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Module Prevention Flashcards

0
Q

What is the largest contribution to the increase in life expectancy?

A

Public health investment-

Safe work places, improved housing, better sanitation, nutrition initiatives, mass immunization

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1
Q

What is the most current life expectancy?

A

78.7 as of 2010

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2
Q

What is the reason for the 50-60% reduction of cardiovascular deaths?

A

Risk factor reduction NOT treatments and diagnosis in disease

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3
Q

What are the major causes of morbidity and mortality in the us? (Age/gender)

A

Age/gender

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4
Q

How do the characteristics of individuals and populations affect the occurrence of disease and the provision and utilization of health services

A

Based on age, gender, language, religion, income, education, culture, race, ethnicity, and lifestyle

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5
Q

What are the goals of the healthy people 20/20 initiative?

A

1) attain high quality, longer lives free of preventable disease, disability, injury and premature death
2) achieve health equity, eliminate disparities, and improve the health of all groups
3) create social and physical environments that promote good health for all
4) promote quality of life, healthy development, and healthy behaviors across all life stages

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6
Q

What are primary, secondary, and tertiary prevention strategies applied in clinical care?

A

Primary prevention-prevent disease from occurring ie smoking cessation
Secondary prevention-involves screening interventions that detect a symptomatic disease and improve outcomes
Tertiary prevention-intervention to reduce complications of an established disease ie optho exams in db or statin post MI

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7
Q

What are the standards of a good screening?

A

.

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9
Q

What is incidence?

A

the number of new cases of a disease in a particular population during a specific time period

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10
Q

What is prevalence?

A

the total number of cases of the disease in a particular population at a specified instant in time

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11
Q

What are age adjusted rates? Case fatality rates?

A

age adjusted rates: allows comparison of a health outcome to be compared in two populations with different age distributions
-case fatality-deaths from a disease among pts diagnosed with that disease

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11
Q

What is sensitivity? Specificity?

A

.

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13
Q

What is sensitivity? Specificity?

A 
sensitivity = true + / true + & false - (proabability of the test finding disease among those who have the disease, proportion of people with disease who have a positive test result)
specificity = true - / false + & true - (probability of the test finding no disease among those who do not have the disease, the proportion of people free of a disease who have a negative test)
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14
Q

What is ppv?

A

PPV=true + / true + & false + (the % of people with a positive test result who actually have the disease, post test porbability that an individual has a diease after a positive test)
NPV= true - / true - & false - (the percentage of people with a negative test who do not ahev the diease, the post test probability that someone does not have the disease after a negative test)

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14
Q

What are the essential components of community oriented primary care? (COPC)

A

.

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15
Q

What is validity? Reliability?

A

validity: the degree to which a test actually measures what it claims to measure
reliability: the degree to which a consistent measurement is yielded by repeated applications of a test, a test is reliable if the average measurement error is small over time

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16
Q

What are the top ten causes of death in the us?

A

Cardiovascular, cancer, chronic lower respiratory diseases, stroke, accidents, Alzheimer’s, diabetes, influenza/pneumonia, nephritis/nephrotic syndrome/nephrosis, suicide

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17
Q

What is the most common cause of cancer death?

A

Lung cancer

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18
Q

Which of the three has the highest life expectancy at birth-blacks, nonhispanic white, Hispanic?

A

Hispanics

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19
Q

What % of direct medical costs are due to chronic disease? % of deaths?

A

Chronic disease accounts for 83% of costs, 7/10 deaths

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20
Q

What are the major goals of prevention?

A

1) reduce the burden of suffering for the major preventable diseases 2) control expenditures by reducing the need for intensive management of late-stage illness

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21
Q

What are the 12 topic areas of the 2020 healthy people initiative?

A

Access to health care services, clinical preventative services, environmental quality, injury and violence, maternal/infant/child health, mental health, nutrition&physical activity& obesity, oral health, reproductive/sex health, social determinants, substance abuse, and lastly tobacco

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22
Q

What are preventative services?

A

Immunizations
Chemo prophylaxis
Screening for early detection of disease
Education and counseling of patients about behaviors that impact their health

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24
Q

What is RISE?

A 
Risk assessment and identification 
Immunization and chemo prophylaxis 
Screening 
Education and change 
- should be used and integrated in everyday clinical practices for prevention
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25
Q

what are the elements of risk assessment and identification?

A

age, past and current medical history, past surgical history, psychiatric history, sexual history, social history (substance use, abuse history), safety, occupational history

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26
Q

who is considered varicella immune?

A

anyone born before 1980

27
Q

what two issues must be considered before starting chemoprophylaxis?

A

1-benefits of chemoprophylaxis must outweigh any potential harm
2- chemoprophylaxis must be cost effective

28
Q

when is aspirin recommended for men?

A

grade a-age 45-79 when potential benefit of MI rr outweigh potential GI bleed
grade D-no aspirin under 45

29
Q

when is aspirin recommended for women?

