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HADM 208 > Module 5 > Flashcards

Module 5 Flashcards

1
Q

Natural History of Disease

A

Course of a disease from onset to resolution

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2
Q

Critical point (in course of disease)

A

Time during pathogenesis beyond which there are serious consequences
*If detection before critical point, then secondary prevention is possible

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3
Q

Clinical horizon

A

Time during pathogenesis when signs/symptoms occur

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4
Q

Screening test

A

Presumptive identification of unrecognized disease through tests, exams, or other procedures that can be applied rapidly and inexpensively to populations
*Positive screening tests are followed up by diagnostic tests to confirm actual disease

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5
Q

Primary Prevention

A

Avoiding illness altogether by preventing disease development (occurs during pre pathogenesis)

  • General health promotion (primordial prevention)
  • Disease-specific efforts
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6
Q

Active Primary Prevention

A

Necessitates behavior change on the part of the subject

Ex: vaccine, protective devices

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7
Q

Passive Primary Prevention

A

Does not require behavior change

Ex: fluoridation of public water, vitamin fortification of bread and milk products

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8
Q

Secondary Prevention

A

Aimed at reducing illness onset, duration, and further transmission (occurs during pathogenesis)
Ex: screening programs

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9
Q

Tertiary Prevention

A 
Aims to: 
-Cure illness 
-Limit disability due to disease
-Restoring optional functioning
Ex: physical therapy for stroke, fitness for heart attack
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10
Q

Screening Concepts

A

Distinguish people with disease from those without

  • Major strategy for secondary prevention
  • Not diagnostic
  • Can be applied to entire population or selected at risk
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11
Q

Screening test

A

Stage: before symptoms
Characteristics: less risky, less expensive, acceptable
Population: healthy

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12
Q

Diagnostic test

A

Stage: after symptoms
Characteristics: ordered by doctor, expensive, risky, time consuming, pain/discomfort, definitive diagnosis
Population: individuals with disease

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13
Q

Characteristics of a good screening test

A

Simple, rapid, inexpensive, safe acceptable (by target pop)

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14
Q

Evaluation of screening tests

A

Reliability: consistency of results
Validity: accuracy
Sensitivity: proportion with disease test +
Specificity: proportion w/o disease test -
Positive Predictive Value: prop test + w/ disease
Negative Predictive Value: prop test - w/o disease

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15
Q

Reliability (Precision)

A

The ability of a measuring instrument to give consistent results on repeated trials

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16
Q

Validity (Accuracy)

A

The ability of a measuring instrument to give a true measure

*Can be evaluated only if an accepted/independent method for confirming the test measurement exists (gold standard)

17
Q

Relationship between reliability and validity

A
  • Possible for a measure to be highly reliable but invalid

- Impossible for a measure to be valid but unreliable

18
Q

Validity measures of screening tests

A

Sensitivity and Specificity

19
Q

Sensitivity

A

The ability of the test to correctly identify those who have the disease
TP/(TP+FN) OR TP/all those with the disease

20
Q

Specificity

A

The ability of the test to correctly identify those who do not have the disease
TN/(FP+TN) OR TN/all those without the disease

21
Q

To improve sensitivity

A

Cut point for disease should be moved farther into the non-diseased range

22
Q

To improve specificity

A

Cut point should be moved farther into the range typically associated with disease

23
Q

Positive Predictive Value

A

The proportion of individuals screened positive by the test who actually have disease
TP/(TP+FP) OR TP/all those with a positive result

24
Q

Negative Predictive Value

A

The proportion of individuals screened negative by the test who actually do not have the disease
TN/(FN+TN) OR TN/all those with a negative test result

25
Q

Effects of prevalence on predictive value of screening

A

When prevalence falls:
-PPV falls
-NPV rises
Ex: flu testing when flu isn’t prevalent

26
Q

Criteria for a good screening program

A
  • High sensitivity and specificity
  • Simplicity, low cost, safety, patient acceptability
  • Serious disease
  • Test detects disease at earlier stage
  • Treatment if screen positive more effective
  • High prevalence in population screened
  • Follow-up diagnostic/treatment available

HADM 208 (13 decks)

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