What is primary prevention?
Health care initiatives aimed at maintaining or improving health among people who are currently free of symptoms.
This includes the modification of risk factors (e.g. smoking, diet, alcohol intake) to avoid development of disease. E.g. Health promotion campaigns
What is secondary prevention?
Interventions aimed to detect diseases early to delay or halt disease progression and developing symptoms.
What is tertiary prevention?
Rehabilitation or treatment interventions of already established disease/illness
What are the three types of screening?
Population Screening: Services aimed at identifying specific health problems, e.g. mammography and PAP smear
Self-Screening: Behaviours aimed at identifying health problems, e.g. breast and testicular self-examination and H1N1 Flu (Swine Flu)
Opportunistic Screening: Adjunctive identification of (other) health problems, e.g. hepB in pregnancy and depression in primary care
Name 4 common variations in screening uptake
Disease: Patients are more likely to attend screening for certain diseases
Country: Uptake of screening in different countries differ
Geographical region: Different regions of the country have different levels of screening uptake
Sub-groups: Certain groups are less likely to attent screening e.g. low socioeconomic groups, ethnic minorities.
What factors can influence the uptake of screening
Patient factors: Background demographic factors, stable individual differences, social network, and situational factors
Provider factors: Provider beliefs and behaviour (how HCPs communicate with patients)
Organisational factors: Invitation delivery and screening location e.g. via post or personally, if location is local or not
What are some of the ethical issues/controversy over screening?
A large number of people are tested in order to detect a small proportion of individuals who have preclinical disease.
Many people screened unnecessarily, and screening may have negative effects. Thus, a much larger number of people may experience harm from screening than those who experience the potential benefits from screening.
The effect of screening on others e.g. relatives following genetic screening
What are the four phases of screening?
Invited to participate
Complete the screening test
Wait for results
Receiving results and recommendations
What are the possible outcomes of screening and what effects can this have on the patient?
True (+): Anxiety, fear, stress, guilt, etc. Has an effect n the patient, patient’s family, and provider
False (+): Unnecessary treatment
True (–): Maintain health-damaging behaviours or may initiate health-damaging behaviours. May ignore subsequent symptoms due to the fact they have already been screened.
False (–): Untreated progression of disease,
Even if incorrect results are amended. There can be a loss of trust in service, and provider Will result in less and delayed use of health care.
What is the ICD10 classification of hazardous use of alcohol?
A pattern of alcohol consumption that has a risk of harmful consequences to the drinker.
These consequences may be damaging to physical or mental health, or social consequences to the drinker or others.
Other potential consequences include worsening of existing medical conditions or psychiatric illnesses, injuries caused to self or others due to impaired judgment after drinking, high risk sexual behaviours while intoxicated, and worsening of personal or social interactions”.
What is the ICD10 classification of harmful use of alcohol?
A pattern of drinking that is already causing damage to health.
The damage may be either physical (e.g. liver damage from chronic drinking) or mental (e.g. depressive episodes secondary to drinking).
What is the ICD10 classification of alcohol dependene?
A cluster of behavioural, cognitive, and physiological phenomena that develop after repeated alcohol use.
- a strong desire to take alcohol
- difficulties in controlling its use
- persisting in its use despite harmful consequences
- a higher priority given to alcohol use than to other activities and obligations,
- increased tolerance, and sometimes a physical withdrawal state
What is the CAGE questionnaire?
Used to screen patients with a suspected alcohol problem
Have you ever felt the need to Cut down your drinking?
Have you ever felt Annoyed by criticism of your drinking?
Have you had Guilty feelings about your drinking?
Did you ever need a morning Eye-opener?
What are the 5 A's and when are they used?
For every patient at every consultation with an addictive/ poor health behaviour e.g. smoking
ASK the patient if he or she uses tobacco
ADVISE him or her to quit
ASSESS willingness to make a quit attempt
ASSIST him or her in making a quit attempt
ARRANGE for follow-up to prevent relapse
How do the stages of change relate to an individual's motivation?
Precontemplation: not thinking about stopping
Contemplation: thinking about stopping
Preparation: planning to stop
Action: trying to stop
Maintenance: stopped for some time
Why is it important to assess nicotine dependence in patient's who want to quit smoking?
Once a decision to quit has been made, success is determined more by level of dependence than level of motivation.
Assessing dependence will guide the choice of therapy given - nicotine dose of drug should reflect dependence level.
Give two questions you could ask to assess a patient's motivation to quit smoking?
Why is this important?
Do you want to stop smoking for good?
Are you interested in making a serious attempt to stop in the near future?
Are you interested in receiving help with quitting smoking?
Assessing the motivation of a patient can be used to allocate resources. Those with high motivation will be able to receive behavioural support and medication while thosw with low motivation require interventions to increase motivation.
What two questions could you use to screen for nicotine dependence?
How many cigarettes do you smoke a day? (15+ = high)
How soon after you wake up do you smoke your first cigarette? (within 30 minutes reflects high dependence)