DR.

SALSBEEL KHAN
ASSISTANT PROFESSOR
HEALTH
⚫ “Health is a state of complete physical, mental, social well-
being and not merely the absence of disease or infirmity.”
- World Health Organization
⚫ In recent years, this definition has been
amplified to include “the ability to lead socially and
economically productive life”.

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CONCEPT OF HEALTH

Changing concept of health till now are:

⚫ Biomedical concept
⚫ Ecological concept
⚫ Psychosocial concept
⚫ Holistic concept

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BIOMEDICAL CONCEPT
⚫ Traditionally, health has been viewed as an “absence of
disease”, and if one was free from disease, then the person
was considered healthy.
⚫ This concept has the basis in the “germ theory of disease”.
⚫ The medical profession viewed the human body as a machine,
disease as a consequence of the breakdown of the machine
and one of the doctor’s task as repair of the machine.

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ECOLOGICAL CONCEPT
⚫ Form ecological point of view; health is viewed as a dynamic
equilibrium between human being and environment, and
disease a maladjustment of the human organism to
environment.
⚫ According to Dubos “Health implies the relative absence of pain
and discomfort and a continuous adaptation and adjustment to
the environment to ensure optimal function.”

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PSYCHOSOCIAL CONCEPT

⚫ According to psychosocial concept “health is not only biomedical

phenomenon, but is influenced by social, psychological, cultural,
economic and political factors of the people concerned.”

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HOLISTIC CONCEPT

⚫ This concept is the synthesis of all the above concepts.

⚫ It recognizes the strength of social, economic, political and
environmental influences on health.
⚫ It described health as a unified or multi dimensional process
involving the wellbeing of whole person in context of his
environment .

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DIMENSIONS OF HEALTH

⚫ Health is multidimensional.
⚫ World Health Organization explained health in four
dimensional perspectives:
physical, mental, social and spiritual.
⚫ Besides these many more may be cited, e.g. emotional,
vocational, political, philosophical, cultural, socioeconomic,
environmental, educati onal, nutritional, curative and
preventive.

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PHYSICAL DIMENSION

⚫ Physical dimension views health form

physiological perspective.
⚫ It conceptualizes health that as biologically a state in which
each and every organ even a cell is functioning at their
optimum capacity and in perfect harmony with the rest of body.
⚫ Physical health can be assessed at community level by the
measurement of morbidity and mortality rates.

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MENTAL DIMENSION

⚫Mental health is a state of balance between the

individual and the surrounding world, a state of
harmony between oneself and others, coexistence
between the realities of the self and that of other
people and that of the environment.
⚫Mental health is not merely an absence of
mental illness.

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SOCIAL DIMENSION

⚫ It refers the ability to make and maintain relationships

with other people or communities.
⚫ It states that harmony and integration within and between
each individuals and other members of the society.
⚫ Social dimension of health includes the level of social skills
one possesses, social functioning and the ability to see oneself
as a member of a larger society.

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SPIRITUAL DIMENSION
⚫ Spiritual health is connected with religious beliefs and
practices. It also deals with personal
creeds, principles of behavior and ways of achieving peace
of mind and being at peace with oneself.
⚫ It includes integrity, principle and ethics, the purpose of life,
commitment to some higher being, belief in the concepts
that are not subject to “state of art” explanation.

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INDICATORS OF HEALTH
“A health indicator is a characteristic of an individual, population,
or environment which is subject to measurement (directly or
indirectly) and can be used to describe one or more aspects of the
health of an individual or population (quality, quantity and time)”.
- WHO, Health Promotion Glossary 1998.
CHARACTERISTICS OF INDICATORS
• Valid – they should actually measure what they are supposed to
measure.
• Reliable – the results should be the same when measured by
different people in similar circumstances.
• Sensitive – they should be sensitive to changes in the situation
concerned.
• Specific – they should reflect changes only in the situation
concerned.
• Feasible – they should have the ability to obtain data when
needed.
• Relevant – they should contribute to the understanding of the
phenomenon of interest.
CLASSIFICATION
Indicators may also be classified as;
1. Mortality indicators
2. Morbidity indicators
3. Disability rates
4. Nutritional status indicators
5. Health care delivery indicators
6. Utilization rates
7. Indicators of social and mental health
8. Environmental indicators
9. Socio-economic indicators
10. Health policy indicators
11. Indicators of quality of life
12.Other indicators
1. MORTALITY INDICATORS
(a) Crude death rate:
It is defined as the number of deaths per 1000 population per year
in a given community.
(b) Expectation of life

• Life expectancy at birth is "the average number of years

that will be lived by those born alive into a population if the
current age-specific mortality rates persist".
• Life expectancy at birth is highly influenced by the infant
mortality rate where that is high.
• Life expectancy at the age of 1 excludes the influence of
infant mortality, and life expectancy at the age of 5
excludes the influence of child mortality.
(c) Infant mortality rate:

• Infant mortality rate is the ratio of deaths under 1 year of

age in a given year to the total number of live births in the
same year; usually expressed as a rate per 1000 live births.

