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PGZ2024: Summary of CASES + TRAINING + additions of the tutorial
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Summary of the cases + Training Health Counseling + additions of the tutorial (some little parts are in Dutch).
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Summary CasesPGZ2024
Disease and Prevention
Academic year: 2020-2021
1
,Index
Case 1: Petition........................................................................................................................... 3
Case 2: The asparagus fields .................................................................................................... 27
Case 3: the new normal............................................................................................................ 48
Case 4 Recommendations for the Minister ............................................................................. 67
Case 5: To test or not to test? (Pre-implantation genetic diagnosis) ...................................... 88
Case 6: To test or not to test? Prenatal screening ................................................................. 104
Case 7: Tennis friends............................................................................................................. 124
Case 8: Alzheimer disease ...................................................................................................... 148
Case 9: The challenge of colorectal cancer survivorship ....................................................... 171
Case 10: Taking care of yourself? ........................................................................................... 192
Case 11: Chronic Back Pain..................................................................................................... 212
Lecture 1 Introduction Health Counseling ............................................................................ 236
Lecture 2 Non-directive counseling ....................................................................................... 244
2
,Case 1: Petition
Learning goals
1. What is immunisation? And how does vaccination work?
- How herd immunity works? How does it work? When is it achieved?
2. What are the national immunisation programmes?
- What is the difference between MenC and MenB?
3. What are the requirements for vaccinations to be either mandatory or not? (mortality,
prevalence, incidence, infectiousness)
- What are the regulations/determinants important for government action?
4. What are the effectiveness of vaccinations and possible side effects?
5. What is the cost-effectiveness of vaccinations?
6. What are the target groups for vaccinations?
7. What are the different approaches to public opinion?
- Why often people are misinformed/concerned?
8. What is the role of social media (vaccinations)?
What is immunisation? And how does vaccination work?
Source: Centers for Disease Control and Prevention
Immunity
= is the ability of the human body to tolerate the presence of material indigenous to the body
(“self”), and to eliminate foreign (“nonself”) material.
→ is het vermogen van het menselijk lichaam om de aanwezigheid van materiaal dat inheems is in
het lichaam ("zelf") te tolereren en om vreemd ("niet-zelf") materiaal te elimineren.
This discriminatory (onderscheidende) ability (vermogen) provides (biedt) protection from infectious
disease, since most microbes are identified as foreign (lichaamsvreemd) by the immune system.
Immunity to a microbe is usually indicated (aangegeven) by the presence of antibody to that
organism. Immunity is generally specific (algemeen specifiek) to a single organism or group of closely
related organisms.
There are two basic mechanisms for acquiring (verkrijgen) immunity, active and passive:
- Active immunity is protection that is produced by the person’s own immune system.
o → This type of immunity usually lasts for many years, often during a lifetime.
- Passive immunity is protection by products produced by an animal or human and
transferred to another human, usually by injection
o → Passive immunity often provides effective protection, but this protection wanes
(disappears) with time, usually within a few weeks or months the antibodies will
degrade (afgebroken).
The immune system is a complex system of interacting cells whose primary purpose (doel) is to
identify foreign (lichaamsvreemde / “nonself”) substances (stoffen) → referred to as antigens (die
antigenen worden genoemd).
Antigens can be either alive (such as viruses and bacteria) of inactivated. The immune system
develops a defense against the antigen.
This defense is known as the immune response and usually involves the production of protein
molecules by B lymphocytes, called antibodies (or immunoglobulins) and of specific cells, including Y-
lymphocytes (also known as cell-mediated immunity) whose purpose is to facilitate the elimination of
foreign substances. → Deze afweer staat bekend als de immuunrespons en omvat meestal de
3
, productie van eiwitmoleculen door B-lymfocyten, antilichamen (of immunoglobulinen) genoemd, en
van specifieke cellen, waaronder Y-lymfocyten (ook bekend als celgemedieerde immuniteit) die tot
doel hebben de eliminatie van vreemde stoffen.
B-lymphocytes provide mediated (gemedieerde) immunity:
- They produce immunoglobulin
- And they release antibodies to detect antigens and eliminate with the help of other cells. T-
lymphocytes (T-killer cells) help the B-lymphocytes with the elimination of antigens.
Passive immunity
= is the transfer of antibody produces by one human or other animal to another. Passive immunity
provides (biedt) protection against (tegen) some infections, but this protection is temporary
(tijdelijk).
The antibodies will degrade (afgebroken) during a period of weeks to months, and the recipient
(ontvanger) will no longer be protected. The most common form of passive immunity is that which
an infant receives from its mother.
Antibodies are transported across the placenta during the last 1-2 months of pregnancy. As a result, a
full-term (voldragen) infant will have the same antibodies as its mother. These antibodies will protect
the infant from certain diseases up to a year. Protection is better against some diseases (e.g.
measles, rubella, tetanus) than others (e.g. polio, pertussis).
Kortom: je maakt zelf GEEN antistoffen aan, maar krijgt deze toegediend. Daarom is de bescherming
maar tijdelijk. Bijv. via de placenta tijdens de zwangerschap óf als je gebeten bent door een slang en
je een injectie toegediend krijgt.
Active immunity
= is stimulation of the immune system to produce antigen-specific humoral (antibody) and cellular
immunity.
Unlike passive immunity, which is temporary, active immunity usually lasts for many years, often for
a lifetime.
There are two ways to acquire (verkrijgen) active immunity:
- To survive infection → with the disease-causing form of the organism: while exceptions
(like malaria) exist, in general once persons recover from infectious diseases, they will have
lifelong immunity to that disease. The persistence (aanhouden) of protection for many
years after the infection is known as immunologic memory. Following exposure (na
blootstelling) of the immune system to an antigen, certain cells (memory B cells) continue
to circulate in the blood (and also reside in the bone marrow) for many years.
Upon re-exposure (bij nieuwe blootstelling) to the antigen, these memory cells begin to
replicate and produce antibodies very rapidly to reestablish protection.
o Hierbij moet je dus gewoon de ziekte ondergaan.
- Vaccination → vaccines interact with the immune system and often produce an immune
response similar to that produced by the natural infection, but they do not subject
(onderwerpen) the recipient (ontvanger) to the disease and its potential complications.
Many vaccines also produce immunologic memory (immunologisch geheugen) similar to
that acquired by having the natural disease. → Many factors influence the immune
response to vaccination: presence of maternal antibody, nature and dose of antigen, route
of administration, and the presence of an adjuvant (e.g. aluminum-containing material
added to improve the immunogenicity of the vaccine). Host factors such as age, nutritional
factors, genetics, and coexisting disease, may also effect the response.
4
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