Search results

(169,821 - 169,840 of 182,214)

Pages

CRS85-1026SPRp035
Title
CRS85-1026SPRp035
Page from
info:fedora/mu:56047
Text
CRS-33 feeling or sensation, unusual sensitivity to touch, control of urination and defecation, sweating, cyanosis, pallet, and reaction to heat or cold. s. Mental status: includes a description of reactions to and influence of parents, spouse, siblings, children, friends and associates; sexual adjustments, successes and failures, illnesses, mood swings, nervous- ness, periods of anxiety, nightmares, insomnia, hallucinations, intellectual impairment, delusions, severe sadness or depression, memory loss, homicide or suicide attempts. Physical Examination After completion of the review of body systems, the next step in conduct- ing a medical examination is to perform a physical examination of all the systems, mentioned above. ‘One limitation associated with the physical examina- tion is the lack of a systematic approach that can encompass the variety of signs possible. Nevertheless, in performing the physical examination the examiner employs the classical senses of sight, hearing, touch, and smell. Four primary methods are-used to perform the examination: inspection, palpation, percussion, and auscultation. Inspection is derived from the Latin word specere, to look. This aspect of the physical examination encompasses visual as well as auditory and olfac- tory (smell) observations. Inspection is used to ascertain the individual's state of wellness and reactions to the health assessment process. Inspection is of paramount importance in obtaining a general survey of the individual. The general survey usually constitutes an overview of health and includes
CRS85-1026SPRp032
Title
CRS85-1026SPRp032
Page from
info:fedora/mu:56047
Text
CRS-30 a. Itegument (skin): history of unexplained changes in skin color (e.g., yellowing), excessive skin dryness, rashes or itching, unexplained bruises, changes in moles, skin sores, loss of hair, or any changes in the color or texture of nails. b. Lymph nodes: history of enlargement, pain, and location of nodes. ' c. Bones, joints, and muscles: history of fractures, dislocations, sprains, arthritis, pain, swelling, stiffness, muscular weakness, wasting or atrophy, or night cramps. d. Hematopoietic system (blood): history of anemia (type, therapy, and response), and bleeding (spontaneous, traumatic, familial). e. Endocrine system:” information on growth, body configuration,. weight, size of hands, feet, and head, especially changes during adulthood; hair distribution, skin pigmentation, weakness, goiter, dryness of skin and hair, intolerance to heat or cold, tremor; secondary sex characteristics, impotence, sterility, treatment; history of excessive hunger, thirst, urination, and the presence of sugar in the urine (will be discussed further in the section on diagnosis of endocrine disease). f. Allergic and immunologic history: indication of dermatitis, urticaria (hives, itching wheals or welts), excema, hay fever, asthma, migraine; known sensitivity to pollens, foods, or drugs; previous skin tests and their results; and results of tuberculin tests and other tests.
CRS85-1026SPRp034
Title
CRS85-1026SPRp034
Page from
info:fedora/mu:56047
Text
CRS-32 o. Cardiovascular system: history of difficulty in breathing while exercising, when lying down, or during sleep; chest pain, heart palpita- tions, or heart murmur; high blood pressure, swollen feet, blue hands or feet, unexplained coldness of hands or feet, sharp pain or cramps in legs, or varicose veins. p. Gastrointestinal system: history of changes in appetite or weight, nausea or vomiting, vomiting of blood, heartburn, persistent belching or burping, bloating, swelling or fluid in abdomen, flatulence, change in bowel habits, hemorrhoids, blood in stools. \ q. Genitourinary system: history of changes in urine color, blood in the urine, painful urination, urge to urinate in middle of night, decreased or excessive urination, inability to empty the bladder completely; menstrual history (includes age of onset, frequency of periods, regularity, duration, amount of flow, date of last period, date and character of menopauses, postmenopausal bleeding); pregnancies (number, abortions, miscarriages, stillbirths, complications of pregnancy); venereal disease history (chancre, bubo, penile discharge, and past treatments). r. Nervous system: cranial nerves: history of disturbances of the senses or equilibrium, difficulty in chewing, facial weakness, difficulties in speech or swallowing, paralyses of limbs, atrophy, involuntary movements, convulsions, gait, or uncoordination; pain, numbness, tingling, loss of
CRS85-1026SPRp033
Title
CRS85-1026SPRp033
Page from
info:fedora/mu:56047
Text
, sneezing, or stuffy nose, severe nosebleeds; painful sinuses, or any changes in the senses of smell or taste. k. Mouth and throat: indication of persistent soreness of mouth or tongue, symptoms referable to teeth, gum bleeding, unusual mouth odors or taste, hoarseness, change in voice, recent cough or sore throat, or difficulty in swallowing food. 1. Neck: indication of swelling, pus forming lesions
CRS85-1026SPRp043
Title
CRS85-1026SPRp043
Page from
info:fedora/mu:56047
Text
limitation of the HRA process. Another limitation of HRA instruments that rely on the Tables is that they pro- vide mortality risk estimates for the leading 10 or 12 causes of death only. Some criticisms of this approach are: l) the groupings for each cause of death are somewhat arbitrary, 2) the top 10 to 12 causes of death are not the gflj Goetz, Health Risk Appraisal: Some Methodologic Issues. .2§/ Hall
CRS85-1026SPRp041
Title
CRS85-1026SPRp041
Page from
info:fedora/mu:56047
Text
/ Goetz, Axel A., J. F. Duff, and J. E. Berstein. Health Risk Appraisal: the Estimation of Risk. Public Health Reports, v. 95, Mar./Apr. 1980. p. 119-126. 33/ National Health Information Clearinghouse, Dept. of Health and Human Services. Health Risk Appraisals: An Inventory. Office of Health Information, Health Promotion, Physical Fitness and Sports Medicine. Wash., D.C. DHHS (PHS) Pub. No. 81
CRS85-1026SPRp045
Title
CRS85-1026SPRp045
Page from
info:fedora/mu:56047
Text
that _3__9_/ Ibid. 39/ Wagner, Edward H., W. L. Beery, V. J. Shoenback, and R. M. Graham. An Assessment of Health Hazard/Health Risk Appraisal. American Journal of Public Health, v. 72, 1982. p. 347-352.
