Introduction to Health Promotion and Disease Prevention Flashcards
(114 cards)
1
Q
Main preventative care services
A
Immunizations
Screening
Behavioral counseling
Chemoprevention (meds and immunization)
Colorectal screenings
2
Q
Primary Prevention
A
Healthy patients (do not have disease yet)
3
Q
Goal of primary prevention
A
prevent disease from occurring at all
Treat or remove the cause of disease
Occur in clinical settings, community activities, public health
4
Q
Example of primary prevention
A
Immunizations or behavioral counseling: smoking cessation
5
Q
Promoting public health through lectures is an example of
A
primary prevention
6
Q
Onset of diabetes to diagnosis
A
7 years
7
Q
Secondary prevention
A
Patients already have the disease, but usually early stage and asymptomatic
8
Q
Goal of secondary prevention
A
Early detection and cure, prevent disease progression
screening
early diagnosis
effective treatment and management
9
Q
Example of secondary prevention
A
HIV screening
10
Q
Tertiary prevention
A
patient already has the disease
11
Q
Goal of tertiary prevention
A
Prevent progression/deterioration
treatment
focus on long term outcomes rather than short term outcomes
12
Q
Example of tertiary prevention
A
diabetic management: glycemic control, foot care, retinal evaluations
13
Q
Primary prevention _____________
A
prevents disease from occurring
14
Q
Secondary prevention ___________
A
detects and cures disease in the asymptomatic phase
15
Q
Tertiary prevention _____________
A
reduces complications of the disease
16
Q
Cardiac primary prevention
A
patients do not have ischemic heart disease or vascular disease
17
Q
Cardiac secondary prevention
A
patients have known disease: treatment to prevent progression
OR
patients at very high risk of disease
18
Q
Neurology primary prevention
A
prevention of stroke with people with risk factors
19
Q
Neurology secondary prevention
A
Patients who have had a stroke, patients who have had a TIA, patients who are at a very high risk of ischemic stroke
20
Q
The same tests can be used for _______ levels of prevention and for diagnosis
A
all
21
Q
Primary prevention: Colonoscopy
A
screening to find and remove pre-cancerous polyp
22
Q
Secondary prevention: Colonoscopy
A
screening to find and remove an early colon cancer
23
Q
Tertiary prevention: colonoscopy
A
follow-up of a patient who has been treated for colon cancer
24
Q
Primary Prevention KEY
A
Patients do not have the disease, goal is to prevent the development of the disease
25
Secondary and tertiary prevention KEY
patients already have the disease or are at extremely high risk (specialty specific)
26
Primum non nocere
First, do no harm
27
Non-maleficence is important for patients
who do not have disease
28
What do we consider in screening?
1. How great is the burden of disease?
2. How good is the screening test?
3. How good is the treatment?
29
Burden of disease
How common is it (epidemiology, etiology)?
How much suffering does it cause?
30
The 5 Ds
Death
Disease
Disability
Discomfort
Dissatisfaction
31
How good is the test?
Sensitivity and specificity
Positive predictive value and negative predictive value
Simplicity
Cost
Safety
Acceptability
32
How good is the test: PPD
not useful in early stages of disease because IGg, cheap, simple, can be more complicated because more than one appointment needed
33
Disease State: True Positive
(+ test/+ disease state)
34
Disease State: False Positive
(+ test/ - disease state)
35
Disease State: False negative
(- test/ + disease state)
36
Disease state: true negative
(- test/ - disease state)
37
Sensitivity
probability that a patient + with disease will have a + test
38
If sensitivity if high
Most people with disease all have a positive test
Few false negatives
negative test, likely they do not have a disease
39
SNOUT
high sensitivity rules out if the test is negative
40
Specificity
The probability that a patient without the disease will test negative
Very few false positives
If someone has a positive they probably have the disease
41
Strep test specificity or sensitivity higher?
specificity higher
42
SPIN
specificity rules in
43
Positive predictive value
Likelihood that a person with a positive test has the disease
Dependent on the prevalence
"how truly positive is the test"
44
Negative predictive value
Likelihood that a person with a negative test does NOT have the disease.
