Adolescent
13 - 17 years of age
Chronic Diseases/Lifestyle
Preface
Abdominal Aortic Aneurysm (AAA)
Assess Need for Aspirin and/or Statin Therapy for CVD & Stroke Risk
Cognitive Impairment in Older Adults
Diabetes Mellitus (Type 2)
Folic Acid
Hypertension
Lipids
Obesity
Osteoporosis
Substance Use Disorders
References
ABDOMINAL AORTIC ANEURYSM:
USPSTF. Abdominal aortic aneurysm: screening. 2019.*
CARDIOVASCULAR RISK:
AHA/ASA. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults. Available at:
http://circ.ahajournals.org/content/circulationaha/129/25_suppl_2/S1.full.pdf
AHA/ASA. Guidelines for the primary prevention of stroke. 2014. Available at:
http://stroke.ahajournals.org/content/early/2014/10/28/STR.0000000000000046
Coronary heart disease risk calculator. Medical College of Wisconsin website:
http://www.mcw.edu/calculators/CoronaryHeartDiseaseRisk.htm.
National Lipid Association. Recommendations for patient-centered management of dyslipidemia:
Part 1—full report. 2015. Available at: http://www.lipidjournal.com/article/S1933-2874(15)00059-
8/fulltext#sec2
U.S. FDA. Use of aspirin for primary prevention of heart attack and stroke. 2014. FDA website:
http://www.fda.gov/Drugs/ResourcesForYou/Consumers/ucm390574.htm
USPSTF. Evidence Summary: Statins for Prevention of Cardiovascular Disease in Adults. 2016.
Available at: https://www.uspreventiveservicestaskforce.org/Page/Document/evidence-summarystatins/statin-use-in-adults-preventive-medication1
COGNITIVE IMPAIRMENT:
Jin J. Screening for Cognitive Impairment in Older Adults. JAMA. 2020;323(8):800.
doi:10.1001/jama.2020.0583
Patnode CD, Perdue LA, Rossom RC, et al. Screening for cognitive impairment in older adults:
updated evidence report and systematic review for the US Preventive Services Task Force [published
February 25, 2020]. JAMA
American Academy of Family Physicians (AAFP). Clinical preventive service recommendation:
dementia. AAFP website. https://www.aafp.org/patient-care/clinicalrecommendations/all/dementia.html. Accessed January 6, 2020.
American Academy of Neurology (AAN). Practice guideline update: mild cognitive impairment. AAN
website. https://www.aan.com/Guidelines/home/GetGuidelineContent/882. Published 2017. Accessed
January 6, 2020.
Center for Medicare and Medicaid Services (CMS). Annual wellness
visit. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-NetworkMLN/MLNProducts/Downloads/AWV_Chart_ICN905706.pdf. Published August 2018. Accessed
January 6, 2020.
National Institute on Aging website. https://www.nia.nih.gov/. Accessed January 6, 2020.
DIABETES:
American Diabetes Association. Standards of Medical Care in Diabetes—2017. Available at:
https://professional.diabetes.org/sites/professional.diabetes.org/files/media/dc_40_s1_final.pdf
Federal Bureau of Prisons. Clinical guidance for diabetes. 2017.**
USPSTF. Prediabetes and type 2 diabetes screening. 2021.*
FOLIC ACID SUPPLEMENTS:
USPSTF. Folic acid to prevent neural tube defects: preventive medication. 2017.*
HYPERTENSION:
Federal Bureau of Prisons. Clinical guidance for hypertension. 2015.**
USPSTF. High blood pressure in adults: screening. 2021.*
Federal Bureau of Prisons Preventive Health Care Screening
Clinical Guidance July 2022
35
IMMUNIZATIONS:
CDC. Recommended Immunization Schedule for Adults Aged 19 Years or Older, United States,
2018.
Available at: https://www.cdc.gov/vaccines/schedules/downloads/adult/adult-combined-schedule.pdf
OBESITY:
CDC. Body mass index. CDC website: http://www.cdc.gov/healthyweight/assessing/bmi/index.html.
USPSTF. Weight Loss to Prevent Obesity-Related Morbidity and Mortality in Adults: Behavioral
Interventions, 2018.
OSTEOPOROSIS:
Gourlay, ML. Bone-density testing interval and transition to osteoporosis in older women. N Engl J
Med. 2012;366:225–233. Available at: http://www.nejm.org/doi/full/10.1056/NEJMoa1107142
Raisz LG. Clinical practice. Screening for osteoporosis. N Engl J Med. 2005;353:164–171. Available
at: http://www.nejm.org/doi/full/10.1056/NEJMcp042092
U.S. DHHS. Bone Health and Osteoporosis: A Report of the Surgeon General. Rockville, MD: U.S.
Department of Health and Human Services, Office of the Surgeon General, 2004. Available at:
http://www.ncbi.nlm.nih.gov/books/NBK45513/
USPSTF. Osteoporosis: screening. 2018.*
SUBSTANCE USE DISORDERS
USPSTF. Unhealthy Drug Use Screening. 2020.*
USPSTF. Unhealthy Alcohol Use in Adolescents and Adults: Screening and Behavioral Counseling
Interventions. 2018.*
Abdominal Aortic Aneurysm (AAA)
At risk: Men, age 65–75, with a history of smoking.
