LEAPS Final Flashcards
What are the 4 main principles of medical ethics?
- Autonomy – self determination, informed consent, advanced care planning, competence, refusal of treatment
- Beneficence – best interest of patient
- Non-maleficence
- Justice – access to care, existing inequalities (i.e. rural), global considerations (war, drug patents, IP, water etc)
Virtue Ethics
- trust
- compassion
- capacity for self-reflection
- justice integrity
- temperament
- honest
etc
Elements of informed consent
Valid consent must:
- Be freely given - no pressure, failure to provide sufficient time
- involve disclosure - by doctor of sufficient into, including material risk
- be specific for the proposed procedures
- be competent to consent
- have an understating of proposed procedure/treatment
Confidentiality principles and exceptions
Confidentiality required else patient might withhold important info which would hinder doctor’s efforts.
Based on autonomy, respect for others and trust.
EXCEPTIONS:
- Ethical:
- Serious risk to patient or another person
- where required by law
- where part of approved research
- where there are overwhelming societal interests - Legal:
- Poses a serious threat to a third party (non-maleficence to them)
- infectious and STD’s
- suspected child abuse, injuries and serious offences
- health professionals’ access to patient records if they are part of the healthcare team (consent is implied)
- judicial proceedings etc
List 4 sustainable development goals that are different to MDGs.
- Clean water and Sanitation
- Affordable and clean energy
- Decent work and economic growth
- life on land
- life below the water
Elements of evidence based practice
- evidence conducted with sound research methods
- clinical expertise
- patient circumstances, wishes and values
Steps to practicing evidence based medicine
- Formulate clinical question
- Track down best evidence
- Appraising the evidence
- Apply the evidence
- Evaluating your performance
Well built clinical question
PICO
- Patient
- Intervention
- Comparison
- Outcome
What are the types of clinical questions? And which types of studies would be most helpful for the above types of questions?
- Diagnostic:
- prospective, blind comparison to a gold standard - Therapy - RCT
- RCT>cohort>case control>case series - Prognosis - Cohort Study
- Cohort>case control>case series - Aetiology/harm - RCT
- RCT>cohort>case control> case series - Prevention - RCT
- RCT>cohort>case control>case series - Clinical Exam
- prospective, blind comparison to a gold standard - Cost
- economic analysis
What is the hierarchy of evidence?
- Systematic reviews and met-analyses
- Evidence based synopses
- RCT
- Cohort/non-randomized trials
- Case control/Case series
- Case study/reports
Why is inequality making us sick? Use racial discrimination as an example
Racism impacts pregnancy outcomes even once socioeconomic factors have been accounted for.
In America, black women with college education or higher have infant mortality rates almost 3x higher than white women with the same level of education. This rate is actually higher than white women who have not even completed high school.
Use rural Australia to illustrate the concept of determinants of health
- fewer doctors, fewer or no specialists
- limited access to medical equipment/pharms
- higher risk occupations
What are the main features of the following study designs:
- RCT
- cohort study
- case-conrtolled study
- case reports/case series
- ecological/correlational studies
RCT:
- people are allocated at random (by chance alone) to receive one of several clinical interventions
- The control may be a standard practice, a placebo (“sugar pill”), or no intervention at all.
- compared
Cohort:
- starts with cohort who don’t have disease
- groups them according to whether they are exposed to a potential cause of disease
- whole cohort followed over time
- compare groups
Case-controlled:
- starts with group who has disease and group who doesn’t
- The exposure status to a potential cause of disease is determined for both cases and controls.
- Then the occurrence of the possible cause of the disease could be calculated for both the cases and controls.
Define:
- prevalence
- incidence
- morbidity rate
- mortality rate
- case-fatality rate
- attack rate
Prevalence:
Measures the amount of a disease in a population at a given point in time
Incidence:
Number of new cases (of an illness, disease or event) occurring during a given period
Morbidity rate:
The frequency with which a disease appears in a population.
Case-fatality rate:
the proportion of deaths within a designated population of “cases” (people with a medical condition), over the course of the disease.
Attack-rate:
biostatistical measure of frequency of morbidity, or speed of spread, in an at risk population
Calculate:
- prevalence
- incidence
Prevalence = No. of people with disease at time T / Total number of people in population
Incidence = No. of people who develop disease in given time period / Average no. of people in the population at risk for developing that disease in that time period
What is the relationship between prevalence and incidence?
The prevalence of a disease is related to both the incidence of the disease and how long people live after developing it (survival).
