Module 3 (Lecture 22, 23)

Question 1

What is primary, secondary and tertiary prevention strageties?

Answer 1

Primary = Happens just before the biological onset of disease. So these disease strategies target the risk factors of the disease by preventing the biological onset of disease. Secondary is identifying the early stages of disease and tertiary occurs after the disease, trying to prevent the complications of the disease.

Question 2

Give examples of primary, secondary and tertiary prevention strageties.

Answer 2

Primary= Screening women for alcohol intake to prevent breast cancer. Secondary is Breast Cancer screening. Teritary is screening for bone densityafter chemotherapy to manage long-term effects.

Question 3

What are the 4 criteria of screening and the objective?

Answer 3

1. Suitable disease
2. Suitable screening test
3. Suitable treatment
4. Suitable screening programme
   The objective is to improve health outcome (morbidity, mortality
   and/or disability)

Question 4

What is the 2 criteria for suitable disease?

Answer 4

1. An important public health problem
   - Relatively common
   - Relatively uncommon:
   Early detection and intervention better outcome
2. Knowledge of the natural history of the disease
   * Relationship between risk factor/s and condition is known
   * Disease is detectable at an early stage (disease marker)
   * Increased duration of pre-clinical phase

Question 5

What is the benefit of having a longer preclinical phase?

Answer 5

“If the preclinical phase is longer, it is better for screening because there is more time to detect the disease early, respond with treatment, and potentially improve outcomes for a larger population.”

Question 6

Explain suitable test

Answer 6

Reliable – provides consistent results
* Safe
* Simple
* Affordable
* Acceptable
* Accuracy - The ability of a test to indicate which
individuals have the disease and which do not
- Sensitivity, Specificity

Question 7

Difference bewtween gold standard test and diagnostic accuracy study.

Answer 7

A gold standard test is a type of diagnostic test where it is the MOST accurate, best and reliable one, and it is used to compare with diagnostic test accuracy studies. This is because the researchers want to use a screening test on the population, they want to see how accurate it is. They do this through a diagnostic accuracy study — a study that compares the screening test to the most trusted test (the gold standard) to see if it gives correct results. Which is why Diagnostic test accuracy studies test the accuracy of the screening test before it is included in a screening programme.

Question 8

When does diagnosis test happen vs diagnosis accuracy study?

Answer 8

Diagnosis test happen after the screening where it sees the specificity and sensitivity. Diagnosis accuracy study is a study to measure how accurate a diagnostic or screening test is. This happens BEFORE the screening. Gold standard Iis a type of diagnosis test.

Question 9

Why can’t we apply the diagnostic test to the eligible population?

Answer 9

Because it is too expensive and invasive. So we apply it to people who get tested positive for screening.

Question 10

What happens to the people who get tested negative and positive for the gold standard test?

Answer 10

Negative = Re-screened after a period of time. Positive = Intervention/ treatment.

Question 11

What are the approaches of population health actions and what can they be classified as?

Answer 11

1. Health promotion
2. Disease prevention
3. Health protection
   These approaches can come under population strategy or individual strategy.

Question 12

Define population health strategy

Answer 12

Population based (mass) strategy focuses on the entire population, aims to reducing diseases in ALL individuals, not just high risk groups. This is useful for a widespread/common disease.

Question 13

Define individual health strategy

Answer 13

Focus on individuals that are high risk of disease. The intervention is well
matched to individuals and
their concerns meaning they want to push people towards more favourable outcome.

Question 14

List the advantages of population based strategy for prevention

Answer 14

1. Radical it tackles the root causes of diseases (vaccines), meaning it shifts the whole population towards a more favourable outcome.
2. Large potential benefit for whole
   population
3. Behaviourally appropriate because it changes norms in society.

Question 15

List the disadvantages of population based strategy for prevention

Answer 15

1. Small benefit to individuals
2. Poor motivation meaning individuals will not follow because they think the prevention is too minor and won’t occur to them. Unless there is a legislation process.
3. If there is a downside to the strategy, it will affect the whole population. There will be a less favourable benefit to risk ratio to because not all of us will benefit from the intervention.

