ThiQar college of Medicine - PowerPoint Presentation

Slide1

ThiQar

college of Medicine

Family & Community medicine dept.

Family Medicine

Lec

7

post graduate-FAMCO

prepared by:

Dr.Muslim

N.

Saeed

Tuesday , December 16

th

,2014

Slide2

Disease Prevention

ADHD

Dental caries

Domestic violence

Falls in elderly

Influenza

NTD

SIDS

Anemia

Syphilis

HIV

Asymptomatic

Bacteriuria

Celiac disease

Slide3

Attention

Deficit/Hyperactivity Disorder

(ADHD)

-Children aged 6–12 years with inattention, hyperactivity, impulsivity, academic under- achievement, or behavioral problems.

-

Diagnosis requires

the child

meet DSM-IV criteria and direct supporting evidence

from

parents or

caregivers

and classroom

teacher.

Evaluation of a

child with

ADHD

should include assessment for coexisting disorders.

Slide4

DSM-IV

Criteria for ADHD:

I

: Either A or B.

A: Six or more of the following symptoms of inattention have been present for at least 6 months to a point that is disruptive and inappropriate for developmental level.

Inattention:

Often

does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities.

Often

has trouble keeping attention on tasks or

play activities.

Often

does not seem to listen when spoken to directly.

Often

does not follow instructions and fails to finish schoolwork, chores, or duties in

the workplace

(

not due

to oppositional behavior or failure to understand instructions).

Often

has trouble organizing activities.

Slide5

6) Often

avoids, dislikes, or does not want to do things that take a lot of mental effort for a long period of time (such as schoolwork or homework

).

7) Often

loses things needed for tasks and activities (

eg

, toys, school assignments, pencils, books, or tools).

8) Is

often easily distracted.

9) Is

often forgetful in daily activities.

Slide6

B: Six or more of the following symptoms of

hyperactivity-impulsivity

have been present for at least 6 months to an extent that is disruptive and inappropriate for developmental

level.

Hyperactivity:

Often

fidgets with hands or feet or squirms in seat.

Often

gets up from seat when remaining in seat is expected.

Often

runs about or climbs when

and where it is not appropriate (adolescents or adults may feel very restless).

(

4) Often has trouble playing or enjoying leisure activities quietly.

(

5) Is often “on the go” or

often acts

as if “driven by a motor.”

(

6) Often talks excessively.

Slide7

Impulsivity:

(1) Often

blurts out answers before questions have been finished.

(

2) Often has trouble waiting one’s turn.

(

3) Often interrupts or intrudes on others (

eg

, butts

into conversations

or games

).

II: Some symptoms that cause impairment were present before age 7 years.

III: Some impairment from the symptoms is present in two or more settings (

eg

, at school/work and at home).

IV: There must be clear evidence of significant impairment in social, school, or work functioning.

V:

The

symptoms are not better

accounted for

by another mental disorder (

eg

, mood disorder, anxiety disorder, dissociative disorder, or a personality disorder).

Slide8

Dental Caries

Children and

adolescents:

Recommends fluoride supplementation

to

prevent dental

caries for infants

and children

aged 6 months

through 16

years residing in areas

with inadequate

fluoride in the

water supply

(< 0.6 ppm

).

# controversy …

Slide9

Domestic Violence

Adolescents, adults and adult women:

Recommend programs that emphasize preventing violence

.

-

Interventions of possible efficacy include

:

a.

School-based programs

that

teach children to recognize

and

avoid abusive situations

.

b. Empowerment

and relationship skills training

for women.

c. Programs

that change

social

and cultural gender norms

.

Slide10

Falls in

the Elderly

1. 30%–40% of

all community-dwelling persons aged

≥ 65 years

fall at

least once a year.

2. Falls are

the leading

cause

of fatal

and

nonfatal injuries among persons

aged ≥

65 years

.

3. A review

and modification of chronic medications, Including psychotropic medications

,

is important although not

proven

to reduce

falls.

Slide11

Recommendations:

1.

Ask older persons(screen)

at least

yearly about falls.

2

.

Recommends vitamin

D supplementation

(

800 international

units [IUs]

orally daily

).

3

.

Recommends

home-hazard modification (adding nonslip tape to

steps,

provision of

grab bars, etc.) for all homes

of persons

aged ≥ 65 years.

4

.

Recommends exercise or

physical therapy

interventions

targeting gait

and balance training.

Slide12

Influenza Chemoprophylaxis

1. Influenza vaccination

is the

best way to

prevent influenza

.

2.

Antiviral chemoprophylaxis

is not

a substitute

for

influenza vaccination

.

3. Duration

of chemoprophylaxis is 2

weeks

post-vaccination in

most persons but

is indicated

for

6 weeks in children

who were

not previously

vaccinated

or who

require two

vaccine doses

.

