Getting the most out of your patient-centered medical home
by Lisa S. on 9/18/2012 8:55:40 AM
If you are lucky enough to receive your primary healthcare from a medical practice that is a patient-centered medical home (PCMH), you may know that you are part of the care team. The PCMH revolves around you, not your doctor. He or she, your nurse practitioner or physician assistant, nurse and medical assistant all regard you as the key decision-maker when it comes to your health.
The goal of the medical home is providing you with easy access to a personal healthcare team. Those team members know who you are, know your medical history and are dedicated to helping you navigate the complex healthcare system when you are sick, and more important, work with you to stay healthy.
To get the most out of this partnership, recognize that you have certain responsibilities before, during and after an appointment.
Before your visit
If you’re asked to complete any tests, do so before the visit so you and your healthcare team can use the information in your care plan.
Write down your questions and concerns so you don’t forget to ask them, or give the list to your team when you arrive.
Bring a complete list of your medications, vitamins and supplements — prescribed and over-the-counter. Your team needs this information to prevent drug interactions.
During your visit
Try to be an active participant in your care. Your healthcare team wants to know your needs, your thoughts, your concerns. Team members want to work with you to develop a care plan that fits your needs and abilities.
Because your providers believe in shared decision-making, they will explain any treatment options and ask which you prefer. Ask questions until you’re sure you understand the pros and cons. Make your decision as an informed participant.
Be sure to ask the questions you wrote down prior to the visit. You can expect responses to all your concerns.
After your visit
Follow the care plan you and your care team developed together. This will help you be in control of your health and recuperate as quickly as possible from illness or injury.
Ensure you get recommended laboratory tests, treatments, screenings and/or referrals, and take medications as prescribed.
Don’t hesitate to contact your care team if you have questions or problems between visits. Your providers want to work with you to keep you healthy.
In a serious health situation
Life-threatening health situations require the emergency room, but your PCMH can attend to many serious injuries and illnesses with less waiting, less stress and less expense. Indeed, you probably want to see your own primary care providers if a serious situation arises. Your PCMH:
Can get you an appointment within 24 hours or the same day, if necessary;
Can be reached by phone or e-mail;
Probably has extended weekday and weekend hours; and
Has an on-call service to reach your providers in case of an urgent need.
Be active in your care. Remember, you are the most important member of your healthcare team.
Running interference: Primary care clinicians and pediatric head injuries
by Lisa S. on 8/28/2012 5:52:57 AM
Primary care clinicians are often the first to see young patients with possible concussion. If a head injury was overlooked or not dramatic enough to prompt treatment on the playground or playing field, you are likely the first medical professional to examine a head-injured child when a parent learns of the incident or when symptoms appear.
The Centers for Disease Control and Prevention defines a concussion as “a type of traumatic brain injury … caused by a bump, blow, or jolt to the head that can change the way your brain normally works.”1 Concussion is a functional injury caused by rotational or angular forces to the body — not necessarily the head alone.2
Headache is the most frequent symptom of concussion; the table shows the four common symptom categories:
Source: Centers for Disease Control and Prevention. Concussion. What are the signs and symptoms of concussion? www.cdc.gov/concussion/signs_symptoms.html
Scorza, et al. note that “Concussion can be difficult to recognize, complicated by the lack of a universal definition. Additionally, there are not direct objective measures for diagnosis or recovery, no treatments with well-documented effectiveness, and limited empiric prospective data to guide return-to-play decisions.”3
Lacking consensus on classification of concussions, the current literature recommends an individualized approach to monitoring symptoms to resolution, followed by a graded strategy to return the patient to play or other vigorous activity.4
Concerns in addition to initial head injury
Symptoms of concussion typically last less than 72 hours5 and most resolve spontaneously within seven to 10 days.6
As the first treating physician, you want to address two concerns in addition to a potential concussion’s presenting symptoms. First is the possibility of second-impact syndrome, which arises from a second concussion before indications from the first have diminished.7 The second concern is when to refer a head-injured patient to a neurologist or other specialist if symptoms don’t resolve in 10 to 14 days.8
Research on the effects of cumulative concussions is not definitive. Some studies show no long-term effects in children who suffered a concussion; others indicate that victims may experience post-concussion syndrome for months or longer — suffering from dizziness, headaches, mood swings and difficulty concentrating.
