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Epidemiological Transition/Public Health Transition

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a concept indicating the change that has been historically observed as part of social and economic development, from mortality & morbidity dominated by infections, to morbidity and mortality dominated by what has been called non-communicable disease or degenerative and man-made diseases.

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Screening

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testing individuals who are asymptomatic for a particular disease as part of a strategy to diagnose a disease or identify a risk factor

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asymptomatic

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without symptoms (when screening, implies the absence of symptoms of the disease being sought)

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Incremental Cost-effectiveness

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a measurement of the additional cost relative to the additional net-effectiveness

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Lead-time bias

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the situation in screening for disease in which early detection does not alter outcome but only increases the interval between detection of disease & occurrence of the outcome, such as death

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False positives

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Individuals who have a positive result on screening test but turn out not to have the disease

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False negatives

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individuals who have a negative result on a screening but turn out not to have the disease

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True positives

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individuals who have a positive result on screening test and turn out to have the disease

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Bayes Theorem

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Math formula that can be used to calculate post test probability of disease based on the pretest probability of the disease plus the test's sensitivity and specificity.

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Pretest probability of disease

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probability of the disease before the test results are known. An estimate based on prevalence of the disease, the presence of risk factors for the disease, & if present, signs or symptoms suggestive of the disease.

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Post-test probability of disease

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the probability of the disease after the results of the test are known

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sensitivity

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the probability of a positive test when the disease is present

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specificity

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the probability of a negative test when the disease is absent

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predictive value of a positive

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the post test probability of the disease when the test results are positive

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predictive value of a negative

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the post test probability that the disease is absent when the test results are negative

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sequential testing/consecutive testing

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a screening strategy the uses one test followed by one or more additional tests if the 1st test is positive

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Simultaneous testing/parallel testing

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screening strategy that uses (2) tests initially, with follow-up testing if either test is positive

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Multiple risk factor reduction

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simultaneous efforts to reduce more than one risk factor

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Cost-effectiveness

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a measure of the cost of an intervention relative to its benefit. In interventions, implies that any additional benefit is considered worth the cost. The term can also imply that a large cost savings is worth a small reduction in net effectiveness

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net effectiveness/net benefit

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a measure of the benefits minus the harms of an intervention

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prediction rule

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a quantitative formula designed to increase the ability to predict the outcome of a condition and thereby guide the use of interventions

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phenotypic expression

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the clinical presentation of a disease, which may be quite variable despite the same genetic composition, or genotype

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communicable disease

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-microbial agent -a disease due to an organism such as a bacteria or virus which is transmitted person-to-person or from animals or the physical environment to human by various routes ie) from air & water, from contaminated articles or by insect bites or animal bites) -considered a subset of infectious disease

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Non-communicable disease

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-perhaps genetic disorder or unhealthy lifestyle -a medical condition or disease that is NOT transmitted between persons *may be chronic diseases of long duration & slow progression *may be accurate & result in more rapid death such as some types of sudden stoke

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According to the WHO, what are the four main types of non-communicable diseases?

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-cardiovascular -cancers -chronic respiratory diseases (asthma, infazima, etc.) -diabetes exception: cervical cancer is caused by human papillomavirus (HPV)

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what are some examples of non-communicable disease?

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-autoimmune diseases -heart disease -stroke -many cancers -asthma -diabetes -chronic kidney disease -osteoporosis -Alzheimer's disease -cataracts

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Non-communicable vs Chronic

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*sometimes NCDS are incorrectly referred to as synonymous with chronic disease -NCDs are distinguished only by their non-infectious cause-not their duration -some chronic diseases of long duration, such as HIV/Aids, are caused by transmissible infections *chronic diseases require chronic care management as do all diseases that are slow to develop & of long duration

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The epidemiological transition

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*also called the public health transition *describes changing patterns of disease -often resulting from social & economic development -prevalence of acute infectious diseases decline -prevalence of chronic diseases increases *emerging diseases, pandemic diseases, & drug-resistant bacterial infections threaten reemergence of infectious disease

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leading causes of dead for 15-24yr olds 2011

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1) unintentional injury 48% 2) suicide 19% 3) homicide 18% 4) malignant neoplasms 6.3% 5) heart disease 3.9%

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leading causes of death for 65+yr olds 2011

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1) heart disease 34% 2) malignant neoplasms 28.5% 3) chronic lower respiratory disease 8.7% 4) cerebrovascular 7.8% 5) Alzheimer's disease 6%

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Leading population approach to non-communicable diseases