4. Chemoprophylaxis

for 10

days in a household

in which

a family

member has

influenza.

5. Agents

for chemoprophylaxis of influenza

A (H1N1) and

B:

zanamivir

or

oseltamivir

.

Slide13

Recommendations

-

Consider antiviral chemoprophylaxis

for

adults and

children aged ≥ 1 year

at high

risk of

influenza complications when any

of the

following conditions

are present:

a. Influenza vaccination

is contra-indicated.

b. Unvaccinated adults

or children

when

influenza activity

has been

detected in

the

community. Vaccinate

simultaneously.

c. Unvaccinated adults

and children

in close

contact with

people

diagnosed with

influenza.

d. Residents

of extended-care facilities with

an

influenza outbreak

.

Slide14

Influenza Vaccination

-

Highest-risk

groups

for influenza

complications are:

a. Pregnant women

b. Children aged

6 months–4

years

d. Adults aged ≥ 50 years

e. Persons with

chronic medical conditions.

f. Residents of

extended care facilities.

h. Morbidly obese (

BMI ≥

40)

persons.

i. Healthcare

personnel.

j. Household contacts

or caregivers

of

children aged

< 5 years or

adults aged

≥ 50

years.

Slide15

Recommendations

All

persons aged

≥

6

months receive

Annual trivalent

seasonal

influenza immunization.

Slide16

Neural

Tube Defects

Recommendation :

Women planning or capable of pregnancy take

a

daily supplement containing 400–800

mcg

of folic acid.

Women

planning a

pregnancy should

start folic

acid supplementation

at

least 1

month before

conception and

continue through the

first 2–3 months of pregnancy.

Recommend

4 mg/day

folic acid

for women with a

history of

a child affected by a

neural tube

defect.

Slide17

Sudden

Infant Death

Syndrome

(SIDS)

-Stomach and

side sleeping

have

been identified

as

major risk

factors for SIDS

.

-Recommendations:

Counsel all

parents to

place

their infants

on their

backs to sleep.

Slide18

Anemia

-Infants aged 6–12 months:

Risk assessment based on

diet, socio-economic

status

, prematurity

,

and

low-birth-weight

should

be done

.

- High

risk infants

Includes

infants living in poverty,

from

developing countries, preterm and low-birth-weight infants, and infants

on unfortified

cow’s milk or soy milk.

Slide19

Anemia

-

Pregnant women:

Screen all

women with

hemoglobin

or hematocrit

at

first prenatal

visit

.

Slide20

Syphilis

-Strongly

recommends routine

screening of

all pregnant

women at

the first

prenatal visit

.

-A

non-

treponemal

test (Venereal

Disease Research

Laboratory [VDRL] or

rapid plasma

reagent [RPR] test) should

be used

for initial screening

.

-Recommends

screening high-risk

persons.

Slide21

Syphilis

High-risk includes:

commercial

sex

workers

persons

with other STDs (including

HIV)

sexually

active homosexual

men

sexual contacts of persons with

syphilis

gonorrhea, chlamydia, or HIV infection.

Slide22

Human Immunodeficiency Virus

(HIV)

A

-

Pregnant

women:

Include HIV testing in panel

of routine

prenatal screening tests.

Retest high-risk women

at 36

weeks’ gestation.

Rapid HIV testing of women

in labor

who have not

received prenatal

HIV testing.

Slide23

Human Immunodeficiency Virus (HIV)

B. HIV screening should be

offered to

all people who

seek evaluation

for STDs and

all adolescents

who are

sexually active

or

who engage in injection

drug use

.

-HIV testing should

be voluntary

and must have

a verbal

consent to test

.

-

Educate

and counsel

all high-risk

patients regarding

HIV testing,

transmission, risk-reduction

behaviors,

and implications

of infection.

Slide24

Risk factors for HIV

Homosexual men

multiple

sexual

partners

history

of intravenous drug

use

Prostitution

history

of sex with an

HIV-infected person

history of

STDs

persons

requesting an HIV test.

Slide25

Asymptomatic

Bacteriuria

-Recommend screening for

bacteriuria

at

first prenatal

visit or

at 12–16

weeks gestation

.

# no recommendation for screening in men and non pregnant women.

Slide26

Celiac Disease

-IgA tissue

trans-

glutaminase

(TTG) is the test of choice

.

-Recommend serologic

testing

in children and adults to screen for Celiac disease in the following:

Chronic diarrhea

, failure to

thrive, persistent, recurrent

or

unexplained GI symptoms, prolonged fatigue,

unexpected

weight loss

, unexplained

anemia, autoimmune

thyroid

disease,

IBS,

type

1 diabetes, or

first-degree relatives

with celiac disease

.

Slide27

Thank you