AFMC primer notes

Question 1

Sensitivity is inversely associated with

Answer 1

False negative rate

Question 2

Low sensitivity leads to

Answer 2

Low negative predictive value

Question 3

In a low prevalence disease setting, a test may appear

Answer 3

to have a low positive predictive value
but SEnsitivity and SPecificity are the SAME
You will find many more FALSE positives

Question 4

tests with positive LRs higher than about X are useful in ruling in a disease.

Answer 4

5

Question 5

Sensitivity =

Answer 5

TP/TP+FN

Question 6

Positive predictive value =

Answer 6

TP/TP+FP

Question 7

What are the advantages of the individual-centered high risk strategy model (Rose)

Answer 7

• intervention approprtiate to individual
• people more likely to change their behavior
• physicians feel justified in reducing risk factors in high risk individuals
• cost-effective use of resources
• high risk more likely to benefit

Question 8

What are the disadvantages of the individual-centered high risk strategy model (Rose)

Answer 8

• cost and difficulty in identifying high-risk individuals
• dividing line between average and high risk is arbitrary (avg risk could still be at risk)
• does little to disease burden (majority of people with disease are average -moderate risk)
• palliative and temporary
• may be behaviorally inappropriate

Question 9

What are the advantages of the population-centered average risk strategy model (Rose)

Answer 9

• identifies the root of the problem (includes those at low and average risk)
• tackles early stages - may be more effective
• a small change at the level of the risk factor could improve health of a large number of people
• socially appropriate (smoking becoming more normal)

Question 10

What are the disadvantages of the population-centered average risk strategy model (Rose)

Answer 10

• may be inefficient (targeting people who may not have the disease)
• little motivation for low risk individuals
• risk of increasing inequality if vulnerable populations aren’t taken into account

Question 11

the goal of prevention is to

Answer 11

improve quality of life and longevity

Question 12

As a resource for their practice clinicians should

Answer 12

• implement continuous quality improvement
• make sure their practice setting promotes health
• advocate for the health of their practice populations

Question 13

what is the precontemplation stage of behavior?

Answer 13

Not planning to change in the next 6 months. physician should encourage patient to start thinking about change

Question 14

contemplation stage of change

Answer 14

thinking about changing but hasn’t started the change - intends to do so within 6 months
encourage patient to evaluate benefits and barriers in a balanced way

Question 15

preparation stage of change

Answer 15

not begun to change but is thinking of doing so in the next 30 days
encourage the patient to develop a plan to change - set a date

Question 16

action stage of change:

Answer 16

Individual has changed his behavior in the past 6 months (quit)
give support and encouragement

Question 17

Maintenance stage of change

Answer 17

practices this new behavior for 6 months

help the new behavior become “normal”

Question 18

relapse stage

Answer 18

finding it hard to maintain and cant keep up the behavior

try to re-egnage the patient in the process again

Question 19

What is harm reduction?

Answer 19

refers to reducing the negative consequences of risk behaviours, rather than trying to eliminate the behaviours themselves

Question 20

Health promotion is also known as…

Answer 20

primordial prevention
to enhance health in order to develop the person’s resistance to the adverse influences of physical and social environments

Question 21

who needs the health promotion intervention?

Answer 21

It is NOT about who has the problem, it asks at what level would the intervention be effective and efficient

Question 22

What are the major influences that determine if an intervention will be applied?

Answer 22

Patient factors: personal factors, such as the patient’s education, health knowledge, and income.
Physician factors: the physician’s training and technical expertise.
Health care delivery system factors: the costs, risks, effectiveness and acceptability of the intervention itself.
Situational factors: cues to action during the consultation influence intervention.

Question 23

what is the assumption underlying screening?

Answer 23

disease diagnosed early in its development responds better to treatment than it does once it has started causing signs and symptoms, so that early diagnosis results in better quantity and quality of life for the patient

Question 24

What are misconceptions of screening?

Answer 24

Early detection means good prognosis
People who are screened may live longer, but for other reasons
personal testimonies
belief that screening is 100% effective
benefit to individuals may actually be quite small (population death rate from Brca may drop 30% an individuals risk may drop only 1% from 4 to 3%)

Question 25

what is lead time bias?

Answer 25

may detect disease earlier so a patient lives longer with the diagnosis but may not live longer overall. “apparent increase in life expectancy”

Question 26

Length bias?

Answer 26

screening is more likely to detect slowly progressing disease
(will identify 2 cases of rapid progressing, and 5 slow progressing, may have the same incidence, there is an impression of increasing survival)

Question 27

what are some ethical issues related to screening?

Answer 27

Patient autonomy
equity
beneficence and non-maleficence

Question 28

what are some of the WHO criteria for screening?

Answer 28

1. must respond to a need
2. should be a defined target population
3. scientific evidence for effectiveness
4. minimize risk, quality assurance programs
5. ensure informed choice and patient autonomy
6. promote equity in access
   7 . benefits should outweight the harm

Question 29

ask about CH20PD2

Answer 29

Community: neighbourhood sources of hazard; industry, waste storage
Home: year of construction, renovations; materials used in construction and decoration; moulds; garden and house plants; use of cleaning products, pesticides, herbicides
Hobbies and leisure: exposure to chemicals, heavy metals, dusts, or micro-organisms
Occupation: current and previous occupations; work with known hazards; air quality
Personal habits: hygiene products; smoking
Diet: sources of food and water; cooking methods; food fads
Drugs: prescription, non-prescription, and alternative medications; health practices

Question 30

some ways of controlling the source of the hazard?

Answer 30

Modify
redesign
substitute
relocate
enclose

Question 31

some ways of controlling the pathway of the hazard?

Answer 31

Ventilate
absorb
dilute
ventilate

Question 32

some ways of controlling the receiver of the hazard?

Answer 32

enclose
protect
relocate

Question 33

what are some personal characteristics that affect how a receiver perceives a message?

Answer 33

1. General disposition: optimisitic/pessimistic
2. perception of threat
3. confirmatory bias (focus on info that supports the outcome)
4. reduction of vulnerability (receive bad news, get a second opinion, question validity)
   5.

Question 34

what are some factors that affect how the information is transmitted?

Answer 34

1. emphasis on gain vs loss
2. The default option
3. positive framing - glass half full vs empty
4. people prefer whole numbers rather than fractions
5. people focus on the numerator and forget the denominator
6. relative and absolute risk assessments
7. Uncertainty (using right words, describing risk as high or low, risk should always include a time frame)

Question 35

5 basic principles for workers compensation

Answer 35

1. No fault compensation
2. Collective Liability -
3. Security of payment
4. exclusive jurisdiction
5. Independent board