Assessment of concussion can be challenging
Your evaluation of the concussed patient should include a concussion history and
detailed neurological examination focusing on mental status, cognitive function, gait and balance.9
As Provance notes, “It is important to determine whether there has been improvement or deterioration in clinical status since the time of injury. The primary care provider must also determine if there is a need for an emergent CT scan.”10
Martha Johns, MD, MPH, a family medicine physician and HealthTeamWorks’ medical director for guidelines and evaluation says, “The great majority of the time, children with mild head injuries will not have serious concussions and will not require CT scans or referral to specialists. The challenge is to detect those few cases which require further evaluation. It’s also important for us to educate parents on the research about concussion and the possible long-term or cumulative effects.”
Assessment is challenging because concussion’s indicators are often subtle.11 Various graded head injury and symptom scales, neuropsychological tests and postural stability tests exist, but “Because concussion recovery is variable, rigid classification systems have mostly been abandoned in favor of an individualized approach. A graded return-to-play protocol can be implemented once a patient has recovered in all affected domains.”12
1. Centers for Disease Control and Prevention. Injury Prevention & Control: Concussion and Mild TBI www.cdc.gov/concussion/, accessed Aug. 21, 2012, accessed Aug. 21, 2012.
2. Scorza KA, O’Connor FG, Raleigh MF. Current concepts in concussion: Evaluation and management. Am Fam Physician, Jan. 15, 2012; 85(2).
5. Ellemberg D, Henry LC, Macciocchi SN, Guskiewicz KM, Broglio SP. Advances in sport concussion assessment: From behavioral to brain imaging measures. J Neurotrauma. 2009;26;(12):2365-2382.
6. McCrory P, Meeuiwisse W, Johnston K, et al. Consensus statement on concussion in sport: The 3rd International Conference on Concussion in Sport held in Zurich, Nov. 2008. Online: Br J Sports Med 2009;43:i76-i84 doi:10.1136/bjsm.2009.058248, accessed Aug. 14, 2012.
7. Provance AJ. Not just a bump on the head: Concussion management for youth athletes in primary care. Practice update 2010, Children’s Hospital Colorado. www.childrenscolorado.org/news/publications/practiceupdate/2010PracticeUpdate/concussion-management.aspx
Depression: The diagnosis you don't always look for
by Lisa S. on 7/16/2012 3:40:49 AM
Primary care clinicians’ caseloads feature a great deal of variety: infectious diseases, acute and chronic conditions, minor injuries, preventive care, even imagined complaints. Regardless of the circumstances for a visit, though, you need to watch for depression in your patients and address it appropriately.
Primary care clinicians deliver half to most of the care for depression in this country.1,2 Depression’s prevalence in general practice care is modest, but diagnosis could be improved by routine use of a validated instrument such as the Patient Health Questionnaire 9 (PHQ-9), a nine-item depression scale.3 A 2009 study published in the journal Lancet found that primary care practitioners can rule out depression in most people, but because the condition does not appear frequently in general-practice clinics, “misidentifications outnumber missed cases.”4
About 9 percent of U.S. adults suffer from depression, including 4.1 percent who can be classified as having major depression.5 Those more susceptible to depression include:
People 45-64 years of age;
Blacks, Hispanics, non-Hispanic persons of other races or multiple races;
People with less than a high school education;
Those previously married;
People unable to work or unemployed; and
People without health insurance coverage.5
The primary care physician is often the first healthcare professional a depressed patient turns to. Alternatively, the primary care clinician may be the first to recognize depression in a patient presenting for other reasons.
“Sometimes it’s obvious when a patient is depressed; she appears sad, cries easily, has lost hope and enjoyment in life, or may even tell you that she feels depressed,” says Martha Johns, MD, MPH, FACPM, HealthTeamWorks medical director for Guidelines and Implementation. “However, many patients with depression come to your office with multiple physical complaints, such as fatigue, insomnia, digestive problems and weight loss. You have to constantly be alert and maintain a high index of suspicion.”
