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Science
Medicine
Preventive Medicine
Lecture 29: Principals of Screening and Immunization
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Terms in this set (57)
Practice Q1
Ans: C
Screening is defined as the Identification of an ....... disease, disease precursors, or susceptibility to disease in persons without evidence of disease, by rapidly applied tests, examinations or other procedures?
Unrecognized
Screening focuses on ..... populations and looks for ..... disease?
Healthy
Asymptomatic
The Goals of Screening are to ..... disease or ...... when it is more easily / more successfully treated and to reduce .... and .....?
Identify
Susceptibility
Morbidity and Mortality
The Objective of Screening is to classify individuals as .... or .... to have the disease (or susceptibility)?- Those who are then classified as ..... are refereed for .... testing?
Likely or Unlikely
Likely--> Diagnostic testing
Differences between Screening and Diagnosis include:
1- Screening is applied to .... groups while ..... is applied to ..... groups?
2- Screening has a .... cost per test while Diagnostic testing has a ..... cost
3- Screening has a ..... yield per test while Diagnostic testing has ..... probability of case detection
4- Screening has a ...... adverse consequence of error while Diagnostic screening a failure to ID or delay treatment can ..... the prognosis?
Asymptomatic vs Symptomatic
Lower cost vs Higher cost
Lower yield vs Increased probability
Lower
Worsen
What Conditions should we screen for?- We should routinely screen for:
-Breast cancer should be screened for every 1-2 years
-Colon cancer screening every 10 years
-Lung cancer
-Testicular cancer is a rare disease --> Screening does not work for rare diseases
-Cardiovascular --> we screen all the time
-Stroke --> don't screen for it but can try to prevent it
-HIV, Scoliosis --> screened all the time
Examples of Screening tests include- ....... , ...... examinations, ..... tests, ...... tests, ...... exams etc?
Questionnaires
Clinical (Kids for Scoliosis, Adults for Colonoscopy)
Laboratory (Prostate Specific Antigen PSA)
Genetic (newborn- PKU)
Radiographic (Mammogram)
The Time frame for Disease development starts with a Healthy person having an onset of a disease which leads to occurrence of .......- this leads to the patient seeking ...... - then the patient goes to a physician and is ...... after which ...... starts?
Symptoms
Care
Diagnosis
Treatment
Without screening, diagnosis of disease only occurs after ...... develop?§However, disease frequently begins long before symptoms occur and may be detected by a screening test- The Time interval between possible detection by screening and later detection after symptoms is the ...... phase?
Symptoms
Detectible Preclinical Phase (DPCP)
ie it is the window before the symptoms start showing up
- We hope that detection of disease in the DPCP will lead to earlier treatment and that this, in turn, will lead to a better outcome
The Detectable Preclinical Phase (DPCP) is the phase after ...... and before ..... develop?
Screening
Symptoms
The Characteristics for a Good Screening test include - they are ...... , they are ..... to administer, they cause minimal ....... , they are ........ and they provide ..... results?
Inexpensive
Easy
Discomfort
Reliable (consistent)
Valid (distinguishes diseased & non-diseased people)
Screening can be beneficial in many cases for eg- when the disease is ...... , when treatment before symptoms occur is more ..... than treatment that is delayed until symptoms appear and when the prevalence of disease in the ...... Phase is relatively high?
Serious eg: Cervical cancer
Effective
Detectable Pre-Clinical Phase (DPCP)
- By these criteria, Blood pressure screening to detect and treat hypertension is an ideal circumstance for screening
The 2 Expected consequences/results for a Screening test are either ..... or .....?
True Positive (TP)
True Negative (TN)
A True Positive (TP) Screening result allows for early ..... , early ....., reduced ..... , ...... and ..... , reduced ...... and a ..... effect?
Diagnosis
Treatment (possibly less radical)
Morbidity, Mortality and Disability
Cost
Labelling
A True Negative(TN) Screening result gives us ....... ?
