Changing Health Behaviors: A Prescription for Health The two primary risk factors associated with most chronic diseases are unhealthy diets and physical inactivity. Fortunately for us, many c
IMMUNIZATION
Let’s talk more about immunization (vaccines) as a health promotion practice:
“THE PARABLE OF THE PEBBLES”:
A man was out walking in the desert when a voice said to him, "Pick up some pebbles and put them in your pocket, and tomorrow you will be both happy and sad."
The man obeyed. He stooped down and picked up a handful of pebbles and put them in his pocket. The next morning he reached into his pocket and found diamonds and rubies and emeralds. And he was both happy and sad. Happy he had taken some - sad that he hadn't taken more.
And so it is with education…maybe vaccination? The more the better?
What are vaccines?
Vaccines are biological substances that interact with the person’s immune system to produce an immune response identical to that produced by the natural infection.
Vaccines can prevent the debilitating and, in some cases, fatal effects of infectious diseases. Vaccines help to eliminate the illness and disability of polio, measles, and rubella. However, the organisms that cause these diseases have not disappeared. Rather, they have receded and will reemerge if the vaccination coverage drops. The serious health burden of vaccine-preventable diseases (VPDs) is evident from the measles resurgence of 1989 to 1991, resulting in more than 55,000 cases, 11,000 hospitalizations, 120 deaths, and $100 million in direct medical care costs.
Vaccines protect more than the vaccinated individual. They also protect society. When vaccination levels in a community are high, the few who cannot be vaccinated—such as young children and persons with contraindications to vaccination—often are indirectly protected because of group immunity (in other words, they live among vaccinated persons who may offer protection from exposure to disease).
Vaccines provide significant cost benefits. Three childhood vaccines—diphtheria, tetanus toxoids, and acellular pertussis vaccine (DTaP); measles, mumps, and rubella vaccine (MMR); and Haemophilus influenzae type b (Hib) vaccine—result in substantial direct medical savings for each dollar spent to vaccinate children against these diseases. Varicella vaccine saves roughly 90 cents in direct medical costs for every dollar invested. Consideration of indirect savings—prevention of work loss by parents to care for ill children and prevention of death and therefore lost earnings from disability—shows that vaccines routinely recommended for children are highly cost saving. Savings range from $24 for every dollar spent on DTaP to $2 for the more recently approved Hib vaccine.
How vaccines got their start:
People noticed that milkmaids who contracted cowpox from cows seemed immune to smallpox
In 1796 Dr. Edward Jenner inoculated (injected) cowpox into a healthy child, who became ill with cowpox – after that, the boy was immune to smallpox
VACCA means “cow” in Latin – that is how “VACCINE” got its name
or, some people say that “vaccine” comes from the Latin word for smallpox (vaccinia)
Smallpox eradication:
smallpox was eliminated from the entire world in 1977 – why we no longer need to vaccinate against it
the only place smallpox exists in the world is in laboratories for scientific investigation
Near-eradication of other illnesses worldwide:
poliomyelitis (polio) is ALMOST eradicated worldwide
Some vaccine-preventable diseases: anthrax, cervical cancer (Human Papilloma virus, HPV), diphtheria, hepatitis A, hepatitis B, haemophilus influenza type b, human papillomavirus, influenza, Japanese encephalitis, Lyme disease, measles (rubeola), meningococcal meningitis, monkey pox, mumps, pertussis, pneumococcal pneumonia, polio, rabies, rotavirus, rubella, shingles, smallpox, tetanus, typhoid, tuberculosis, varicella, yellow fever
Are vaccines just for young people? No!
There are specific vaccination (immunization) recommendations for adults
The Centers for Disease Control (CDC) has a website devoted to the adult immunization recommendations, see: http://www.cdc.gov/vaccines/schedules/hcp/adult.html (Links to an external site.)Links to an external site.
The website has links to PDF files that can be printed for display
Some vaccines for adults and getting INDIVIDUALIZED recommendations online:
A good resource is the CDC website with information on vaccines for adults: http://www.cdc.gov/vaccines/adults/index.html (Links to an external site.)Links to an external site.