Studies have demonstrated factors that interfere with primary clinicians’ recognition of depression. Some occur on the patient side and some on the clinician side. Variables that relate to the patient include:
On the physician side, depression may go undiagnosed because of:
Lack of knowledge about the disease;
Lack of training in its management; and
Reluctance to ask patients direct questions about depression.7
The health system, too, often prevents depressed patients from getting help. Many insurers provide little or no coverage for mental illnesses. Healthcare financing under capitation, the imperative to treat patients for billable conditions and lack of continuity in the physician-patient relationship also contribute to depression being underdiagnosed or unaddressed.
Johns says, “Diagnosis of depression in primary care can be improved by changes at the individual clinician and practice level and at the national healthcare-system level. Obviously, education is the first step. As recommended in our HealthTeamWorks Depression Guideline, use of a screening tool such as the PHQ-9 can be very helpful to validate the provider’s clinical judgment. Some practices have decided to have every patient complete a PHQ-9 as part of their routine history and screening. Recent NCQA* requirements for monitoring depression diagnosis and treatment as part of the patient-centered medical home will also move this important issue forward. Finally, healthcare reform is slowly coordinating primary care with mental health care for more previously underserved people.”
HealthTeamWorks’ Depression Guideline for primary care providers provides information on screening and assessment, diagnosis and treatment. The guideline is available for free download, and you can order laminated, two-sided hard copies by calling 303-446-7200. In addition, HealthTeamWorks offers an in-practice rapid improvement activity (RIA) on depression. A RIA is a one-hour on-site training for the entire practice team, with lunch or breakfast provided. The RIA serves as the first step towards implementing a clinical guideline into routine care and introduces the basics of quality improvement.
*National Committee for Quality Assurance
1. Docherty JP. Barriers to the diagnosis of depression in primary care. J Clin Psychiatry.1997;58 Suppl 1:5-10.
2. Mitchell AJ, Vaze A, Rao S. Clinical diagnosis of depression in primary care: A meta-analysis. Lancet. 2009 Aug 22;374(9690):609-19. Epub 2009 Jul 27.
5. Centers for Disease Control and Prevention. CDC features. An Estimated 1 in 10 U.S. Adults Report Depression. www.cdc.gov/Features/dsDepression/
Safe sunning always good advice
by Lisa S. on 5/15/2012 1:23:44 AM
However, official word on skin protection varies
Ah, summer. Long days, warm temperatures, plentiful sunshine … and a heightened risk of skin cancer.
Melanoma is one of seven cancers whose incidence is on the rise (the others are HPV*-related mouth and throat cancers, esophageal cancer, pancreatic cancer, liver and bile duct cancer, thyroid cancer, and kidney and renal pelvic cancer.)
Primary care clinicians may want to advise patients on safe sun exposure. However, the U.S. Preventive Services Task Force (USPSTF) does not give us much guidance on the topic.1 It “concludes that the evidence is insufficient to recommend for or against routine counseling by primary care clinicians to prevent skin cancer … Counseling parents may increase the use of sunscreen for children, but there is little evidence to determine the effects of counseling on other preventive behaviors (such as wearing protective clothing, reducing excessive sun exposure, avoiding sun lamps/tanning beds, or practicing skin self-examination) and little evidence on potential harms.” This does not mean that counseling is never effective; it only means that the topic has not been studied enough for us to be able to draw conclusions about its effects.
Insufficient evidence prompts the USPSTF to shy away from endorsing a whole-body skin examination “by a primary care clinician or patient skin self-examination for the early detection of cutaneous melanoma, basal cell cancer, or squamous cell skin cancer in the adult general population.”
Nevertheless, malignant melanoma deserves consideration by primary care clinicians. It’s the fifth most common cancer in men and the sixth most common in women, although it doesn’t rank among the 10 most fatal cancers for either sex. Still, the American Cancer Society predicts that melanoma will kill 9,180 Americans this year — 6,060 males and 3,120 females. Physicians will diagnose as many as 76,250 new cases in 2012. Over a lifetime, one in every 55 women will develop the disease, and one in every 36 men.
The American Academy of Dermatology recommends that you:
Apply a broad-spectrum, water-resistant sunscreen with a Sun Protection Factor (SPF) of 30 or more to all exposed skin every two hours when outdoors, even on cloudy days, and after swimming or sweating.
Use clothing, when possible, to protect skin from sun exposure: long-sleeved shirt, pants, a wide-brimmed hat, and sunglasses.
Seek shade when appropriate.
Recognize that water, snow and sand reflect and intensify the sun’s damaging rays of and increase the chances of sunburn.
