Week 2: Discussion- Screening and Reliability

Week 2: Discussion- Screening and Reliability

Define the test, its positive predictive value, reliability and validity. Discuss patient medical or family history that may alter your recommendation for screening?

Mar 4, 2018 Hi Clasand Dr. Weaver, The Healthy People 2020 topic that I chose was about nutrition and weight status. Overweight and obese people are at higher risk for developing type II diabetes mellitus (DM II), a disease that causes further permanent destruction to vital organs such as heart, kidneys, and eyes, and could be prevented with timely screening and intervention.As healthcare professionals, we understand that the best cure for many diseases is primary prevention, which in essence is stopping the disease before it occurs. A screening test identifies asymptomatic individuals who may have the disease. Thus, screening for DM II is a grade “B,” which stands for high certainty that the net benefit is moderate to substantial, is recommended by the U.S. Preventive Services Task Force (USPSTF) for all overweight and obese adults 40 to 70 years of age who are seen in primary care and have no obvious symptoms of diabetes, as a part of cardiovascular risk assessment (USPSTF, 2017). African Americans, Native Americans, Asian Americans, Pacific Islanders, Hispanics, family history of diabetes, gestational diabetes, and polycystic ovarian syndrome are non-modifiable risk factors that require DM II screening at a younger age even with healthy body weight (USPSTF, 2017).

5/9/2018Topic: Week 2: Discussion- Screening and Reliability https://chamberlain.instructure.com/courses/24843/discussion_topics/455918?module_item_id=28391972/68 Screening for DM II can be done by measuring the glucose level in the blood with fasting plasma glucose (FPG), oral glucose tolerance test (OGTT), and Hemoglobin A (HbA), where all abnormal test results require a repeat with the same test on a different day, to confirm the diagnosis (Siu, 2015). HbA is an indicator of a long-term blood glucose concentration and does not require fasting. FSG, HgA is a single blood draw test while the OGTT requires two draws, one fasting and the other two hours after ingestion of 75 grams of oral glucose. Normal test values are <5>

References

Gordis, L. (2014). Epidemiology (5 ed.). Philadelphia, PA: Elsevier Saunders.

Pipit, K., Li, M., & Gurgle, H. E. (2016). Diabetes mellitus: Screening and diagnosis. American

Family Physician, 93(2), 103-109. Retrieved from https://aafp.org

Shimodara, M., Okaniwa, S., Hanyu, N., & Nakayama, T. (2015). Optimal hemoglobin A1c levels for screening of diabetes and prediabetes in the Japanese population. Journal of Diabetes

Research, 2015, 1-6. doi: 10.1155/2015/932057

1c 1c 1c 1c 1c 1c1c 1c 1c th

5/9/2018Topic: Week 2: Discussion- Screening and Reliability https://chamberlain.instructure.com/courses/24843/discussion_topics/455918?module_item_id=28391973/68  Reply 

Siu, A. L. (2015). Screening for abnormal blood glucose and type 2 diabetes mellitus: U.S.Preventive Services Task Force recommendation statement. Annals of Internal Medicine, 163(11),

861-868. Doi: 10.7326/M15-2345

U.S. Preventive Services Task Force. (2017). Recommendations for primary care practice.Retrieved from https://www.uspreventiveservicestaskforce.org/Page/Name/recommendations Woo, Y. C., Lee, C. H., Fong, C. H. Y., Tso, A.W. K., Cheung, B. M. Y., & Lam, K. S. L. (2017).Validation fo the diabetes screening tools proposed by the American Diabetes Association in an

aging Chinese population. PLoS One, 12(9). doi: 10.1371/journal.pone.0184840

(httpAmy Weaver (Instructor) Mar 5, 2018  Reply   Eleina, nice post. I have always said I would love to see how much of a decrease in certain diseases we would see if everyone was at their ideal weights. Diabetes, joint pain, htn, cad, these are all some examples of diseases that are either caused by or exacerbated by obesity. Do you think we will ever win the war with obesity?(httpEleina Sapoz

(hps://chamberlain.instructure.com/courses/24843/users/24

Mar 7, 2018 Hi Dr. Weaver, Thank you for the comments on my post. I saw a documentary about obesity incidence in India. In the center of the story was a family of four-mom, dad, and two elementary school kids. This family used to have normal body weights when the mom was staying at home and cooking meals. When they moved into a big city, not only there were a lot of temptations such as pizza, burgers, sugary drinks, the mom started to work and chose not to cook every meal. The family was able to afford a game console for the kids, which nailed the boy to the couch with a slice of pizza and the sweet drink for dinner. Within several years everybody but the girl, who still enjoyed playing outside with her friends, went from normal weights to honing in on morbid obesity. Unfortunately, stories like this one are prevalent around the world in both developed and developing countries.Watkins and Jones (2015) noted that parents who knew what good food choices were still felt confused as to their parenteral roles when it came to being a “good” parent. Was it

5/9/2018Topic: Week 2: Discussion- Screening and Reliability https://chamberlain.instructure.com/courses/24843/discussion_topics/455918?module_item_id=28391974/68  Reply 

cooking at home wholesome healthy meals or taking kids out to the fast food places as a treat in addition to stating that they did not always have time or desire to cook at home (Watkins & Jones, 2015). The conclusion was that practitioners needed to engage both parents and children in the healthy initiatives and programs to promote a growing knowledge about healthy food choices (Watkins & Jones, 2015).I think that the majority of the population does not understand the BMI cutoffs and implications of carrying around extra body weights. In the last decade, a lot of work is done by media to convince the population that all body types are acceptable, which is not true from the medical and healthcare standpoint. Thus, the medical providers are not comfortable telling patients that they are indeed overweight or obese and need to make lifestyle changes. Wee (2015) suggested that in lieu of behavioral treatments and adequate reimbursement, effective commercial weight- loss programs that offer a modest weight loss could provide a partial solution to the obesity epidemic. Perhaps if the insurance companies reimbursed the attendance in this programs, employers offered onsite attendance, and schools would invite the reps in to talk about food and nutrition, more people would sign up.References Watkins, F., & Jones, S. (2015). Reducing adult obesity in childhood: Parental influence on the food choices of children. Health Education Journal, 74(4), 7473-484. doi:

10.1177/0017896914544987

Wee, C. C. (2015). The role of commercial weight-loss programs. Annals of Internal

Medicine, 162(2), 522-523. doi: 10.7362/M15-0429

(httpAmy Weaver (Instructor) Mar 9, 2018  Reply   Wow, that's an amazing story Eleina. The American diet and lifestyle can be detrimental to the health, as evidenced by the story of the Indian family. I saw a very overweight little girl, about 4 years old at the store with her mother. She begged for something out of the vending machine and ate a 2 pack Pop Tart while her mother was in line. I really wondered what the little girls diet looked like at home. I suspect sugary drinks and high carbs. Much more education is still needed for sure.