Number of deaths under 1 year of age in given year x1000

__________________________________________________
The total number of live births in the same year
(d) Child mortality rate:

• Another indicator related to the overall health status is the early

childhood (1-4 years) mortality rate.

Number of deaths at ages 1-4 years in a given year X 1000

_________________________________________________
Children in that age group at the mid-point of the year
(e) Under-5 proportionate mortality rate :

• It is the proportion of total deaths occurring in the under-5 age

group.
(f) Maternal (puerperal) mortality rate:
• Maternal (puerperal) mortality accounts for the greatest
proportion of deaths among women of reproductive age in
most of the developing world.

(g) Proportional mortality rate :

2.MORBIDITY INDICATORS
The following morbidity rates are used for assessing ill- health in
the community;
1. Incidence and prevalence
2. Notification rates
3. Attendance rates at out-patient departments, health centres,
etc.
4. Admission, readmission and discharge rates
5. Duration of stay in hospital and
6. Spells of sickness or absence from work or school
1.Incidence and Prevalence

Incidence rate is defined as : “the number of NEW cases

occurring in a defined population during a specified period of
time”. It is given by the formula:
Incidence =
no of new case of specific disease during given time period х 1000
___________________________________________________________
Population at risk during that period

• E.g. The incidence of Tuberculosis in India is 210 per 100,000.

Prevalence:
Refers specifically to all current cases (old + new) existing at a
given point in time, or over a period of time in a given population.

2. Notification rates
Calculated from the reporting to public authorities of certain
diseases e.g. yellow fever , poliomyelitis
3. DISABILITY RATES
Sullivan's index:
This index (expectation of life free of disability) is computed by
subtracting from the life expectancy the probable duration of bed
disability and inability to perform major activities, according to
cross-sectional data from the population surveys.
4. NUTRITIONAL STATUS INDICATORS
Three nutritional status indicators are considered important
as indicators of health status:

(a) anthropometric measurements of preschool children, e.g.,

weight and height, mid-arm circumference;

(b) heights (and sometimes weights) of children at school

entry

(c) prevalence of low birth weight (less than 2.5 kg).

5. HEALTH CARE DELIVERY INDICATORS

The frequently used indicators of health care delivery are:

(a) Doctor-population ratio
(b) Doctor-nurse ratio
(c) Population-bed ratio
(d) Population per health/subcenter
(e) Population per traditional birth attendant
6. UTILIZATION RATES

• In order to obtain additional information on health status, the

extent of use of health services is often investigated.

•Immunization coverage, % of Hospital Delivery, hospital bed

occupancy rate, average length of stay in hospital and bed
turnover rate etc.
7. INDICATORS OF SOCIAL AND MENTAL HEALTH

These include rates of suicide, homicide, road traffic accident,

alcohol and substance abuse, domestic violence, etc.

These indicators provide a guide to social action for improving

the health of people.
8. ENVIRONMENTAL INDICATORS

These reflect the quality of physical and biological environment

in which diseases occur and people live.

• The most important are those measuring the proportion of

population having access to safe drinking water and sanitation
facilities, level of air pollution, water pollution, noise pollution etc.
9. SOCIO-ECONOMIC INDICATORS
These indicators do not directly measure health. Nevertheless,
they are of great importance in the interpretation of the
indicators of health care. These include :

• Rate of population increase

• Level of unemployment
• Literacy rates, especially female literacy rates
• Family size
• Housing: the number of persons per room
10. HEALTH POLICY INDICATORS
The single most important indicator of political commitment is
"allocation of adequate resources". proportion of GNP spent on
health services, proportion of GNP spent on health related
activities

11. INDICATORS OF QUALITY OF LIFE

It includes;
1. Infant mortality
2. Life expectancy at age one
3. Literacy

12. Other indicators

a) Social indicators
b) Basic needs indicators
c) Health for All indicators
DETERMINANTS OF HEALTH

⚫ Health is determined by multiple factors.

⚫ The health of an individual and community is influenced by:
individual (internal) and external factors.
⚫ The individual factors include by his own genetic factors and
the external factors include environmental factors.

