Screening and Health Promotion Flashcards
what is the purpose of screening ?
detect disease at pre-symptomatic stage,
interrupt the natural history of disease,
detect individuals vulnerable to disease and reduce risk,
enable informed reproductive choices,
protect public health
what is screening ?
a process that identifies unrecognised conditions by rapidly applied tests on a large scale
not diagnostic and requires follow up investigations and treatment
what are the three types of screening ?
selective, mass and opportunistic
give an example of selective screening for a single disease
chest x-ray in coal miners
give an example of selective multiphase screening
antenatal examinations
give an example of mass screening for a single disease
cervical, breast, prostate screening
give an example of mass multiphase screening
routine check ups over 75 year olds
describe the selective screening mechanism
identify individuals at high risk of disease,
screen for early disease,
convert to low risk by behaviour modification and/or intervention
what are the benefits of effective screening?
preventive measure, reduces morbidity and mortality, reduces costs, less radical treatment, reassurance for those deemed healthy
what are the principles of screening ?
condition should be important health problem, natural history understood, recognisable symptoms, suitable test for examination, acceptable test and treatment, effective in reducing mortality/morbidity, benefits outweigh harm, economic, agreed policy on whom to treat
what characteristics should diseases have in order to be suitable for screening?
slow but progressive natural history,
major effects,
high prevalence
what are the stages of screening?
identify at risk group
apply screening test
apply appropriate diagnostic tests
treat those with positive results
what is meant by sensitivity ?
probability that the test will be positive if the disease is truly present
what is meant by specificity ?
probability that the test is negative if the disease is truly absent
what is meant by positive predictive value?
probability of truly having the disease when a screening test is positive
what is meant by negative predictive value ?
probability of being disease free when the screening test is negative
who is responsible for setting the principles of screening ?
National Screening Committee
what are the factors influencing health ?
human biology, physical environments, social environments, behaviour and lifestyles, health services
how does environment and lifestyle influence health ?
behaviour is a product of routine and social encounters,
behaviour is psychological,
social and physical environments provide and restrict the range of options from which people are able to make choices
what percentage of public expenditure relates to oral health in high income countries ?
5-10%
what are the aims of health promotion ?
tackle the determinants of health,
work in partnership with agencies and sectors,
adopt a strategic approach with a range of actions to promote population health
what is the definition of health promotion ?
the process of enabling people to increase control over and to improve their health
what are the principles of health promotion?
involve the population as a whole,
directed towards action on determinants,
effective and concrete public participation,
not a medical service,
health professionals have a role in enablement, mediation, advocacy and education
what are the 5 approaches to health promotion?
prevention, behaviour change, education, empowerment, social change
what does health promotion lead to ?
healthy public policy
what do health promotion interventions need to be supported by ?
evidence
what is meant by opportunity cost ?
the benefit of an intervention compared to its cost
how is the cost effectiveness of public health interventions measured ?
cost per QALY (quality adjusted life years)
what are the settings for oral health promotion ?
population, community, school, workplace, dental practice
what are the 5 strategic elements of the WHO Ottawa Charter 1986?
building healthy public policy, creating supportive environments, strengthening community action, developing personal skills, reorienting health services
what are the problems with health promotion ?
long interval between preventive strategy and measurable improvements.
time consuming,
politically controversial,
must be rigorously evaluated,
politicians place emphasis on personal lifestyle choices
what are the dilemmas for health promotion?
healthism, victim blaming, inaccessibility of information, appropriation of health promotion by specialist groups, evaluation and effectiveness
what are the main overall focusses of health promotion ?
focus on the population as a whole, make the healthy choices the easy and inexpensive choices
How can healthy public policy be achieved ?
Remove barriers to healthy policy to make them the easier choices,
Health impact assessment,
Legislation and regulation eg seat belts
Fiscal policies eg taxes on food/tobacco
How can supportive environments be created ?
Create work environments that are safe and satisfying
Encourage communities to work together and conserve natural resources
Wider environment - access to healthy food
Work/school - food and smoking regulations, exercise facilities, health and safety
Home - facilities
How is strengthening of community action achieved ?
Set priorities, make decisions, plan local strategies, implement plans
Eg food co operatives, farmers markets, smoking cessation, cookery clubs
How can personal skills be developed ?
Health education, Knowledge, attitudes, behaviour, Coping strategies, Self esteem, Self efficacy, Empowerment
How are health services reoriented ?
Ensure health services aimed at the pursuit of health not just curing disease
Primary healthcare approach - address inverse care law