CRS85-1026SPRp038
Title
CRS85-1026SPRp038
Page from
info:fedora/mu:56047
Text
CRS-36 2. Health Risk Appraisal* Health Risk Appraisal (HRA) is a generic term that refers to a process that uses information concerning personal health characteristics and habits known to influence risk, to describe the probability that an individual will become ill or die from selected causes within a specified period of time. HRA is also used to estimate the reduction in risk that would accrue
CRS85-1026SPRp044
Title
CRS85-1026SPRp044
Page from
info:fedora/mu:56047
Text
CRS-42 same for certain population subgroups, 3) a cause not among the top ten in a younger age group may become important later on, but may have the greatest potential for prevention now, and 4) epidemiological data and mathematical formulas are available which allow consideration of other causes of death. For HRA instruments not based on the Geller-Gesner Tables, the number of causes of death addressed appears to be limited primarily by the desired length of the questionnaire. gzf The quality of the mortality data collected by the U.S. Vital Statistics System influences the individual risk estimates provided by all HRA instru- ments. Some sources of error for mortality data include: the accuracy of information recorded on death certificates, differences over time in classifi- cation rules for causes of death, and errors in estimating the size of the U.S. population. In general, mortality data are considered more accurate for the U.S. population as'a whole than for population subgroups. In addition, when mortality rates for the U.S. are used to project mortality risk for population subgroups, such as occupational groups or healthy groups partici- pating in medical screening, risk of mortality is generally overestimated. This source of error is sometimes referred to as the "healthy worker effect," and occurs because most selected subpopulations to which HRA is applied are in general healthier than average, since average rates include data concerning institutionalized (ill) people. §§/ Most HRA instruments provide individual risk estimates only for death because the quality of morbidity data is relatively poor. Average incidence 21/ Goetz, Health Risk Appraisal: Some Methodologic Issues. }§/ Ibid.
CRS85-1026SPRp040
Title
CRS85-1026SPRp040
Page from
info:fedora/mu:56047
Text
CRS-38 interactive computer program, or by having the participant complete a written form. Objective data such as laboratory values may be entered by a medical practitioner. The number and type of questions contained in the questionnaire varies with the HRA instrument used, although the information requested concerns "risk indicators" and "risk factors". Risk indicators are personal character- istics that modify one's risk of disease or death from that of the general population. A risk factor is the relative quantitative weight of a risk indi- cator. For example, blood pressure, blood cholesterol, age and cigarette smoking behavior are risk indicators for cardiovascular diseases. A person's actual blood pressure and blood cholesterol values, age, and the number of. cigarettes smoked each day are examples of risk factors. The accuracy of the risk estimate produced by HRA depends on the validity and reliability of the responses collected by the questionnaire. The validity of the HRA questionnaire refers to the accuracy with which it collects responses that truly reflect the characteristics of the respondent, such as whether the reported height is the true height of the respondent. Reliability refers to the consistency of responses, such as whether the same height is reported on different occasions. Some scientists consider validity the more important measurement property of an HRA questionnaire. Because much of the information gathered for HRA is dependent on self-reporting, the validity and reliability of responses is dependent on the knowledge, memory, and honesty of the respon- dent, and can be influenced by the conditions under which the responses are given. 32/ The validity of HRA is believed to be jeopardized if persons participate for reasons other than those that are voluntary and self-motivated. 32/ These conditions include characteristics of the questionnaire, such as how questions are phrased.
