Prevention Flashcards
What are the top 10 causes of death for all races, sexes, and ages? in order
Heart disease
Cancer
Chronic lower respiratory diseas
Stroke
Accidents
Alzheimer’s disease
Diabetes
Influenza/pneumonia
Nephritis, nephrotic syndrome, nephrosis
Intentional self harm (suicide)
Note that septicemia is #11, hypertension & hypertensive renal disease is #13, homicide is #15. AIDS/HIV doesn’t make the top 15 list when looking at everybody combined
What is the most common cause of cancer death in men? women?
Lung cancer
What are the top 3 causes of cancer deaths in men?
In order:
Lung
Colorectal
Prostate
Causes of death in younger v. older people?
Younger people: HIV/AIDS, accidents, liver disease, suicide, and homicide.
Older people: chronic lower respiratory diseases, Alzheimer’s disease, renal disease, and septicemia.
Leading causes of death that are high for both groups are diseases of the heart, cancer, and diabetes.
Life expectancy at birth is often used as a general measure of overall health in a population. According to 2008 CDC data, which one of the following three groups in the U.S. had the highest life expectancy at birth?
Hispanics
Which factors account for increased mortality in blacks v. whites?
Includes: higher rates of infant mortality, HIV, homicide, and heart disease in blacks
Persists across income levels and age
How many deaths are due to chronic disease?
How much of medical costs does this include?
7/10
83% of health care costs are on managing chronic disease
How much of Medicaire expenses go towards final year of life?
25%
Cost v. saving on public health expenditures
$2.9 billion in community-based disease prevention programs would save $16.5 billion annually
$1 in biking trails and walking paths would save nearly $3 in medical expenses;
$1 in wellness programs by companies would save $3.27 in medical and $2.73 in absenteeism costs;
$1 targeting poor eating and physical activity generated $1.17 of savings.
1 spent on water fluoridation, $38 is saved in dental restorative treatment costs
What are the 2 major goals of prevention?
- Reduce the burden of suffering for the major preventable diseases.
- Control expenditures by reducing the need for intensive management of late-stage illness.
What is Healthy People 2020?
Healthy People 2020 is the third in a series health targets set every decade by the U.S. Department of Health and Human Services (HHS).
“setting objectives and providing science-based benchmarks to track and monitor progress can motivate and focus action.”
What are the goals of Healthy People 2020?
- Attain high quality, longer lives free of preventable disease, disability, injury, and premature death
- Achieve health equity, eliminate disparities, and improve the health of all groups
- Create social and physical environments that promote good health for all
- Promote quality of life, healthy development, and healthy behaviors across all life stages
What are the 12 topics areas and 26 leading health indicators selected as the goals for the healthy people 2020?
Access to Health Services
• Persons with medical insurance
• Persons with a usual primary care provider
Clinical Preventative Services
• Adults who receive a colorectal cancer screening based on the most recent guidelines
• Adults with hypertension whose blood pressure is under control
• Adult diabetic population with an A1c value greater than 9 percent
• Children aged 19 to 35 months who receive the recommended doses of diphtheria, tetanus, and pertusses (DTaP); polio; measles, mumps, and rubella (MMR); Haemophilus influenza type b (Hib); hepatitis B; varicella; and pneumococcal conjugate (PCV) vaccines
Environmental Quality
• Air Quality Index (AQI) exceeding 100
• Children aged 3 to 11 yeares exposed to secondhand smoke
Injury and Violence
• Fatal injuries
• Homicides
Maternal, Infant, and Child Health
• Infant deaths
• Preterm births
Mental Health
• Suicides
• Adolescents who experience major depressive episodes (MDEs)
Nutrition, Physical Acitivity, and Obesity
• Adults who meet current Federal physical activity guidelines for aerobic physical activity and muscle-strengthening activity
• Adults who are obese
• Children and adolescents who are considered obese
• Total vegetable intake for persons aged 2 years and older
Oral Health
• Persons aged 2 years and older who used the oral health care system in the past 12 months
Reproductive and Sexual Health
• Sexually active females aged 15-44 years who received reproductive health services in the past 12 months
• Persons living with HIV who know their serostatus
Social Determinents
• Students who graduate with a regular diploma 4 years after starting ninth grade
Substance Abuse
• Adolescents using alcohol or any illicit drugs during the past 30 days
• Adults engaging in binge drinking during the past 30 days
Tobacco
• Adults who are current cigarette smokers
• Adolescents who smoked cigarettes in the past 30 days
What are the 4 classic preventative services?
- Immunizations
- Chemoprophylaxis
- Screening for early detection of disease
- Education and counseling of patients about behaviors that impact their health
What are the three levels of prevention strategies and how do you define each of them?
Primary prevention involves interventions that prevent disease from occurring such as discussing with the patient strategies such as the advantages of using a helmet when riding a bicycle or motorbike, smoking assessment and counseling, or a tetanus vaccination.
Secondary prevention involves screening interventions that detect asymptomatic disease and improve outcomes, such as pap smears and a blood pressure assessment.