What are the leading causes of burden of disease?
The six leading specific causes of burden in Australia in 2011 were:
- coronary heart disease,
- other musculoskeletal conditions
- back pain & problems,
- chronic obstructive pulmonary disease,
- lung cancer and
- dementia.
What are the 4 dimensions to emotions in mental health?
Thoughts, feelings, bodily sensations, impulses.
What is mental health? What is mental illness?
a state of well-being in which every individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.
Mental illness: Mental illness is defined as “collectively all diagnosable mental disorders” or “health conditions that are characterized by alterations in thinking, mood, or behavior (or some combination thereof) associated with distress and/or impaired functioning.”
What are some of the health effects due to mental illness? Use anxiety to describe the short terms
effects (bodily effects) and the long-term effects
Anxiety:
Short term:
- throat troubles
- tense muscles
- active spleen
- skin reactions
- liver reactions - increase blood sugar
Long Term:
- digestion problems
- weakened immune system
- sleep problems
- cardiovascular problems
- weaker respiratory functions
What is the GAD-7?
Over the last 2 weeks, how often have you been bothered by the following problems?
- Feeling nervous, anxious, or on edge
- Not being able to stop or control worrying
- Worrying too much about different things
- Trouble relaxing
- Being so restless that it’s hard to sit still
- Becoming easily annoyed or irritable
- Feeling afraid as if something awful might happen
What are the types of anxiety?
- Panic Disorder
- Social Phobia
- GAD
- OCD
- PTSD
- agoraphobia
What is the diagnostic criteria for generalised anxiety disorder? (DCM-V)
A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).
B. The individual finds it difficult to control the worry.
C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months):
Note: Only one item is required in children.
Restlessness or feeling keyed up or on edge.
Being easily fatigued.
Difficulty concentrating or mind going blank.
Irritability.
Muscle tension.
Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).
D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).
F. The disturbance is not better explained by another mental disorder (e.g., anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder social phobia, contamination or other obsessions in obsessive-compulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in posttraumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety disorder, or the content of delusional beliefs in schizophrenia or delusional disorder).
have 4 strong facts on
burden/prevalence etc of anxiety and again 4 for depression
- 14.4% of Australians had experienced an anxiety disorder in past 12 months
- highest rates in the 35-44 years group
- 12.6% of medical students currently had anxiety
- 4.1% of Australians had experienced a depressive episode in past 12 months
- 8.1% of medical students were depressed
- anxiety and depression were twice as high for females
-
Tell me about measuring psychological stress and the scale used to measure it
K10 = Kessler Psychological Distress scale
This simple checklist aims to measure whether you may have been affected by depression and anxiety during the past four weeks. The higher your score, the more likely you are to be experiencing depression and/or anxiety.
Describe:
- relative risk
- odds ratio
- absolute risk
- population attributable risk
Relative Risk: Cohort Studies
How many times more likely are exposed persons to become diseased, relative to non- exposed persons?
Odds ratio: Case-Control
odds of exposure among cases / odds of exposure among controls
Absolute Risk [Incidence]:
What is the incidence of disease in a group initially free of the condition?
Population-Attributable Risk:
What is the incidence of disease in a population, associated with the prevalence of a risk factor?
In regard to the issue of efficient and equitable resource allocation, discuss Levels of Decision Making / Resource Allocation
Federal government first involved in deciding what proportion of GDP is allocated to health. Government has traditionally also directed how the health care budget will be divided, i.e. hospital vs community care vs treatment vs prevention, however more recently they have tended to shift this onto regional areas so local communities can identify their own health needs.
BUT at the allocation of med resources at the regional level (‘meso-level’), decisions tend to be influenced by politicians, administrators and various committees and hospital managers.
At the micro level – doctors, i.e. their use of time, appointments, diagnostic treatments etc. They inadvertently affect distribution of resources.
Public hospitals generally owned by state health departments and run by boards of management appointed by the state government. A small number of private ones exist, some are state – so they are basically public. Federal government funds (in part?) the public hospital system but the systems are the responsibility of the states.
GP’s and other health care services are also provided by community health services in some states, funded partly by state government and partly by medicare.
Medicare regulates a lot of the health care system (federal).
