Disease Control: Levels Of Prevention Flashcards

1
Q

Disease prevention

A

A process consisting of specific population and individual based interventions aimed at reducing the burden of disease and associated risk factors.

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2
Q

What do the 4 levels of prevention correspond to? List each

A

They correspond to the different phases of the natural history of a disease.

-Primordial and Primary: Target the seemingly healthy people

  • Secondary & Tertiary: Focus on people with or without overt signs of disease.
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3
Q

Aim of primordial prevention

A

To take action to prevent the emergence and establishment of environmental and behavior patterns of living that contribute to elevated risk of disease (alter underlying determinants of disease).

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4
Q

What are the Environmental and Behavioral patterns of living that cause a high risk of disease?

A

Environmental: Social - economic and cultural- physical, biological.

Behavioral patterns - Unhealthy lifestyles, eating habits

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5
Q

What does Primordial prevention provide?

A

An enabling environment through policies and programs to reduce the influence of disease-causing determinants on society.

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6
Q

Examples of Primordial prevention at work - nutrition, exercising, substances, sanitation

A

*Nutrition [standards for import/export of foods,
food processing & labeling, etc.]
*Exercising [promoting environments for walking,
subsidized fitness programs. etc.]
*Tobacco, alcohol and substance use [taxes, labeling, bans, etc.]
*Improving sanitation with laws and measures
reduces or removes the exposure to infections in the first place

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7
Q

Aim of Primary Prevention

A

Reduce the incidence of disease by controlling specific causes and risk factors I.e., alter exposures that lead to disease or enhancing resilience to effects of exposure. (ensure non-exposure to determinants

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8
Q

Strategies of primary prevention 1

A

Population or mass strategy - benefits society as a whole, might not necessarily benefit the immediate individual using the intervention e.g., wearing of seatbelts, vaccination campaigns [cervical cancer, polio, hep B, etc.]

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9
Q

Strategies of primary prevention - high risk individual strategy

A

High risk individual strategy- Focuses on those at high risk of disease e.g., cholesterol reducing agents for those with hypercholesterolemia, smoking cessation for smokers, exercises for the obese, etc.

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10
Q

Aim of Secondary Prevention

A

Reduce consequences of disease through early detection I.e., diagnosis and treatment. [Detect and treat pathological process at an earlier stage when treatment can be more effective.(preclinical and part of clinical phase)

Occurs when treatment is most effective and reduces disease prevalence

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11
Q

Prerequisites for secondary prevention

A
  • Safe and accurate method of disease detection at the preclinical stage through screening. E.g. cancer screening programs, diabetes routine FBS for persons
    above 40 years and hypertension screening

*Effective methods of prevention. E.g., preclinical management of cervical cancer, early management of diabetes and hypertension through exercise and nutrition, etc.

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12
Q

Aim of Tertiary Prevention

A
  • Reducing the progress or complications of an established disease.

*Important aspect of therapeutic and rehabilitative medicine.

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13
Q

What does Tertiary Prevention do?

A

Reduces suffering and facilitates adjusting of patients to incurable conditions

E.g., managing full fledged HPT, DM, strokes, blindness, injuries, etc.

Targets individuals and families
- coping and adapting mechanisms
* Prevent relapses and further deterioration via follow up care and rehabilitation

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14
Q

Screening

A

The process of using tests on a large scale to identify presence of a disease in apparently healthy people.

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15
Q

Types of Screening

A

Mass- Screening whole population or subset

Multiple/Multiphasic - Using several tests at the same time

Targeted - For groups with specific exposures

Case finding/Opportunistic - Testing for other conditions a person did not report with. E.g., urine test for sugar in a malaria patient.

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16
Q

Requirements for instituting a screening program 1

A
  1. The disorder being screened for
    -should be well defined
    -should have an effective remedy
  2. The prevalence of the disorder should be known
  3. Concerning the natural history of the disorder - there should be a long period between first signs and overt disease
  4. The test choice should be simple and safe
17
Q

Requirements for instituting a screening program ii

A
  1. Test performance
    - We should be aware of the test outcomes in persons with or without the disorder I.e., sensitivity and specificity
  2. Financial implications of the test
    - Should be cost effective
  3. Access to the test
    - Should be available or easily provided
18
Q

Requirements for instituting a screening program iii

A
  1. Acceptability of the test
    - Procedures following a positive result should be agreed upon and acceptable to screeners and those being screened.
  2. Equitable access to test and post test management
  • Population has equitable access to screening methods
  • Effective, acceptable and safe treatment available to population.
19
Q

Characteristics of a Screening Test

A
  1. Test should not be costly
  2. Test should be easy to apply
  3. Test should be acceptable to the public
  4. Results should be reliable - provide consistent results.
  5. Test results should be valid - correctly categorizes people into groups with or without the disease i.e. Has good sensitivity and specificity
20
Q

Define Sensitivity and Specificity

A

*Sensitivity
proportion of people with a disease who are appropriately identified as
ill [positive] by the test relative to a GOLD STANDARD

*Specificity
proportion of disease free people who are appropriately identified as
not having the disease [negative] by the test relative to a GOLD STANDARD

21
Q

Characteristics of A Screening Test II (Predictive values)

A

6) Positive predictive value of x% implies that
*a person who tests positive in the population under question is x% likely to develop the outcome of interest [disease] in question

7) Negative predictive value of y% implies
that
*a person who tests negative for a screening test in the population in
question is y% likely not to develop the outcome of interest [disease] in question

22
Q

What do predictive values depend on?
What do sensitivity and specificity depend on?

A

8) Note!!!
* Predictive values depend on the prevalence of a disease condition in the population.
* Sensitivity and specificity depend solely on test outcomes in those studied.