Prevention in Clinical Practice

1. Patterns of Illness and Medical Practice in the United States.- 1. Introduction.- 2. Morbidity and Mortality in the United States.- 2.1. Adolescents and Young Adults.- 2.2. Adults.- 2.3. Elderly.- 3. Patterns of Practice.- 4. Prevention.- References.- 2. History of Preventive Medicine.- 1. Introduction.- 2. Personal Health.- 3. Society.- 4. Applied Science.- 5. United States.- References.- 3. Screening for Early Disease: Interpretation of Diagnostic Tests.- 1. Introduction.- 1.1. Diagnosis of Asymptomatic Disease.- 1.2. Identification of Risk Factors for the Development of Disease.- 1.3. Monitoring the Result of an Intervention Aiding in Disease Prevention.- 2. Terminology.- 2.1. Two-by-Two Table.- 2.2. Gold Standard.- 2.3. Sensitivity and Specificity.- 2.4. Accuracy of Positive Prediction and Accuracy of Negative Prediction.- 2.5. Prevalence.- 2.6. Reliability.- 3. Effect of Prevalence on Predictive Values.- 4. Characteristics of a Good Screening Test.- 4.1. High Sensitivity.- 4.2. Relatively High Specificity.- 4.3. Simplicity.- 4.4. Safety.- 4.5. Acceptability.- 4.6. Low Cost.- 5. Factors That Affect Sensitivity and Specificity.- 5.1. Spectrum of Patients.- 5.2. Bias.- 5.3. Exercise Testing as an Example.- 6. Characteristics of Diseases for which Screening Is Worthwhile.- 6.1. Relatively High Prevalence.- 6.2. Long Duration.- 6.3. Serious Consequences.- 6.4. Treatable Disease.- 7. Distortions Created by Screening.- 7.1. Pseudodisease.- 7.2. Bias.- 8. Application of Diagnostic Test Theory to Screening Tests.- 8.1. Syphilis Screening.- 8.2. Screening for Coronary Artery Disease.- 8.3. Screening for Breast Cancer.- References.- 4. Adult Immunization.- 1. Introduction.- 2. Influenza Vaccine.- 3. Pneumococcal Vaccine.- 4. Measles, Mumps, and Rubella Vaccines.- 5. Poliomyelitis Vaccines.- 6. Combined Tetanus and Diphtheria Toxoid.- 7. Conclusion.- References.- 5. Antimicrobial Prophylaxis.- 1. Introduction.- 2. Indications for Use.- 2.1. Exposure to a Specific Pathogen.- 2.2. Predisposition to Infection.- 2.3. Surgical Infections.- References.- 6. Hepatitis.- 1. Introduction.- 2. Hepatitis A.- 2.1. The Virus.- 2.2. Epidemiology.- 2.3. Mode of Transmission.- 2.4. Incidence.- 2.5. Incubation Period and Period of Communicability.- 2.6. Strategies for Prevention and Infection.- 2.7. Prevention of Viral Spread.- 2.8. Passive Immunoprophylaxis.- 3. Hepatitis B.- 3.1. The Virus.- 3.2. Spectrum of Disease.- 3.3. Epidemiology.- 3.4. Modes of Transmission.- 3.5. Incubation Period and Period of Communicability.- 3.6. Strategies for Prevention of Infection.- 4. Delta Agent.- 4.1. The Virus.- 4.2. Spectrum of Disease.- 4.3. Epidemiology.- 4.4. Modes of Transmission.- 4.5. Strategies for Prevention of Infection.- 5. Non-A-Non-B Hepatitis.- 5.1. The Virus.- 5.2. Spectrum of Disease.- 5.3. Epidemiology.- 5.4. Strategies for Prevention of Infection.- References.- 7. Streptococcal Pharyngitis.- 1. Introduction.- 2. Epidemiology.- 2.1. Streptococcal Pharyngitis.- 2.2. Rheumatic Fever.- 3. Rationale for Treatment.- 4. Diagnosis.- 4.1. Clinical Diagnosis of GABHS Pharyngitis.- 4.2. Throat Culture.- 4.3. Rapid Tests Utilizing Group A Streptococcal Antigen.- 4.4. Use of Tests in Clinical Situations.- 5. Prevention of Rheumatic Fever.