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BIOLOGICAL DETERMINANTS
⚫ The health of an individual partly depends on the
genetic constitutions.
⚫ A number of diseases e.g. chromosomal anomalies,
inborn error of metabolism, mental retardation and
some types of diabetes are some extent due to
genetic origin.

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ENVIRONMENTAL FACTORS
⚫ Biological: disease producing agent (e.g. bacteria, virus,
fungi), intermediate host (e.g. mosquito, sand fly), vector
(e.g. house fly), reservoir (e.g. pig in JE).
⚫ Physical: Air, water, light, noise, soil, climate, altitude, radiation
housing, waste etc.
⚫ Psychosocial: psychological make up of individual and
structure and functioning of society. e.g. habit, beliefs,
culture, custom, religion etc.

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LIFE STYLE
⚫ Behavioral pattern and life long habits e.g. smoking and
alcohol consumption, food habit, personal hygiene, rest and
physical exercise, bowel and sleeping patterns, sexual
behavior.

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SOCIO-ECONOMIC CONDITIONS

⚫ It consist of education, occupation and income.

⚫ The world map of illiteracy closely coincides with the maps of
poverty, malnutrition, ill health, high infant and child mortality
rates.
⚫ The very state of being employed in productive work promotes
health, because the unemployed usually show a higher incidence
of ill-health and deaths.
⚫ There can be no doubt that economic progress has positive
impact factor in reducing morbidity, increasing life expectancy
and improving the quality of life.

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AVAILABILITY OF HEALTH AND FAMILY
WELFARE SERVICES
⚫ Health and family welfare services cover a wide spectrum of
personal and community services for treatment of diseases,
prevention of disease and promotion of health.
⚫ The purpose of health services is to improve the health
status of population.
⚫ For example, immunization of children can influence the
incidence/prevalence of particular disease. Provision of safe
water can prevent mortality and morbidity from water-borne
diseases.

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AGING OF THE POPULATION

⚫ By the year 2020, the world will have more than one billion
people aged sixty or over and more than two-thirds of them
living in developing countries.
⚫ A major concern of rapid population aging is the increased
prevalence of chronic diseases and disabilities both being
condition that tend to accompany the aging process and
deserve special attention.

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OTHER DETERMINANTS OF HEALTH
⚫ Except above discussed determinants, there are many more
determinates of health and disease of an individual and
community. These include:
⚫ Science and technology
⚫ Information and communication
⚫ Gender
⚫ Equity and social justice
⚫ Human rights etc.

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CONCEPT OF DISEASE

⚫ Webster defines disease as “a condition in which body health is

impaired, a departure from a state of health, an alteration of the
human body interrupting the performance of vital functions”.

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CONCEPTS OF DISEASES CAUSATION
1. Germ Theory of disease
⚫ In 1860, Louis Pasteur demonstrated the presence of
bacteria in air.
⚫ This theory emphasized that the sole cause of disease is
microbes.
⚫ The theory generally referred to as one-to- one
relationship between disease agent and disease.
Disease agent Man Disease

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2. Epidemiological Triad concept
⚫ The germ theory of disease has many limitations
⚫ For example it is well – known that not all exposed to
tuberculosis bacilli develops tuberculosis, the same
condition in an undernourished person may result in
clinically manifest.

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EPIDEMIOLOGICAL TRIAD
(a) Agent factors:
Substance living or non living , or a force, tangible or intangible,
the excessive presence or relative lack of which may initiate or
perpetuate a disease process.

1. Biological Agents – bacteria, virus, fungi, protozoa, etc

2. Nutrient – fats, proteins, carbohydrates, vitamins
3. Physical – excessive cold, heat, radiation, humidity, pressure
4. Chemical – (a) endogenous: urea, ketones, uric acid, etc
(b) exogenous: metals, fumes, dust, gases.
5. Mechanical – crushing, tearing, sprains, dislocation
6. Social – unhealthy lifestyle, smoking, poverty, drug abuse and
alcohol, etc
(b) Host factors: defined as a person or animal.
Classified as;
1. Demographic characteristics: age, gender, etc
2. Biological characteristics: genetic factors
3. Social & Economic: education, occupation, marital status, etc
4. Lifestyle factors: personality traits, living habits, physical
exercise

(c) Environmental factors:

1. Physical
2. Biological
3. Psychosocial
3. MULTI-FACTORIAL ETIOLOGY
⚫ Disease is caused due to multiple factors, not a single one.
The germ theory of disease or single cause of disease is
always not true.
⚫ PETTENKOFER OF MUNICH (1819-1901)-early proponent of
this concept. “Germ theory of disease "or “single cause idea
"in late 19th century overshadowed the multiple cause theory.

