Gordis Chapter 1 Flashcards
Primary Prevention, Example
An action taken to prevent the development of a disease in a person who is well and does not (yet) have the disease in question.
- legislation/enforcement to ban or control the use of hazardous products (e.g. asbestos) or to mandate safe and healthy practices (e.g. use of seatbelts and bike helmets)
- education about healthy and safe habits (e.g. eating well, exercising regularly, not smoking)
If we can help to stop people from ever smoking, we can eliminate __ to __ % of lung cancer in human beings
80-90%
True or False. Primary prevention is possible for most diseases.
False. For many diseases, such as prostate cancer and Alzheimer disease, we do not yet have the biologic, clinical, or epidemiologic data on which to base effective primary prevention programs
Secondary Prevention
- Occurs during what stage of a disease ?
ID of disease in a person in whom a disease has already begun but who has not yet developed clinical signs and symptoms of the illness.
- occurs in preclinical phase (vs tertiary prevention -assoc with CLINICAL phase)
Rationales:
Primordial prevention
Primary prevention
Secondary prevention
Tertiary prevention
Primordial- prevent positive risk factors for disease
Primary- prevent disease from occurring
Secondary-prevented disease progression by identifying earlier in its natural history (prior to signs/symptoms- in preclinical phase).
Tertiary -prevent complications
in those w/ signs and symptoms of illness & diagnosed (i.e., people who are in the clinical phase of their illness)
Immunizations are an example of ____ prevention
Primary prevention (of diseases due to viral infections)
Government policies: Increasing taxes on cigarettes; Decreasing advertisement of tobacco- examples of ____ prevention
Primordial prevention
Following are Examples of Prevention:
Papanicolaou (Pap) smear
Mammography
Colonoscopies
Blood Pressure screening
Secondary Prevention:
Pap smear -early detection of cervical cancer
Mammogram-early detection of breast cancer
Colonoscopy (routine
testing of the stool for occult blood can detect treatable colon cancer early in its natural history but colonoscopy is a better test, [albeit far more expensive and invasive])
BP- for hypertension
Following are examples of ____ prevention:
Tobacco Cessation Programs
Needle Exchange Programs
Micro-Nutrient Supplementation Programs
Primary Prevention-
Tobacco Cessation- Lung cancer
Needle Exchange Programs- HIV/AIDS, hepatitis B, and hepatitis C
WIC, etc.- malnourishment
What are the specific objectives of epidemiology?
- To ID the etiology, or cause, of a disease and its relevant risk factors,
- To determine the extent of disease/ burden of disease in the community?
- Study the natural history/prognosis of disease
- Evaluate existing & newly developed preventive and therapeutic measures and modes of health care delivery .
- Develop public policy
It’s impossible to implement a prevention strategy even when the exact cause of the disease is unknown. T or F.
Semmelweis had no knowledge of germ theory, but proved it is possible to implement a prevention strategy even when the exact cause of the disease is not known.
Based on his hypothesis of causation of childbed fever (lack of physician handwashing between patients), he proposed a successful intervention (handwashing before examining each patient).
Semmelweis directed the General Hospital in Vienna in July 1846.
At that time there were 2 obstetrical clinics, the First and the Second. Pregnant women were admitted for childbirth to the First Clinic or to the Second Clinic on an alternating 24-hour basis. The First Clinic was staffed by
MDs/ medical students and the Second Clinic by midwives.
D.A. Henderson
WHO 1967 began international efforts to eradicate smallpox using vaccinations with vaccinia virus (cowpox). Smallpox afflicted 15 million people annually throughout the world, (of whom 2 million died and millions of others were left blind or disfigured).
WHO 1980 certified that smallpox had been eradicated/ directed by Dr. D.A. Henderson.
The WHO estimated that 350 million new cases had been prevented over a 20-year period.
https://www.gavi.org/vaccineswork/how-covid-19-world-can-learn-last-person-get-smallpox?gclid=CjwKCAjw5dqgBhBNEiwA7PryaJscNtwgM1WmVYvePHeorYrqGL0QtCVnF99BYYSXi1dDs6zSmlkB5BoCoN4QAvD_BwE
Epidemiologic transition
As developing countries become industrialized they manifest the mortality patterns currently seen in
developed countries, (with mortality from chronic diseases becoming the major challenge)
Edward Jenner
Observed, (as had other people before him), that dairy maids, the young women who milked cows, developed a mild disease called cowpox. Later, during smallpox outbreaks, smallpox appeared not to develop in these young women.
Jenner administered cowpox material to an 8-year-old “volunteer,” James Phipps.
-6 weeks later, to test his conviction, he inoculated the child with material that had just been taken from a smallpox pustule. The child did not contract the disease.
Miasmatic Theory - in relation to cholera
Defined- disease transmitted by a miasm, or cloud, that clung low on the surface of the earth. If this were so, we would expect that people who lived at lower altitudes would be at greater risk of contracting a disease transmitted by this cloud than those living at higher elevations.
In relation to cholera- Farr collected data to support his hypothesis. The data he collected was quite consistent with his hypothesis: the lower the elevation, the higher the mortality rate from cholera.
