Prevention of diseases after 60: Important examinations

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Prevention of diseases after 60: Important examinations

I. Cardiovascular system: a shield from heart disease and blood vessels

After 60 years, the risk of developing cardiovascular diseases (SVD) increases significantly. Atherosclerosis, hypertension, coronary heart disease (coronary heart disease), heart failure and stroke become more common. Regular examinations help identify risk and disease factors in the early stages, allowing you to start treatment in a timely manner and prevent serious complications.

A. Arterial pressure: control – pledge of health

  1. Why is it important: Increased blood pressure (hypertension) is one of the main risk factors for the development of SVD. Hypertension often occurs asymptomatic, so regular control of blood pressure is extremely important. Uncontrolled hypertension can lead to a stroke, myocardial infarction, heart failure and renal failure.
  2. How often to measure: It is recommended to measure blood pressure at least once a year, and in the presence of risk factors (heredity, overweight, smoking, increased cholesterol) – more often, on the recommendation of a doctor.
  3. Measurement procedure: Arterial pressure is measured by a tonometer. Measurement rules:
    • Measure the pressure in a calm state, after 5-10 minutes of rest.
    • Do not use coffee or tea before measurement.
    • Sitting straight, with the support for the back, the legs should stand on the floor.
    • The hand should be relaxed and located at the level of the heart.
    • Measure the pressure on both hands and use a higher value.
  4. Interpretation of the results: The blood pressure below 120/80 mm Hg is considered normal. Art. Pressure from 120/80 to 129/84 mm Hg. Art. It is considered increased. Hypertension of the first degree – from 130/80 to 139/89 mm Hg. Art. Hypertension of the second degree – 140/90 mm Hg. Art. And above.
  5. What to do with increased pressure: If increased blood pressure is detected, consult a doctor to diagnose and prescribe treatment. The treatment of hypertension includes a change in lifestyle (diet, physical activity, refusal of smoking), as well as taking drugs prescribed by a doctor.

B. Lipid profile: cholesterol level assessment

  1. Why is it important: Lipid profile (blood test for cholesterol and triglycerides) allows you to evaluate the risk of atherosclerosis – the process of cholesterol deposit on the walls of blood vessels, which leads to their narrowing and impaired blood flow. Atherosclerosis is the main cause of coronary heart disease, stroke and other SVDs.
  2. How often to conduct an analysis: It is recommended to take a lipid profile at least once every 5 years, and in the presence of risk factors (heredity, hypertension, diabetes, smoking, overweight) – more often, on the recommendation of a doctor. People with already diagnosed CVDs need to control the lipid profile regularly, in accordance with the doctor’s recommendations.
  3. Preparation for analysis: A blood test for a lipid profile is given on an empty stomach, after 12-14 hours of starvation. It is allowed to drink only water.
  4. Interpretation of the results: The lipid profile includes the following indicators:
    • General cholesterol: The norm is less than 5.0 mmol/l.
    • High density lipoprotein cholesterol (HDL, “good” cholesterol): The norm is more than 1.0 mmol/l for men and more than 1.2 mmol/l for women. A high level of HDL is considered a protective factor.
    • Low density lipoprotein cholesterol (LDL, “bad” cholesterol): The norm is less than 3.0 mmol/l. The lower the level of LDL, the lower the risk of atherosclerosis. For people with a high risk of SVD, the target level of LDL can be even lower (for example, less than 1.8 mmol/l).
    • Triglycerides: Norm – less than 1.7 mmol/l. A high level of triglycerides is also a risk factor in the CVD.
  5. What to do with deviations from the norm: If deviations from the norm are detected, consult a doctor to diagnose and prescribe treatment. Treatment includes a change in lifestyle (a low content of saturated fats and cholesterol, physical activity, smoking rejection), as well as taking drugs that reduce cholesterol (statins, fibrates, ezetimib) prescribed by a doctor.