Get vitamin D through a healthy diet that may include vitamin supplements, not from seeking the sun.3
Avoid tanning beds. Studies have shown that people who used tanning beds have a much higher risk of developing melanoma.
Check every inch of your body annually for moles or growths that are changing, growing or bleeding.
These guidelines are especially important for children, since most people get 80 percent of their sun exposure before the age of 18.
“If you choose to talk to patients about sunscreen, target your conversations to issues that will motivate them,” advises Martha Johns, MD, MPH, FACPM, HealthTeamWorks medical director for Guidelines and Implementation. “For example, preventing uncomfortable sunburns may be important even to teenagers. New parents want to protect their baby’s delicate skin. Many adults would like to prevent wrinkles and premature aging of the skin. And everyone in Colorado needs to be reminded of the stronger effects of the sun at high altitude.”
*Human papilloma virus
1. United States Preventive Services Task Force. Counseling to prevent skin cancer. Recommendations and Rationale. www.uspreventiveservicestaskforce.org/3rduspstf/skcacoun/skcarr.htm
Falls are no laughing matter, especially for the elderly
by Lisa S. on 4/23/2012 1:57:55 AM
You laugh when it happens to the Marx Brothers or Inspector Clouseau. Little kids do it all the time and get right back up. But falling — especially for older adults — poses a significant risk of serious injury, disability and even death.
Falls are the leading cause of injury death among those 65 and older and the most frequent reason for nonfatal injuries and hospital admissions for trauma.1,2 One out of three adults 65 or older falls each year, but less than half talk to their healthcare providers about it.2 In 2008, more than 19,700 older adults died from injuries sustained in unintentional falls.3
Aging takes a toll on eyesight, hearing, strength and balance, increasing the likelihood of falls. Medications for depression, sleep problems, high blood pressure, diabetes and heart conditions can make patients unsteady on their feet. Poor health and lack of physical conditioning can also make seniors more vulnerable to falls.4
Help your senior patients avoid falls
Primary care providers can play an important role in preventing falls among older patients. Review their medication lists carefully, noting drugs that can cause dizziness. Ask your senior patients about:
Dizziness, weakness or unsteadiness;
Vision changes, cataracts, glaucoma and other eye problems, and whether they get annual check-ups from an eye specialist;
Foot pain, corns or bunions, ability to trim their toenails; and
Feelings of mental confusion.
Encourage seniors to make their environment as safe as possible. You might suggest that they:
Wear supportive shoes with nonskid soles;
Keep their homes well lit so they can avoid obstacles;
Use night lights in the bedroom, bathroom, hallways and stairways;
Remove throw rugs or secure them to the floor with carpet tape, and tack down carpet edges;
Keep pathways clear of electrical cords;
Install grab bars in the bathtub, shower and toilet areas;
Install handrails on both sides of stairways;
Stay off stools and stepladders;
Avoid waxing floors or use a nonskid wax; and
Maintain sidewalks and walkways to keep surfaces smooth and even.
After an assessment, you may suggest that patients unsteady on their feet use a cane or walker. Advise patients to sit on the side of the bed for a few moments when arising — during the night or in the morning — to allow blood pressure to adjust. Tell those who go to the bathroom frequently at night to consider using a bedside commode.5
Regular exercise, vigilant relatives help prevent falls
Physical strength and general well-being contribute to fall prevention. Encourage senior patients to get regular exercise, especially walking. Suggest exercises they can do to strengthen muscles used for walking and lifting. Advise a limit of one to two alcoholic beverages a day, and encourage smokers to quit.
Family members often accompany elderly patients to the visit, and you can enlist them in making the senior’s home safer from fall hazards, watching for changes in strength or balance and noting complaints about dizziness, weakness or unsteadiness. Vigilant relatives can help keep seniors safe from falls and take them to see you if concerns arise.
1. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web–based Injury Statistics Query and Reporting System (WISQARS) [online]. www.cdc.gov/HomeandRecreationalSafety/Falls/adultfalls.html.
2. Hornbrook MC, Stevens VJ, Wingfield DJ, Hollis JF, Greenlick MR, Ory MG. Preventing falls among community–dwelling older persons: results from a randomized trial. The Gerontologist 1994:34(1):16–23
3. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web–based Injury Statistics Query and Reporting System (WISQARS) [online].