In regard to the issue of efficient and equitable resource allocation, discuss the Criteria for evaluating health care (and therefore prioritising health resources)
- Equity (Justice)
- Effectiveness
- Efficiency
- Consumer preferences
- Burden of Disease
In regard to the issue of efficient and equitable resource allocation, discuss efficiency
Getting maximum health benefit for scarce health dollars
Outline the factors that influence risk perception
- Trust vs Lack of Trust
- Voluntary/Controllable vs coerces/uncontrollable
- natural vs man made
- chronic vs catastrophic
- not dreaded vs dreaded
- familiar/awareness vs unfamiliar/not aware
- affects adults vs affects children
Outline the leading behavioural and biomedical risk factors in Australia and name some
diseases/conditions that are connected to these risk factors
Behavioural:
- smoking
- excessive alcohol
- drugs
- inadequate fruit/vege intake
- insufficient physical activities
Biomedical:
- obesity
- BP
- abnormal blood lipids
- impared fasting glucose
Non-modifiable:
- age
- gender
What are the three main models that are used to understand and bring about health behaviour change?
o Health Belief Model:
Likelihood of an individual taking action related to a given health problem is based on the interaction between four different types of belief:
1. Perceived susceptibility to a problem (perceived threat)
2. Perceived seriousness of consequences (perceived threat)
3. Perceived benefits (outcome expectations)
4. Perceived barriers (outcome expectations)
o The Theory of Reasoned Action/ Theory of Planned Behaviour
o The Transtheoretical [Stages of Change] Model
In motivational interviewing, what are the 5 As?
ASK
ASSESS - i.e. readiness to change
ADVISE
ASSIST - motivational interviewing, support services etc
ARRANGE - regular follow up visits to monitor maintenance and prevent relapse
What are the critical components of motivation?
- The importance of change for the patient (willingness)
- The confidence to change (ability)
- Whether change is an immediate priority (readiness).
features of motivational interviewing
O - ask open-ended questions
A - Provide affirmation
R - Reflective Listening
S - Summarising statements
- Generate a gap - Develop discrepancy – generate inconsistency between how they see their current situation and how they would like it to be.
- Roll with resistance
- Avoid argumentation
- Can do - Support self-efficacy – build confidence that change is possible
- Express empathy, warmth and genuineness – facilitate engagement an d build rapport.
Skills:
- open ended questions
- affirmation
- reflective listening
- summarizing
- eliciting change talk
Other tools:
- decisional balance (pros and cons)
- SMART goal setting – specific, measurable, achievable, realistic and timely
- Readiness/confidence rulers
What are the stages of change?
a) Pre-contemplation – raise doubt
b) Contemplation – tip the balance
c) Determination – help them determine the best course of action (or preparation/decision making)
d) Action – help them take steps toward plan – ‘Action Plan’
e) Maintenance – prevent relapse
f) Relapse – renew stage of change
Define endemic, epidemic and pandemic
Endemic: A disease that occurs regularly in a particular area
Epidemic: a widespread occurrence of an infectious disease in a community at a particular time.
Pandemic: prevalent over a whole country or the world.
Give a
reasonable outline of the steps in investigating an outbreak of a communicable disease
A. Obtain background info:
- Prepare for field work
- Establish the existence of an outbreak, consider severity, potential for spread, public concern and availability of resources
- Verify diagnosis
B. Define the problem
- Define and identify the cases - case definition and line listing
- Describe and orient the data in terms of time, place and person (descriptive epidemiology) - PLOT EPIDEMIC CURVE
C. Formulate a hypothesis
6. Develop hypothesis (agent, host, environment, trait) = chain of transmission
D. Develop a study to test hypothesis, collect data and observations, evaluate results.
7. Evaluate hypothesis (analytical studies must have control group)
E. Determine if H is true/modify (8), formulate conclusion (9) and report results (10).
- Refine hypothesis and carry out additional studies
- Implement control and prevention methods
- Communicate findings
Discuss measles in relation to global health
- elimination of endemic measles due to good uptake of MMR in 1999
- Average = 100 per year due to imported cases
- two doses of MMR to Aus children at 12 and 18 months
- contagious - 1 person = 12-18
- Aus - campaigns to prevent measles being brought in to the country by unvaccinated travellers
- AMA guidance is that vaccination rates below 93% are unsafe
- Rachel and Lola - deaf
- NOTIFIABLE DISEASE
GLOBAL:
Disney land - 95 infected
Worldwide many countries got >1000 cases per 5 month period from 2013
- one of the leading causes of vaccine-preventable death in children world wide
Discuss pertussis in relation to global health
- early 2015, baby Riley died of whooping cough in Perth
Discuss TB in relation to global health
- Tuberculosis (TB) is second only to HIV/AIDS as the greatest killer worldwide due to a single infectious agent
- huge in south africa
- Stop TB partnership
In Aus, • The Western Australian Department of Health is notified and the Western Australian Tuberculosis Control Program take over the management of the outbreak. The Department of health staff begin tracing and screening close contacts – this includes immediate household members, extended family and friends and workplace contacts (staff and patients)
Discuss chlamydia in relation to global health
Australian re-emerging infection
83,000 cases diagnosed in 2012
Describe the 4 main factors that may determine the impact an infection has on an individual or community
- characteristics of the infectious organism
- the characteristics of the host,
- transmission and
- environment
Outline the various methods of control of communicable disease.