C. Electrocardiogram (ECG): Assessment of the heart of the heart

  1. Why is it important: ECG is a method of registering electrical activity of the heart. ECG allows you to identify heart rhythm (arrhythmias), signs of coronary heart disease (angina pectoris, myocardial infarction), myocardial hypertrophy and other heart diseases.
  2. How often to conduct an ECG: It is recommended to conduct an ECG at least once a year, and in the presence of risk factors (hypertension, diabetes, smoking, heredity) or symptoms (chest pain, shortness of breath, heart heartbeat, interruptions in the heart) – more often, on the recommendation of a doctor.
  3. Procedure: ECG is a painless and non -invasive procedure. Electrodes that record electrical activity of the heart are applied to the skin of the chest, arms and legs.
  4. Interpretation of the results: The ECG results are evaluated by a cardiologist. Signs of various heart diseases, such as arrhythmias, coronary heart disease, myocardial hypertrophy, heart blockade and others, can be detected on the ECG.
  5. What to do when detecting deviations: If deviations on the ECG, it is necessary to consult a cardiologist for further examination and treatment. Additional examinations, such as echocardiography (ultrasound of the heart), Holter monitoring of ECG, stress test, can be prescribed.

D. Echocardiography (ultrasound of the heart): heart visualization

  1. Why is it important: Echocardiography is a method of ultrasound of the heart, which allows you to visualize the structure and function of the heart. Echocardiography allows you to evaluate the size of the heart chambers, the thickness of the heart walls, the function of the heart valves, the contractility of the myocardium, the presence of fluid in the pericardium and other parameters.
  2. How often to conduct echocardiography: It is recommended to conduct echocardiography as prescribed by a cardiologist in the presence of indications, such as suspicion of heart failure, heart defects, myocardial hypertrophy, cardiomyopathy, pulmonary hypertension.
  3. Procedure: Echocardiography is a painless and non -invasive procedure. A special gel is applied to the skin of the chest, and the doctor conducts the sensor on the chest, receiving the image of the heart on the screen.
  4. Interpretation of the results: The results of echocardiography are evaluated by a cardiologist. Echocardiography allows you to detect various heart disease, such as heart defects, heart failure, myocardial hypertrophy, cardiomyopathy, pulmonary hypertension, blood clots in the heart cavities, pericarditis.
  5. What to do when detecting deviations: When identifying deviations on echocardiography, you must consult a cardiologist for further examination and treatment.

E. Dopplerography of blood vessels (ultrasound of the vessels): blood flow assessment

  1. Why is it important: Dopplerography of blood vessels is a method of ultrasound examination of blood vessels, which allows you to evaluate blood flow in the vessels. Dopplerography of blood vessels allows you to identify vessels (stenosis), blockage of blood vessels (thrombosis), vascular aneurysm and other vascular diseases.
  2. What vessels are examined: Most often, dopplerography of the vessels of the neck (carotid and vertebral arteries), the lower extremities (arteries and veins), as well as the abdominal aorta and its branches are performed.
  3. How often to conduct dopplerography of blood vessels: It is recommended to conduct prepoplerography of the vessels as prescribed by a doctor in the presence of indications, such as dizziness, headaches, ears noise, interspersing lameness, swelling of the legs, varicose veins.
  4. Procedure: Dopplerography of blood vessels is a painless and non -invasive procedure. A special gel is applied to the skin above the vessel, and the doctor conducts the sensor on the skin, receiving the image of the vessel and information about the blood flow on the screen.
  5. Interpretation of the results: The results of the dopplerography of the vessels are evaluated by a surveying surgeon or a diagnostic doctor. Dopplerography of blood vessels allows you to identify vessels, blockage of blood vessels, vascular aneurysm, as well as evaluate the degree of blood flow.
  6. What to do when detecting deviations: When identifying deviations on the pre-Popplerography of blood vessels, it is necessary to consult a surgeon-surgeon for further examination and treatment. Treatment may include conservative methods (drug therapy, wearing compression knitwear) or surgical methods (angioplasty, stenting, shunting).

II. Oncological diseases: Early diagnosis – a chance of recovery

After 60 years, the risk of developing oncological diseases increases significantly. Regular screening examinations help identify cancer in the early stages, when treatment is most effective.

