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2017 HCHB_digital

Preventive Health There

Preventive Health There are certain lifestyle choices people can make to increase their chances of living a long and healthy life. Most are simple and readily available. A summary of key preventive health topics is given below. For more information about staying well, see the New Zealand Ministry of Health’s website for New Zealanders, HealthEd (www.healthed.govt.nz). Immunisation Immunisation is one of the most cost-effective ways to prevent disease. It stimulates the body’s natural immune system to build resistance to specific infections. The National Immunisation Schedule of New Zealand is the series of vaccines that are offered free to babies, children, adolescents and adults. For more information on vaccination and the diseases vaccinated against, see Childhood Diseases and Immunisations. While many of these diseases are no longer prevalent in New Zealand, some are endemic overseas and people travelling should ensure their full childhood course of immunisations has been completed. Eating and Activity Guidelines The weight of New Zealanders continues to increase with nearly 32% of adults reported as obese in the 2015/2016 New Zealand Health Survey, and a further 35% reported as overweight (but not obese). Maori and Pacific adults have comparatively high rates of obesity (47% and 67% respectively). Obesity rates in children have remained relatively stable at 11% of children aged two to 14 years; however, Pacific children were more than three times as likely to be obese as non-Pacific children. The New Zealand Eating and Activity guidelines recommend to: • eat a variety of nutritious foods everyday including plenty of vegetables and fruit; grain foods (mostly wholegrain and high in fibre); some milk and milk products (mostly low and reduced fat); some legumes, nuts, seeds, fish and other seafood; poultry and some red meat (with the fat removed) • choose foods that contain unsaturated fat (rather than saturated fat), that are low in sodium (salt), with little or no added sugar, that are mostly whole and less processed »» Use salt sparingly and choose iodised salt over uniodised salt. • make plain water your preferred drink • keep alcohol intake low if you choose to drink alcohol; avoid alcohol during pregnancy or when trying to get pregnant • partake in at least 150 minutes of moderate or 75 minutes of vigorous intensity physical activity spread throughout the week. Do muscle strengthening exercises on at least two days per week. Break up long periods of sitting with activity. Funded screening programmes Screening aims to identify the presence or risk of a disease before it has fully developed or become harmful and there is a range of screening activities open to a person throughout their lifecourse. Not all are government funded and several lack evidence that screening is in fact beneficial. Five screening programmes and one quality improvement programme are currently coordinated by the National Screening Unit of New Zealand. These are: • Breastscreen Aotearoa: screens women for breast cancer • National Cervical Screening Programme: screens women for abnormal changes to cells on the cervix • Newborn Metabolic Screening Programme: screens newborns for certain metabolic disorders • Antenatal HIV Screening Programme: screens pregnant women for HIV to reduce mother-to-child transmission • Universal Newborn Hearing Screening Programme: screens newborn babies for hearing loss • Antenatal screening for Down syndrome and other conditions (quality improvement for screening). See the table next page for further information about some of these government-funded screening programmes and others. Eye health Glaucoma affects 2% of the population over 40 years and is largely symptomless. Glaucoma NZ recommends all adults have an eye examination for glaucoma by the time they are 45 and then every five years thereafter if the examination is normal. In addition, macular degeneration – a condition that affects almost one in seven older New Zealanders and is the leading cause of blindness – should be screened for in those over the age of 50. Maintaining good oral health Good oral health is essential to overall health, and oral health services are free for all New Zealanders until their 18th birthday. Despite this, the prevalence and severity of child dental decay In New Zealand is higher than that seen in the United States, Australia, or the United Kingdom. Significant differences exist in the number of children who are dental caries-free by age five associated with ethnicity, region and water fluoridation status, and these inequalities, particularly between Maori and non-Maori, are worsening. In some areas of New Zealand the severity of dental decay in children is at the level of developing Eastern European countries. Pharmacy staff are in an ideal position to educate their customers about good oral hygiene and free dental healthcare for their children (see www. healthysmiles.org.nz or ask at the child’s school). For more information see Oral Health or Toothache. Sexual and reproductive health Sexually transmitted infections (STIs) are common in New Zealand particularly in adolescents and adults aged 15–25 years. Chlamydia is New Zealand’s most commonly diagnosed STI and if left untreated (70% of people who have it have no symptoms), can lead to pelvic inflammatory disease, ectopic pregnancy, urethritis and infertility. The New Zealand Ministry of Health recommends chlamydia testing be considered