Some of these adult vaccines include:
Influenza (flu) vaccine annually
Tetanus and Tetanus/diphtheria
Zoster (shingles) vaccine
Pneumonia vaccines
A personalized online quiz can be taken to determine the individual’s need for vaccines in adulthood: http://www2.cdc.gov/nip/adultimmsched/ (Links to an external site.)Links to an external site.
The questions include sex, reproductive status, travel plans, living arrangements (e.g., nursing home), immune status, medical diagnoses, sexual practices, history of certain illnesses)
The quiz will give individualized recommendations!
EXERCISE, NUTRITION, OBESITY TOPICS:
Physical Activity (Exercise):
"Activity for fitness" includes recommendations for achieving 60-90% of maximum heart rate for 3-5x/week and during sessions lasting > 30 minutes (activities such as running, swimming, vigorous aerobics).
“Activity for health” includes reaching 50-85% of maximum heart rate, 5-7x/week, and accumulation of 30 minutes/day (suggested activities include gardening, walking). This is essentially 30 minutes per day of brisk walking.Or, vigorous-intensity aerobic activity 20 min on three days per week.
From American Heart Association (AHA) update on physical activity for adults: http://circ.ahajournals.org/content/116/9/1081.full.pdf (Links to an external site.)Links to an external site.
From Health.gov:http://www.health.gov/paguidelines/pdf/paguide.pdf (Links to an external site.)Links to an external site.
Figure 1:American Heart Association. (2014). American Heart Association Recommendations for Physical Activity in Adults. Retrieved from http://www.heart.org/HEARTORG/HealthyLiving/PhysicalActivity/FitnessBasics/American-Heart-Association-Recommendations-for-Physical-Activity-in-Adults_UCM_307976_Article.jsp (Links to an external site.)Links to an external site.
Healthy Weight Basics and guidelines:
From the American Heart Association – heart-healthy diet for adults: http://circ.ahajournals.org/content/114/1/82.short (Links to an external site.)Links to an external site.
From the National Institutes of Health – the CHILD-1 diet for children: http://www.nhlbi.nih.gov/health-pro/guidelines/current/cardiovascular-health-pediatric-guidelines (Links to an external site.)Links to an external site.
From the National Institutes of Health: http://www.nhlbi.nih.gov/health/public/heart/obesity/wecan/healthy-weight-basics/index.htm (Links to an external site.)Links to an external site.
Choose My Plate: http://www.choosemyplate.gov (Links to an external site.)Links to an external site.
Dietary Recommendations for Americans 2015-2020: http://health.gov/dietaryguidelines/2015/ (Links to an external site.)Links to an external site.
What about obesity?
Definitions:
Weight for height: being 20-30% over ideal weight (by sex, height/weight tables)
BMI for adults (body mass index):
Underweight <18.5, normal 18-25, overweight 25 - 29.9, obese 30- 39.9, morbid obesity 40+.
To get your BMI, lookup on table, or do this math:
multiply your weight in pounds x 0.45 = wgt in kg
convert your height to inches, multiply the inches by 0.025 to get meters
multiple that number (hgt in meters) x itself to get meters-squared
divide your weight in kg by the meters-squared = Body Mass Index (BMI)
Waist-to-hip Ratio (WHR): Measurement of the waist:hip ratio (WHR) may be of clinical importance in prognosis of CVD & lipid management. May be more important in women.
Using Weight & Caliper Measurement: Weight > 120% of ideal weight for age = obesity, or caliper measure of triceps skinfold thickness.
Waist measurement as a clue to Metabolic Syndrome: places patient at increased risk of cardiovascular illness. Measure at umbilicus or 1 cm above umbilicus. Abnormal: Men > 40", Women > 35"
Obesity and Adults:
Meaning of the BMI numbers:
Underweight = BMI <18.5
Normal weight = BMI 18.5-24.9
Overweight = BMI 25-29.9
Obesity = BMI of 30-39.9
Morbid Obesity = BMI 40 or greater
NIH website for adult BMI calculator (plug in your weight & height, plus info on meaning of the numbers): http://www.nhlbi.nih.gov/guidelines/obesity/BMI/bmicalc.htm (Links to an external site.)Links to an external site.
Read about BMI (why to use it, how to use it) from the CDC: http://www.cdc.gov/obesity/downloads/BMIforPactitioners.pdf (Links to an external site.)Links to an external site.