A. Tolstoy cancer: colonoscopy and fecal analysis for hidden blood

  1. Why is it important: Colon cancer is one of the most common oncological diseases. Early diagnosis significantly increases the chances of successful treatment.
  2. How often to conduct examinations:
    • Colonoscopy: It is recommended to carry out colonoscopy every 10 years, starting from 45-50 years. In the presence of risk factors (family history of cancer of the colon, polyps in the colon, inflammatory diseases of the intestine) – more often, on the recommendation of the doctor.
    • Hidden blood analysis: It is recommended to analyze feces for hidden blood annually.
  3. Colonoscopy: Procedure and preparation: Colonoscopy is an endoscopic examination of the colon, which allows you to visualize the mucous membrane of the colon and identify polyps or other formations. Before the colonoscopy, it is necessary to carry out thorough preparation of the intestines (cleansing enemas, taking special drugs). The procedure is carried out under sedation to minimize discomfort.
  4. Hidden blood analysis: how is it: The analysis of feces for hidden blood is a non -invasive method that allows you to identify the presence of blood in the feces, which can be a sign of colon cancer or other intestinal diseases.
  5. What to do with positive results: With a positive result of the analysis of feces for hidden blood, it is necessary to carry out a colonoscopy to exclude cancer of the colon. If polyps are detected during colonoscopy, they are removed and sent for histological examination.

B. breast cancer: mammography and ultrasound of the mammary glands

  1. Why is it important: Breast cancer is the most common oncological disease in women. Early diagnosis significantly increases the chances of successful treatment.
  2. How often to conduct examinations:
    • Mammography: It is recommended to conduct mammography every 1-2 years, starting from 40-50 years.
    • Ultrasound of the mammary glands: It is recommended to conduct an ultrasound of the mammary glands annually, especially in women with a dense structure of the mammary glands.
  3. Procedures:
    • Mammography: Mammography is an X -ray examination of the mammary glands, which allows you to identify tumors in the early stages. During mammography, the mammary glands are compressed between two plates.
    • Ultrasound of the mammary glands: An ultrasound of the mammary glands is an ultrasound examination of the mammary glands, which allows you to evaluate the structure of the tissues of the mammary glands and identify tumors.
  4. What to do when detecting deviations: If deviations on mammography or ultrasound of the mammary glands, it is necessary to conduct additional examinations, such as the biopsy of the mammary gland, to exclude breast cancer.

C. Cervical cancer: cytological examination (papa test) and HPV testing

  1. Why is it important: Cervical cancer is one of the most common oncological diseases in women. The main reason for the cervical cancer is the human papillomavirus (HPV).
  2. How often to conduct examinations:
    • Cytological study (papa test): It is recommended to conduct a papa test every 3 years, starting from 21 years.
    • HPV testing: It is recommended to conduct HPV testing every 5 years, starting from 30 years.
  3. Procedure:
    • PAP test: A papa test is a cytological study that allows you to identify atypical cells on the cervix, which can be a sign of cervical cancer or precancerous changes. During the papa test, the doctor takes a smear from the cervix.
    • HPV testing: HPV testing is an analysis that allows you to identify the presence of HPV in the cervical cells.
  4. What to do when detecting deviations: If deviations in the results of the papa test or HPV testing, it is necessary to conduct additional examinations, such as colposcopy and cervical biopsy, to exclude cervical cancer or precancerous changes.

D. Prostate cancer: Analysis for PSA and finger rectal examination

  1. Why is it important: Prostate cancer is the most common oncological disease in men. Early diagnosis significantly increases the chances of successful treatment.
  2. How often to conduct examinations:
    • Analysis for PSA (prostat-specific antigen): It is recommended to conduct an analysis for the dog annually, starting from 50 years. In the presence of risk factors (family history of prostate cancer, African American origin)-from 40-45 years.
    • Finger rectal study: It is recommended to conduct a finger rectal study annually, starting from 50 years.
  3. Procedures:
    • Analysis for PSA: PSA analysis is a blood test that allows you to determine the level of the PSA in the blood. The increased level of the dog can be a sign of prostate cancer, but can also be caused by other diseases of the prostate gland (prostatitis, benign prostate hyperplasia).
    • Finger rectal study: A finger rectal examination is an examination of the prostate gland through the rectum. During a finger rectal examination, the doctor can identify seals or other changes in the prostate gland.
  4. What to do when detecting deviations: If an increased level of the PSA or changes in the prostate gland during a finger rectal examination, additional examinations, such as the biopsy of the prostate gland, to exclude the prostate cancer.