- 6. Prevention of Recurrences of Rheumatic Fever.- 7. Treatment of Streptococcal Pharyngitis.- 8. Endocarditis Prophylaxis.- 9. Future Developments.- References.- 8. Tuberculosis.- 1. Introduction.- 2. Epidemiology.- 2.1. Risk of Infection.- 2.2. Risk of Active Disease.- 3. Preventive Strategies.- 3.1. Primary Prevention—BCGVaccination.- 3.2. Secondary Prevention.- 4. Active Tuberculosis.- 5. Special Situations.- 5.1. Urban Tuberculosis and the Homeless.- 5.2. Drug-Resistant Tuberculosis.- 5.3. Tuberculosis and Acquired Immunodeficiency Syndrome.- 6. Summary.- References.- 9. Sexually Transmitted Diseases.- 1. Introduction.- 2. Epidemiology.- 2.1. Incidence of STDs.- 2.2. Factors Influencing STD Trends.- 2.3. Magnitude of the STD Problem.- 3. Transmission of STD Agents.- 4. Prevention of STDs.- 4.1. Primary Prevention.- 4.2. Secondary Prevention.- 4.3. Tertiary Prevention—Rehabilitation.- 5. Prevention of STDs in Newborns.- 6. Prevention of STDs in Homosexuals.- References.- 10. AIDS.- 1. Introduction.- 2. Epidemiology.- 2.1. Risk Characteristics.- 2.2. Male Homosexuality.- 2.3. Intravenous Drug Use.- 2.4. Heterosexual Transmission.- 2.5. Nonsexual Contact.- 2.6. Health Care Workers.- 2.7. Blood Transfusions and Blood Products.- 2.8. Vectors and Environmental Factors.- 3. Diagnosis of HIV Infection.- 3.1. Diagnostic Criteria and Classification.- 3.2. Diagnosis: Laboratory Methods.- 3.3. Clinical Evaluation.- 4. Counseling Patients.- 4.1. Prognosis.- 4.2. Precautions.- 4.3. Measures to Maintain Health.- 5. Counseling Patients at Risk for HIV Infection.- 6. Precautions for Health Care Workers.- References.- 11. Coronary Artery Disease.- 1. Introduction.- 2. Risk Factors for Coronary Artery Disease.- 2.1. Cigarette Smoking.- 2.2. Hypertension.- 2.3. Diabetes.- 2.4. Lipid Abnormalities.- 2.5. Obesity.- 2.6. Other Potentially Modifiable Risk Factors.- 3. Rationale for Prevention.- 4. Office Strategies.- 4.1. Primary Prevention.- 4.2. Secondary Prevention.- References.- 12. Diabetes.- 1. Introduction.- 2. Concepts Concerning Diabetes Prevention.- 3. Prevention of Acute Complications.- 3.1.Diabetic Ketoacidosis.- 3.2. Hyperosmolar Hyperglycemia Nonketotic Diabetic Coma.- 3.3. Hypoglycemia.- 4. Prevention of Chronic Complications.- 4.1. Introduction.- 4.2. Retinopathy.- 4.3. Nephropathy.- 4.4. Neuropathy.- 4.5. Foot Ulceration.- 4.6. Macrovascular Disease.- 5. Diabetes and Pregnancy.- 6. Conclusion.- References.- 13. Hypertension.- 1. Introduction.- 2. Measurement of Blood Pressure.- 3. Definitions of Hypertension.- 4. Epidemiology and Risk.- 5. Efficacy of Treatment.- 6. Nonpharmacological Treatment.- 7. Evaluation of Hypertension.- References.- 14. Thromboembolism.- 1. Epidemiology.- 1.1. Frequency.- 1.2. Morbidity.- 1.3. Risk Factors.- 2. Tests for Thromboembolism.- 2.1. Venous Thrombosis.- 2.2. Pulmonary Embolism.- 3. Prevention.- 3.1. Mechanical Methods.- 3.2. Pharmacological Methods.- 3.3. Combination Treatment.- 4. Costs, Risks, Benefits.- References.- 15. Nephrolithiasis.- 1. Introduction.- 1.1. Diagnosis.- 1.2. Metabolic Evaluation of the Patient with Nephrolithiasis.- 2. Predisposing Factors.- 2.1. Oxalate Stones.- 2.2. Magnesium Ammonium Phosphate (Struvite) and Calcium Phosphate (Apatite)—“Triple-Phosphate Stones”.- 2.3. Calcium Phosphate Stones.