Reassurance
- that the person does not have the disease
In some situations Screening is not always appropriate for eg: Many people with ..... remain asymptomatic and do not require surgery, people with ..... cancer because early detection by screening and thus earlier treatment does not seem to prolong survival substantially and in situations where the ...... of the disease is low?
Gallstones
- If they become symptomatic, the gallbladder can be removed, and the delayed treatment generally causes no problem
Lung cancer
Prevalence
eg: -Testicular cancer --> has low prevalence in population so screening for it is not advised
The 2 Adverse consequences/results for a Screening test are either ..... or .....?
False Positive (FP)
- people who test positive even though they really don't have disease
- Many will undergo unnecessary invasive diagnostic procedures such as needle biopsy and surgical biopsy
- In the case of fecal blood testing for colorectal cancer, patients with positive screening tests will undergo colonoscopy, which is expensive, inconvenient, and uncomfortable, and carries risks (e.g., perforation)
False Negative (FN)
- people who test negative even though they really have disease
- The other problem is false negatives, who will be reassured that they don't have disease, when they really do
- These hazards of screening must be considered before a screening program is undertaken
WHO Prerequisites for a Successful Screening Program-1
WHO Prerequisites for a Successful Screening Program-2
WHO Prerequisites for a Successful Screening Program-3
Sources of Screening Recommendations
The ...... is the Major agency for Screening whose recommendations are considered the Gold Standard?
USPSTF (United States Preventative Services Task Force)
In terms of the Strength of the Recommendations of the USPSTF (United States Preventative Services Task Force) that clinicians routinely provide [the service] to eligible patients- A - ....... this service, B- ..... this services, C- makes ....... for this service, D- ......... this service and I concludes that the evidence is ..... to recommend for or against the service?
A --> Strongly Recommends
B --> Recommends
C --> No Recommendation
D --> Recommends against
I --> Evidence is Insufficient
The 2 Recommended Screening tests for Infants are for ....... and .....?
Phenylketonuria (PKU)
Congenital Hypothyroidism
The 3 Recommended Screening tests for Sexually active adolescents (Girls) are ...... at ..... years, ....... cancer ie .... test from .... to ..... years of age and ......?
Chlamydia at ≤ 25 yrs
Cervical cancer ie Pap test at 21-65 yrs
Rubella
The 5 Recommended Screening tests for Adults are: ..... cancer for women, ..... cancer for men and women at ..... age, .... cancer for women at ..... age, .... disorders for men at .... age and women at ..... age and ..... for women at ..... age?
Cervical (Pap test)
Colorectal--> > 45 years
Breast cancer--> > 40 years
Lipip--> Men at > 35 years and Women at > 45 years
Osteoporosis --> at > 60 years
Practice Q2
Ans: A
Vaccine-Preventable Rash Illnesses Smallpox
The 3 Vaccine preventable Rash illnesses are?
1- Chickenpox/Varicella
2- Measles
3- Rubella/German Measles
The 3 Vaccine preventable Childhood illnesses are?
1- Mumps (MMR)
2- Diphtheria (DTap)
3- Pertussis/Whooping Cough (DtaP)
The 2 Vaccine preventable Neuromuscular Diseases are?
1- Poliomyelitis (IPV)
2- Tetanus (DTaP)
A .... is any biologically derived substance that elicits a protective immune response when administered to a susceptible host?
Vaccine
- Vaccination* - administration of a vaccine
..... is described as the Development of ..... after Vaccination?
Immunization
Immunity
An Antigen is a Substance that when introduced into the body stimulates an ......response such as production of ......?
Immune
Antibodies
-Examples: toxins, microorganisms, foreign blood cells, cells of transplanted organs
An ..... is a Protein produced by ..... lymphocytes in response to antigenic stimulus that neutralizes the antigen by binding to it? It's purpose is to facilitate ..... of the foreign substance?
Antibody
B-lymphocytes
Destruction (elimination)
...... is described as the Resistance of a group to an attack by a disease to which a large proportion of the members of the group are immune?
Heard Immunity
Heard Immunity states that if a large percent (%) of population is ..... then the entire population is protected and not just those who are immune?