- immunisations
- restriction on attending school/work
- tracing and screening
Immunisation has been a very successful method of control of communicable disease – outline the
reasons why immunisation has been a successful communicable disease control method.
- MMR
- TB (SA)
- hep
- pneumococcal
- varicella
- diptheria etc etc
Outline the various functions of the notifiable diseases
register. (part of surveillance)
The Public Health Unit staff’s role now is to work with both you and the patient to:
• find out how the infection occurred
• identify other people at risk of
infection
• implement control measures (such as immunisation and restrictions on attending school or work)
• provide any other advice as needed
Be able to define the terms emerging, newly emerging, and re-remerging infectious diseases – be able to give one example of each
Re-emerging = TB
Newly Emerging = AIDS
Why is TB re-emerging?
- being immunocompromised with HIV/AIDS
- Multi drug resistance
- social disruption/migration/poverty due to war
Outline the contributing factors involved in the newly emerging and the re-emergence of some infectious diseases
- Malaria re-emergence due to abandonment of environmental control
Is Ebola likely to spread to to pandemic proportions? Why/why not?
No, although it is novel and can cause significant illness and death, it doesn’t spread easily from person to person.
Is Zika virus likely to spread to to pandemic proportions? Why/why not?
Likely pandemic in the making. It is novel, can cause significant injury (microcephaly) and it spreads easily from person to person.
It has already spread to over 23 countries (April 2016) and was only first detected last May.
Define refugee, asylum seeker, internally displaced persons
Refugee – a person who has been forced to leave their country in order to escape war, persecution, or natural disaster.
Someone who has a:
- well founded fear of persecution
- is outside the country of their nationality
- is unable or unwilling, owing to such fear, to avail themselves to the protection of that country
- OR doesn’t have a nationality
- And is outside the country of their former habitual residence
- is unable or unwilling, owing to such fear, to return
Asylum seeker – a person who has made a claim that they are a refugee and are waiting for the claim to be accepted or rejected.
Internally displaced persons: like refugees but they remain in their country. They are not covered by refugee convention. Therefore they are at even greater risk than refugees – they have less aces to resources and support from the international community.
Case study – Joseph and Paul – make sure you go over this case study and identify the key points – including pre-departure screening/testing; on arrival what happens and the onshore health assessment; and understand malaria at the level we used in this tutorial.
x
Know about a 2-3
agencies for refugees
- Humanitarian Entrant Health Service (HEHS) - provides voluntary and free holistic health screen to humanitarian entrants (refugees) settling in WA
- AseTTs - provides services to people who are humanitarian entrants or are from a refugee type background and who have experienced torture or trauma
Outline the barriers to GPs talking about overweight/obesity
GPs skipping weighing patients and waist circumference due to:
- time constraints
- fears about offending patients
- software problems
What are the main issues in relation to nutritional excess, specifically in relation to obesity?
- decreased vegetable consumption
- increased savoury snack consumption
- increased confectionary consumption
- expense of healthy foods
- availability of unhealthy foods
- lack of education
How much salt should we consume each day?
WHO
What is the main negative impact of excess salt?
Hypertension
What are the consequences of iodine deficiency especially for high risk groups
- Abortion
- mental retardation
- growth retardation
- goiter - a swelling of the neck resulting from enlargement of the thyroid gland
- nodular goiter and hyperthyroidism
- lower intelligence
- goiter and hypothyroidism
- increased infant mortality
Discuss why populations can be iodine deficient and specifically why
Australia has become an iodine deficient country in more recent times.
- mountainous area
- areas having frequent flooding
- make their own salt
Australia:
Re-emerging in Australia UK and NZ, with children in NSW and Victoria mildly iodine sufficient. And longstanding problem in Tasmania.
