Pearls for Health Care Professionals

“Pearls” are practical and applicable bits of information from varied sources that may assist the busy heath care professional.

Many of these topics are specific to Georgia:

• Adverse Vaccine Reactions
• Asthma
• Cancer
• Cardiovascular Disease 
• Death
• Diabetes
• Obesity
• Stroke
  
  

NOTE: To see health care statistics for your state (if you are not a Georgia resident), you may want to check statehealthfacts.org . You will find health statistics for each state which are regularly updated.

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Adverse Vaccine Reactions

These new recommendations were issued by the Joint Task Force on Practice Parameters, representing the American Academy of Allergy, Asthma and Immunology; the American College of Allergy, Asthma and Immunology and the Joint Council of Allergy, Asthma and Immunology.

Specific summary statements in the parameter include the following:

1. Mild local reactions, fever, and other constitutional symptoms after vaccinations occur often and are not a contraindication to subsequent doses.
2. Anaphylactic reactions after vaccination are rare, with incidence of approximately 1 per million doses.
3. Even if the vaccine is not clearly the cause, all serious events occurring after vaccine administration should be reported to the Vaccine Adverse Event Reporting System.
4. Measurement of IgG antibody levels to the immunizing antigen in a vaccine suspected of causing a serious adverse reaction can determine if levels are protective and whether subsequent doses are needed.
5. Ideally, all suspected anaphylactic reactions to vaccines should be evaluated so that the responsible allergen may be identified.
6. Gelatin, egg protein, or other vaccine components are more likely than the immunizing agent itself to cause IgE-mediated reactions to vaccines.
7. Immediate-type allergy skin testing should be performed in patients who appear to have had an anaphylactic reaction after vaccination. This testing should help confirm that the reaction was IgE mediated and identify the responsible vaccine component.
8. If the intradermal skin test result is negative, it is extremely unlikely that the patient has IgE antibody to any vaccine component, and the patient can be vaccinated in the usual manner. In a patient with a history suggesting anaphylactic reaction, however, it is prudent to vaccinate with the patient under observation and to have epinephrine and other emergency treatment available.
9. In patients with history and skin tests results suggesting an IgE-mediated reaction to a vaccine but who need additional doses of the suspected vaccine or other vaccines with shared ingredients, the clinician can consider administering the vaccine in graded doses while observing the patient.
10. There are other less common but more serious reactions to vaccines, but only a few represent absolute contraindications to future doses.
11. Pregnant women should not be given live vaccines.
12. Live vaccines should generally not be given to immunocompromised persons.
13. Epidemiologic studies have not supported associations between specific vaccines or vaccination in general with long-term sequelae such as atopy, autism, and multiple sclerosis.

Source: Joint Task Force on Practice Parameters

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Asthma in Georgia

More than 10,000 hospitalizations for asthma occurred in Georgia in 2006.

• Asthma hospitalization rates were highest among young children and older adults.
• Blacks are twice as likely as whites to be hospitalized with asthma.
• Approximately 230,000 (10%) children in Georgia have asthma.
• Hospitalization charges related to asthma totaled more than $124 million in 2006.
• More than 49,000 ER visits for asthma occurred in Georgia in 2006.
• Blacks are 2.5 times more likely than whites to die from asthma and women are 1.6 times more likely than men to die from asthma.

Know the common triggers for asthma. Exposure to the following environmental irritants and allergens can cause an asthma attack:

• Tobacco smoke 
• Dust mites
• Pets (animal dander)
• Cockroaches
• Fungi and molds (indoor and outdoor)

52% of children with asthma having never been given an asthma action plan by a doctor or other health professional.

78% of adults with asthma reported having never been given an asthma action plan by a doctor or other health professional.

Practice Application: Develop an asthma action plan for patients to follow and inform patients about the common triggers for asthma.

Source: Georgia Department of Human Resources, Division of Public Health http://health.state.ga.us/epi/cdiee/asthma.asp

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Cancer in Georgia

Cancer is the leading cause of death in Georgia.