4. What causes falls in the elderly? How can I prevent a fall? American Academy of Family Physicians. Am Fam Physician. 2000 Apr 1;61(7):2173-2174. www.aafp.org/afp/2000/0401/p2173
White rice in large quantities may not be so nice
by Lisa S. on 4/2/2012 1:28:19 AM
The bad news: Eating large quantities of white rice increases the risk of developing type 2 diabetes. A recent article in The British Medical Journal presented this conclusion after its authors conducted a meta-analysis of prospective cohort studies on the topic. The researchers found that each daily serving was associated with an 11 percent increase in the risk of diabetes in the overall population.
Because white rice is a dietary staple of Asian countries such as China and Japan, the risk for those populations is greater than for Western countries whose citizens favor other grains. White rice in Asian countries composes the populations’ main dietary glycemic load; the study notes that glycemic load is consistently associated with increased risk of developing type 2 diabetes. The Chinese and Japanese typically eat three to four servings of white rice a day, while Westerners eat one to two servings a week.
Lifestyle changes in Asia contribute to diabetes risk
Rice consumption in Asian nations has always been high, but not so the risk of type 2 diabetes. “The recent transition in nutrition characterised by dramatically decreased physical activity levels and much improved security and variety of food has led to increased prevalence of obesity and insulin resistance in Asian countries,” the authors state. “Although rice has been a staple food in Asian populations for thousands of years, this transition may render Asian populations more susceptible to the adverse effects of high intakes of white rice, as well as other sources of refined carbohydrates such as pastries, white bread, and sugar sweetened beverages. In addition, the dose-response relations indicate that even for Western populations with typically low intake levels, relatively high white rice consumption may still modestly increase risk of diabetes.”
“Like many research findings, these results need to be put into context,” says Martha Johns, MD, MPH, FACPM, HealthTeamWorks medical director for Guidelines and Implementation. “As the researchers point out, modern cultural changes in Asian populations have led to increases in other refined carbohydrates, decreases in physical activity and increasing obesity, all of which are risk factors for diabetes. White rice is only one factor.”
Brown rice may lower risk of diabetes
What about brown rice? The data are limited but seem to indicate that consumption of brown rice may “modestly” lower the risk of type 2 diabetes. “More studies with larger sample sizes and longer durations of follow-up are warranted to examine the effects of substituting brown rice for white rice on risk of diabetes,” the researchers say.
HealthTeamWorks has just updated its clinical guideline on type 2 diabetes. All HealthTeamWorks guidelines are available for free download.
The upshot of this study for white rice lovers: Enjoy, but in moderation. This is good advice for nearly all foods.
Hu EA, Pan A, Malik V, Sun Q. White rice consumption and risk of type 2 diabetes: Meta-analysis and systematic review. BMJ 2012; 344 doi: 10.1136/bmj.e1454 (Published 15 March 2012)
What do you say to parents who resist immunizing their children?
by Lisa S. on 3/5/2012 1:10:02 AM
Parents reluctant to have their children immunized against common diseases present a frequent, often daunting challenge to family physicians and pediatricians. “There are many reasons parents may want to avoid vaccinations for their kids,” says Robert Brayden, MD, professor of pediatrics at University of Colorado and board president of the Colorado Children’s Immunization Coalition. “Some are concerned about mercury [used in vaccines as a preservative] — they fear it can cause seizures or nervous system disorders. Some worry about aluminum, a vaccine adjuvant, stimulating an immune system response. Others believe vaccine manufacturers give physicians financial incentives to immunize patients.”