Global:
Most at risk:
Parts of south America in particular and North America, China, some parts of Africa.
~ 1/3 worlds population live in areas with some iodine deficiency
Know the high risk groups and the additional amount of iodine needed at certain life stages
- children
- pregnant ladies
- lactating mothers
- adolescents
consider the pros and cons of food fortification with iodine (are there any adverse consequences)
Iodine deficiency - Iodine is one of the leading causes of preventable mental retardation and brain damage in the world.
Salt - Reducing dietary salt intake lowers blood pressure for most people, which is the leading risk factor for the global disease burden.
BUT may not be a conflict. Just put more iodine in salt.
What are pre and post-test probabilities?
Pre:
Pretest Probability is defined as the probability of a patient having the target disorder before a diagnostic test result is known.
Post:
the proportion of patients testing positive who truly have the disease.
What are likelihood ratios?
- alternate method of assessing performance of diagnostic test
- express how many times more/less that a test result is to be found in diseased compared with not diseased people
- The higher the LR for a positive test, the better the test is at diagnosing disease
- The lower the LR for a negative test, the better the test is at diagnosing non-disease
- Rule of thumb – diagnostic tests with positive LRs >10 and /or negative
Describe the criteria to
introducing an ethical screening program
- Important health problem
- Disease should be understood
- latent period or early symptomatic stage
- Available facilities for diagnosis
- Test is simple, safe, accurate (sensitivity, specificity) and validated (suitable) test or examination
- Reliability: (precision)
- Acceptable to the population to be screened
- Suitable cut-off level defined
- Yield: Amount of disease detected in the population, relative to the effort - Prevalence of disease/positive predictive value
- Effective treatment or intervention for patients identified
- Clinical management of the condition and patient outcomes should be optimised in all health healthcare providers prior to participation in a screening program
- RCTs should evidence that is reduces morbitiy
- Clinically, socially, and ethically acceptable
- Benefits>harms
- Costs justifiable
Discuss the ethical issues surrounding screening individuals and populations
Genetic:
- should disclosure be made to insurance companies etc? I.e. confidentiality
- should genetic testing be done on babies for the purpose of predicting issues with future pregnancies, even though that baby doesn’t stand to benefit?
- Should people testing positive for certain disordered be counseled not to have children?
Why is colorectal cancer a suitable disease for screening?
Give a few facts/stats
Important health problem:
Second highest incidence and 2nd leading cause of cancer death in Aus
80% no known family history
CRC has a definite premalignant phase, and early identification can prevent or significantly modify the risk of developing the disease:
Stage A survival rate: 85-85%
What is the screening test and what is the diagnostic test for colorectal cancer?
Screening: I-FOBT
Diagnostic Test: Colonoscopy
List a few facts about lung cancer epidemiology
- Leading cause of death in Australia, but only 5th in diagnosis.
- tobacco smoke causes 90% of lung cancer in males and 65% in females
- 15% of of people with lung cancer will survive 5+ years
Discuss tobacco as a risk factor
- Diseases caused by smoking:
- Cancer – throat, lunch, stomach, pancreas, kidney, ureter, colon, cervix, bladder etc
- stroke
- blindness, cataracts
- aortic aneurysm
- coronary heart disease
- pneumonia
- COPD
- reproductive effects on women
- atherosclerotic peripheral vascular disease - Diseases caused by secondary smoke:
a) Children:
- middle ear disease
- respiratory symptoms
- sudden infant death syndrome
- lower respiratory illness
- more with causative suggestion
b) Adults:
- stroke
- nasal irritation/cancer
- coronary heart disease
- lung cancer
- reproductive effects in women
- more with causative suggestion
What are the strategies used in Tobacco control, including health policy, advocacy and legislation?
- all tobacco products in Aus required to be sold in plain packaging
- smoking inside pubs and clubs banned
- states ban smoking in cars carrying children
- tobacco industry sponsorship has been phased out
- graphic anti smoking adds
- advertising cigarettes banned
- tax
- advertising not to smoke and strategies to quite
Describe Historical developments of tobacco use, the present national and the present and future global picture – brief
overview
In Australia, 15% of Australians over 14 were smokers in 2007.
Groups with high rates of smoking:
- low socioeconomic
- unemployed
- prisoners
- mental illness
- aboriginal and torres strait islanders
- remote area
- consumption increasing globally, but decreasing in some high/middle income countries
What are the symptoms of lung cancer?
