Fallstudie
Tutorial Cases Disease and Prevention
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All cases summarized, good for the exam
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InhaltsverzeichnisCASE 1: PETITION..............................................................................................................................................................1
CASE 2: THE SPARAGUS FIELDS ...................................................................................................................................4
CASE 4: RECOMMENDATIONS FOR THE MINISTER.............................................................................................15
CASE 5: TO TEST OR NOT TO TEST? (CARRIER SCREENING AND PRE-IMPLANTATION GENETIC
TESTING)...........................................................................................................................................................................20
...............................................................................................................................................................................................24
CASE 6: TO TEST OR NOT TO TEST (PRENATAL SCREENING AND DIAGNOSIS)........................................25
CASE 7: CANCER...............................................................................................................................................................30
CASE 8: DEMENTIA.........................................................................................................................................................36
CASE 10: THE CHALLENGE OF COLORECTAL CANCER SURVIVORSHIP........................................................46
CASE 11: CHRONIC NON-SPECIFIC LOW BACK PAIN...........................................................................................51
,Case 1: Petition
1. What are the working mechanisms of vaccines?
Immunity:
- ability of the human body to tolerate the presence of material indigenous to the
body and to eliminate foreign substances.
- The immune system develops a defense against antigens, which are substances that
can stimulate the immune system(immune response), involved the production of:
1. Protein molecules (immunoglobulins or antibodies) by B-lymphocytes
2. Specific cells, including T-lymphocytes (cell-mediated immunity)
Types of Immunity:
1. Passive immunity:
- Protection by antibody or antitoxin produced by animal/human & transferred to
another
- provides immediate protection against infection, but that protection is temporary.
2. Active immunity:
- Protection produced by a person’s own immune system stimulated by an antigen
to produce antibody-mediated and cell-mediated immunity.
- Active immunity lasts for many years, often for a lifetime
Classification of Vaccines:
Their characteristics are different and determine how each type is used:
1. Live, weakened:
- One dose can be enough
- Derived from “Wild” viruses or bacteria are attenuated (weakened) in a lab.
- To produce an immune response, live, attenuated vaccines must replicate in the
vaccinated person.
- These vaccines do not cause the disease, if they do its a milder form
2. Inactivated:
- Inactivated vaccines are not live and cannot replicate.
- These vaccines do not cause the disease, even if an immune supressed person.
- The immunity provided by inactivated vaccines are NOT as long-lasting as achieved
from live vaccines Multiple doses needed to obtain ongoing immunity.
What is herd immunity and how can you achieve it?
- refers to the resistance of a group attacked by a disease bc of the immunity of a
large proportion of the members and the consequent lessening of the likelihood of
an infected individual coming into contact with a susceptible individual.
- idea is based on the relationship between the transmission dynamics of infectious
agents and population immunity.
How to achieve it:
- achieved by mass immunization against infectious diseases that are transmitted
directly from person to person (e.g. measles) especially those for which humans
are the only reservoir or one of the important reservoirs of infection.
- CAN NOT be achieved when infectious are not transmitted from person to person
and humans are not an important reservoir of infection (e.g. tetanus)
- Herd immunity concept → The simple “herd immunity threshold” concept assumes
that vaccines induce solid immunity against infection in a randomly mixing
1
, population key determinants of herd immunity are based on the basic
reproduction number R0 (the average number of others individuals each infected
individual will infect in a population that has no immunity to the disease)
- Recent conceptual developments in vaccine “herd immunity” or “herd protection”
that addresses the complexities of imperfect immunity, heterogeneous populations,
nonrandom vaccine uptake and “freeloaders”.
1. An ideal vaccine should be highly immunogenic & would present solid immunity
against infections to all recipients. BUT, if a vaccine doesn`t grant solid immunity,
the threshold level of vaccination required to protect a population will increase.
2. In a heterogenous population, the “R0” in the formula should also account for
the factors that affect the interaction of various groups in a population
→ groups that are highly interconnected will dominate transmission resulting in a
higher value of R0, requiring a large vaccination threshold.
3. Simple results will no longer follow if vaccination traces depending on the risk
behaviors of the groups.
E.g.: if every high-risk person in a population infects four individuals & every
individual in low-risk group infects only one person, outbreaks in theory can most
effectively be prevented by vaccinating 75% of the high-risk group. Problems
arise if high-risk persons are least likely to be vaccinated/ mix with unvaccinated
4. “Freeloaders” - people who wish that everyone else around them is vaccinated
except themselves create a special scenario. They take the advantage of herd
immunity without taking the trouble of getting the vaccine.
What is the role of vaccination programs?
- The overall aim of a national vaccination program is to protect the population from
vaccine preventable diseases and reduce the associated mortality and morbidity.
- Reduce burden on health system, disease spread, preventing complications & deaths
What is the role of social media and the government in decision-making for vaccines?
Interaction of technology & PH: Technology-based public health services may interact with
members of communities, healthcare provides, and policymakers in multiple ways:
1. Providing information → through websites and apps
2. Providing counseling or navigation → through chat functions
3. Behavioral change interventions → through eHealth
4. Identifying service locations → tailored recommendations of service locations near
to technology users
5. Commodity ordering → programmes to deliver home-testing kits for sexually
transmitted infections
!!: Decision process in the individual has 3 stages:
1. Pre-decisional phase: individuals consider their options to either vaccinate within the
recommended time frame, with delay or not at all.
2. Decisional phase: individuals evaluate potential outcomes of alternative actions
(vaccinating or not) based on the gained information. Theories assume that
individuals must perceive themselves as being at risk before taking proactive action.
3. Post-decisional phase: individuals receive imbalance feedback regarding their
decision: while vaccination costs such as pain, time, money & potential adverse
events are immediate and tangible, benefits are typically delayed or less tangible.
2
, What can influence our decision to get vaccinated:
1. Role of narratives in altering risk perception and vaccination intentions
- personal stories of patients who describe in vivid language the health problems
they believe to be the result of vaccination (correctly or incorrectly)
- Narrative reports have always been part of anti-vaccination messages, their
distribution has grown via these media.
- Narratives have advantages over communication formats more memorable
2. People tend to share more negative stories than positive stories
What are the challenges and opportunities of vaccination decisions?
Challenges encountered by public health communicators:
- keep up with and react to the fast moving medium of social media real time and
rapid dissemination during crisis → requires communication strategies & guidelines
(who is allowed to communicate official messages, what they are permitted to say)
- Language barriers → difficulty in communicating complicated scientific terms and
findings quickly in comprehensible messages to the public
- Form of presenting information (numbers, memorable, information that people can
connect with) Numbers to demonstrate risk are perceived as rather abstract
information with only limited intensity and realistic value.
- Privacy concerns associated with new communication technologies to facilitate
delivery of public health information & services. (transmission of health-related
information must be conducted in compliance with recognized standards of security
and encryption to avoid disclosure of health-related information)
- Health literacy
- Risk of confirmation: people mainly read information consistent with their existing
beliefs & ignore inconsistent information (i.e, selective exposure), tend to evaluate
consistent information as more accurate than inconsistent (i.e, biased evaluation).
Opportunities of using Web 2.0:
- Web 2.0 → applications reduce major technical barriers to facilitate interactions with
other users. Example: Social media → providing opportunity to publicly express
support for an issue and forward information to friends without great effort.
3
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