Deck 14: Prevention: Better Than Cure

Question 1

When attempting to predict or model the future benefits that might accrue from an effective preventive intervention, should the reference category for the causal agent
Of interest, e.g.sun exposure or cigarettes, (i.e.the level of exposure to which the
Intervention aims to shift the population) be:

A)The null category, i.e.zero exposure to the cause
B)Half the current exposure level
C)A plausible minimum level of the degree of change that seems achievable based on evidence from trials or other sources
D)The average exposure in a different population with lower disease rates (e.g.for an Australian population, the reference level could be sun exposure in England)
E)A, C and D

Answer 1

A, C and D

Question 2

Which of the following actions is not an example of primary prevention?

A)Applying sunscreen before going to the beach
B)A GP treating a patient with elevated blood pressure with drugs
C)Buckling up your seat belt before starting your car
D)Referring a stroke patient to a rehabilitation unit
E)Banning cigarette advertising at sports events

Answer 2

Referring a stroke patient to a rehabilitation unit

Question 3

The multi‐drug polypill to reduce primary and secondary cardiovascular events (CHD and stroke), is mentioned in the text as a possible simple, safe and cheap preventive.
Early trials suggest it can improve compliance in patients already taking a number of
Its component drugs separately; and it is expected there will be results within a year
On whether it is effective in reducing blood pressure and serum cholesterol.It will
Take further years of follow‐up before definitive data on whether it reduces
Cardiovascular morbidity and mortality are available.Choose the best policy to
Implement now from among the following options:

A)License the polypill for general preventive use through doctors' prescriptions for at‐ risk patients who already take some or all the drugs in the pill
B)License the polypill for general preventive use through doctors' prescriptions for at‐ risk patients whether or not they currently take any of the drugs
C)Make the polypill freely available to the public from pharmacies without needing a doctor's prescription
D)Wait for the early results of the trials to see if patients levels of risk factors decrease
E)Wait until the longer‐term results of trials show a definitive lowering of CHD and stroke events and deaths, and the pill is approved by national drug oversight
Agencies such as the FDA

Answer 3

Wait until the longer‐term results of trials show a definitive lowering of CHD and stroke events and deaths, and the pill is approved by national drug oversight
Agencies such as the FDA

Question 4

A 'high risk' strategy for prevention:

A)Should never be used
B)Always has poor benefit to cost ratio
C)Can only be used in the context of a wider, population‐based programme
D)Is only appropriate for selected occupational groups and other at‐risk sub‐ populations
E)Is the most difficult strategy to 'sell' to the target group

Question 5

Which one of the following options offers the best approach to controlling a chronic disease?

A)A primary prevention programme
B)Training GPs to detect early disease better
C)Improving treatment outcomes
D)A + B
E)A + C

Question 6

The Minister for Health has announced that an additional $5 million will be provided to strengthen mental health treatments and services to prevent attempted suicide in
The population.You have collected some data on mental disorders and attempted
Suicide in this population (presented in the table below), and you are asked by the
Minister to recommend which disorder should be targeted to ensure the biggest
Impact on the burden of attempted suicide in the population.Which mental disorder
Do you recommend?

A)Substance use disorder
B)Affective disorder
C)Anxiety disorder
D)Psychosis

Question 7

Which of the following data sources do you think would provide the best data to evaluate how well a national primary prevention programme of behavioural change
To decrease the mortality rate from a cancer is working?

A)A cohort study
B)A prevalence survey in the community to measure behaviour change
C)A large‐scale randomised trial
D)Routinely collected mortality data
E)Incidence rates from a cancer registry

Question 8

Campaigns to lower smoking rates and advances in medical and surgical therapies have both helped bring about large declines in mortality from coronary heart disease
(CHD) in Canadian men.Which of the following study designs and epidemiological
Measures could contribute to assessing their relative contributions?

A)Looking at how in‐hospital mortality among patients with CHD has changed over time using case‐fatality ratios from short‐term prognostic (cohort) studies
B)Looking at time trends in the incidence rate of CHD over the same period that CHD mortality has been falling
C)Evidence from repeated cross‐sectional national surveys showing that the prevalence of smoking in men has fallen over the same time period
D)Repeat surveys of GPs showing increasing levels of detection and treatment of raised blood pressure over the same time period
E)All of the above