A

grade a: age 55-79 years old, risk in harm due to ischemic strokes outweigh harm of an increase GI hemorrhage
grade d: no stroke prevention under age 55 with aspriing-GI bleed risk outweigh benefits

30
Q

what are the principles of screening?

A
  1. there should be an sig health problem
  2. treatment available
  3. facilities for diagnosis and treatment
  4. latent stage of disease
  5. should be a test or exam of the condition
  6. acceptable test to the population
  7. natural history of the disease should be understood
  8. there should be an agreed policy on whom to treat
  9. cost o finding case should be balanced in relation to medical expenditure as a whole
  10. case finsind should be a continuous process, not just a once and for all project
31
Q

what is the labeling effect?

A

an abnormal test whether a false positive or true positive may cause dstress, anxiety and depression

32
Q

when should a screen not be performed?

A
  1. the service benefits no or very few people in the target population
    - the service has no or little effect in the target population, the condition has low prevalence in the target population, the screening is “unfocused” (ordring a chem 12 rather than just a BMP may pick up more abnormalities that may not be clinically significant
  2. the service causes net harm to the target population
  3. there is uncertain balance of benefits and harms
33
Q

is hemochromatosis screening recommended?

A

n, rare in the general population poor evidence that early therapeutic phlebottomy improves morbidity and mortality in screening detected versus clinically detected individuals

34
Q

what is selective screening?

A

screening only select high risk population

35
Q

what are the USPSTF recommendations for breast cancer screening?

A

1) bi ennial screening mammography for women aged 50-74 years (grade B)
2) decision to start regular, biennial screening mammogrpahy before the age of 50 should be an individual one and take patient context into account, (grade C)
3) not enough evidence to assess the benefits and harms of screening mammography in women 75 years or older (i statement)
4) No teaching self breast exam (grade D)
5) insufficient evidence to assess benefits and harms of clinical breast exam beyond mammo in women 40 years and older (I statement)
6) current evidence in sufficient to assess additional benefits and harms of either digital mammography or MRI instead of film mammography as screening modalities for breast cancer (I statement)

36
Q

what are the three general categories of behavior change?

A
  1. reduction or elimination of destructive behaviors
  2. promotion of healthier lifestyles
  3. adherence to medical regimens
37
Q

what are the stages of change? what do each of these mean?

A
  1. precontemplation-patient denies or minimizes the issue; may be defensive about discussing
  2. contemplation-the pt has considered the pros and cons of the issue; is willing to discuss it
  3. preparation/determination- the pt commits to a time and a plan to address the issue
  4. action- the pt regularly engages in activites to change behavior
  5. maintenance- the pt integrates the new behavior into a “regular” way to live; the patient is vigilant about relapsing
  6. relapse- the pt has returned to one of the previous stages after a period of resolution
38
Q

how do you approach the precontemplative pt?

A

request permission to discuss the issue, express concern, or as the patient to think or read about the issue between visits

39
Q

how do you approach the contemplative pt?

A

ask about the pts opinions on the issue or help the pt weigh the pros and cons

40
Q

how do you approach a pt in the preparation/determination stage?

A

provider can summarize the pts reasons for the behavior change, negotiate a start date to begin the behavior change and encourgae that the patient make a “public” announcement about the change

41
Q

what can a dr do for a pt in the action stage?

A

provide support, modify the plan if not optimal, schedule follow up contact to provide further support

42
Q

what can the physician do for the paitent in the maintenance stage?

A

continue to give support and admiration for the bahavior change, ask about commitment to change in the future and ask about the patients expectations

43
Q

what can the physician do if the patient relapses?

A

can reassure the patient that relapses occur on the pathway to long term change and relapses can offer opportunities to learn i preparing for the next action stage

44
Q

what are the 5 As for smoking cessation?

A

Ask about tobacco use during every visit (during vitals)
Advise all smokers to quit
Assess the patients willingness to quit (Set a date, requent encouragement from family and friends, anticipate triggers and cues to smoking, suggest changes to the enviornment)
Assist the patient in his or her attempt to quit
Arrange follow up contact (w/in 1st week, 2nd date within month)

45
Q

smoking cessation during pregnancy:

A

intensive counseling much better than brief counseling, pharmacotherapy during pregnancy not well studied-may be unsafe or not beneficial

46
Q

who should be screened for intimate partner violence?(women)

A

all women of childbearing age with provision of or referral to services for women who screen positive
-sexuality not impt

47
Q

which is better questionnaire or direct interview?

A

no difference in prevalence

48
Q

what is HITS? HARK?

A

Hurt, Insult,Threaten, Scream

Humiliation, Afraid, Rape, Kick

49
Q

what is absolute risk reduction? relative risk reduction?

A

arr-the risk difference between the control group event rate and the experimental group event rate, the individual risk of developing a disease over a time period.
rrr- the difference between the experimental risk reduction and the control group rate, “the proportional reduction in rates of bad outcomes between experimental and control participants in a trial

50
Q

what is the number needed to treat?

