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67 Cards in this Set
- Front
- Back
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Goal of preventative medicine
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To promote health, minimize disease, injury and sequelae
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Describe the relevance of CPM to the clinician (4 points)
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• What happens in the community affects the health of the patient
• Patients prefer to remain healthy/prevent disease than to get sick and be treated • HEDIS provide preventative services • Payers are experimenting w/ bonuses for keeping people healthy |
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Examples of CPM in the practice of clinical medicine (5)
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In the US, there are over 24 specialty boards and 100 subspecialties that use preventative measures -
• Internal MD/GP: Counseling obese w/ high sugar levels • Surgery: the decision to use a prophylactic Ab • OBGyn: Recommendation of Folic acid • Pediatrician: usage of vaccines for school • Ophamology: measuring introcular pressure |
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Three core approaches to CPM
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• Screening
• Counseling • Immunization |
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Examples of interaction btwn PH agencies and clinicians (5)
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• Lab testing
• PH surveillence results • Health alerts (i.e. anthrax, influenza) • Selected vaccines, anti-toxins • Prevention materials |
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The responsibility clinicians have to PH agencies (3)
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• PH surveillance reporting
• Completing death certificates • Reporting suspected child/elder abuse |
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The 3 levels of prevention, their disease stage and the appropriate response
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• Primary, pre-disease, Health promotion, specific prevention
• Secondary, latent, Screening & Tx • Tertiary, Sx disease, Tx-disability limitation-rehab |
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Key word for physician-produced disease or injury
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Iatrogenic
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Key word for hospital-acquired infections and its #1 cause
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Nosocomial; Hand washing is #1 cause
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Ways to prevent surgical and medical errors
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more training, system changes, surveillance/reporting
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5 interventions to reduce risk of heart disease and its complications:
• (2) Primary • (2) Secondary • (1) Tertiary |
• primary - making exercise grounds/sports available, outlawing cig sales to minors
• secondary - Screening for hypertension and hypercholesterolemia, EKG for a diabetic w/ 3 risk factors • Tertiary - daily aspirin following acute MI |
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4 interventions to reduce risk of diabetes and its complications:
• (1) Primary • (1) Secondary • (2) Tertiary |
5 interventions to reduce risk of diabetes and its complications:
• Primary - Counseling obese non-diabetics • Secondary - Screening using fasting plasma glucose • Tertiary - Measuring HbA1c ever 3-4 months, eye exams for retinopathy |
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The goal of screening (2)
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To ID disease or susceptibility when it is more easily/successfully treated
To minimize mortality and morbidity |
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The Objective of screening
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To classify individuals as likely/unlikely to have a disease, then refer the likely for diag testing
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Difference between Screening and Diagnosis
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In screening, asymptomatic people are tested to determine if further testing is needed whereas in diagnosis, those who are suspected to have the disease are tested for presence/absence of it ---> No sx group screened vs sx group being screened
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Most important WHO requisite for a successful screening program
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Early tx influences the course and prognosis of the disease
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According to WHO, a screening test/exam is suitable if it follows these points (5)
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• Relatively sensitive and specific
• Detects disease at a latent or early sx stage • Simple & inexpensive • Safe • It is acceptable to the population and providers |
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Consequences of a True-positive result (5)
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• early dx
• early or less radical tx • reduced morbidity, mortality and disability • "labeling effect" • reduced cost |
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Consequence of a true-negative result
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reassurance
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Consequences of a false-positive (4)
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• Unnecessary follow-up tests
• labeling, anxiety • Over-treatment of questionable abnormalities • inciting fear of future tests |
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Consequences of a false negative (4)
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• Delayed dx, leading to the disease advancing/premature diability or death
• Disregarding of early signs/sx • False reassurance • Exposure of others to infection |
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Sources of screening recommendations (6)
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Government agencies and the panels convened by them
Medical specialty associations Special interest organizations Individual experts National Guideline Clearing House |
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The USPSTF base their recommendations on this
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Evidence of the effectiveness of clinical preventative services
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Def of passive immunity
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A susceptible host receives protection through transfer of immunity products from another organism.
The protection os temporary and wanes with time. |
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Examples of passive immunity (5)
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• Maternal Abs
• Igs and Hyper Igs • Anti- (toxins and venoms) |
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Def of Active immunity
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In response to a foreign/non-self antigen, protection is produced by the person's own immune system.
