Week 1_introduction to disease prevention Flashcards
List the 5 top leading DALYs in Australia (2011)
- Cancer (grouped)
- Cardiovascular (grouped)
- mental health
- musculoskeletal
- injuries
What are the 6 top risk factors contributing to disease burden?
- tabacco smoking
- overweight
- alcohol harm
- physical inactivity
- High blood pressure
What are the 2 key approaches to prevention?
- Individual strategies aimed at high risk patients.
- population strategies aimed at broader public: public Health
List some high risk prevention strategies
- aimed at individuals at high risk of a particular disease
- undertake interventions that are appropriate to that particular individual traditional medical approach
- individual focus
- screening patients opportunistically
- Brief intervention techniques
List some advantages and disadvantages of high risk prevention strategies:
Adv:
- appropriate for individual
- patient and doctor motivated to use. eg. patient who has just had an MI will be motivated to loose weight.
- cost-effective use of resources
- favourable risk-benefit ratio
Dis-adv:
- costs of screeing- who, how, when, uptake, borderline cases
- temporary effect- underlying cause remains
- behaviourally inappropriate-social norms ie. behaviours engrained over a lifetime
- Most people with risk factors won’t get the disease (unknown absolute risk)
- Most people who get the disease do not have risk factors.
What is the prevention paradox and how is this a limit to high risk prevention strategies?
A prevention measure which brings much benefit to the population offers little to each participating individual.
- difficult to predict absolute risk of disease in an individual
- a large population at low risk may give rise to more cases of disease that a small population at high risk.
IF WE ONLY TARGET AT RISK GROUP, WE WON’T REACH THE LARGER NUMBER OF CASES.
eg. cancer in smokers vs cancer in non-smokers
eg. down syndrome in pregnancies in women over 45 vs less than 30yrs.
What is the aim of population based strategies?
- Attempt to control the determinants of the disease
- Aim to shift the whole distribution of an exposure in a favourable direction
- May be environmental or behavioural by changing societal norms
eg. for years we said we couldn’t do anything about smoking. When we shifted focus from ‘you’ shouldn’t do that, to ‘what can we do from a societal point of view’ which makes it less appealing from a societal point of view, then more people will be sifted into the safe zone.
What are the advantages and disadvantages to population strategies?
ADV:
- attempts to reduce the underlying causes of a disease
- small change/effect can become very significant when it occurs across an entire population
- behaviourally appropriate-change social norms
- TARGETING A LARGE NUMBER OF PEOPLE WILL ALWAYS REACH A LARGER PERCENTAGE OF PEOPLE
DIS-ADV:
- ltd benefit to individual eg. immunisation- low risk of disease
- poor motivation eg. exercise- ltd short term reward
- benefit- risk ratio much lower
Of the 30yrs in average lifespan gain since early 1900s, what percentage is due to advances in public health?
25 yrs due to advances in public health
5% due to curative medicine advances
Analyse at least 5 prevention strategies that have made a difference to human health:
NB: The better you do, the less people think they need it.
- Antismoking campaigns:
- regognistion of tabacco as health hazard
- legislation re: sales to minors, advertising, enclosed spaces
- smoking reduced from 40 to 20%
- still high in indig. and young women. - motor vehicle accidents:
- Personal behaviour change (seat belts, helmets, drink driving (RBT))
- large reduction in deaths
- mortality rates in Aus 5.1/100,000 vs 11/100000 in US, 3/100,000 in UK, 6 in NZ - Vaccination
- eradication of smallpox
- imminent eradication of poliomyelitis
- control of measles (free of endemic measles in Aus), tetanus, HiB - Work related health problems.
- shifted ethos from inherent risk to not accepting risk.
- legislation > injury reduction
- OHS at all sites
- smoking ban
-40% reduction in workplace deaths
- communicable disease control:
- clean water and sanitation
- Antibiotics for TB and STIs
- Vector control
Challenges remain- HIV, TB, Malaria - Reduction in CVD mortality:
- risk factor reduction
- BP control
- smoking cessation
- earlier detection
- safer more effective treament - Food safety:
- decreased microbial content
- increased nutritional content - food fortification
- food safety legislation and education for handlers
- Major nutritional deficiency diseases almost eliminated (rickets, goiter, pellagra) - Mothers and babies’ health:
- hygiene and nutrition
- antibiotics
- access to health care
- technology
- infant & maternal mortality decreased by over 90% - family planning:
- smaller family sizes
- fewer infants and maternal deaths
- changed role for women - social and economic > better health
- barrier methods reduce unwanted pregnancies and STIs.
nb. prevent infant and maternal death, families stop having as many children > fam size decreases > increases SES for family. - Fluoridation of water
- all social groups benefit
- adult tooth loss reduced by up to 40%
- tooth decay in children reduced by up to 60%
Define lifestyle medicine
- Trying to get people to modify their behaviours which may decrease the likelihood of them getting sick.
- bridges gap b/w health promotion and conventional medicine
Define primary, secondary and tertiary prevention
Primary: an activity which prevents a disease ie immunisation
Secondary: Picks up disease early, stops it taking a hold
Tertiary: Try to prevent complications and manage a disease
Screening guideline 1. The condition.
Discuss rationale
- should be an important health prob
- should have recognisable latent or early symptomatic stage
- the natural history of the condition, including development from latent to declared disease, should be adequately understood.
Screening guideline 2: The test
Discuss rationale
- Should be simple, safe, precise and validated
- should be acceptable to the target population
- the distribution of test values in the target population should be known and a suitable cut-off level defined and agreed
Screening guidelines 3: Treatment
Discuss rationale
- there should be an effective treatment identified with evidence that early treatment leads to better outcomes
There should be an agreed policy on who should be treated and how