A

the number of patietns who need to be treated in order to prevent one additional bad outcome-the inverse of the absolute risk reduction (NOT relative)

51
Q

what is relative risk?

A

used to compare the probability of an event in two distinct groups, represents the event rate in an exposed group divided by an event rate in an unexposed group, also known as the risk ratio, often reported in randomized clinical trials and cohort studies

52
Q

what is an odds ratio?

A

odds=comparison of the probability of an event to the probability that an event does not take place
-divides the odds of finding or not finding a particular outcome in the exposed group/ odds of finding or not finding an outcome in the unexposed group

53
Q

what is the number needed to treat?

A

the number of pts who need to be treated in order to prevent on additional bad outcome (inverse of ARR)

  • two caveats:
  • when the likelihood of an outcome is low, the NNT will be high
  • the NNT will decrease as either the likelihood of the outcome increases or as the benefit of treatment decreases
54
Q

what four questions should be asked when reviewing a study on screening to decide whether the screen is beneficial or harmful?

A
  1. is there evidence based on randomized control trials that early diagnosis really leads to improved survival or quality of life or both?
  2. are the early diagnosed patients willing partners in the treatment strategy?
  3. how do benefits and harms compare in different people and with different screening strategies?
  4. do the frequency and severity of the target disorder warrant the degree of effort and expenditure?
55
Q

what is the US preventive services task force?

A

conduct rigorous assessments of the scientific evidence for the effectiveness of a broad range of clinical preventive services, including screening, counseling, and chemoprophylaxis

  • representatives on the panel incluse: private sector (non governmental) family medicine physicians, general internists, pediatricians, OB GYNs, and nursing professionals
  • recommendations considered the gold standard for clinical preventive services
56
Q

who are the recommendations made by the USPSTF made for?

A

intended for use in primary care and provide clinicians with information about the evidence behind each recommendations, recommendations made for asymptomatic populations

57
Q

what does the USPSTF assess when making recommendations?

A

1-the quality of evidence supporting a specific preventive service
2- the magnitude of net benefit in providing the service

58
Q

what do the USPSTF grades mean? A, B, C, D, I?

A

A: service recommended, high certainty that the net befit is substantial
B: service recommended, high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial
C: routinely providing this service is not recommended, there may be considerations that support providing the service in an individual patient, there is at least moderate certainty that the net benefit is small, offer or provide this service only if other considerations support the offering or provide the service in an individual patient
D: recommend against this service, there is moderate or high certainty that the service has no benefit or that the harms outweigh the benefits, discourage the use of this service
I: current evidence is insufficient to assess the balance of benefits and harms of the service, evidence is lacking of poor quality or conflicting, and the balance of benefits and harms cannot be determined

59
Q

what is the community task force?

A

assesses and makes evidence based recommendations for effective prevention strategies at the community or population level
-considers interventions including environmental improvements, health policy, education, service delivery and system improvement

60
Q

What is COPC?

A

community oriented primary care
-community involvement and participation are essential, disease prevention and health promotion is not limited to individual patients but should be extended to the community in which they practice

61
Q

what are the essential steps to develop a true COPC initiative?

A
  1. define the community-identify the targeted population by collecting relevant demographic, historical, political, cultural and economic data.
  2. identify the health problem-identify the needs of a target population (“community diagnosis”), health issues in the target population that are out of proportion to the national distribution should be benchmarked.
  3. prioritize health needs-conduct neighborhood surveys and focus groups to enable community participation in prioritization of which health issues to address. include community members on the oversight team that makes final decisions on setting priorities
  4. implement appropriate interventions to address the health needs (involve community members in implementation by including community members on the teams overseeing and deploying the intervention. interventions may include healthy school menus, worksite injury prevention progrmas, community garden development, vocational training for at risk youth, or campaigns for changes in local environmental policy
  5. evaluate the impact of intervention, maintain ongoing surveillance, evaluation and assessment of the outcomes of the COPC program. train and or partner with community members to include them on surveillance, evaluation and assessment team.
  6. Modify future interventions-based upon evaluation and reassess outcomes
62
Q

what are health disparities?

A

differences in health outcomes that disproportionately affect members of a group defined by race, ethnicity, gender, lifestyle, income or other demographics. Arise from many societal factors but they can arise from factors specific to health care

63
Q

what did Barbara starfiel, leiyu shi and james amchino find in 2005 regarding primary care and health?

A
  1. health is better in areas with more primary care physicians
  2. people who receive care from primary care physicians are healthier
  3. the characteristics of primary care are associated with better health
64
Q

what did starfield et all, show as the six mechanisms that alone an din combination may account for the beneficial impact of primary care on population health?

A
  1. greater access to needed services
  2. better quality of life
  3. a greater focus on prevention
  4. early management of health problems
  5. cumulative effect of the main primary care delivery characteristics
  6. role of primary care in reducing unnecessary and potentially harmful specialist care

Prevention (1 decks)

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