Сөж тақырыбы: Evidence-based prevention. The main types, problems of implementation and analysis of the results of screening programs

Adapting or Developing a Program

• Even if you can`t find an evidence-based program that means your needs, your efforts can still be informed by evidence.
• When adapting a prevention program or developing a new one, make sure that it:
• Is grounded in a thorough understanding of local problems and assets
• Targets known, research-based risk and protective factors for …
• Is guided by research-based theories (e.g., behavior change theories)
• Has a clear theory of change documented in a logic model or conceptual model that shows how the program will achieve its intended results
• Draws from research on related programs and their effectiveness

There are three main types of prevention: primary,secondary and tertiary

Screening

Screening tests make it possible to identify those who are likely to have the disease from those who seem healthy and those who probably do not. The screening test is not intended for diagnosis. Persons with positive or suspicious results should be referred to their doctors to establish a diagnosis and prescribe the necessary treatment. "

The sensitivity of the tests

High sensitivity of tests is good if the disease is treatable atearly stages, and if possible false-positive results do notcause physical and psychological trauma to people. So thePap smear is a very sensitive test for cervical cancer and thediagnosis is easily confirmed with a biopsy.

Treat the disease with its early diagnosis

Such diseases as in situ cancer or local invasive cervical cancer may be treatable. The prognosis for the treatment of colorectal cancer is significantly improved when it is detected early by means of endoscopic methods or samples for internal bleeding. Tumors, similar in type with colorectal cancer, came to the attention of the treating physicians relatively recently in the historical plan.
Cancers of the breast, prostate, cervix and lung are so common at a certain age and among certain populations that screening for them is almost a medical indication. Screening the entire population of the UK for gastric cancer is not advisable because of its rare occurrence, but it is more than shown in Japan, where this disease is more common.

What contingents should conduct surveys?

In a number of countries, women aged 20-65 years are recommended to take swabs for cervical cancer every 3 years. In the UK, such strokes are recommended for all sexually active women every 5 years. At the moment it is unclear what recommendations can be given on the frequency of ultrasound examinations (diagnosis of uterus and ovarian cancer) or the frequency of passing endoscopic examinations. The group at increased risk of developing ovarian cancer includes unmarried women over the age of 40, men and women over 50 are at risk for colorectal cancer.
Standard monitoring can cause feelings of anxiety and fear in the population, which can be especially strong in individuals. When screening the entire population of certain regions, significant money investments and a large expenditure of time are required. The actual clinical effect of the surveys may be incommensurably small for large material costs. With the incidence of breast cancer in 50-70-year-old women at 2 cases per year per 1000 population, a monitoring survey of 10,000 women every 2 years will reveal 40 additional cases of the disease.
In the UK, surveys are conducted in clinics by qualified mammography nurses and cost around £ 50 for one analysis. If, as a result of all the tests performed, the overall cure rate rises from 40% to 60%, then it turns out that 250 thousand pounds sterling was spent annually to save these 8 lives. Thus, screening of this type is one of the most costly of the means spent to save one human life, even in comparison with other high-tech procedures. But for some types of cancer, the question of the need for screening lies not in the economic plane.

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