in all sexually active people under the age of 25. Although not as prevalent as chlamydia, the number of people diagnosed with READY, SET, LEARN! Page 124 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION Screening in New Zealand SCREENING CONDITION Breast cancer Cardiovascular disease (CVD) SCREENING TESTS Mammography Ultrasound Fasting lipid profile Fasting plasma glucose Blood pressure COMMENTS The New Zealand Breast Cancer Foundation recommends annual screening mammograms for women from 40 years on. Free breast screening every two years is available for women aged 45–69 years through the National Breast screening programme, BreastScreen Aotearoa (freephone 0800 270 200 to enrol). See also Heart Health All men from the age of 45 and women from the age of 55 should have a cardiovascular disease risk assessment, unless they have risk factors or are Maori, from the Pacific Islands or Indian subcontinent, then a check should be conducted 10 years earlier. Cervical cancer Pap smear The NZ National Cervical Screening programme (0800 729 729) recommends that any woman who has ever been sexually active should have a cervical smear test every three years from the time they turn 20 until they turn 70. Includes all women who have been immunised against HPV. Colorectal cancer Osteoporosis Colonoscopy Sigmoidoscopy Faecal occult blood test FRAX tool Dual energy x-ray absorptiometry (DEXA) of the hip and spine Ultrasound of the heel Bowel cancer is the most frequently diagnosed cancer and the second highest cause of cancer death in New Zealand. Pilot scheme started in 2011 and extended until the end of 2017 to screen people aged 50–74 years living in the Waitemata District Health Board area (Auckland) using a faecal occult blood test. No decision has yet been made on implementing a national programme at time of going to print. For other tests, recommended screening interval is dependent on screening test. FRAX tool calculates the probability of an osteoporotic fracture occurring based on clinical risk factors. Uses either a body mass index (BMI) or bone mineral density T-score (available at www.shef.ac.uk/FRAX). Determining who is at risk of falls may be more important than just DEXA measurement. The Health Quality and Safety Commission of New Zealand (www.hqsc.govt.nz) recommends health professionals make it routine practice to ask older people about falls. Access to and funding of bone densitometry scanning varies throughout New Zealand. Bone density usually only measured if result will impact on decision making. May be considered in women aged >60 years, men aged >70 years, and those with risk factors for osteoporosis (ie, previous fracture, low body weight, family history of osteoporosis, premature menopause, glucocorticoid or anticonvulsant use, smokers). Prostate cancer Digital rectal examination (DRE) Prostate specific antigen (PSA) Prostate biopsy No funded population-based screening in New Zealand. Controversy exists over value of encouraging screening requested by individuals. It is recommended that every man has the right to decide for himself whether or not to be tested. Practice of prostate screening varies widely in New Zealand, some doctors screen up until age 75. United States guidelines recommend against prostate cancer screening in asymptomatic men. Most patients present with potentially curable disease and most do not have symptoms even if the cancer is extensive within the prostate. PSA test is not specific for prostate cancer. Can be normal in some men with cancer and can elevate with some other conditions (eg, urinary tract infections, prostatitis, benign prostatic hyperplasia [BPH]). gonorrhoea, genital herpes, genital warts, or infectious syphilis is increasing. Two hundred and twenty four people were diagnosed with HIV in 2015. Over 68% were men infected through having sex with men. All New Zealand citizens and permanent residents are entitled to free maternity care (www.findyourmidwife.co.nz). Supplements of folic acid are recommended for those attempting to conceive and iodine should be taken from pregnancy confirmation until the end of breastfeeding (see Pregnancy Tests and Supplements). Skin cancer Rates of skin cancer in New Zealand are among the highest in the world. Skin cancer is largely preventable (see Sun Care), and finding skin cancer as early as possible is the key to successful treatment. All adults over the age of 20 should regularly check their skin for changes or abnormal moles, freckles or spots. Smoking cessation New Zealand has been at the forefront of tobacco control internationally and the New Zealand Government is committed to the goal of New Zealand becoming smokefree by 2025. Despite New Zealand’s progress, smoking remains the single biggest cause of preventable morbidity, with approximately 5000 deaths each year attributable to direct smoking or second-hand smoke. For more information see Smoking Cessation. TREATMENT OPTIONS Category Examples Comments Natural products eg, Turmeric 15800 Complex* Turmeric complex contains turmeric, ginger, and ashwagandha; anti-inflammatory properties of these natural ingredients may help with joint aches and pains and gastrointestinal health. Products with an asterisk have a detailed listing in the Preventive Health section of OTC Products, starting on page 256. Locate this icon throughout the Healthcare Handbook. Then find the corresponding Pharmacy Today and ELearning articles. Read all three to unleash learning prizes and giveaways! Page 125

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