- 2.4. Uric Acid Nephrolithiasis.- 2.5. Cystine Stones.- 2.6. Summary.- 3. Prevention: General Principles and Specific Therapies.- 3.1. General Principles.- 3.2. Calcium Oxalate Nephrolithiasis.- 3.3. Prevention of Idiopathic Calcium Stones.- 3.4. Prevention of Triple-Phosphate Stones.- 3.5. Prevention of Calcium Phosphate Stones.- 3.6. Prevention of Uric Acid Nephrolithiasis.- 3.7. Prevention of Cystine Stones.- 3.8. Summary.- References.- 16. Cancer.- 1. Introduction.- 2. Carcinogenesis.- 3. Factors Associated with the Development of Cancer.- 4. Evidence for Cancer Prevention.- 4.1.International Differences in Cancer Incidence.- 4.2. Migration Studies.- 4.3. Laboratory Research.- 5. Adverse Factors in Cancer Causation.- 5.1. Smoking.- 5.2. Dietary Fat.- 6. Protective Factors.- 6.1. Vitamin A.- 6.2. Fiber.- 6.3. Other Protective Factors.- 7. Strategies for Cancer Prevention.- 7.1. Smoking Cessation.- 7.2. Dietary Changes.- 8. Early Detection of Cancer.- 8.1. Cancer of the Uterine Cervix.- 8.2. Breast Cancer.- 8.3. Lung Cancer.- 8.4. Colorectal Cancer.- 8.5. Prostatic Cancer.- 8.6. Malignant Melanoma.- 8.7. Endometrial Cancer.- 9. Exceptions.- 10. Economics.- References.- 17. Stroke.- 1. Stroke Epidemiology.- 1.1. Stroke Definition and Classification.- 1.2. Stroke Risk Factors.- 2. Asymptomatic Carotid Bruits.- 3. Transient Ischemic Attacks.- 4. Cardiac Disease and Stroke.- 4.1. Atrial Fibrillation.- 4.2. Mitral Valve Prolapse.- 4.3. Rheumatic Heart Disease.- 4.4. Myocardial Infarction.- 4.5. Prosthetic Heart Valves.- 4.6. Cardiomyopathy.- 5. Intracranial Hemorrhage.- 5.1. Congenital Berry Aneurysm.- 5.2. Arteriovenous Malformation.- 6. Conclusion.- References.- 18. Osteoporosis.- 1. Introduction.- 1.1. Definition.- 1.2. The Problem.- 1.3. Some New Ideas.- 2. Osteoporosis in Clinical Practice.- 2.1. Diagnosis.- 2.2. Classification.- 2.3. Risk Factors.- 2.4. Screening.- 3. Prevention.- 3.1. Calcium.- 3.2. Estrogens.- 3.3. Other Measures.- References.- 19. Preventable Visual Loss.- 1. Introduction.- 2. Glaucoma.- 2.1. Definitions.- 2.2. Epidemiology.- 2.3. Pathophysiology.- 2.4. Diagnosis and Screening.- 2.5. Corticosteroids and Glaucoma.- 2.6. Costs.- 3. Diabetic Retinopathy.- 4. Amblyopia.- 5. Injury Prevention.- References.- 20. Health Advice for International Travelers.- 1. Introduction.- 2. Epidemiology of Travel-Associated Illness.- 3. How to Find Health Information for Travelers.- 4. Pretrip Evaluation.- 5. Medical Aspects of Air Travel.- 6. Immunizations.- 6.1. Routine Vaccinations.- 6.2. Vaccines Sometimes Required.- 6.3. Vaccines Often Recommended for Tropical Travel.- 6.4. Vaccines for Special Circumstances.- 6.5. Discontinued or Unavailable Vaccines.- 7. Malaria Prophylaxis.- 8. Common-Sense Precautions while Traveling.- 8.1. Water.- 8.2. Food.- 8.3. Climate.- 8.4. Altitude.- 8.5. Traffic.- 8.6. Swimming.- 8.7. Insects.- 8.8. Animal Bites.- 8.9. Medications.- 9. Prevention and Treatment of Traveler’s Diarrhea.- 10. Assessing the Returning Traveler.- References.- 21. Occupational Medicine.- 1. Introduction.- 2. Guide to this Chapter.- 3. General Principles of Occupational Disease.- 4. Special Skills for the Practice of Occupational Medicine.- 4.1. Obtaining the Occupational History.- 4.2. Additional Sources of Exposure Information.