Well Adult Care

Adults age 60, whether or not they report prior episodes of herpes zoster.

One time to adults 65 and older, and to younger patients with chronic disease, immunosuppression, or asplenia. Alaskan natives and certain Native American populations.

• Who: Adults with HTN or hyperlipidemia.
• When: Every 1-3 yrs.
• *Fasting plasma glucose >125.

• Who: men older than 40, postmenopausal women, younger people at risk of CAD
• When: every 5 yrs or when CAD risk factors detected.
• *Address potential harms of therapy (GI)

• Who: Age 50 avg risk, Age 40 high risk. End when age or comorbid conditions limit life expectancy
• What: Fecal occult blood: annually
• Sigmoidoscopy: Every 5 yrs
• Colonoscopy: q 10 yrs

• Who: Travelers to endemic areas, chronic liver disease, clotting factor disorder, men who have sex with men, illegal drug use, lab exposure, consider food handlers
• When: 2 doses 6-12 mo's apart
• Contra: avoid if hypersensitive to alum or 2-phenoxyethanol.

• Who: men age 50-70. Age 45 high risk
• When: interval unknown
• How: PSA and DRE
• High risk: African American, or first degree relative with prostate cancer.

• Who: Men age 65-75 w/ hx of smoking
• When: one time if initial screen negative. If intermediate size AAA (4-5.4cm) periodic screen.
• How: Abd U/S has 95% sensitivity and 100% specificity.

• Who: Women Age 65, or 60 at high risk.
• When: minimum 2 yrs to measure change in bone mineral density. Longer intervals ok for screening.
• How: DEXA scane of femoral neck best predictor of hip fx.
• Risk factors: Low body weight (<70kg) best predictor of low BMD, then not using estrogen. White/Asian, hx of fx, hx of osteoporotic fx, hx of falls, smoking, alcohol or caffeine use, limited physical activity.

• All sexually active women <25
• Asymptomatic women at increased risk of infection (prior STD, new or multiple partners, inconsistent condom use, sex work, durg use or African American)
• High risk pregnant patients
• When: non-pregnant women interval uncertain. In pregnancy -1st prenatal visit, then repeat in 3rd trimester.

All sexually active women <25. Asymptomatic women at increased risk for infection. Routine pap (annual) or other pelvic until 25. Also women over 25 at increased risk (prior STD, new or multiple partners, inconsistent condom use, sex work, drug use, or African American), Pregnancy.

• 3 yrs after onset of sex or age 21 whichever comes first. Screen at least every 3 yrs (annually according to ACS, ACOG)
• No need for routine pap after hysterectomy for benign reasons

Age 40 every 1-2 yrs. Screening mammogram with or without clinical breast exam.

• Men 35 and older
• Women 45 and older
• 20 and older if risk factors of CAD
• *Screen q 5 yrs, more often if lipid levels close to needing therapy. Less if lipid levels low.
• Risk factors: diabetes, Fam hist of heart dz male<50, female <60
• fam hist o high chol.--multiple risks for CHD (HTN, smoking)

2 doses at least 4 weeks apart, 3rd dose 6-12 months after 2nd dose. Booster every 10 years. Give if wound present & >5 yrs since last dose.

Women contemplating conception...but pregnancy should be avoided within 30 days of vaccination.

1956.

Annually to all adults age 50 or over, people with chronic medical conditions, nursing home residents, women in second or third trimester of pregnancy, household contacts or caregivers of high risk individuals.