Tertiary prevention involves an intervention to reduce complications of established disease. Some examples are ophthalmology examinations in diabetic patients or statin use in post-myocardial patients (Essentials of Family Medicine, Sixth Edition, Lippincott. 2012. pp 29).
What is the RISE pneumonic?
Tool to keep prevention strategy integrated in everyday clinical practice
Risk assessment & identification
Immunization and chemoprophylaxis
Screening
Education and Counseling
Which vaccines are important in adults?
Influenza, Pneumococcal polysaccharide (PPV), MMR, Td/Tdap, Zoster, Hepatitis A, Hepatitis B, Meningococcal vaccine, Human papillomavirus (HPV);
What are the side effects of vaccines?
local pain, irritation, fever, vasovagal syncope, occasionally cellulitis, or rarely, an unexpected allergy, anaphylaxis or seizure
What is chemoprophylaxis?
What are the considerations for using it?
administration of a medication or natural substance for the purpose of preventing a disease or infection
2 concerns:
- Benefits of chemoprophylaxis must outweigh any potential harm.
- Chemoprophylaxis must be cost-effective.
Aspirin as chemoprophylxis
Tertiary prevention: The use of aspirin in men and women in certain age groups with known cardiovascular disease has been shown to reduce the risk of death and further vascular events
Primary prevention: of CVD - more balanced risks & benefits depending on the individual; SE include risk of intracranial and GI bleeding
For which groups is aspirin recommended as primary prophylaxis?
Grade A: recommended bc benefit > risk of GI bleed
CVD in men age 45-79 - prevent MI
CVD in women age 55-79 - prevent ischemic strokes
Grade D: not recommended bc benefit < risk
To prevent CVD in women younger than age 55 - prevent stroke
Men <45 to prevent MI
Women <55 to prevent stroke
Grade I: Insufficient evidence
Men and women 80+ years old to prevent CVD
Both risk of CHD and GI bleeding are high
Every man older than 45 and woman older than 55, should be assessed for their own personal risk of cardiovascular disease and the harms / benefits of taking aspirin for primary prevention
Calculate their 10 year cardiovascular risk based on Framingham model
Weigh against bleeding risk which increases with age
What are the WHO principles of screening?
- The condition should be an important health problem.
- There should be a treatment for the condition.
- Facilities for diagnosis and treatment should be available.
- There should be a latent stage of the disease.
- There should be a test or examination for the condition.
- The test should be acceptable to the population.
- The natural history of the disease should be adequately understood.
- There should be an agreed policy on whom to treat.
- The total cost of finding a case should be economically balanced in relation to medical expenditure as a whole.
- Case-finding should be a continuous process, not just a “once and for all” project, in step with the natural history and prevalence of disease, and needs of the population.
Sensitivity, Specificity, PPV, and NPV equations
Sensitivity = True positive/ Total who are actually positive
Specificity = True Positive/Total who are actually negative
Positive Predictive Value = True positive/Total who test positive
Negative Predictive Value = True negative/Total who test negative
Sensitivity
The probability of the test finding disease among those who have the disease. Alternatively, the proportion of people with disease who have a positive test result.
Specificity
The probability of the test finding no disease among those who do not have the disease. Alternatively, the proportion of people free of a disease who have a negative test.
Positive Predictive Value (PPV)
The percentage of people with a positive test result who actually have the disease. This is also the posttest probability that an individual has a disease after a positive test.
Negative Predictive Value (NPV)
The percentage of people with a negative test who do NOT have the disease. This is also the posttest probability that someone does not have a disease after a negative test.
Experemental event rate and control event rate
Experimental Event Rate (EER)
Event rate in the treatment group.
EER = A/(A+B)
Control Event Rate (CER)
Event rate in the control group.
CER = C/(C+D)
Relative Risk
RR = EER / CER = A/(A+B) / C/(C+D)
It’s used to compare the probability of an event in two distinct groups
It’s also known as risk ratio
It’s often reported in randomized trial studies and cohort studies to compare teh two groups
Relative Risk Reduction = RRR
The proportional reduction in rates of bad outcomes between experimental and control participants in a trial” (Centre for Evidence Based Medicine Web Site 2008). This number is often used because the numerical value appears to be huge, but often overestimates clinical relevance.
RRR = |EER – CER|/CER = |A/(A+B) - C/(C+D)| / C/(C+D)
Absolute risk reduction (ARR)
ARR represents the risk difference between the control group event rate and the experimental group event rate.
ARR = CER - EER = C/(C+D) - A/(A+B)
Odds Ratio
Odds Ratio = (A/B) / (C/D) = (AxD)/(BxC)
Odds are a comparison of the probability of an event to the probability that an event does not take place. The odds ratio divides the odds of finding or not finding a particular outcome in the exposed group by the odds of finding or not finding an outcome in the unexposed group (STATS, George Mason University). In case-control or other studies where the incidence is unknown, only associations can be measured, and expressed using the odds ratio for comparison. Because of the ambiguity in the odds ratio, drawing conclusions can sometimes be difficult. In cohort and other prospective studies, where the incidence is known (and causality might be inferred), relative risk is a more appropriate comparison. Use of the odds ratio in these situations should raise suspicion.
COPC Cycle