Immune
- Once a high proportion of all people in the population or community are immune, the probability is small that an infected person will encounter susceptible person and transmit infection
Due to Herd immunity, highly protective immunization can occur without requiring ..... immunization rates?
100%
eg: For measles, approximately 94% immunity is required to interrupt the chain of transmission
The Conditions Necessary for Herd Immunity include- 1- Disease agent must be restricted to a ..... host species within which transmission occurs, 2- ..... must be relatively direct from one member of the host species to another, 3- Operates optimally when there is random .... in the population or community and 4-Infections must induce solid ....?
Single
Transmission
(i.e., NO reservoir for the infective organism outside the human host)
Mixing
Immunity
Herd Immunity works when: 1- The Probability of an ...... person encountering every other individual in the population (random mixing) is the same and 2- The ..... percentage of the population is immune?
Mixing
Population
Herd Immunity does not work when an infected person interacts only with people who are ...... as likely to transmit the disease to those people?
Susceptible (no random mixing)
... immunity is Protection produced by the Person's own immune system (in response to non-self antigen)? It is usually .... lasting ie .....?
Active immunity
Long
Permanent
- Basic premise of immunization:
Immunity and immunologic memory similar to natural infection but without the disease
..... immunity is Protection conferred to a Susceptible host by transfer of immunity products from another person or animal? It confers ..... protection that ..... over time?
Passive
Temporary
Decreases (wanes)
eg:
-Maternal antibodies across placenta or in breast milk
-Immune globulin
-Hyper-immune globulin
-Antitoxins
-Anti-venoms
An Infection is an example that confers ...-...... immunity? Vaccination is an example of a process that confers ....-...... immunity?
Natural-Active
Artificial-Active
The Transfer of Maternal Antibodies to her Baby via Placenta or Breast milk is an example ...-...... immunity? The Transfer of Monoclonal antibodies for example from Serum transfusion is an example of a process that confers ....-...... immunity?
Natural-Passive
Artificial-Passive
..... ........ is the concept by which memory cells respond much more rapidly when re-exposed to the same antigen?
Immunologic Memory
-Upon re-exposure to the antigen, these B cells replicate and produce antibody to neutralize the threat
- figure --> upon re-infection the secondary response is quicker and more efficient
Differences in the Primary and Secondary Immune Response
In terms of Vaccination Efficacy asks the question ...... while Effectiveness asks the question .......?
Does the Vaccine Work
- -In general, vaccine development proceeds from a study of immunogenicity to a randomized controlled trial that determines vaccine efficacy under ideal conditions.
Does the Vaccination Help people
- Vaccination effectiveness can be evaluated in a prospective clinical trial, although few such studies have been undertaken
- Effectiveness is usually assessed retrospectively, sometimes using a screening test, but more often in a case-control or cohort study.
What are the 4 Types of Vaccines?
1- Live Attenuated (LAV)
2- Inactivated (Killed Antigen)
3- Subunit (purified Antigen)
4- Toxoid (inactivated Toxins)
...... vaccines are vaccines in which live "wild" virus is weakened ie ........ through chemical or physical processes in order to process an immune response without causing clinical disease?
Live Attenuated
Weaken ie Attenuate
Live Attenuated Vaccines induce both ...... and ...... immunity? LAV usually require ..... doses ?
Humoral and Cell Mediated
Fewer
The Inactivated Polio Vaccine (IPV) is administered via ........ and can be used for ...... persons?
Intra-muscular
Immuno-compromised
In Live Attenuated Oral Polio Vaccine (OPV) the attenuated(weakened) virus is shed in the .....? It provides ..... lasting immunity than IPV?
Stool
Longer
What are the 5 Immunization Recommendations for Healthcare workers?
1- Hepatitis B
2- Influenza (annually)
3- MMR (Measles, Mumps, Rubella)
4- Varicella
5- Tetanus, Diphtheria, Pertussis
6- Meningococcal - only for microbiologists routinely exposed to N. meningitidis
Immunization Recommendations (Travelers)
Practice Q3
Ans: D
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