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Top 2 actual causes of death

Smoking, poor diet and sedentary lifestyle. The contribute to the top 3 causes of death: heart disease, cancer and COPD.


Obesity in 1985 vs. obesity in 2012.

In 1985 no state had a population with obesity > 20%. In 2012, no state has a population with obesity < 20%.


How does the military BMI compare to that of the civilian population?

Military: 51% overweight and 12% obese. Civilian: 1/3 overweight and 1/3 obese.


Difference between cost effectiveness and cost savings

Cost effectiveness = public health interventions decrease total health care expenditures. Cost savings = health intervention that yields a return from the healthcare investment.


Levels of prevention

Primary: prevents disease before it happens (vaccines). Secondary: intervention before disease is clinically apparent (mammograms & pap smears). Tertiary prevention: treatment or rehabilitation to prevent further complications (insulin)


What is the domain of USPSTF?

Primary or secondary preventive services: screening, counseling, immunization and chemoprevention.


What must a disease have for a screening test to be relevant?

A detectable pre-clinical phase. It also needs to be an important public health problem. There must be an effective intervention available that results in a better outcome if given during the detectable pre-clinical phase.


Adverse effects of screening

Labeling (false positive, poor specificity and false negatives, poor sensitivity) and pseudodisease (overdiagnosis) that results in more harm than help for the patient (breast cancer and colon cancer)


Steps in the USPSTF process

Create research plan -> Compile evidence report -> Develop recommendation -> Disseminate recommendation


USPSTF grade definitions

Do all A’s and B’s for patients. Don’t do the D’s. Only do C’s and I’s after explaining all risks and benefits to patient.


Grade D recommendation for breast cancer screening?



Grade I recommendation for breast cancer screening?

Mammograms > 75 yrs, clinical breast exam > 40 yrs, digital mammogram and MRI.


When are mammograms a B recommendation?

Women 51-74. It is C for women 40-49.


Grade D recommendation for prostate cancer?

PSA-based screening


Who makes the bright futures recommendations?

American Academy of Pediatrics. Note that they recommend clinical breast exams after age 20.


How does american cancer society differ in breast cancer recommendations?

Mammograms for all women > 40 years old. Clinical breast exam from age 20 on. MRIs for high risk patients.


When is it appropriate to follow LDL levels and initiate a patient on statin therapy?

Clinical CVD, LDL > 190, Diabetes


What is the difference between the clinical guide put out by the USPSTF and the community guide put out by the TFCPS?

Both are independent organizations that utilize evidence-based studies to generate recommendations.


USPSTF recommendation of chlamydia screening

24 years old or younger or at high risk


When would you screen for asymptomatic bacteremia?

Pregnancy check ups


What clinical preventive service should you discuss with all women of reproductive age?

All women of reproductive age are recommended to have a daily multivitamin w/folic acid


What cancers show no benefit from screening tests?

Testicular, pancreatic and bladder.


According to the TFCPS, what intervention is strongly recommended to prevent and control obesity?

Worksite programs


According to the TFCPS community recommendations, what intervention is shown to reduce tobacco initiation?

Increasing the tobacco unit price and mass reach health communication interventions.