Question 16

What is benefit - to risk - ratio?

Answer 16

The benefit-to-risk ratio means comparing the positive effects (benefits) of an action to the possible negative effects (risks).

Question 17

List the advantages of high-risk population based strategy.

Answer 17

1. Appropriate to individuals
2. High individual motivation because it it target to individuals, so more of them will likely to carry out the strategy.
3. Cost effective uses of resources because it only applies to individuals, not the mass population.
4. Favourable benefit to risk ratio because there are more targeted interventions.

Question 18

List the dis-advantages of high-risk population based strategy.

Answer 18

1. Cost of screening because say there is a group who have high risk on cancer. They have to undergo screening which is costly.
2. There is only a temporary effect meaning you have to get screening done every year.
3. Limited overall impact: Misses those not yet identified as high-risk.
4. Behaviourally inappropriate because it is difficult for individuals to take up interventions due to the societal norms placed.

Question 19

What is health promotion and does it is primarily focus on?

Answer 19

Health promotion is a process that focuses on improving the well-being of health, Enables/empowers people to increase control
over, and improve, their health and its interventions related to everyday contexts.

Question 20

What are the two main goals for Alma Ata 1978?

Answer 20

1. Protect and promote health of all
2. Advocated a health promotion approach to primary care
   But they said that before they can achieve the goals, they must meet the pre-requites.

Question 21

Name the pre-equities for health in Alma Ata 1978?

Answer 21

Peace and safety from violence
* Shelter
* Education
* Food
* Income and economic support
* Stable ecosystem and sustainable resources
* Social justice and equity

Question 22

What is the OThe Ottawa Charter for health promotion (WHO)

Answer 22

A document that focuses on health promotion (WHO). The aim is to mobilise community development.

Question 23

Which key feature of the The Ottawa Charter was not existent earlier on?

Answer 23

That health was a fundamental right (human rights perspective).

Question 24

What are the other key important features of the The Ottawa Charter?

Answer 24

A fundamental right for everybody
* That it requires both individual and collective
responsibility
* The opportunity to have good health should be equally
available
* And that good health is an essential element of social
and economic development

Question 25

What are the priority actions of the Ottawa Charter?

Answer 25

Develop personal skills meaning people need to take initiative over their own health. – Strengthen community action meaning communities need to be empowered to address their own health issues. – Create supportive environments – Reorient health services towards primary health care so not just curing the disease but preventing it as well. – Build healthy public policy by bringing health into ALL sectors not just health sector.

Question 26

What is the focus of the next approach, disease prevention?

Answer 26

Disease focus, looks at particular diseases (or injuries) and ways of preventing them e.g. the incidence, the prevalence, risk factors, or impacts.

Question 27

What are the factors for primary disease prevention strategy (disease prevention)? Give examples.

Answer 27

Limit the occurrence of disease by controlling specific causes and risk factors and reduces disease incidence. BCG Vaccination for TB.

Question 28

What are the factors for secondary prevention strategy (disease prevention)? Give examples.

Answer 28

Early detention to reduce the more serious consequences of disease and reduces prevalence. Breast cancer screening.

Question 29

What are the factors for tertiary prevention strategy (disease prevention)? Give examples.

Answer 29

Reduce the complications of established disease. Rehabilitation service.

Question 30

What is health protection?

Answer 30

Focus on environmental hazards.

Question 31

Give examples of health protection.

Answer 31

Risk/Hazard assessment – Environmental epidemiology – Safe air and water, biosecurity * Occupational health & Monitoring – e.g. safety regulations on work sites biomarkers of exposure to hazardous substances * Risk communication – e.g. relating environmental risks to the public

Question 32

Which of the strategies are predeceased?

Answer 32

1. Primary disease prevention, health protection and health promotion.

Question 33

How to know wehether is it primary disease prevention?

Answer 33

Look at the risk factor.