Current guidelines recommend:
Identify those who need to lose weight
Counsel the benefits of weight loss
Lifestyle intervention and counseling – weight-loss programs
Bariatric surgery: BMI40+ or those BMI 35+ with comorbidity
Risks of abnormal BMI: this is a “Goldilocks” situation – best to be “just right”
Obesity increases risks of:
Cardiovascular disease
Development of diabetes mellitus (DM)
Neural tube defects in the offspring of obese pregnant women (not preventable with folate)
Dementia
Overweight increases risks of:
Premature mortality
Underweight:
Does increase illness and premature mortality, but usually from different causes than obesity
Portion Distortion:
Part of the problem is portion distortion (size of restaurant portions has increased over the past 20 years) à
Powerpoint slideshow with the changes in portions downloadable (also can view online): http://www.nhlbi.nih.gov/health/public/heart/obesity/wecan/portion/index.htm (Links to an external site.)Links to an external site.
It also tells you how long you’d have to do different exercises to burn off the extra calories – great if you have to educate an audience on eating and obesity!!
Diets for Obesity:
Diets to treat overweight and obesity:
Balanced: all macronutrients in balance with portion control emphasized
Weight Watchers (http://www.weightwatchers.com (Links to an external site.)Links to an external site.) and other “incentivized” programs
Initial loss and maintenance work best when combined with personal interactions
Low Fat: emphasis on counting fat grams and reducing saturated fat
examples are Pritikin (http://www.pritikin.com (Links to an external site.)Links to an external site.) and Dean Ornish (http://www.ornish.com (Links to an external site.)Links to an external site.)
Low Carbohydrate High Protein (LC-HP) (low glycemic) diets:
emphasis on reducing or eliminating simple sugars from diet (theory is that hyperinsulinemia from high “glycemic index” foods causes fat production and weight gain)
glycemic index of foods refers to how rapidly glucose is released from the gut after eating
after weight loss, “stages” of reintroducing complex carbohydrates
increased protein intake may pose risk to kidney health & calcium metabolism (?osteoporosis) but protein does increase lean body mass (not fat storage)
examples are Atkins (http://www.atkins.com (Links to an external site.)Links to an external site.) and the South Beach Diet (http://southbeachdiet.com (Links to an external site.)Links to an external site.) and Sugar Busters (http://www.sugarbusters.com (Links to an external site.)Links to an external site.)
In general:
if vegetable sources of fat/protein are chosen, may reduce risk of coronary heart disease
weight loss is due to reduced caloric intake and the length of time on the diet
maintenance of weight loss may be better with a reduced glycemic index (high protein) diet
high protein diet may cause mild dehydration (water loss); constipation (lack of fiber); bad breath; headaches (dehydration); loss of hair (?? Nutritional deficiency); malnutrition (caloric deprivation); potential long-term health problems (deficiency of fiber and phytochemicals); osteoporosis & fractures (increased rate of bone loss from renal losses of calcium due to high amino acid intake); renal insufficiency (decline in GFR)
OVERALL it seems that extra calories increase fat mass and protein increases lean mass
Avoid sugar-sweetened beverages: http://circ.ahajournals.org/content/121/11/1356 (Links to an external site.)Links to an external site.
Fructose vs. sucrose: http://www.ncbi.nlm.nih.gov/pubmed/23280226 (Links to an external site.)Links to an external site. and http://www.ncbi.nlm.nih.gov/pubmed/23280229 (Links to an external site.)Links to an external site.
Traffic Light Diet for Overweight Children:
Uses red/green/yellow to help choose foods
http://medicine.buffalo.edu/research/research_highlights.host.html/content/shared/smbs/research_highlights/traffic-light-diet.detail.html (Links to an external site.)Links to an external site.
Many diet & exercise suggestions from the NIH:
http://go4life.nia.nih.gov/ (Links to an external site.)Links to an external site.
