Sei sulla pagina 1di 12

LEARNING OBJECTIVES CHAPTER 6

3. Relate the different stages of the development of


a disease to the phases of prevention.

Describe the advantages and disadvantages of
population and high-risk prevention strategies.

Understand the role and limitations of screening
regarding the early detection of disease.
Overhead 6.1
PRIMORDIAL PREVENTION

Prevention of the emergence of living patterns
that contribute to increased risk of disease
(e.g., maintenance of low fat diet in Asian
countries).
Overhead 6.2
PRIMARY PREVENTION

Prevention of disease by controlling risk
factors (e.g., non-smoking promotion).

STRATEGIES :
Population
High-risk
Overhead 6.3
PRIMARY PREVENTION :
The Population Strategy

Advantages
Radical
Large potential for population
Behaviourally appropriate

Disadvantages
Small benefits to individuals
Poor motivation of subject
Poor motivation of physician
Benefit-to-risk ratio may be low

Overhead 6.4
PRIMARY PREVENTION :
The High-risk Strategy

Advantages
Appropriate to individuals
Subject motivation
Physician motivation
Benefit-to-risk ratio is favourable
Disadvantages
High screening costs
Temporary effect
Limited effect
Behaviourally inappropriate

Overhead 6.5

PREVENTION PARADOX

A preventive measure which brings much benefit to the
population often offers little to each participating
individual.

(Rose, 1985)
Overhead 6.6
SECONDARY PREVENTION

Reduction in consequences of disease by early diagnosis
and treatment (e.g., cervical cancer screening)


TERTIARY PREVENTION

Reduction of complications of disease
(e.g., MV crashes and ICU)
Overhead 6.7
SCREENING

The organized attempt to detect, among
apparently health people in the community,
disorders or risk factors of which they are
unaware.
Table 6.1. Levels of prevention
Level of prevention Phase of disease Target
Primordial Underlying conditions leading
to causation
Total population and
selected groups
Primary Specific causal factors Total population,
selected groups and
healthy individuals
Secondary
Early stage of disease
Patients
Tertiary Late stage of disease
(treatment, rehabilitation)
Patients
Table 6.2. Advantages and disadvantages of strategies for
primary prevention
Population strategy High-risk individual strategy
Advantages
Radical
Large potential for whole population
Behaviourally appropriate
Appropriate to individuals
Subject motivation
Physician motivation
Favourable benefit-to-risk ratio
Disadvantages
Small benefit to individuals
Poor motivation of suject
Poor motivation of physician
Benefit-to-risk ratio may be low
Difficulties identifying high-risk
individuals
Temporary effect
Limited effect
Behaviourally inappropriate
Table 6.3. Criteria for instituting a screening programme
Disease Serious
High prevalence of preclinical stage
Natural history understood
Long period between first signs and overt disease

Diagnostic test Sensitive and specific
Simple and cheap
Safe and acceptable
Reliable

Diagnosis and Facilities are adequate
Treatment Effective, acceptable, and safe treatment available
Table 6.4. Validity of a screening test
Disease status
Present Absent Total
Positive
Negative
Screening test
a b
c d
a + b
c + d
a + c Total b + d a + b + c + d
KEY :
a : no. of true positives c : no.of false negatives
b : no. of false positives d : no. of true negatives
Sensitivity = probability of a positive test in people with the disease
= a/(a + c)
Specificity = probability of a negative test in people without the disease
= d/(b + d)

Positive predictive value = probability of the person having the disease when the test is positive
= a/(a + b)

Negative predictive value = probability of the person not having the disease when the test is negative
= d/(c + d)

Potrebbero piacerti anche