Robert Brayden, MD (photo from childrenscolorado.org)
For the record:
Mercury is an ingredient in the preservative thimerosol, discontinued or used in only trace amounts in children’s vaccines since 2001. Extensive research has shown that vaccines containing thimerosol do not cause autism. The reduction or elimination of thimerosol in vaccines came as part of a general move to discontinue mercury in all products, although the type of mercury in thimerosol is not the same as the mercury that poses a health hazard in some seafood and other sources.1
The levels of aluminum in vaccines are not dangerous to an infant’s or child’s health and actually stimulate a more prolonged immune response. Aluminum is a common element in the natural environment and appears in air, water, soil, food, breast milk and infant formula.2
Physicians often lose money on vaccines. But recognizing their life-saving benefits, doctors encourage immunizations to keep children healthy and to safeguard the health of the general population.3
Brayden’s approach to hesitant parents begins with communication. “I encourage people to discuss their concerns and I truly listen.” Then he uses the example of a disease — tetanus, which is not transmitted person-to-person — and the vaccine that prevents it. Because the tetanus bacterium is found universally in soil, it threatens every human being. The disease it causes is characterized by jaw spasms (“lockjaw”), stiff neck, difficulty swallowing and stiff abdominal muscles. Tetanus can also cause fever, sweating, elevated blood pressure and rapid heart rate. The disease can be cured with weeks of intensive treatment, but 10 percent of its victims die.4
Martha Johns, MD, MPH, FACPM, HealthTeamWorks medical director for Guidelines and Implementation, agrees with Brayden that the clinician must start by listening to parents’ concerns. In addition to emphasizing vaccines’ ability to protect against a host of serious illnesses, she describes the importance of "herd immunity." "Herd immunity protects unimmunized individuals from the contagious disease because a critical percentage of members of the community are immunized and the disease does not easily spread, reducing the probability of infection throughout a population," Johns says.
Brayden notes that vaccination has dramatically reduced the worldwide rate of tetanus. “If we had the health system of Somalia, we’d have 53 million cases of tetanus a year worldwide.” Because of vaccination, there were fewer than 10,000 reported cases in 2010.5 “If the world had the U.S. rate of tetanus immunization, there would be only 630 cases a year,” Brayden says.
He estimates that 3 percent of his patients don’t receive immunizations because of parents’ wishes, and that about 7 percent of children seeking to enroll in school have incomplete immunization records. (Colorado schools require that children show proof of vaccination against preventable diseases.)
Ultimately, “It’s important to keep one’s emotions out of this discussion,” Brayden says. “If a parent decides not to immunize, thinks you’re full of bunk, then people have to agree to disagree. I can’t make everybody see the benefit of vaccines. We can’t prevent every bad outcome. I just have to think I did the best I could.”
HealthTeamWorks has posted the 2012 immunization schedules for children and adolescents on our website. The schedules endorse those approved by the Advisory Committee on Immunization Practices, the American Academy of Pediatrics and the American Academy of Family Physicians.
1. Immunize Colorado. Fact or fiction – Thimerosol. www.immunizeforgood.com/fact-or-fiction/thimerosal, accessed March 1, 2012.
2. Immunize Colorado. Fact or fiction – Aluminum. www.immunizeforgood.com/fact-or-fiction/aluminum, accessed March 1, 2012.
3. Immunize Colorado. Fact or fiction – Vaccines are money-makers for docs? www.immunizeforgood.com/fact-or-fiction/vaccines-are-money-makers-for-docs, accessed March 1, 2012.
4. Immunization Action Coalition. www.vaccineinformation.org/tetanus/qandadis.asp, accessed March 1, 2012.
5. World Health Organization. Immunization surveillance, assessment and monitoring – Tetanus. www.who.int/immunization_monitoring/diseases/tetanus/en/index.html, accessed March 1, 2012.
Men need preventive health screenings, too
by Lisa S. on 1/30/2012 3:00:47 AM
Men’s health often gets less attention than women’s health, perhaps because men are 24 percent less likely than women to have seen a doctor within the past year.1 Just over half of U.S. men (57 percent) visit a doctor, nurse practitioner or physician assistant for routine care, compared with 74 percent of women.2 Regardless, men need certain preventive tests and screenings on a regular basis to ensure good health.
Prostate cancer: To screen or not to screen
Unique to men is screening for prostate cancer. Screening can detect cancers early and treatment may be more effective for early disease. Screening is done by digital rectal exam (DRE) or a blood test for prostate-specific antigen (PSA). In DRE, the clinician inserts a gloved, lubricated finger into the rectum to feel the prostate, estimate its size and feel for any abnormalities.
The PSA test measures the level of PSA in the blood. Prostate cancer can cause an elevated PSA level, but many factors, such as age and race, can also affect it.
The most recent evidence suggests that PSA testing does not lower the risk for death from prostate cancer. A 13-year follow-up report published in the Journal of the National Cancer Institute concluded that there is no evidence of benefit from PSA screening. The test can, in fact, cause harm because of false-positive tests and overdiagnosis.3 This finding extends the trial's 10-year results, which also showed no mortality benefit.