The protection os usually long-lasting |
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Criteria for a live attenuated vaccine
(4) |
• Must replicate in the host to be effective
• Produces an immune response similar to a natural infection but without causing clinical disease • Induces both humoral and cell-mediated immunity • With the exception of oral forms, it requires fewer doses |
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Complications with live attenuated vaccines
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• Fragile
• Severe rxns are possible, especially those who are immuno compromised • Can interfere with circulating Abs • Though rare, they can revert back to a being a virulent strain |
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Two groups of Inactivated vaccines and the subtypes of each
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• Whole
- viruses - bacteria • Fractional - Protein-based (toxoid and subunit) - Poly-saccharide based (pure and conjugate) |
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Characteristics of Inactivated vaccines (7)
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• Cannot replicate or revert
• Generally not as effective a live • Less interference from circulating ABs • Fewer side effects • More doses usually required (3-5) • Mostly a humoral response • Antibody titer may diminish w/ time requiring boosters |
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Differences btwn WHO and US vaccine recommendations for children
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WHO includes the recommendations of DTP, OPV live polio, YF and +/-BCG
The US includes DTaP, Inactivated IPV polio, Hepatitis A, influenza, rotovirus and varicella |
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Only vaccination given at birth
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Hep B
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The number of vaccine types recommended for children
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9
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The number of doses to complete the Hep B vaccine
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3
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The final vaccines given to children (age 4-6 yrs)
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DTaP, IPV, MMR/VZ and Influenza (can be given much earlier)
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Description of Part 1 (line a) of the cause of death section
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Immediate cause of death
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This should be listed last in Part 1 of the cause of death section
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The underlying cause of death
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These are never listed as an immediate cause of death
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Mode of dying and terminal event (e.g. cardiac or respiratory arrest)
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Define death/mortality rate and list 4 possible types
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It is the frequency of death in a defined pop during a specified period
• Crude • Cause-specific • Age-specific • Infant mortality |
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Best to worst infant mortality rates for US, UK, Grenada and Canada
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Canada>UK>US>Grenada
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In the equation for mortality rate:
(num/denom) x 10^n, What is the significance of 10^n? |
It represents a comparison population, usually of 1000.
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3 actual causes of death in the US
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Tobacco > Diet/inactivity > Alcohol
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3 leading causes of death in US, UK and CAREC
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HD, cancer and stroke
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Purpose of ICD codes
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To code for disease and causes of death worldwide
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Physicians, Hospitals and Labs report suspected or confirmed communicable diseases here
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Local Health Agencies
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Physicians are also required to report these 4 situations
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• Impaired driving
• Various types of abuse • Weapon/crime injuries • Burns > 5% of the body |
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HIPAA protects the privacy of the person but specifically does not do this (3)
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• Interfere w/ state PH reporting
• Interfere w/ investigations • Interfere w/ interventions |
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The Key to analytic epidemiology and why it is needed
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The key is a comparison group which is typically a control group; it is a population w/o the disease and needed to estimate the expected level of exposure
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Role of the clinician in an outbreak investigation (4)
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• see and dx patients
• report cases to the health department • provide medical records • incorporate health dept alerts/findings into their clinical practice |
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Major modifiable risk factors for heart disease (7)
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• High BP
• Abnormal blood lipids (dyslipidemia) • Tobacco use • Physical inactivity • Obesity • Unhealthy diet • Diabetes mellitus These are indirect causes on each other |
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Topics to ask when taking an environmental exposure hx
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Communit
Home Hobbies Occupation Personal habits Diet Drugs |
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Common risk factors for diabetes (6)
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• Family hx and genetics
• Ethnicity • Hx of gestational diabetes • Dyslipidemia • Over weight and Obesity • Poor diet and physical activity |
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Two drugs shown to reduce the risk of diabetes
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Metformin and Acarbose
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In relation to diabetes prevention, medicine and lifestyle changes have shown to do this
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increase the probability of reverting from IGT to normal glucose tolerance
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Tertiary Prevention for screening diabetics (4)
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Annual eye exams
Periodic foot exams HbA1c testing Psychosocial assessment |
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Tertiary Prevention for vaccinating diabetics (2)
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Influenza and Pneumococcal
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The APHA Policy recommendations for prevention (3 parts)
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The two types of influenza and the type which is more virulent
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Type A and Type B; Type A is most virulent and causes epidemics
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Surface antigens on Type A
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Hemagglutinin and Neuroamidase (both are glycoproteins)
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Difference between antigen drift and shift and the type that produces new strains
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Drift refers to minor mutations whereas shift refers to much larger immunological change, resulting in new subtypes or strains (reassortment)
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This may cause seasonal epidemics
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Antigenic drift
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Components of seasonal influenza
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Type A - H1N1, H3N2
Type B |
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Difference btwn Intramscular injection and Intranasal spray influenza vaccines
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Intramuscular - inactivated
Intranasal - Live, attenuated |
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Two important facts about the 1918-1919 Pandemic
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- Began in Spring as highly contagious, but not deadly
- Eventually had the highest death rate of those 15-35yrs of age |
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The Avian Flu strain
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H5N1
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Criteria for an Influenza pandemic
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• A new human influenza subtype (via antigenic shift)
• Must cause serious illness • Must spread easily from human to human |
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Trend in history of the age group with the highest mortality rate for influenza
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< 40 yrs
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