- 4.3. Translating Exposure Data into Clinical Terms.- 4.4. Taking Action when Occupational Disease Is Suspected.- 4.5. Protecting the Patient.- 4.6. Protecting Present and Future Co-Workers.- 5. Principal Occupational Diseases Affecting the Major Organs.- 5.1. Lung Disease.- 5.2. Skin Disease.- 5.3. Cardiovascular Disease.- 5.4. Musculoskeletal Disorders.- 5.5. Gastrointestinal Disturbances.- 5.6. Neurological Disease.- 5.7. Psychiatric Illness.- 5.8. Disorders of the Urinary Tract.- 5.9. Endocrine/Reproductive Disorders.- 5.10. Infectious Diseases.- 5.11. Hematological Disorders.- 6. Conclusion.- Annotated Bibliography.- References.- 22. Nutrition.- 1. Introduction.- 2. Nutrition in the United States.- 2.1. Surveys.- 2.2. Nutritional Deficiency in Special Groups.- 3. Natural Food versus Processed Food.- 3.1. Organic Food.- 3.2. Pesticides and Additives.- 3.3. VegetarianDiets.- 3.4. Vitamin Misuse.- 3.5. Herbal Remedies.- 4. Obesity.- 4.1. Epidemiology.- 4.2. Associated Diseases.- 5. Lipids.- 5.1. Definitions.- 5.2. Lipids and Atherosclerosis.- 5.3. Determinants of Serum Cholesterol.- 5.4. Fish Oils.- 6. Sugar.- 6.1. Dietary Sugar.- 6.2. Sugar and Diabetes.- 6.3. Sugar and Dental Caries.- 6.4. Obesity.- 6.5. Fruits, Vegetables, Grains.- 7. Fiber.- 7.1. Definitions.- 7.2. Physiological Effects.- 7.3. Fiber and Disease.- 8. Salt.- 8.1. Physiology.- 8.2. Diet and Sodium.- 8.3. Sodium Requirements.- 8.4. Sodium and Hypertension.- 9. Vitamins and Trace Minerals.- 9.1. Vitamins.- 9.2. Minerals, Elements, Electrolytes.- 10. Dietary Change.- 10.1. Obesity and Weight Loss.- 10.2. Hypertension and Salt Restriction.- 10.3. Vascular Disease and Lipid Restriction.- 11. Summary.- References.- 23. Smoking.- 1. Prevalence.- 2. Lung Cancer.- 3. Pathological Changes.- 4. Coronary Heart Disease.- 5. Cerebrovascular Disease.- 6. Laryngeal Cancer.- 7. Oral Cancer.- 8. Esophageal Cancer.- 9. Bladder Cancer.- 10. Other Cancers.- 11. Chronic Lung Diseases.- 12. The Economics of Smoking.- 13. Smoking Cessation.- 14. Community Response to Smoking.- 15. Passive Smoking.- References.- 24. Mental Disorders.- 1. Introduction.- 2. Prevention of Mental Disorders.- 3. Epidemiology of Mental Disorders.- 4. Identifying the Groups at Risk for Mental Disorders.- 4.1. Life Stress.- 4.2. Family History.- 4.3. Acute and Chronic Medical Illness.- 5. Disorders Associated with Depression.- 6. Disorders Associated with Anxiety.- References.- 25. Alcoholism and Drug Abuse.- 1. Epidemiology.- 1.1. Alcoholism.- 1.2. Drug Abuse.- 2. Associated Psychiatric Illness.- 3. Associated Medical Illness.- 4. Social Costs.- 4.1. Economic Implications.- 4.2. Associated Violence.- 5. Recognition of Alcoholism.- 6. Rationale for Prevention.- 7. Substance Abuse Intervention: Detoxification and Rehabilitation.- 8. Summary.- References.- 26. Periodic Health Examination.- 1. Introduction.- 2. Definition of Terms.- 3. Selection of Preventable Conditions.- 4. Limitations of Periodic Health Examination.- 5. Clinical Implications of Periodic Health Examination.- 6. Historical Development of Periodic Health Examination.- 7. Recommendations for Periodic Health Examination.- 7.1. Recommendations of the 1970s.- 7.2. Recommendations of the 1980s.- 7.3. Specific Recommendations.- 7.4. Preventive Counseling.- 7.5. Immunization.- References.