This is a summary of all cases and lectures of course 4 Disease and Prevention. The cases are very extensive by using all literature. Sources are mentioned in the document. Additions from the tutorial are marked in red. The health counseling training and the visit Maastricht Study are also included...
Lecture prevention by vaccination ................................................................................................................... 7
Case 1: Petition .............................................................................................................................................. 14
Lecture introduction into genetics.................................................................................................................. 38
Case 2: The asparagus fields ........................................................................................................................... 61
Case 3: the new normal .................................................................................................................................. 83
Lecture Health counselling skills 1 ................................................................................................................ 100
Lecture Health counselling skills 2 ................................................................................................................ 105
Case 5: To test or not to test? (Pre-implantation genetic diagnosis) ............................................................. 146
Lecture Down syndrome & Ethics of prenatal decision making .................................................................... 161
Case 6: To test or not to test? Prenatal screening......................................................................................... 168
Lecture cancer and prevention ..................................................................................................................... 192
Case 7: Tennis friends ................................................................................................................................... 203
Case 8: Alzheimer disease ............................................................................................................................ 235
Lecture Colorectal cancer survivorship ......................................................................................................... 262
Case 9: The challenge of colorectal cancer survivorship ............................................................................... 270
Lecture Diabetes type 2 self-management and treatment adherence .......................................................... 297
Case 10: Taking care of yourself? ................................................................................................................. 300
Visit Maastricht Study Research Centre ....................................................................................................... 321
Lecture Chronic back pain ............................................................................................................................ 323
Case 11: Chronic Back Pain ........................................................................................................................... 332
,Course opening
Public health
“the art and science of preventing disease, prolonging life and promoting health trough the
organized efforts of society” – WHO 1988
Three main approaches in the field of PH
- Health protection
o Management of environmental, food, toxicological and occupational safety
- Disease prevention
o Aimed at minimizing the burden of diseases and associated risk factors trough
primary and secondary prevention efforts
- Health promotion
o Enabling people to increase control over and improve their health trough social and
environmental interventions
PH prevention, management and treatment of
- Communicable diseases: infectious diseases
o Decrease of mortality
- Non-communicable diseases: chronic diseases (e.g. cardiovascular diseases, cancers, mental
disorders)
o Increase of mortality
o Since 2007 cancer is the number one cause of death in the Netherlands
PH has changed
Transition from infectious to chronic diseases, because of
- Developments in society have led to changes in het prevalence of risk factors
- Medical and scientific progress had led to improves detection/screening/treatment → detect
cases early and treat people better
- As a result, more people living with chronic diseases
Tuberculosis is nearly gone in the Netherlands
There are two spikes: 1915-1920: Spanish flue and 1945: WOII: hunger winter → when there is war
→ infectious diseases spread quickly. Immune system of people is lower.
Breast cancer:
Risicofactoren zijn verandert: women get children later in life en less children → greater risk on
breastcancer. Decrease in early 90: breast cancer screenings → detect cases early → treat them
early.
Mortality due to total cancer: stayed the same since 1950
Mortality due to cvd: decreased → we are better at treating people
, Disease burden
• Mental disorders
• Have their first on set very early in life
• Has an impact during the rest of your life
• Later in life: decrease mental disorders & increase dementia
Successes of PH: are not always visible to the public. Mostly primary prevention is not visible → the
cases did not occur (vaccination!)
Total number of prevented deaths: >16.000 per year!
Life expectancy
• Increasing average life expectancy
• Women: life expectancy in good health isn’t increasing
Disease
• Knowledge on disease is essential for a PH professional
• You have to able to acquire information on diseases
• Disease characteristics determine which interventions possibilities you have
Questions you need to answer before deciding on the right public health intervention:
• How does the disease develop, what are the risk factors?
• What are the symptoms, how is the diagnoses made?
• What are the treatments possibilities, what is the prognosis?
• What are the consequences of the diseases for quality of life and participation (in society)?
Prevention
When you answer these questions, you find out why it is not affective to have a screening
programme for lung and prostate cancer.
Classification according to disease stage
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