Dependent on prevalence
45
When ordering screening test keep in mind
prevalence of disease
positive predictive value of your test
negative predictive value
46
Goal for screening tests
-minimal prep by the patient
-easy to administer
-quick-rapid turn around
-cheap (is it covered by insurance)
-no special appointments
-Should be VERY safe
-patients need to be willing to have the test
47
Considerations for how good is the treatment
- is there a treatment that works?
- what are the risks/harms of the treatment?
- cost/benefit
- does it matter if you get treated earlier (asymptomatic) vs. (symptomatic)
48
Harms of preventative care
- adverse effects of screening tests or treatment
- dealing with false positive tests
- risk of overdiagnosis
- finding an "incidentaloma"
49
Harms of false positive tests
- need for additional testing
- additional cost
- may involve higher risk procedures
- stress and anxiety for patients, even if further work-up is negative
50
A good study
account for bias and adequately assess risk and benefits
51
Lead time bias
People who are diagnosed with screening survive longer after diagnosis than patients who present with symptoms, even if early treatment doesn't make a difference
just because we find them early doesn't mean they live longer
52
Lead time bias should use ______
mortality rates rather than survival rates
53
Types of bias
- Lead time bias
- Length time bias
- Compliance bias
54
Length time bias
- Has to do with growth rates
- slower growing cancers (which have a better prognosis) are more likely to be found by screening
- fast growing cancer (which have a worse prognosis) usually present between screenings or before screening starts
55
slow growing cancer
prostate
56
fast growing cancer
pancreatic cancer, lung cancer
57
Compliance bias
patients have a better prognosis than non-compliant patients, regardless of screening
Not clear: more interested in their health, usually healthier
Sometimes treatment is worse than disease
58
USPSTF
United States preventative task force
Created in 1984
Independent volunteer panel of national experts in disease prevention and evidence-based medicine
59
Internal validity
- whether the results of the research are correct for the patients who are studies
60
Problems with internal validity
chance: random error
bias: systematic error
61
Systematic error bias
problems with:
randomization
blind
losing patients to follow-up
publication bias
62
External validity
how well does this study apply to patients who were NOT in the study
63
Task forces
make evidence-based recommendations about clinical preventative services
64
USPSTF does NOT make recommendations about
immunizations
65
USPSTF Recommendation: Grade A
recommends this service. High certainty that the net benefit is substantial
66
USPSTF Recommendation: Grade B
recommends this service. High certainty that the bet benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial
67
USPSTF Recommendation: Grade C
recommends selectively. Offer to individual patients based on professional judgement or patient preference. Moderate certainty that the bet benefit is small
68
USPSTF Recommendation: Grade D
recommends against this service. There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits
69
USPSTF Recommendation: Grade I
current evidence is insufficient to assess the balance or benefits of harms in the service. Evidence is lacking, poor quality or conflicting and the risk/benefit can not be determined
70
Level of certainty: High
Consistent results from well-designed/conducted studies in representative populations. Result is unlikely to be changed with results from future studies
71
Level of certainty: Moderate
evidence sufficient to determine the effects of preventative service on health outcomes with constraints (number, size, quality of studies. inconsistent findings. limited generalizability). Findings could change as further studies performed.