The symptoms of lung cancer can often be vague and mimic those of other conditions. Unexplained, persistent symptoms lasting more than three weeks can include:
- A new or changed cough
- Coughing up blood – this is called haemoptysis
- A chest infection that won’t go away
- Chest pain and/or shoulder pain
- Shortness of breath
- Hoarse voice
- Weight loss or loss of appetite
What are the diagnostic tests for lung cancer?
- physical examination
- chest X-ray
- examination of a sputum sample
- imaging, i.e. X-ray, CT or MRI
- bronchoscopy - biopsy
What are the risk factors for lung cancer besides tobacco smoking?
Environmental factors:
- Passive smoking
- Radon exposure
- Occupational exposure e.g. asbestos, diesel exhaust Air pollution
Personel Factors:
- age
- family history
- previous lung diseases
Learn the size of the problem because it is related to criteria of screening – but just choose 2-3 facts
- tobacco kills nearly 6m people each year, >600,000 are non-smokers exposed to second-hand smoke
Discuss lung cancer
screening and the potential harms.
There is evidence that screening persons aged 55 to 74 years who have cigarette smoking histories of 30 or more pack-years and who, if they are former smokers, have quit within the last 15 years reduces lung cancer mortality by 20% and all-cause mortality by 6.7%.
Harms:
- Radiation exposure
- False positives and risks of follow-up interventions
- Quality of life
- Over-diagnosis
- Effect on smoking rates
Do you need high sensitivity or specificity for screening?
Sensitivity
What is the prevalence of current daily smokers?
15%
Who are the high risk groups?
Groups with high rates of smoking:
- low socioeconomic
- unemployed
- prisoners
- mental illness
- aboriginal and torres strait islanders
- remote area
Discuss the global epidemic of tobacco smoking
- obacco kills nearly 6 million people each year.
- Nearly 80% of the world’s one billion smokers live in low- and middle-income countries.
What is the incidence, death rate and burden of skin cancer?
more than 434,000 people treated for one or more non-melanoma skin cancers in Australia each year.
In 2012, 12,036 Australians were diagnosed with melanoma.
In 2013, 2,209 people died from skin cancer in Australia
Burden: most common cancer in Australians aged 15-44
What are the risk factors of skin cancer?
- type 1 skin and age > 45
- more than 100 naevi
- past history of melanoma
- red hair
- spend lots of time outdoors
- no slip, slop, slap, seek or slide
- use solariums
- work outdoors
Discuss the detection and screening, and diagnosis of skin cancer
The current Australian standard is patient self skin check and opportunistic screening
Non-melanocytic skin cancer (NMSC) does not meet the recognised criteria for the implementation of screening because the disease in the vast majority of cases is not life-threatening or serious enough to cause long term illness.
Currently there is insufficient evidence that screening the general population for melanoma offers reduced morbidity and mortality
What are the types/levels of skin cancer prevention?
Sun Smart program:
- Social Marketing Campaign
- SunSmart Schools and Childcare
- Workplace Sun Protection
Just know a 2-3 facts about skin cancer
- 2/3 Australians will be diagnosed with skin cancer by the time they are 70
- most common cancer in Australians aged 15-44
What are the key messages to some of the campaigns and link them to the health behaviour change models such as the health belief model.
- Slip, slop, slap, seek and slide
- Rowan’s story
- How to remove a skin cancer - hard hitting and graphic
Describe diffusion of innovation in relation skin cancer and health behaviour change
Diffusions of innovation theory:
Rogers proposes that four main elements influence the spread of a new idea:
- the innovation itself,
- communication channels,
- time
- a social system.
This process relies heavily on human capital. The innovation must be widely adopted in order to self-sustain. Within the rate of adoption, there is a point at which an innovation reaches critical mass.
Understand the damage that solariums can cause
People who use a sunbed regularly before the age of 30 have:
75% greater risk of skin cancer than those who do not use solariums
Class 1 status ‘carcinogenic to humans’
Discuss the regulatory restrictions on solarium use and the issue of banning this product
n 2008, registration of all sun-tanning units which use UV radiation for cosmetic purposes in a commercial setting, became mandatory in Western Australia under the section 36 of the Radiation Safety Act.
What are the criteria for causal inference? (Bradford-Hill)?
SCSTGPCEA
- Strength of association
- Consistency - reproducibility
- Specificity
- Temporality
- Gradient (dose-response)
- Plausibility
- Coherence - with natural history of disease
- Experimentation - with significant
- Analogy - similar known causes?
