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Rach SOCPOP > Block 5 > Flashcards

Block 5 Flashcards

1
Q

What are the major antenatal/newborn screening programmes in the UK?

A

Downs syndrome

Infectious disease in pregnancy

Newborn bloodspot

Newborn hearing screening

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2
Q

What is the ‘Wilson and Jungner’/’National Screening Committee’ criteria for a screening program? 1968

A

Used by the UK national screening comitte to make decisions

  1. Important health problem
  2. Treatment must be available
  3. Facilities for diagnosis and treatment should be available
  4. Should be latent stage of the disease
  5. Should be a test/examination for the condition
  6. Test and treatment should be acceptable to the population (colorectal exam is unpleasant)
  7. Natural history of disease should be adequately understood
  8. Agreed policy on who to treat
  9. Should be cost effective
  10. Case-finding should be a continuous process
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3
Q

How do you classify test results?

A

True positive (TP) -

True negative (TN) -

False positive (FP) - dont have it but test incorrectly diagnoses

False negative (FN) - got disease and test missed it

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4
Q

Define sensitivity of a screening test and the equation used to determine it.

A

The proportion of people who have the disease that the test correctly detects

=TP/(TP + FN)

Dont miss too many cases

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5
Q

Define specificity of a screening test and the equation used to determine it.

A

The proportion of people who do not have the disease that the test correctly identifies as not having the disease

= TN/ (TN + FP)

Dont get too many false positives - need this to be very high for screening to be economically viable

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6
Q

What is the relevance of specificity and sensitivity?

A

Together, both measure test performance and are independent of the prevalence of the disease in the population.

This means:

If disease is present

Sensitivity tells you the probability the test will pick it up

Positive test

Neither model can tell the probability that you have disease, as this depends on the prevalence of the disease.

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7
Q

Define positive predictive value (PPV)

A

The probability that a person has the disease given that they have had a positive test result

= TP/ (TP + FP)

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8
Q

Define Negative predictive value (NPV)

A

The probability that a person does not have the disease given that they have a negative test result

= TN/ (TN + FN)

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9
Q

What issues are related to screening quality assurance?

Bias

A

1. Healthy screenee:

‘people who attend screening when invited live longer than those that do not, even if the screening test is useless’ People invested are more likely to be interested in living a healthy life

2. Length time bias:

Screening is better at detecting disease that develops more slowly/milder cases.

Slow developing diseases means that person has longer life as more likely to detect over time

3. Lead time bias:

Screening can detect illness earlier when it is more responsive to treatment and thus improve survival times

If survival time increases - is this because it was detected earlier?

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10
Q

How is child disability is defined in the UK?

A

Limiting long-term conditions/impairments that have a substantial impact on daily living

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11
Q

What is the prevalence of child disability in UK?

A

0.8 million disabled children and young people

(age 0 – 18 years) in UK

6% of all children

Remained stable over the past decade

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12
Q

What are the reasons put forward to explain increased prevalence of some conditions (autism/ADHD)?

A

Autism:

Increased prevalence likely due to increased awareness, new administrative classifications and diagnostic practices

ADHD:

Rise associated with increased recognition and diagnostic practices

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13
Q

What are the risk factors associated with child disability?

A
  1. Pregnancy outcomes (weight and premature)
  2. Sex
  3. Ethnicity
  4. Socio-economic disadvantage
  5. Parental behaviours
  6. Communicable diseases
  7. Unintentional injuries
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14
Q

What are the risk factors associated with child disability and pregnancy?

A

Low birth weight linked to a number of impairments (cerebral palsy, reduced cognitive function, epilepsy)

Improvements in neonatal care linked to increased survival rate for preterm births

Backed by evidence

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15
Q

What are the risk factors associated with child disability and sex?

A

Prevalence of all causes of disability is higher in boys in early years

By late teans prevalence for girls is similar to boys

Neurodevelopmental disabilities are more common in boys

May be linked with genetic differences - undiagnosed in girls?

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16
Q

What are the risk factors associated with child disability and ethnicity?

A

Limited evidence to suggest association

UK studies that control for socio-economic status found an increased risk for all-cause disability among children of mixed ethnicity and African/Caribbean origin only

Complex pattern for neurodevelopmental disability

  • Rates of identification lower in 7-15 year olds in minority ethnic groups
  • High rates of less severe intellectual disability among gypsy/Roma and traveller children of Irish heritage
  • More severe forms of intellectual disability among Pakistani and Bangladeshi heritage
17
Q

What are the risk factors associated with child disability and socio-economic disadvantage?

A

Prevalence of disability increases down the socio-economic gradient

Exposure to socio-economic disadvantage in early childhood is a predisposing factor for later onset disabling impairment/condition

Explanation:

Children from low SES households are more exposed to social/environmental risk factors in prenatal and early childhood

18
Q

What are the risk factors associated with child parental behaviours?

A

Parental smoking:

(mainly maternal) linked to low birth weight, preterm birth and autism

Alcohol consumption:

Associated with growth before and after birth, educational outcomes, fetal alcohol syndrome

Unsupportive/unstimulating parenting:

Linked with some intellectual disabilities and conduct disorders

Many parental behaviours linked to poor health outcomes are linked to poor personal and household resources

19
Q

What are the risk factors associated with child disability and communicable diseases?

A

Rubella during pregnancy

Measles and mumps in later childhood

Greatest risk for children not immunised

(not registered with GP, looked after children, some minority ethnic groups)

20
Q

What are the risk factors associated with child disability and unintentional injuries?

A

Risk increases as children get older

At all ages, children from poorer households at greater risk

21
Q

What interventions can be used to reduce child disability?

A

Primary prevention strategies:

Reduce socio-economic disadvantage

Improve material environments

Reduce exposure to environmental hazards

Reduce exposure to smoke

Promote safe alcohol consumption

Ensure adequate dietary intake of key nutrients

Immunisation against common diseases

Secondary prevention strategies:

Screening

Developmental assessments

Parents

Contact with other services (non-health)

22
Q

What are the major young person/adult screening programmes in the UK?

A

Abdominal Aortic Aneurysm

Diabetic retinopathy

Breast cancer

Cervical cancer

Bowel cancer

23
Q

What is Neuroblastoma?

Should it be screened for?

A

Childhood cancer of the nerve

50% survival rate increased to 97% when screening introduced

However death rate didn’t change as they were finding subclinical cases that never would have developed symptoms and would have self resolved - overdiagnosis and deaths as a result of treatment compications

24
Q

Define overdiagnosis

A

Correct diagnosis of a disease, but the diagnosis is irrelevant because the disease will never cause symptoms within the patients lifetime.

25
Q

Define overtreatment

A

Unnecessary treatment which does not improve health

Occurs in unessary screaning

Brest cancer screening - saves 1,300 lives a year but also 400 recieve un-necessary treatment eg radiotherapy

26
Q

Should we screne for prostate cancer?

A

Lives saved from screening is minimal commpared to the harm done regarding sexual dysfuntion etc.

Do not offer in the UK - Can request a PSA test from dr

27
Q

What is the popularity paradox of sceening?

A

The more you overdiagnose the more the popularity of the screening programme increases

Also occurs with awareness campaigns eg. Melonoma and incidental findings eg. chest x-ray

New diagnsosis increases but deaths haven’t decreased or increased

28
Q
A

Rach SOCPOP (5 decks)

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