E. skin cancer: independent examination and examination by a dermatologist

  1. Why is it important: Skin cancer is one of the most common oncological diseases. Early diagnosis significantly increases the chances of successful treatment.
  2. How often to conduct examinations:
    • Independent skin examination: It is recommended to conduct an independent examination of the skin monthly, paying attention to new moles or changes in existing moles (change in size, shape, color, the appearance of itching or bleeding).
    • Inspection by a dermatologist: It is recommended to conduct an examination by a dermatologist annually, especially in the presence of a large number of moles or risk factors (history of sunburn, light skin, family history of skin cancer).
  3. What to look for when examining: Pay attention to the ABCDE rule:
    • A (Asymmetry): Asymmetry. If you divide the mole in half, the halves will not be the same.
    • B (Border): Borders. Uneven, blurry or jagged edges.
    • C (Color): Color. Uneven color, the presence of several colors (black, brown, red, white, blue).
    • D (Diameter): Diameter. Mole is more than 6 mm.
    • E (Evolution): Change. Any changes in the amount, shape, color or height of the mole, the appearance of new symptoms (itching, bleeding).
  4. What to do when identifying suspicious moles: When identifying suspicious moles, you must contact a dermatologist for examination. A dermatologist can conduct dermatoscopy (an examination of a mole under an increase) or a mole biopsy to eliminate skin cancer.

III. Endocrine system: hormones control to maintain health

After 60 years, the risk of developing diseases of the endocrine system, such as diabetes mellitus, thyroid disease and osteoporosis, increases. Regular examinations help identify these diseases in the early stages and prevent serious complications.

A. Diabetes: blood test for glucose and glycated hemoglobin

  1. Why is it important: Diabetes mellitus is a disease characterized by an increased blood glucose level. Uncontrolled diabetes mellitus can lead to serious complications, such as damage to the kidneys, eyes, nerves and cardiovascular system.
  2. How often to conduct examinations:
    • Blood test for glucose on an empty stomach: It is recommended to conduct a blood test for glucose on an empty stomach annually, starting from 45 years. In the presence of risk factors (overweight, family history of diabetes, hypertension, increased cholesterol) – more often, on the recommendation of a doctor.
    • Blood test for glycated hemoglobin (HBA1C): A blood test for glycated hemoglobin shows the average level of blood glucose over the past 2-3 months. It is recommended to conduct a blood test for glycated hemoglobin as a doctor’s prescription for suspected diabetes mellitus or to control the glucose level in people with already diagnosed diabetes.
  3. Interpretation of the results:
    • Glucose on an empty stomach: The norm is less than 5.6 mmol/l. The level of glucose on an empty stomach from 5.6 to 6.9 mmol/L indicates a violation of glucose tolerance (pre -orebet). Glucose level on an empty stomach 7.0 mmol/l and above indicates diabetes.
    • Glycated hemoglobin (HBA1C): The norm is less than 5.7%. The level of glycated hemoglobin from 5.7% to 6.4% indicates prediabetes. The level of glycated hemoglobin 6.5% and higher indicates diabetes.
  4. What to do when detecting deviations: If an increased level of glucose in the blood or glycated hemoglobin is detected, it is necessary to consult an endocrinologist to diagnose and prescribe treatment. Treatment of diabetes includes a change in lifestyle (diet, physical activity, weight loss), as well as taking drugs that reduce blood glucose (metformin, sulfonyl gross preparations, DPP-4 inhibitors, SGLT2 inhibitors, insulin) prescribed by a doctor.

B. Diseases of the thyroid gland: blood test for TSH and ultrasound of the thyroid gland

  1. Why is it important: Thyroid diseases (hypothyroidism, hyperthyroidism, nodal goiter, autoimmune thyroiditis) can lead to various disorders in the body, such as weight changes, fatigue, heart and hair problems.
  2. How often to conduct examinations:
    • Blood test for TSH (thyroidropic hormone): It is recommended to conduct a blood test for TSH every 1-2 years, especially in women. In the presence of risk factors (family history of thyroid diseases, autoimmune diseases) – more often, on the recommendation of a doctor.
    • Ultrasound of the thyroid gland: It is recommended to conduct an ultrasound of the thyroid gland as prescribed by a doctor when detecting deviations in the results of blood tests for TSH or on palpation of the thyroid gland.
  3. Interpretation of the results:
    • TSH: Normal TSH values depend on the laboratory, but are usually in the range of 0.4-4.0 honey/l. An increased level of TSH can indicate hypothyroidism (insufficient thyroid function). A reduced level of TSH can indicate hyperthyroidism (excessive thyroid function).
  4. What to do when detecting deviations: If deviations in the results of blood tests for TSH, it is necessary to consult an endocrinologist to diagnose and prescribe treatment. Additional blood tests (T4 are free, T3 is free, antibodies to TPO, antibodies to TG) and ultrasound of the thyroid gland can be prescribed.

