Documente Academic
Documente Profesional
Documente Cultură
imbolnavirilor la nivel
populational.
Screeningul
Curs 3
Studenti - Medicin general-anul V
2016
prezena bolii
numrul de boli care se gsesc la o persoan
frecvena bolii la un grup din populaie
gravitatea bolii
impactul asupra sntii
Decese,
vindecri,
etc.
Dupa Principles of Epidemiology for Public Health (EPID600), Victor J. Schoenbach, Department of 10
Epidemiology, Gillings School of Global Public Health,University of North Carolina
MORBIDITATEA
MORBIDITATE REALA
MORBIDITATE
DIAGNOSTICABILA
MORBIDITATE Se cunoate
la nivelul
DIAGNOSTICATA populaiei
In functie de debut
- Cazuri noi incidenta
- Cazuri noi+vechi prevalenta
In functie de gravitate
- Morbiditate cu incapacitate temporara de munca (ITM)
- Morbiditate cu invaliditate
- Morbiditate spitalizata
- Mortalitate pe cauze medicale (cazul de imbolnavire care
determina decesul)
Rata de inciden
Densitatea incidentei
B C 01 02 03 04 05 06 07 08 09 10
Holera A00
5000
4500
4000
nr. zile concediu medical in mii
3500
3000
2500
2000 1970
2001
1500 2011
1000
500
Tipuri:
- A. Anchete (studii) de prevalen
- B. Screening
Pozitivi
(pb. B)
Test S
Populatie Faza Faza
tinta dg terap
Negativi
(pb. NB)
1. s nu fac ru;
2. s poat fi aplicate rapid;
3. s aib cost redus;
4. s fie simple;
5. s fie acceptate de ctre populaie;
6. s aib o validitate corespunztoare;
7. s aib o reproductibilitate care s ofere o
consisten bun;
8. sa fie fiabile;
9. s aib randament mare;
10. s aib o valoare predictiv bun.
- FN RN N
Este complementar cu proporia FN
Creste Sb scade specificitatea
Total B NB n Proba cu SB mare
FN putini- se pierd putini bolnavi
recomandata pt boli grave
solutia optima pt interventia de
sanatate publica
Catedra de Sanatate Publica si Management, 41
UMF "Carol Davila" Bucureti
Validitate- specificitatea
RN
Sp x100
Boala Tot NB
Exprim proporia rezultatelor
al
+ - negative n masa non bolnavilor
RN/NB
Rezulta
tul
+ RP FP P Este o probabilitate condiionat:
probei exprim probabilitatea de a fi
de negativ cu condiia de a NU fi
screeni bolnav
ng
- FN RN N Este complementar cu proporia FP
Creste Sp scade sensibilitatea
Proba cu Sp mare
Total B NB n FP putini-costuri mici pt.dg ulterior
recom pt boli la care dg e scump
solutia optima pt clinician
- c d c+d
Pentru a fi reproductibil:
Proba s fie standardizat
-Personalul s fie antrenat
-S se asigure controlul
SCREENING SELECTIV
Testele sunt utilizate pentru a detecta o boala specifica sau o
conditie predispozanta in randul persoanelor cunoscute ca fiind
cu risc crescut de a avea sau de a dezvolta boala respectiva.
IMPORTANTA BOLII
ISTORIA NATURALA A BOLII
EFICACITATEA TRATAMENTULUI PRECOCE
EXISTENTA SI ACCEPTABILITATEA
TRATAMENTULUI
CARACTERISTICILE POPULATIEI IN CARE
SE DORESTE APLICAREA SCREENING-ULUI
COSTUL SCREENING-ULUI
1. INDICATORI DE PROCES
Numarul de persoane testate prin screening
Proportia de persoane din populatia tinta testata prin screening
Prevalenta detectata a bolii in stadiu preclinic
Costul total al programului
Costul pentru gasirea unui caz de boala anterior necunoscut
Proportia persoanelor cu rezultat pozitiv la testul de screening
care sunt diagnosticate si tratate
Valoarea predictiva a unui rezultat pozitiv in randul populatiei
testate prin screening
2. INDICATORI DE EFECTE
Reducerea mortalitatii in randul populatiei testate
prin screening
Reducerea ratei de fatalitate in randul indivizilor
testati prin screening
Cresterea procentului de cazuri detectate intr-un
stadiu mai precoce al bolii
Reducerea complicatiilor
Prevenirea sau reducerea recurentelor sau
metastazelor
Imbunatatirea calitatii vietii persoanelor testate prin
screening
Catedra de Sanatate Publica si Management, 54
UMF "Carol Davila" Bucureti
Incidenta cancerului de san, Europa
Female breast cancer incidence per 100000, Last available
Malta 2011
