Health Promotion and Disease Prevention Flashcards
What are the four main preventative care services?
Immunizations
Screening
Behavioral Counseling
Chemoprevention
What are the three categories of prevention?
Primary, Secondary, and Tertiary prevention
In Primary Prevention do patients already have established disease?
No, patients do not have the disease yet. The goal is to prevent the disease from occurring (example: immunizations)
What is the goal of secondary prevention?
Patient already have the disease (usually early stage) or at high risk for disease and the goal is for early detection and cure, prevent disease progression
What are some examples of secondary prevention strategies?
HIV screening, insulin resistance
What is tertiary prevention?
Patient already has the disease and the goal is to prevent progression/deterioration (essentially treatment)
Can certain prevention screenings or interventions fall into several prevention strategy categories?
Yes, for example colonoscopy
What are the three things to considering what we should screen for?
- How great is the burden of the disease?
- How good is the screening test?
- How good is the treatment?
What are the D’s in burden of disease?
Death
Disease
Disability
Discomfort
Dissatisfaction
What is sensitivity?
Probability that a patient with the disease will have a positive test (true positive)
What is sensitivity actually telling you when the test comes back negative?
High sensitivity rules out if the result is negative (SNOUT)
What is specificity?
The probability that a patient without the disease will test negative
What is specificity actually telling you when the test comes back positive?
High specificity rules in if the result if positive (SPIN) - they probably have the disease
What is positive predictive value?
Likelihood that a person with a positive test has the disease, dependent on prevalence
What is negative predictive value?
Likelihood that a person with a negative test does not have the disease, dependent on prevalence
Is it easier to tell someone they don’t have disease (negative predictive value) or that they do (positive predictive value)?
That they don’t have a disease
What is the goal for screening tests?
Simplicity for the patient and cost
What is the number one harm of preventative care?
Dealing with false positive tests
What is lead time bias?
People who are diagnosed with screening survive longer after diagnosis that patients who present symptomatic, even if early treatment doesn’t make a difference
What is a way to avoid lead time bias?
Use mortality rates rather than survival rates
What is length time bias?
Comparing a short growing cancer to a fast growing
What is compliance bias?
Compliant patients have a better prognosis than non-compliant patients, regardless of screening
What is the difference between internal and external validity?
Internal validity are the results of the patients studied vs. external validity is how generalizable the results are to the patients not studied
What is the U.S. Preventative Services Task Force (USPSTF)?
An independent, volunteer panel of national experts in disease prevention and evidence-based medicine that make evidence-based recommendations about clinical preventitive services- goal is primary prevention
What does the USPSTF not make recommendations on?
Immunizations, that falls under the CDC advisory committee
Who should get the Pneumovax (PPSV-23) vaccine?
> /= 65 years old and with shared decision making to determine if they should get Prevnar (PCV-13)
What is a live, attenuated vaccine?
Have a live version of the organism that has been weakened (attenuated) so that it doesn’t cause disease in patients with healthy immune systems.
Can’t give to patients who are immunocompromised.
How many doses are typically needed for live, attenuated vaccines for life-long immunity?
1-2 doses for life-long immunity because your immune system is seeing the actual virus
What are inactivated vaccines?
Use a killed version of the germ, may need several boosters to get long-term immunity or maintain immunity
What are some examples of inactivated vaccines?
Polio injection, hepatitis A
What are subunit vaccines?
Contain part of the germ (often essential antigen), do not cause infection, less side effects
What is an example of a subunit vaccine?
Pertussis
What is a toxoid vaccine?
Prevent disease that are due to toxins that are produced by bacteria, use a weakened form of the toxin (toxoid)
What is a conjugate vaccine?
Prevents an immature immune system from recognizing the polysaccharides produced by some bacteria - immune system reacts to the polysaccharides
What is an example of a conjugate vaccine?
Hib
What are the major contraindications to giving vaccines?
Anaphylaxis to vaccine or component
Pregnancy
Severe immunodeficiency
Encephalopathy within 7 days of getting DTP
What are some precautions to vaccines?
Patient is moderately to severely ill
Received immunoglobulin
Use caution if severe-side effects in the past (Guillain-Barre, seizures, high fevers)
What are some examples of chemoprevention?
Use of statins
Tobacco cessation
Aspirin to prevent ASCVD and colorectal cancer
