Prevention

Question 1

Primary Prevention

Answer 1

to prevent a disease becoming established. It aims to reduce or eliminate exposures and behaviours that are known to increase an individual’s risk of developing a disease. It can be aimed at individual behaviour change or as a population approach (e.g. immunisations or high risk approaches such as weight management).

Question 2

Secondary prevention

Answer 2

to detect early disease and slow down or halt the progress of the disease.

Question 3

Tertiary prevention

Answer 3

Once disease is established, detectable and symptomatic, tertiary prevention aims to reduce the complications or severity of disease by offering appropriate treatments or interventions.

Question 4

Prevention paradox

Answer 4

The prevention paradox states that a larger number of people at small risk of disease may contribute to more cases of that disease than a smaller number of people who are individually at greater risk.

Question 5

High risk

Answer 5

• Target highest risk individuals
• Aim to reduce risk to below set limit
• Accepted by society - treat those outside “normal levels”

Question 6

Population approach

Answer 6

• Target all individuals
• Aim to reduce the risk for each individual
• Recognises that the low risk majority may contribute most cases
• Concerns over treating the well and the “nanny state”

Question 7

Implications of High risk approach

Answer 7

favours those who are more affluent and better educated. They are:
• More likely to engage with health services
• More likely to comply with treatments
• More likely to have the necessary means to change their lifestyle

Question 8

Implications of population approach

Answer 8

generally reduces social inequalities

Question 9

CHD

Answer 9

Cardiovascular disease accounts for 40% of deaths in the UK (1 in 5 men and 1 in 8 women). Rates are decreasing due to lifestyle changes and effective treatments.

Question 10

Primary prevention in CHD

Answer 10

involves lifestyle changes and prevention and management of the related conditions of hypertension, hypercholesterolaemia and diabetes.

Question 11

Lifestyle changes to prevent CHD (and hypertension, hypercholesterolaemia and diabetes)

Answer 11

SNAP
• Smoking (taxation, no public places, cessation services, health warnings, tobacco control)
• Nutrition (recommendations e.g. 5 a day, food standards/regulation/labelling and food in schools)
• Alcohol (know your limits, taxation, alcohol pricing and regulation)
• Physical activity (At least 5 times a week, PE in schools etc)

Question 12

Secondary prevention in CHD

Answer 12

Actions include:
• Primary care CHD registers
• Medical management: Aspirin, B-blockers, ACE inhibitors, statins
• Phase 4 cardiac rehabilitation

Question 13

Cardiac rehabilitation

Answer 13

• Phase 1 – in hospital
• Phase 1 – Early post discharge
• Phase 3 – 4 – 16 weeks
• Phase 4 – long term maintenance of lifestyle change (SNAP)

Question 14

Changes in risk factors and treatments of CHD

Answer 14

• Obesity and diabetes have risen and physical activity is decreasing. These increase the risk of CHD.
• Smoking, cholesterol, blood pressure levels, deprivation and other factors have fallen. This decreases the risk of CHD.
• Treatments for CHD are improving.

Question 15

Risk factors of CHD - two categories

Answer 15

potentially modifiable and unmodifiable

Question 16

unmodifiable RFs for CHD

Answer 16

• Sex
• Age
• Ethnicity
• Family history
• Early life circumstances

Question 17

Potentially modifiable risk factors for CHD

Answer 17

90% of first heart attacks are due to lifestyle factors that can be modified.

Physiological/clinical
• High blood cholesterol
• Hypertension
• Type 2 diabetes

Lifestyle
• Smoking – single avoidable risk factor which causes more death and disability than any other. Decreasing in rate.
• Physical inactivity
• Overweight. BMI = weight in kg/(height in metres)2 normal BMI is 18-25
• Poor nutrition
• Alcohol intake

Question 18

Psychosocial influences for CHD

Answer 18

There are also possible psychosocial risk factors for CHD. These include personality, depression/ anxiety, work and social support.

Question 19

Personality and CHD

Answer 19

Type A behaviours are competitiveness, hostility and impatience. These are coronary prone behaviours. They can be assessed using questionnaires, self report and clinical interviews.

Question 20

Depression/anxiety and CHD

Answer 20

Those people with higher depression ratings have higher CHD rates and associated mortality. Social deprivation could increase depression and anxiety. Major depression is associated with higher mortality in CHD.

Question 21

Work and CHD

Answer 21

A job with high demand and low control (leading to stress) has an association with MI.

Question 22

Social support

Answer 22

Quantity and quality of social relationships helps a patient to cope with life events and motivate them to engage in healthy behaviours. This leads to decreased morbidity and mortality.