• 30-35% of cancer deaths could be prevented by physical activity and eating a healthy diet.
• 55% of all new cancer cases for women are linked to breast, lung and bronchus, and colon and rectum cancers.
• 56% of all new cancer cases for men are linked to prostate, lung and bronchus, and colon and rectum cancers.
• Breast cancer is the leading cause of cancer incidence among females.
• Prostate cancer is the leading cause of cancer incidence among males.
• Colorectal cancer is the third most common cancer diagnosed among males and females.
• Males are 45% more likely to be diagnosed with cancer than females in Georgia.
• In Georgia, the prostate incidence rate is among black males is 79% higher than among while males.

Cancer facts and statistics:

• In the U. S., males have a 1 in 2 lifetime risk of developing cancer while females have a 1 in 3 lifetime risk.
• One in eight American females will develop breast cancer.
• White women are more likely to be diagnosed with cancer than black women but black women are more likely to die from the disease.
• One in six American males will develop prostate cancer.
• Tobacco use accounts for 87% of lung cancers.

Practice Application: The best strategy to prevent and reduce cancer is improving diet, increasing physical activity, stopping tobacco use and appropriate use of mammography, colorectal screening and other early detection examinations.

Source: Georgia Department of Human Resources, Division of Public Health

http://www.health.state.ga.us/programs/gccr/data.asp

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Cardiovascular Disease in Georgia

Cardiovascular disease is the leading cause of death in Georgia. Cardiovascular disease (CVD) includes all diseases of the heart and blood vessels, including congestive heart failure, stroke, ischemic heart disease, hypertensive disease and atherosclerosis.

CVD accounted for one third of deaths in Georgia in 2006.

• Georgia's CVD rate was 9% higher than the national rate in 2006.
• CVD death rates were 1.4 times higher for men than women and 1.3 times higher for blacks than whites in 2006. 

Modifiable risk factors for CVD:

• Smoking
• Lack of physical activity
• Poor eating habits
• Obesity
• High blood pressure
• High cholesterol
• Diabetes

Heart attack warning signs (from the American Heart Association):

• Chest discomfort - discomfort in the center of the chest that lasts more than a few minutes or goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness or pain.
• Discomfort in other areas of the upper body - may include pain or discomfort in one or both arms, the back, neck, jaw or stomach.
• Shortness of breath with or without chest discomfort.
• Other signs may include breaking our in a cold sweat, nausea or lightheadedness.
• Learn the signs and if you are not sure it's a heart attack, have it checked out. Fast action can save lives.

Practice Application: Encourage patients to make modifications in lifestyle to minimize the risk factors:

• Quit smoking.
• Exercise regularly.
• Eat five or more servings of fruit and vegetables daily.
• Control high blood pressure through physical activity, diet and medication if necessary,
• Control cholesterol by dietary changes.

Source: Georgia Department of Human Resources, Division of Public Health

http://health.state.ga.us/epi/cdiee/cardio.asp

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Death in Georgia

The leading causes of death in Georgia in 2006 were:

• Heart disease
• Cancer
• Stroke
• Unintentional injury
• Chronic respiratory
• Alzheimer's
• Diabetes
• Kidney disease
• Influenza/pneumonia
• Septicemia
• Hypertension
• Suicides

The actual causes of death in Georgia were:

• Tobacco
• Poor diet and physical inactivity
• Alcohol
• Microbial agents
• Toxic agents
• Motor vehicle
• Firearms
• Sexual behavior
• Illicit drug use 

Practice Application: Patients can be counseled to modify tobacco use, maintain a proper diet, exercise regularly, drive carefully, monitor alcohol intake and cease drug use to avoid premature death.

Source: Georgia Department of Human Resources, Division of Public Health

http://health.state.ga.us/phchanges/

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Diabetes in Georgia

Diabetes is a common disease in Georgia.

• In 2007, approximately 700,000 adults aged 18 years and older (10.1% of the Georgia adult population) had been diagnosed with diabetes.
• For every two persons with diabetes who have been diagnosed, another has not yet been diagnosed. Therefore, approximately 350,000 additional adult Georgians are estimated to have undiagnosed diabetes.
• In Georgia, the cost of diabetes due to medical care, lost productivity, and premature death is estimated to be over $5.1 billion per year.