Malnutrition and the elderly:
The elderly can be at risk for malnutrition
Reasons include:
Changes in appetite due to medical conditions and medications
Physiological changes in digestion and absorption of foods
Socioeconomic factors (living alone, financial restrictions, lack of food access)
Psychological factors (e.g., depression)
Consequences are potentially severe:
Increased risk of falls due to muscle wasting
Increased risk of broken bones (fractures) due to falls and bone weakness (osteopenia, osteoporosis)
Reduced response to medical management of both chronic and acute conditions
Some strategies for prevention:
Prescribed foods (e.g., oral nutrition supplement drinks such as Ensure or Boost)
Referral for dietary counseling (nutritionist, dietician)
Meal delivery and other access to food
VIEW THIS VIDEO: Malnutrition: A Hidden Epidemic in Older Adults (Links to an external site.)Links to an external site.
Alliance for Aging Research (2016, May, 9) Malnutrition: A Hidden Epidemic in Older Adults. [Video File] Retrieved from https://www.youtube.com/watch?v=iPNZKyXqN1U
Exercise & Sleep – the connection:
in order to AVOID gaining weight, studies have shown that those more successful at avoiding weight gain average up to 60 minutes per day of moderate-intense activity
higher activity levels as a young adult translate to less weight gain as a person ages
Inadequate sleep as a child may lead to obesity in later life
Additional Resources (web links, videos, and articles) for vaccination:
National Vaccine Information Center. (2016). State law & vaccine requirements (Links to an external site.)Links to an external site.. Retrieved from http://www.nvic.org/vaccine-laws/state-vaccine-requirements.aspx
has state requirements for vaccination – see clickable map
Centers for Disease Control (CDC):
Adult vaccination recommendations: http://www.cdc.gov/vaccines/schedules/hcp/adult.html (Links to an external site.)Links to an external site.
Information on adult vaccines: http://www.cdc.gov/vaccines/adults/index.html (Links to an external site.)Links to an external site.
Quiz to obtain INDIVIDUALIZED vaccination recommendations for adults: http://www2.cdc.gov/nip/adultimmsched/ (Links to an external site.)Links to an external site.
Healthy People 2020 website:
General information: http://www.healthypeople.gov/2020/default.aspx (Links to an external site.)Links to an external site.
Specifics on immunization & Healthy People 2020: https://www.healthypeople.gov/2020/topics-objectives/topic/immunization-and-infectious-diseases?topicid=23 (Links to an external site.)Links to an external site.
Additional Resources for Diet, Nutrition and Obesity:
Dietary guidelines:
Choose My Plate (Links to an external site.)Links to an external site.. (http://www.choosemyplate.gov/)
Smart Nutrition 101 (Links to an external site.)Links to an external site.. (http://www.nutrition.gov/smart-nutrition-101)
U.S. Department of Health and Human Services and U.S. Department of Agriculture. (2015). 2015-2020 Dietary guidelines for Americans (8th ed.) (Links to an external site.)Links to an external site.. Retrieved from http://health.gov/dietaryguidelines/2015/
Obesity – clinical guidelines for pediatrics:
Daniels, S. R., Arnett, D. K., Eckel, R. H., Gidding, S. S., Hayman, L. L., Kumanyika, S.,…Williams, C. L. (2005). Overweight in children and adolescents: Pathophysiology, consequences, prevention, and treatment (Links to an external site.)Links to an external site.. Circulation, 2005(111), 1999-2012. http://dx.doi.org/10.1161/01.CIR.0000161369.71722.10
Integrated guidelines for cardiovascular health and risk reduction in children and adolescents (Links to an external site.)Links to an external site.. (2013, January). Retrieved from http://www.nhlbi.nih.gov/health-pro/guidelines/current/cardiovascular-health-pediatric-guidelines
Obesity in Children and Adolescents: Screening (Links to an external site.)Links to an external site.. (2010, January). Retrieved from http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/obesity-in-children-and-adolescents-screening
Screening recommendation (USPSTF): All children age 6 years and older.
Obesity – clinical guidelines for Adults::
Jensen, M. D., Ryan, D. H., Apovian, C. M., Ard, J. D., Comuzzie, A. G., Donato, K. A.,...Yanovski, S. Z. (2013). 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: A report of the American college of cardiology/American heart association task force on practice guidelines and the obesity society (Links to an external site.)Links to an external site.. Circulation. doi:10.1161/01.cir.0000437739.71477.ee
Course Text:
Ferrini, A. & Ferrini, R. (2013). Health in the later years (5th ed.). New York, NY. McGraw-Hill.