C. Osteoporosis: Densitometry

  1. Why is it important: Osteoporosis is a disease characterized by a decrease in bone density, which leads to increased risk of fractures. Especially often there are fractures of the vertebrae, neck of the thigh and forearm.
  2. How often to conduct an examination:
    • Dencitometry: Densitometry is a method for measuring bone density. It is recommended to carry out densitometry for women over 65 and men over 70 years old. Densitometry is also recommended for people with risk factors of osteoporosis (history of fractures, family history of osteoporosis, intake of glucocorticoids, early menopause, smoking, alcohol abuse).
  3. Procedure: Densitometry is a painless and non -invasive procedure. The most commonly used two -energy X -ray absorphytiometry (DEXA).
  4. Interpretation of the results: The results of densitometry are evaluated using T-criteria. T-criteria shows a deviation of bone density from the average bone density in young healthy people.
    • T -criteria from -1.0 and above -the normal density of bone tissue.
    • T -criteria from -1.0 to -2.5 -osteopenia (reduced bone density).
    • T -criteria -2.5 and below -osteoporosis.
  5. What to do when osteopenia or osteoporosis: If osteopenia is detected, it is necessary to consult an endocrinologist or a rheumatologist to prescribe treatment. The treatment of osteoporosis includes a change in lifestyle (a diet rich in calcium and vitamin D, physical activity, the rejection of smoking and alcohol abuse), as well as taking drugs that strengthen bone tissue (bisphosphonates, denosumab, selective estrogen receptor modulators, teripipidate).

IV. Visual organs: Visual preservation is an important task

After 60 years, the risk of developing eye diseases, such as glaucoma, cataracts and age -related macular degeneration (VMD), increases. Regular examinations of an ophthalmologist help to identify these diseases in the early stages and prevent vision loss.

A. Glaucoma: measuring intraocular pressure and eye view examination

  1. Why is it important: Glaucoma is a disease characterized by increased intraocular pressure, which leads to damage to the optic nerve and, ultimately, to blindness. Glaucoma often occurs asymptomatic in the early stages.
  2. How often to conduct examinations: It is recommended to measure intraocular pressure and the inspection of the fundus at the ophthalmologist annually, starting from 40 years. In the presence of risk factors (family history of glaucoma, increased intraocular pressure, myopia, diabetes mellitus) – more often, on the recommendation of a doctor.
  3. Procedures:
    • Measurement of intraocular pressure (tonometry): Measurement of intraocular pressure is a simple and painless procedure. There are various methods of measuring intraocular pressure (apphannational tonometry, non -contact tonometry).
    • Eye view (ophthalmoscopy): Inspection of the eye bottom allows you to assess the condition of the optic nerve and retina. The eye bottom is examined using an ophthalmoscope.
  4. What to do when detecting deviations: If increased intraocular pressure or changes in the optic nerve is detected, it is necessary to contact an ophthalmologist for further examination and treatment. Treatment of glaucoma includes the use of eye drops that reduce intraocular pressure, laser treatment or surgery.

B. Cataract: Crystal examination

  1. Why is it important: Cataract is a clouding of the lens of the eye, which leads to a decrease in vision. Cataract is one of the most common causes of blindness in the world.
  2. How often to conduct examinations: It is recommended to conduct an examination of the lens at the ophthalmologist annually, starting from the age of 60.
  3. Procedure: Inspection of the lens is carried out using a slit lamp.
  4. What to do when identifying cataracts: If cataracts are detected, it is necessary to contact an ophthalmologist to determine the degree of clouding of the lens and treatment planning. Cataract treatment is surgical. During an operation to remove cataracts, a clouded lens is replaced by an artificial lens (intraocular lens).

