AFMC primer notes Flashcards
Sensitivity is inversely associated with
False negative rate
Low sensitivity leads to
Low negative predictive value
In a low prevalence disease setting, a test may appear
to have a low positive predictive value
but SEnsitivity and SPecificity are the SAME
You will find many more FALSE positives
tests with positive LRs higher than about X are useful in ruling in a disease.
5
Sensitivity =
TP/TP+FN
Positive predictive value =
TP/TP+FP
What are the advantages of the individual-centered high risk strategy model (Rose)
- 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
What are the disadvantages of the individual-centered high risk strategy model (Rose)
- 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
What are the advantages of the population-centered average risk strategy model (Rose)
- 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)
What are the disadvantages of the population-centered average risk strategy model (Rose)
- 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
the goal of prevention is to
improve quality of life and longevity
As a resource for their practice clinicians should
- implement continuous quality improvement
- make sure their practice setting promotes health
- advocate for the health of their practice populations
what is the precontemplation stage of behavior?
Not planning to change in the next 6 months. physician should encourage patient to start thinking about change
contemplation stage of change
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
preparation stage of change
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
action stage of change:
Individual has changed his behavior in the past 6 months (quit)
give support and encouragement
Maintenance stage of change
practices this new behavior for 6 months
help the new behavior become “normal”
relapse stage
finding it hard to maintain and cant keep up the behavior
try to re-egnage the patient in the process again
What is harm reduction?
refers to reducing the negative consequences of risk behaviours, rather than trying to eliminate the behaviours themselves
Health promotion is also known as…
primordial prevention
to enhance health in order to develop the person’s resistance to the adverse influences of physical and social environments
who needs the health promotion intervention?
It is NOT about who has the problem, it asks at what level would the intervention be effective and efficient
What are the major influences that determine if an intervention will be applied?
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.
what is the assumption underlying screening?
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
What are misconceptions of screening?
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%)
what is lead time bias?
may detect disease earlier so a patient lives longer with the diagnosis but may not live longer overall. “apparent increase in life expectancy”
Length bias?
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)
what are some ethical issues related to screening?
Patient autonomy
equity
beneficence and non-maleficence
what are some of the WHO criteria for screening?
- must respond to a need
- should be a defined target population
- scientific evidence for effectiveness
- minimize risk, quality assurance programs
- ensure informed choice and patient autonomy
- promote equity in access
7 . benefits should outweight the harm
ask about CH20PD2
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
some ways of controlling the source of the hazard?
Modify redesign substitute relocate enclose
some ways of controlling the pathway of the hazard?
Ventilate
absorb
dilute
ventilate
some ways of controlling the receiver of the hazard?
enclose
protect
relocate
what are some personal characteristics that affect how a receiver perceives a message?
- General disposition: optimisitic/pessimistic
- perception of threat
- confirmatory bias (focus on info that supports the outcome)
- reduction of vulnerability (receive bad news, get a second opinion, question validity)
5.
what are some factors that affect how the information is transmitted?
- emphasis on gain vs loss
- The default option
- positive framing - glass half full vs empty
- people prefer whole numbers rather than fractions
- people focus on the numerator and forget the denominator
- relative and absolute risk assessments
- Uncertainty (using right words, describing risk as high or low, risk should always include a time frame)
5 basic principles for workers compensation
- No fault compensation
- Collective Liability -
- Security of payment
- exclusive jurisdiction
- Independent board