Denmark 2010
Netherlands 2010
Belgium 2010
Finland 2010
Germany 2008
Sweden 2010
France 2011
United Kingdom 2010
Hungary 2011
Switzerland 2009
Luxembourg 2009
Iceland 2009
Italy 2010
Austria 2010
Ireland 2011
Norway 2010
Israel 2010
Czech Republic 2009
Slovenia 2008
Latvia 2011
Cyprus 2008
Croatia 2010
Bulgaria 2011
Portugal 2005
Lithuania 2011
Slovakia 2007
Estonia 2008
Serbia 2010
Poland 2010
Russian Federation 2010
Belarus 2011
Armenia 2011
Ukraine 2011
TFYR Macedonia 2007
Romania2010
Republic of Moldova 2011
Bosnia and Herzegovina 2011
Kazakhstan 2011
Turkey 2008
Georgia 2011
Azerbaijan 2012
Kyrgyzstan 2011
Albania 2010
Uzbekistan 2011
Turkmenistan 2010 Catedra de Sanatate Publica si Management,
Tajikistan 2006
San Marino 2011 UMF "Carol Davila" Bucureti
0 10 20 30 40
IncidentaCervix
cancerului de col uterin, Europa
uteri cancer incidence per 100000, Last available
Romania2010
Bulgaria 2011
Estonia 2008
Serbia 2010
Lithuania 2011
Latvia 2011
Slovakia 2007
Hungary 2011
TFYR Macedonia 2007
Bosnia and Herzegovina 2011
Ukraine 2011
Czech Republic 2009
Russian Federation 2010
Belarus 2011
Republic of Moldova 2011
Armenia 2011
Kazakhstan 2011
Poland 2010
Kyrgyzstan 2011
Croatia 2010
Ireland 2011
Norway 2010
Denmark 2010
Slovenia 2008
Germany 2008
Italy 2002
Portugal 2005
Belgium 2010
Iceland 2009
Turkmenistan 2010
Georgia 2011
Sweden 2010
United Kingdom 2010
Austria 2010
Netherlands 2010
Uzbekistan 2011
France 2011
Malta 2011
Luxembourg 2009
Azerbaijan 2012
Switzerland 2009
Israel 2010
Tajikistan 2006
Cyprus 2008
Albania 2010
Finland 2010 Catedra de Sanatate Publica si Management,
Turkey 2008
San Marino 2011 UMF "Carol Davila" Bucureti
0 5 10 15 20 25 30
Rata standardizata de mortalitate prin cancer
de col uterin in Europa
SDR, cancer of the cervix, all ages, per 100000, Last available
Romania2010
Kyrgyzstan 2010
San Marino 2000
Lithuania 2010
Latvia 2010
Serbia 2011
Kazakhstan 2010
EU members since May 2004 2011
Republic of Moldova 2012
Estonia 2011
Bulgaria 2011
Ukraine 2011
Eur-B+C 2010
Russian Federation 2010
Poland 2011
CIS 2010
Slovakia 2010
CARK 2005
Hungary 2011
Uzbekistan 2005
Belarus 2009
Czech Republic 2011
Bosnia and Herzegovina 2011
European Region 2011
Ireland 2010
Armenia 2009
Montenegro 2009
Croatia 2011
EU 2011
Portugal 2011
Slovenia 2010
Tajikistan 2005
TFYR Macedonia 2010
Belgium 2009
Germany 2011
Austria 2011
United Kingdom 2010
Georgia 2010
Spain 2011
Eur-A 2011
Azerbaijan 2007
EU members before May 2004 2011
Norway 2011
Sweden 2010
Luxembourg 2011
Israel 2010
Greece 2011
Denmark 2011
France 2009
Malta 2011
Netherlands 2011
Albania 2004
Cyprus 2011 Catedra de Sanatate Publica si Management, 58
Iceland 2009
Finland 2011 UMF "Carol Davila" Bucureti
Switzerland 2010
Italy 2010
Mortalitatea standardizata prin cancer de col
uterin la grupa de varsta 0 64 de ani, Europa
SDR, cancer of the cervix, 0-64, per 100000, Last available
Romania2010
Lithuania 2010
San Marino 2000
Latvia 2010
Kyrgyzstan 2010
Serbia 2011
Kazakhstan 2010
Bulgaria 2011
Ukraine 2011
EU members since May 2004 2011
Republic of Moldova 2012
Eur-B+C 2010
Russian Federation 2010
CIS 2010
Estonia 2011
Poland 2011
Slovakia 2010
CARK 2005
Hungary 2011
Uzbekistan 2005
Belarus 2009
Bosnia and Herzegovina 2011
European Region2011
Czech Republic 2011
Ireland 2010
Tajikistan 2005
Croatia 2011
Armenia 2009
EU 2011
Turkmenistan 1998
Montenegro 2009
Portugal 2011
Slovenia 2010
Luxembourg 2011
Georgia 2010
Belgium 2009
Germany 2011
Malta 2011
Azerbaijan 2007
Austria 2011
United Kingdom 2010
Spain 2011
TFYR Macedonia 2010
Eur-A 2011
EU members before May 2004 2011
Norway 2011
Greece 2011
France 2009
Sweden 2010
Denmark 2011
Albania 2004
Israel 2010
Netherlands 2011
Cyprus 2011
Switzerland 2010 Catedra de Sanatate Publica si Management, 59
Finland 2011 UMF "Carol Davila" BucuretiCcccaaa
Iceland 2009
Italy 2010