C. Age macular degeneration (VMD): retinal inspection and optical coherent tomography (OKT)

  1. Why is it important: Age macular degeneration (VMD) is a disease that affects the central region of the retina (macula), which leads to a decrease in central vision. VMD is one of the most common causes of blindness in people over 60 years old.
  2. How often to conduct examinations: It is recommended to conduct a retinal inspection at an ophthalmologist annually, starting from 60 years. In the presence of risk factors (family history of the VMD, smoking, light skin, diseases of the cardiovascular system)-more often, on the recommendation of a doctor.
  3. Procedures:
    • Retinal inspection: The retinal examination is carried out using an ophthalmoscope or a slit lamp.
    • Optical coherent tomography (OKT): OCT is a retinal research method that allows you to get images of high clarity of the retinal layers. OKT allows you to identify the early signs of the VMD.
  4. What to do when identifying the VMD: If the VMD is detected, it is necessary to contact an ophthalmologist to prescribe treatment. Treatment of VMD may include the use of anti-VEGF drugs (injections in the eye), laser treatment or photodynamic therapy.

V. Nervous system: maintaining cognitive functions

After 60 years, the risk of developing diseases of the nervous system, such as Alzheimer’s disease, Parkinson’s disease and stroke. Regular examinations help identify these diseases in the early stages and slow down their progression.

A. Cognitive disorders: Cognitive Assessment

  1. Why is it important: Cognitive disorders are impaired memory, attention, thinking and other cognitive functions. Cognitive disorders can be a sign of dementia (Alzheimer’s disease, vascular dementia, etc.).
  2. How often to assess cognitive functions: It is recommended to assess cognitive functions annually, starting from 65 years. In the presence of complaints about memory violations or other cognitive functions – more often, on the recommendation of a doctor.
  3. Methods for evaluating cognitive functions:
    • Brief scale of mental assessment (MMSE): MMSE is a simple and quick test that allows you to evaluate various cognitive functions (orientation in time and place, memory, attention, speech, praxis).
    • Montreal scale for assessing cognitive functions (MOCA): Moca is a more sensitive test than MMSE, which allows you to identify early cognitive disorders.
    • Neuropsychological testing: Neuropsychological testing is a comprehensive examination that allows you to evaluate various cognitive functions (memory, attention, thinking, speech, praxis, gnosis, executive functions).
  4. What to do when identifying cognitive disorders: If cognitive disorders are detected, it is necessary to consult a neurologist for further examination and treatment. Additional examinations, such as an MRI of the brain, CT of the brain, EEG, can be prescribed.

B. Parkinson’s disease: assessment of motor functions and neurological examination

  1. Why is it important: Parkinson’s disease is a neurodegenerative disease characterized by tremor, rigidity, bradykinesia (slowdown in movements) and postural instability.
  2. How often to conduct examinations: It is recommended to conduct a neurological inspection annually, starting from 60 years. In the presence of symptoms of Parkinson’s disease (tremor, rigidity, slowdown, instability)-consult a neurologist.
  3. Diagnostic methods:
    • Neurological inspection: The neurologist conducts an inspection to assess motor functions, coordination, reflexes, sensitivity.
    • Tests for assessing motor functions: Various tests are used to assess speed, amplitude and coordination of movements.
    • Datrascan (Datscan): Datraskan is a neuroimaging method that allows you to assess the state of dopaminergic neurons in the brain.
  4. What to do with suspicion of Parkinson’s disease: If you suspect Parkinson’s disease, you must consult a neurologist to diagnose and prescribe treatment. Treatment of Parkinson’s disease includes taking drugs that improve motor functions (levodopa, dopamine receptor agonists, MAO-B inhibitors, KOMT inhibitors), as well as physical therapy and other rehabilitation methods.

VI. Infectious diseases: vaccination and prevention

After 60 years, the immune system weakens, which makes people more susceptible to infectious diseases. Vaccination is an effective way to protect against many infectious diseases.

A. FREP: annual vaccination

  1. Why is it important: Influenza is an acute respiratory disease caused by influenza viruses. Influenza can lead to serious complications such as pneumonia, bronchitis, sinusitis, otitis media, exacerbation of chronic diseases.
  2. To whom the vaccination is recommended: The flu vaccination is recommended to all people over 6 months old, especially for people over 65 years old, pregnant women, people with chronic diseases (cardiovascular diseases, lung diseases, diabetes mellitus, kidney disease).
  3. How often to carry out vaccination: The flu vaccination is carried out annually, since the influenza viruses are constantly mutating.
  4. Vaccination effectiveness: Vaccination against influenza

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