Diabetes is a leading cause of death in Georgia.

• In 2006, diabetes was the seventh leading cause of death, killing 1,626 Georgians, equivalent to about 5 deaths every day.
• For every death with diabetes as a primary cause, there are two other deaths in which diabetes is a contributing cause.
  
  

Diabetes can contribute to:

• blindness
• kidney failure
• amputations
• heart disease
• stroke
• hypertension
• nerve damage
• repeated infections
• slow wound healing
• sexual dysfunctions
• skin disorders
• periodontal disease
• pregnancy complications
• disability
• premature death

 

Practice Application: Many complications of diabetes can be prevented with early detection, proper intervention and comprehensive management.

 

Source: Georgia Department of Human Resources, Division of Public Health

http://www.health.state.ga.us/epi/cdiee/diabetes.asp

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Obesity in Georgia

Obesity in children and youth is a significant health problem and the percentage of obese adults in Georgia is rapidly rising.

Obesity facts and statistics:

• 24% of third grade children are obese (28,000)
• 15% of middles school children are obese (43,000)
• 14% of high school students are obese (62,000)
• 29% of adult Georgians are obese (1.9 million)
• The annual cost of obesity in Georgia is estimated at $2.1 billion or $250 per Georgian per year, including indirect health care costs and lost productivity.

Obese individuals are at increased risk for other medical conditions:

• Cardiovascular disease
• Hypertension
• Asthma
• Sleep apnea
• Diabetes
• Stroke
• Osteoarthritis
• Gall bladder disease
• Low self esteem

Factors contributing to the rise of obesity:

• Poor diet (Only 1 in 5 high school students and only 1 in 4 adults consumes 5 or more servings of fruit and vegetable  daily)
• Physical inactivity
• Environments and policies influence health behavior

Practice Application: Obesity can be decreased by creating safe and supportive environments for physical activity and promoting healthful eating.

Source: Georgia Department of Human Resources, Division of Public Health

http://health.state.ga.us/epi/cdiee/obesity.asp

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Stroke in Georgia

NEW - AHA Stroke Community (Providing important info for health care professionals about stroke)

Stroke is the third leading cause of death in Georgia and it is a major cause of disability.

Death and Hospitalization:

• Strokes were responsible for 18% of all cardiovascular deaths in Georgia in 2006.
• Georgia's stroke death rate in 2006 was 16% higher than the national rate.
• The stroke death rate in Georgia was 1.4 times higher for blacks than whites in 2006.
• 23% of those dying from stroke in Georgia in 2006 were less than 65 years old.
•  About 23,000 hospitalizations in 2006 in Georgia occurred due to stroke.
• 16% of cardiovascular hospitalizations in 2006 were attributed to stroke.
• Hospital charges for stroke in Georgia were $618 million in 2006.
• The cost of stroke in Georgia in 2006 was $1.5 billion including direct health care costs and lost productivity.

The majority of Georgians do not know all the signs and symptoms of stroke. 

Warning signs of stroke (from the American Stroke Association):

• Sudden numbness or weakness of the face, arm or leg, especially on one side of the body. 
• Sudden confusion, trouble speaking or understanding.
• Sudden trouble seeing in one or both eyes.
• Sudden trouble walking, dizziness, loss of balance or coordination.
• Sudden severe headache with no known cause.
• Note: If you or someone you know has these signs of stroke, call 9-1-1.
• A clot-busting drug called tissue plasminogen activator (tPA) is the only FDA approved medication for treating stroke within three hours of stroke symptom onset.

Stroke Risk Factors 

• Smoking
• Lack of physical activity
• Poor eating habits
• High blood pressure
• Obesity
• High cholesterol
• Diabetes

Practice Application: Education and better patient care can improve stroke outcomes.

Stroke Treatment (from the Neurology Channel) has a variety of resouces on stroke.

Source:Georgia Department of Human Resources, Division of Public Health

http://health.state.ga.us/pdfs/epi/cdiee/2008%20Stroke%20Data%20Summary.pdf

Also check the CDC page on Georgia's Burden of Heart Disease and Stroke .