CRS85-1026SPRp039
Title
CRS85-1026SPRp039
Page from
info:fedora/mu:56047
Text
. Prospective Medicine. Department of Medical Education, Methodist Hospital of Indiana. Indianapolis, Indiana, 19790 P0 l‘3o
CRS85-1026SPRp042
Title
CRS85-1026SPRp042
Page from
info:fedora/mu:56047
Text
compiles information on nearly all deaths in the United States. Those HRA instruments most closely related to the early HHA tool use a set of death rate tables ,..- derived from vital statistics data referred-to as Geller-Gesner Tables. The tables contain average l0-year moftality rates for the 10 to 12 leading causes of death, organized by race, sex and age group. Other HRA instruments use un- modified
CRS85-1026SPRp050
Title
CRS85-1026SPRp050
Page from
info:fedora/mu:56047
Text
CRS-48 the heart is filling. A blood pressure value of greater than 160/95 (mm Hg) fig] is considered elevated relative to a blood pressure of 140/90 (mm Hg) which is considered the high cutoff for the normal range by most practitioners. The blood pressure measurements are routinely taken as part of a physical examina- tion. Hypertension is thought to contribute to cardiovascular disease
CRS85-1026SPRp047
Title
CRS85-1026SPRp047
Page from
info:fedora/mu:56047
Text
Characteristics. An Epidem- iological Investigation of Cardi 'ascular Disease, Section 28. William B. Kannel and Tavia Gordon, eds. The Framingham Study. National Institutes of Health, Department of Health, Education and Welfare. May 1973. 33/ The risk indicators for cardiovascular diseases are better understood than most other conditions, primarily because of the long-term Framingham Study. The Framingham
CRS85-1026SPRp049
Title
CRS85-1026SPRp049
Page from
info:fedora/mu:56047
Text
values: the systolic pressure (top reading) and diastolic pressure (bottom reading), e.g., 140/90. Systolic pressure is measured when the heart is pumping blood through the system and diastolic pressure is measured when 32/ Rakel, Robert E. Current Therapy. W. B. Saunders Company, Phila- delphia/London/Mexico City, 1984. p. 137-226.
CRS85-1026SPRp048
Title
CRS85-1026SPRp048
Page from
info:fedora/mu:56047
Text
are of particular interest. A discussion of selected diseases of these systems and the diagnostic tests available to identify individuals with these conditions follows. 1. Diagnosis of Cardiovascular Diseases* Cardiovascular disease is the number one killer in the United States today claiming over 600,000 lives annually. Of those who die of cardiovascular disease, about half die of a phenomenon known as "
CRS85-1026SPRp046
Title
CRS85-1026SPRp046
Page from
info:fedora/mu:56047
Text
CRS-44 many of the criticisms of HRA are most pertinent to those based on the Geller-Gesner Tables. Some point out that alternative tools are more accurate, particularly for those conditions such as cardiovascular diseases, where multivariate logistic equations can be used to estimate risk. Health Risk Appraisal and Employment HRA has been used to motivate risk reduction in a variety of age groups, in clinical and workplace settings. "Appraisal age" has not been used as the basis for hiring or retirement decisions in public safety occupations, and to do so would create a number of difficulties. Chronological age is only one of several risk factors considered in calculating appraisal age. The amount of risk that can be attributed to age varies with the disease or cause of death. For cardiovascular diseases, risk increases with age, although a significant amount of risk can be attributed to potentially controllable risk factors such as blood pressure and smoking habits. If appraisal age were used as a basis for hiring and retirement decisions, the validity of responses would probably be affected. For example, respondents may be less likely to accurately report smoking and exercise habits, or family history of heart disease if they knew the information would increase appraisal age, and thereby possibly disqualify them from employment. However, as previously discussed, an alternative to relying on self-reported health risk information would be to consider only those health risk indicators that could be objectively measured. Still, such an approach would produce meaningful health risk information for only those conditions having a
CRS85-1026SPRp052
Title
CRS85-1026SPRp052
Page from
info:fedora/mu:56047
Text
. ¢ £1] Petersdorf, Robert G. farrison's Principles of Internal Medicine. 1983. 10th ed. McGraw-Hill Book Company, New York. p. 1469-1491. fig] Berkow, Robert. The Merck Manual of Diagnosis and Therapy. 1982. Merck Sharp & Dohme Research Lab. Rahway, N.J. p. 439.
CRS85-1026SPRp053
Title
CRS85-1026SPRp053
Page from
info:fedora/mu:56047
Text
’ CRS-51 Obesity Another important risk factor that is associated with cardiovascular diseases is obesity. In general, morbidity and mortality from cardiovascular disease increases with weight, beyond 30 percent over ideal weight. Obesity is defined as weight greater than 20 percent above ideal weight. Data obtained in the Framingham study indicates that obesity may accelerate atherosclerosis
CRS85-1026SPRp054
Title
CRS85-1026SPRp054
Page from
info:fedora/mu:56047
Text
CRS-52 Currently there are several noninvasive tests used to help examine, assess, evaluate, and predict disease of the cardiovascular system: a complete medical history, physical examination, ECG and chest x-ray. The most recent and sensi- tive tools used currently are a combination of the Bruce stress test and the thallium-201 scan test. 29/ Electrocardiogram (ECG) A routine electrocardiogram

Pages