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*screening for early detection and treatment of disease *multiple risk factor interventions *identification of cost effective treatments *genetic counseling & intervention *research

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screening for non-communicable disease

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*testing for asymptomatic individuals *assumption that early detection allows for early intervention (treatment & outcome) *overall reduction of disability and death

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criteria for ideal screening programs

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*disease produces substantial death, disability, or both *early detection is possible & improves outcome -lead time bias *testing strategy for screening is feasible *screening is acceptable in terms of harms, costs & patient acceptance

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screening for disease control

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*examination of asymptomatic people *classification of -likely -unlikely (to have the disease) "unlikely" referred to next screening cycle "likely" further testing for diagnostic -if diagnosed--> treatment -if not diagnosed--> referred to next screening cycle

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screening for cervical cancer?

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pap smear

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screening for breast cancer?

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mammography

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screening for prostate cancer?

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PSA test

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screening for colon cancer?

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fecal occult blood

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screening for diabetes?

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fasting blood sugar

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screening for hypertension?

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blood pressure

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screening for hypercholesterolemia?

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blood cholesterol

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screening for HIV?

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HIV-specific antibody

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evaluating screening tests?

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*how good is the screening test compared to the diagnostic test? *how well does the test perform when applied in the community, ie) to the population at large? -performance yield

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validity

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*the ability of a test to distinguish between who has a disease & who does not *2 components to validity -the screening tests will actually classify a diseased person as likely to have the condition (sensitivity) -the screening test will actually classify a non-diseased person as unlikely to have the condition (specificity)

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screening results chart

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Screened Diseased Not Diseased Total Test + True positive False positives Total test + Test - False negative True negatives Total test - Total Total Diseased Total NOT diseased Total

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Positive predictive value (PPV, PV+)

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the proportion of people with positive test results who are correctly diagnosed as having the disease P(D+/T+) -probability (disease is present given a positive test)

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Negative predictive value (NPV, PV-)

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the proportion of people with negative test results who are correctly diagnosed as not having the disease P(D-/T-) -probability (disease is absent given a negative test)

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screening tests using continuous variables

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*many test results have a continuous scale (are continuous variables) -distribution of biologic measurements in humans may or may not permit easy separation of diseased from non-diseased individuals, based upon the value of the measurement *decisions are made as to where the "cut-point" will be when determining + and - test results

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There are no lines or colors identifying asymptomatic individuals

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*a screening test using a cut-point that is "too high" may miss finding individuals with early disease signs *a screening test using a cut-point that is "too low" will unnecessarily identify individuals for further diagnostic testing and "worry" *the cut-point that identifies more true negatives also identifies more false negatives *the cut-point that identifies more true positives also identifies more false positives

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sensitivity and specificity

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*tradeoff between the two -high sensitivity could reduce specificity -high specificity could reduce sensitivity *how do we decide? -deal with the problem of false positives & false negatives that result from the testing -false + = increased financial & emotional costs (& de-labeling), tax healthcare system -false - = miss early treatment opportunities

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multiple risk factor strategies

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*inherent to population health approach to non-communicable diseases *multiple risk-factor reduction- strategies aimed at numerous risk factors at once with the hope of reducing or minimizing health outcome

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cost effective intervention strategies

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*used effectively against non-communicable diseases *reduce the impact of the course of a disease *combines issues of benefits & harms with issues of financial cost *net effectiveness-benefits are greater than harms

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Genetic counseling and genetic intervention

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*detection of abnormalities related to genes -Tay-sachs disease (Ashkenazi Jews) -Sickle cell anemia (African americans) -Down syndrome (3 copies of gene 21) -phenylketonuria (PKU) -cystic fibrosis (whites in US)

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genetic prevention

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prevent the occurrence of disease (eg. fetal therapy, genetic counseling)

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genetic detection prior to disease

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detect the defect early and do something about it (eg. early diet to treat PKU)

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gene-environmental protection

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(eg. identify combinations of genes that put you at risk in certain occupational settings)

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genotypic-based screening for early diseases

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target those who are high risk (eg. family members tend to have disease)

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newborn screening USA

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*national newborn screening & global resource center -began as cooperative effect with US health resources & services administration, now as non-federal center *babies are genetically tested for a variety of disorders-largely metabolic, but also endocrine & hemoglobin disorders, & other disorders such as cystic fibrosis & SCID *# and type of testing varies by state -all states must screen for at least 21 disorders by law -TX currently screens for 30

Non-communicable Diseases Ch. 6 – Flashcards

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