously or as a result of therapy.
Asthma
Clinical manifestations of asthma:
- paroxysm of breathlessness
- chest tightness
- breathing
- coughing
If risk factors are present,
Confirm
Explain
Educate
Monitor
Refer
Retesting if needed and determine frequency of retesting
Confirm
Example: 140/90 BP stage I, confirm in 2 months
For confirmation of diagnosis
Refer
Detecting high BP is a form of SECONDARY PREVENTION in relation to
Hypertension
Detecting high BP is a form of PRIMARY PREVENTION in relation to
Atherosclerosis
Coronary & brain strokes
Nephropathy
Peripheral vascular disease
Aortic aneurysms
Seventh Report of the Joint Nat’l Committee key messages on High BP
- in persons older than 50 years, systolic BP >140mmHg is a much more important CVD risk
- risk of CVD beginning at 115/75mmHg doubles w each increment of 20/10mmHg; individuals who are normotensive at age 55 have 90% lifetime risk for developing hpn
- individuals w systolic BP of 120-139mmHg or diastolic BP of 80-90mmHg should be considered as prehypertensive and require health promoting lifestyle modifications to prevent CVD
Most accurate and reliable technique for indirect BP measurement
Auscultatory method
CHOL increase, also increases the risk of
CHD coronary heart disease
Where is CHOL produced?
Liver
Cholesterol in food
Meat
Poultry
Fish
Dairy
Recommended amount of dietary cholesterol
Not more than 300mg/day
Cholesterol is carried in the bloodstream to the body’s cells by special proteins called
Lipoproteins
What is the major cholesterol carrier in the blood?
LDL
OGTT should be performed on all ppl who have a high
FPG 5.6-6.9mmol/L
RPG 5.6-11mmol/L
CANCER WARNING SIGNS
CAUTIONUS
Breast cancer is defined as the malignancy of the
Glandular epithelium
Beginning the age of 20, women should have clinical examination every how many years?
Every 2-3 yrs, increasing to once. a year from the age of 40
What do you assess in breast exam?
- location
- number of lumps or nodes (solitary or multiple)
- consistency (soft or hard)
- size
- fixed or movable
- tenderness along the area
Screening must extend from where?
From the 2nd to 6th rib and from the lateral boarder of sternum to the mid-axillary line
Part by part breast exam in a radial pattern from the periphery towards the nipple
Radial pattern (Alan Basset’s Technique)
Left hand and right hand movements
Left: clockwise
Right: counterclockwise
Radial position can be applied in 3 positions namely:
- upright (standing or sitting)
- supine (lying down on back)
- oblique (lying slightly on side)
Makes use of palpations search strategy and visual inspection techniques
Mamma Care Technique (Transverse or Vertical Lines)
First circle
Second circle
Third circle
First circle: very light pressure
Second circle: press midway down to the breast tissue
Third circle: press down firmly into breast tissue as possible without causing discomfort
Visual inspection for breast cancer:
Size: cancer may increase or decrease
Contour: distorted; as the cancer progress, it may pull the skin inward which causes loss of normal contour or may cause dimpling or skin depression
Nipple changes: point to different direction, inward nipp, non-healing ulcer or sore, bloody nipple discharge
Skin changes: rash, orange peel
Breast: cause for concern
Single, non-painful lump
Early warning signs if lung cancer:
Chronic cough or nagging cough
Dull intermittent localized pain
Hx of wt loss
Early warning signs of cervical cancer:
Often asymptomatic
May cause abnormal vaginal bleed (e.g. post-coital bleeding)
What is a screening test to examine cells collected from the cervix to detect cancer or abn cells that may lead to cancer?
Papanicolaou or Pap smear
Pap smear for women in their 20s
Every 2 yrs
Pap smear aged 30 and above who have had 3 normal Pap
Evry 3 yrs
When is pap smear done?
In between menstruation (between 10-20 days after 1st day of LMP)
What is an adjunct procedure to the routine Pap smear to improve detection of cervical dse?
Visual inspection of the cervix 1 minute after application of 3% acetic acid
A condition in which cells lining the cervix canal extend beyond the os on the surface of the cervix.
Cervical ectopion (ectopy)
In VIA, what is the interpretation of areas turned whitish (fades in 5 mins), identified for intermediate referral to hospital for colposcopy and biopsy if needed?
Also atypical BV
Irregular surface contour of cervix
Abnormal cervical areas, suspicious of cancer
What are the early warning signs of prostate cancer?
Symptoms of urethral outflow obstruction such as:
- urinary frequency
- nocturia
- decrease in stream
- post-void dribbling
Digital rectal examination
- Palpate male rectum; px lying in a lateral position or standing, hips flexed, and leaning over the table
- Begin w the right lateral surface and, proceed to posterior, left lateral and anterior surfaces
- While examining anterior rectal surface, lobes of the prostate and median sulcus separating them should be palpated for size, nodularity, and tenderness
What is the normal prostate size?
Approx. 2 x 4 x 3 cm and enclosed in a smooth capsule
What is a blood test that confirms the diagnosis of PC?
Prostate specific antigen (PSA) determination
What are the early warning signs of colorectal cancer?
Change in stool
Rectal bleeding
Pressure on the rectum
Abdominal pain
Screening guidelines for colorectal cancer
> 50y.o. - annual fecal occult blood test and flexible sigmoidoscopy every 5 yrs
Completely valid: repeated 3-6 times on different samples; diet should be free of meats, fish, vegetable sources of peroxidase activity
Consider occult bld in: diverticulitis, gastric carcinoma, and gastritis
Increased GI blood loss in normal and more bleeding in disease; Drugs are: salicylates, steroids, indomethacin, colchines, iron (massive therapy), and rauwolfia derivatives
F(+) in occult bld: borid acid, bromides, colchicines, iodine, inorganic iron, oxidizing agents
Liquid stool may cause F(-) w filter paper mtds
Characteristic symptoms of COPD
Cough
Sputum production
Dyspnea upon exertion
What is done to determine the degree of obstruction and can be diagnosed and categorized as having restrictive, obstructive or mixed pattern of ventilatory defect?
Spirometry
How is airway obstruction evidently known?
If forced expiratory volume (FEV1) is reduced to <80% of predicted values
What is the simplest test of lung fxn appicable to COPD and asthma?
Use of peak flow meter to measure peak expiratory flow rate (PEFR)
Refers to the maximum velocity of air from the lungs when exhaled at maximum effort.
PEFR
Correlate w degree of airway obs and FEV1 in spirometry
PEFR
Its hallmark is the demonstration of reversibility of airway obstruction.
Asthma diagnosis