72
Level of certainty: Low
current evidence is insufficient to assess effects on health outcomes due to limited size/number of studies, flaws in study/methods, gaps in chain of evidence, findings not generalizable, lack of information on important health outcomes
More information may allow estimation of effects on health outcomes
73
CDC advises
on immunization practices
74
Adult immunization recommendations
Influenza
TDAP
Zoster
MMR
Varicella
Pneumococcus
75
Adult influenza
annually
76
Adult TDAP
Single dose for adults 19+ and 10 year booster annually
77
Adult zoster
adults >50 years (live vaccine)
78
Adult MMR
1-2 doses if born in 1957 or later
79
Adult Varicella
>13 years if no evidence of immunity
80
Adult HPV
females: up to age 26 (up to 45 with shared decision making)
Male: up to age 21
Men who have sex with men: up to age 26
81
Adult meningococcal vaccine
adults up to age 21 who are living in college dorms
82
Adult Hep B vaccine
adults age 19-59 with diabetes
other adults at high risk (HCW)
83
Adult pneumococcus
2 separate vaccines:
Pneumovax (PPSV-23)
Prevnar (PCV-13)
>65 all get PPSV-23
not recommended 19-64 and healthy not recommended
19-64 with chronic conditions: PPSV-23
19+ with immunocompromise PCV-13 and then PPSV-23
84
PPSV-23
Pneumovax
85
PCV-13
Prevnar
86
Main types of vaccines
live attenuated vaccines
inactivated vaccines
subunit vaccines
toxoid vaccines
conjugate vaccines
mRNA vaccines
87
Live attenuated vaccines
live version of the organism that has been weakened (attenuated) so that it doesn't cause disease in patients with healthy immune systems
- can cause disease in patients who are immunocompromised
- usually need 1-2 doses for lie-long immunity
88
Examples of live attenuated vaccines
MMR, Varicella/Zoster
89
Inactivated vaccines
use a killed version of the germ
- may need several boosters to get long-term immunity or maintain immunity
90
Examples of inactivated vaccines
polio injection (IPV), Hep A
91
Subunit vaccines
contain part of the germ (essential antigen), does not cause infection and has less side effects
92
Example of subunit vaccine
petrussis
93
toxoid vaccines
prevent disease that are due to toxins that are produced by bacteria, use a weakened form of the toxin (toxoid)
94
Example of toxoid vaccine
tetanus, diphtheria
95
Conjugate vaccines
some bacteria have outer coating of polysaccharides that can prevent an immature immune system (infant and children) from recognizing them
link antigens or toxoids that the immune system does recognize to the polysaccharides (immune response to polysaccharides)
96
Example of conjugate vaccines
Hib (meningitis for infants/toddlers)
97
Major contraindications to vaccines
- anaphylaxis to vaccine or component of vaccine (ex: eggs in flu)
- pregnancy (no live attenuated vaccines)
- severe immunodeficiency
98
Allergen in influenza vaccine
eggs
99
Allergen in varicella vaccine
gelatin
100
Allergen in hepatitis B vaccine
baker's yeast, neomycin
101
Allergen in MMR, polio vaccines
streptomycin
102
Live vaccines are contraindicated in:
immunocompromised, pregnancy
MMR, varicella, live zoster, live influenza
103
Delay vaccines if patient is moderately or severely ______
ill
104
postpone vaccine if patient has received _____________
immunoglobulin
105
Side effects of vaccines
Guillain-barre, high fevers (104.5), seizures, prolonged/inconsolable crying
106
Cervical cancer screening recommendations
ages 21 (25-65)
Frequency and tests depends on age for PAP (maybe will be discontinued), HPV testing (co-testing)
107
Cytology is done every _____ years
3
108
Colorectal screening recommendation
age 50-75 Grade A
age 45-49 Grade B
109
Breast cancer screening
biennial mammography
age 5-74 Grade B
110
Prostate cancer screening
age 55-69, PSA, individual decision, Grade C
111
Lung cancer screening
smokers/former smokers age 50*-80 years old
112
USPSTF types of counseling
tobacco cessation
healthy diet and physical activity
obesity screening
STI
fall prevention
skin cancer behavioral
113
USPSTF types of screening
blood pressure (starts at 18)
depression
HIV
alcohol use
diabetes
intimate partner violence
osteoporosis
AAA
chlamydia and gonorrhea
hepatitis
114
USPSTF types of chemoprevention
- use of statins (hyperlipidemia to prevent MI)
- tobacco cessation
- ASA to prevent ASCVD (atherosclerotic disease) and colorectal cancer (helps prevent polyp formation)