The Centers for Disease Control and Prevention and other federal agencies follow the prostate cancer screening guidelines set forth by the U.S. Preventive Services Task Force, which state that there is not enough evidence to recommend or discourage routine screening for prostate cancer using PSA or DRE.4
Other preventive screening tests
Men — as well as women — should consider a number of other routine screening tests to maintain optimal health:5
Body mass index* — Your body mass index, or BMI, is a measure of your body fat based on your height and weight. It is used to screen for obesity. Find your BMI.
Cholesterol — Once you turn 35 (or once you turn 20 if you have risk factors like diabetes, history of heart disease, tobacco use, high blood pressure, or BMI of 30 or higher), have your cholesterol checked every five years. High blood cholesterol is one of the major risk factors for heart disease.
Blood pressure — Have your blood pressure checked every two years. High blood pressure increases your chance of getting heart or kidney disease and for having a stroke. If you have high blood pressure, you may need medication to control it.
Cardiovascular disease* — Beginning at age 45 and through age 79, ask your doctor if you should take aspirin every day to help lower your risk of a heart attack. How much aspirin you should take depends on your age, your health and your lifestyle.
Colorectal cancer* — Starting at age 50 and through age 75, get tested for colorectal cancer. You and your doctor can decide which test is best. How often you'll have the test depends on which test you choose. If you have a family history of colorectal cancer, you may need to be tested before you turn 50.
Other cancers — Ask your doctor if you should be tested for prostate, lung, oral, skin or other cancers.
Sexually transmitted diseases — Talk to your doctor to learn whether you should be tested for gonorrhea, syphilis, chlamydia or other sexually transmitted diseases.
HIV — Your doctor may recommend screening for HIV if you:
Have sex with men.
Had unprotected sex with multiple partners.
Have used injected drugs.
Pay for sex or have sex partners who do.
Have past or current sex partners who are infected with HIV.
Are being treated for sexually transmitted diseases.
Had a blood transfusion between 1978 and 1985.
Depression* — If you have felt "down" or hopeless during the past two weeks or have had little interest in doing things you usually enjoy, talk to your doctor about depression. Depression is a treatable illness.
Abdominal aortic aneurysm — If you are 65 to 75 years old and have smoked 100 or more cigarettes in your lifetime, ask your doctor to screen you for an abdominal aortic aneurysm. This is an abnormally large or swollen blood vessel in your stomach that can burst without warning.
Diabetes* — If your sustained blood pressure is 135/80 or higher, ask your doctor to test you for diabetes. Diabetes, or high blood sugar, can cause problems with your heart, eyes, feet, kidneys, nerves and other body parts.
Tobacco use — If you smoke or use tobacco, talk to your doctor about quitting. Get tips online on how to quit or call the National Quitline at 1-800-QUITNOW.
Alcohol use — Moderate drinking levels for men are no more than 14 standard drinks on average per week and no more than four drinks on any occasion. Men older than 65 should drink half of what is recommended for younger men (seven drinks on average per week and no more than three on any occasion).
Remember, preventive medical tests benefit you AND your family and loved ones.
*Denotes HealthTeamworks guideline
1. Agency for Healthcare Research and Quality. Healthcare Cost & Utilization Project and Medical Expenditure Panel Survey data.
2. Agency for Healthcare Research and Quality. Men Shy Away from Routine Medical Appointments. AHRQ News and Numbers, June 165, 2010. www.ahrq.gov/news/nn/nn061610.htm
3. Andriole GL, et al. Prostate cancer screening in the randomized prostate, lung, colorectal, and ovarian cancer screening trial: Mortality results after 13 years of follow-up. http://jnci.oxfordjournals.org/content/early/2012/01/06/jnci.djr500.abstract JNCI J Natl Cancer Inst (2012)doi: 10.1093/jnci/djr500First published online: Jan. 6, 2012
4. Chou R, Croswell JM, Dana T, et al. Screening for Prostate Cancer: A review of the evidence for the U.S. Preventive Services Task Force. www.uspreventiveservicestaskforce.org/uspstf12/prostate/prostateart.htm. Oct. 2011.