Screen for abdominal aortic aneurysm (AAA).
• Abdominal
Ultrasonography: Once • Periodic surveillance is recommended for asymptomatic AAAs <5.5 cm diameter.
• In general, referral is recommended for symptomatic AAAs of any diameter or asymptomatic AAAs ≥ 5.5 cm.
Assess Need for Aspirin and/or Statin Therapy for CVD & Stroke Risk
Calculate 10-year CVD/stroke risk every 5 years, based on ACC/AHA pooled cohort risk calculator.
Aspirin Therapy
• Low-dose aspirin (75-100 mg orally daily) might be considered for the primary prevention of ASCVD among select adults 40 to 70 years of age who are at higher risk ASCVD risk but not at increased bleeding risk (class of recommendation [COR] IIb, level of evidence [LOE] A).
• Low-dose aspirin 75-100 mg orally daily) should not be administered on a routine basis for the primary prevention of ASCVD among adults >70 years of age (COR III [harm], LOEB-R).
• Low-dose aspirin 75-100 mg orally daily) should not be administered for the primary prevention of ASCVD among adults of any age who are at increased risk of bleeding (COR III [harm], LOE C-LD)
• For adults aged 40 to 59 years: Estimate CVD risk using a CVD risk estimator.
• In patients whose estimated CVD risk is 10% or greater, use shared decisionmaking, taking into account potential benefits and harms of aspirin use, as well as patients’ values and preferences, to inform the decision about initiating aspirin.
• For patients initiating aspirin use, it would be reasonable to use a dose of 81 mg/day.
• For adults 60 years or older: Do not initiate aspirin for primary prevention of CVD.
Statin Therapy
• Patients 40 to 75 years with CVD risk factors should be considered for primary prevention statin therapy based on current evidence and when CVD/stroke risk is ≥7.5%.
Cognitive Impairment in Older Adults
Age 50 years or older, without recognized signs or symptoms of cognitive impairment
• Screening with MiniCog
http://www.mini-cog.com
Diabetes Mellitus (Type 2)
Age 35 to 70 and overweight or obese:
Screen all age 45 and older regardless of risk factors.
See discussion of screening for diabetes in BOP Clinical Guidance for Diabetes.
• Fasting serum glucose or hemoglobin A1C:
Every 3 years
The BOP recommends the use of serum glucose testing or A1C for initial screening and diagnosis. When fasting serum glucose values are borderline high, a fasting plasma glucose should be obtained.
Folic Acid
• Women of childbearing age: Supplements containing 400–800 µg of folic acid in the periconceptual period to reduce the risk for neural tube defects.
• Counsel inmate patient: Recommend OTC purchase through commissary for non-pregnant inmate patients.
Folic Acid
• Women of childbearing age: Supplements containing 400–800 µg of folic acid in the periconceptual period to reduce the risk for neural tube defects.
• Counsel inmate patient: Recommend OTC purchase through commissary for non-pregnant inmate patients.
Hypertension
• Ages 18 to 39
• Age 40 and older, or with risk factors (risk factors include borderline blood pressure elevations, overweight or obese, or African-American)
Blood pressure screening at baseline and:
• Every 3 to 5 years
• Consider annual screening
Lipids
• If diabetes, CVD, or PVD, beginning at age 20.. Fasting lipoprotein analysis: • Annually
• Average risk ages 21 to 39 Given the lack of data on the efficacy of screening for or treatment of dyslipidemia in adults aged 21–39 years, the USPSTF encourages clinicians to use their clinical judgment for patients in this age group. Total cholesterol & HDL: • Clinician judgement
• Average risk age ≥40 year Every 5 years
If lipid levels are close to warranting therapy, then shorten intervals between screenings.
Lipid lowering therapy should be considered as outlined in an acceptable national guideline. ACC/AHA and USPSTF prevention guidelines are acceptable references.
Obesity
• All sentenced inmate patients Height/weight/BMI:
• At baseline & each preventive health care visit
Osteoporosis
• Women age 65 and older
• Younger women whose fracture risk is equal to or greater than that of a 65-year-old white woman with no additional risk factors
• Risk-factor based: Women age 60–64 with body weight less than 70 kilograms and no current use of estrogen
Bone mineral density screening (BMD):
• The most commonly recommended test is dual x-ray absorptiometry (DXA).
Repeat BMD screening as clinically indicated. The following intervals are recommended:
• Normal BMD (T score of 1.00 or higher) or mild osteopenia (T score of 1.01 to -1.49) screen every 15 years
• Moderate osteopenia (T score of -1.50 to -1.99) screen every 5 years
• Advanced osteopenia (T score of -2.00 to -2.49) screen every year
Substance Use Disorders
• All inmate patients: Based on assessment, provide counseling and referral to BOP substance use disorder and smoking cessation programs.
At intake visit:
• Assess for substance use disorders history and need for withdrawal management and/or treatment.