5. U.S. Department of Health and Human Services. Agency for Healthcare Research and Quality. Get Preventive Medical Tests. www.ahrq.gov/healthymen/prevent.htm
Folic acid essential for healthy developing fetus
by Lisa S. on 1/9/2012 9:22:54 AM
Did you know that a daily dose of a certain B vitamin can reduce birth defects by 46 percent?1 Folic acid helps the body make new cells. In a developing fetus, it can help prevent some major birth defects of the brain and spine by 50 percent to 70 percent.2
Everyone needs folic acid. However, women — particularly women who want to get pregnant — need at least 400 micrograms (mcg) daily to ensure proper development of a fetus. Many multivitamins contain 400 mgc of folic acid. Taking that amount of the vitamin before conception is essential for a fetus’ neural tube to develop fully. The neural tube is the initial, formative part of the spine and back. When the neural tube fails to form completely, the baby may be born without parts of the brain and skull (anencephaly) or with part of the spinal cord exposed (spina bifida).
Jan. 8-14 is National Folic Acid Awareness Week, part of National Birth Defects Prevention Month. HealthTeamWorks, along with the federal government, wants to ensure that people know the risks of insufficient folic acid intake on a developing fetus.
"Promoting protective factors, such as taking a daily multivitamin containing folic acid, eating well and exercising, and reducing risk factors such as smoking, alcohol use, obesity and poor mental health, is critical for the health of all women and any potential offspring," says Linda Archer, MSN, RN, CNS, Maternal Wellness Project specialist with the Colorado Department of Public Health and Environment.
Consuming folic acid daily before and during early pregnancy will help reduce the risk for neural tube defects. Healthcare providers should encourage every woman to consume 400 mcg of synthetic folic acid daily from fortified foods or supplements, or a combination of the two, in addition to getting folate that occurs naturally in certain foods. Good sources include:
Leafy green vegetables such as spinach, broccoli and lettuce;
Fruits such as bananas, melons and lemons;
Meat, including beef liver and kidneys; and
Orange and tomato juice.3
In addition, since 1998, federal law has mandated that food manufacturers add folic acid to cold cereals, flour, breads, pasta, bakery items, cookies and crackers.4 Folic-acid fortified foods can help people increase their intake of the nutrient.
HealthTeamWorks’ clinical Guideline for Preconception and Interconception Care puts folic acid at the top of the list of factors that affect fetal health and development. Because 39 percent of pregnancies in Colorado are unplanned5 (50 percent nationwide6), and because folic acid intake is such a simple way to promote fetal health, we urge providers to counsel their female patients of child-bearing age about the importance of getting enough folic acid.
Anna Kelly, MD, who serves on the Healthy Women Healthy Babies Roundtable, participated in the committee that developed the HealthTeamWorks Guideline for Preconception and Interconception Care, says "While numerous individual preconception interventions are known to improve pregnancy outcomes, the HealthTeamWorks Preconception and Interconception Care guideline strives to summarize, simplify and prioritize interventions that have the strongest evidence. [It does so] in a manner that can serve as a foundation for provider- and consumer-focused preconception projects in Colorado and beyond."
1. Jan. 6, 2012, 60(51);1746. National Birth Defects Prevention Month and Folic Acid Awareness Week — January 2012. www.cdc.gov/mmwr/preview/mmwrhtml/mm6051a6.htm?s_cid=mm6051a6_e. Accessed Jan. 5, 2012.
2. Centers for Disease Control and Prevention. Facts about folic acid. www.cdc.gov/ncbddd/folicacid/about.html. Accessed Jan. 5, 2012.
3. WebMD. Folic acid. www.webmd.com/vitamins-supplements/ingredientmono-1017-FOLIC%20ACID.aspx?activeIngredientId=1017&activeIngredientName=FOLIC%20ACID. Accessed Jan. 5, 2012.
5. Colorado Department of Public Health and Environment, Health Statistics Section (2010). Colorado MCH Data Set 2010. Retrieved October 12, 2010 from www.cdphe.state.co.us/ps/mch/mchadmin/mchdatasets2010/profiles/colorado.pdf.
6. Finer LB, Henshaw SK. Disparities in Rates of Unintended Pregnancy in the United States, 1994 and 2001. Perspectives on Sexual Reproductive Health, 2006:38:90–96.