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4. WEB OF CAUSATION
⚫ Suggested by- Mac Mahon and Pugh.
⚫ “Web of causation” considers all the predisposing factors of
any type and their complex interrelationship with each other.
Removal or elimination of just one link or chain may be
sufficient to control the disease, provided that link is
sufficiently important in the pathogenetic process.
⚫ The web of causation does not imply that the disease can not
be controlled unless all the multiple causes or chain of
causation or at least a number of them are appropriately
controlled.

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WEB OF DISEASE CAUSATION
C h a n g e s in life style
Stre s s

Smoking
i se Emot ional stress
tak
e erc
od
in l ex
o a
f f sic
n t yo P hy
Ple of
ck A g in g
La

H TN
Obesit y

Hyperlipidemia C h a n g e s in the walls

of arteries
C o r o n a r y Occlusion

Coronary Myocardial ischemia Myocardial I schemia

Ath e ros c le ros is
Fig: W e b of causation of MI
41

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5. NATURAL HISTORY OF DISEASE
For successful prevention, control or eradication of disease in
community one should know the natural history of the disease.
Any disease has 2 phases namely:-
1. Pre-pathogenesis phase: Disease agent has not entered man,
but factors favoring disease exist in the environment.
What required is an interaction of these factors to initiate the
disease process.
2. Pathogenesis phase:
Entry of disease agent in susceptible human host.
Disease agent multiplies and induces tissue and physiological
changes.
Final outcome- recovery, disability or death.
This phase may be modified by intervention measures such as
immunization, prophylaxis
6. RISK FACTORS
Where the disease agent is not firmly established, the aetiology is
generally discussed in terms of risk factors.
The term risk factor is used by different authors with at least two
meanings;

(a) An attribute or exposure that is significantly associated with

development of disease.

(b) A determinant that can be modified by intervention, thereby

reducing the possibility of occurrence of disease or other
specified outcomes.
7. SPECTRUM OF DISEASE
Is a graphical representation of variations in the manifestations
of disease.
At one end are subclinical infections which are not ordinarily
identified and at the other end are fatal illnesses.
In the middle of the spectrum lie illnesses ranging in severity
from mild to severe.
8. ICEBERG OF DISEASE
9. CONCEPT OF CONTROL
⚫ DISEASE CONTROL: The term disease control refers ongoing
operation aimed at reducing:
⚫ The incidence of disease.
⚫ The duration of disease and the consequently the risk of
transmission.
⚫ The effect of infection including physical and
psychological complication.
⚫ The financial burden to the community.

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ELIMINATION: Reduction of case transmission to a
predetermined very low level or interruption in transmission.
E.g. measles, polio, leprosy from the large geographic region or
area.

ERADICATION: Termination of all transmission of infection by

extermination of the infectious agent through surveillance and
containment.
“All or none phenomenon”. e.g. Small pox

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LEVELS OF PREVENTION
⚫ Primordial prevention
⚫ Primary prevention
⚫ Secondary prevention
⚫ Tertiary Prevention

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Primordial Prevention:
⚫ Prevention from Risk Factors.
⚫ Prevention of emergence or development of Risk Factors.
⚫ Discouraging harmful life styles.
⚫ Encouraging or promoting healthy eating habits.
Primary Prevention:
⚫ Pre-pathogenesis Phase of a disease.
⚫ Action taken prior to the onset of the disease:
⚫ Immunization & Chemo-prophylaxis

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Secondary Prevention:
⚫ Halt the progress of a disease at its incipient phase.
⚫ Early diagnosis & Adequate medical treatment.
Tertiary Prevention:
⚫ Intervention in the late Pathogenesis Phase.
⚫ Reduce impairments, minimize disabilities & suffering.

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MODES OF INTERVENTION
⚫ Intervention is any attempt to intervene or interrupt the usual
sequence in the development of disease. Five modes of
intervention corresponding to the natural history of any disease
are:
⚫ Health Promotion
⚫ Specific Protection
⚫ Early Diagnosis and Adquate Treatment
⚫ Disability Limitation
⚫ Rehabilitation

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HEALTH PROMOTION
⚫ It is the process of enabling people to increase control over
diseases, and to improve their health. It is not directed against
any particular disease but is intended to strengthen the host
through a variety of approaches (interventions):
⚫ Health Education
⚫ Environmental Modifications
⚫ Nutritional Interventions
⚫ Lifestyle and Behavioral Change

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SPECIFIC PROTECTION
⚫ Some of the currently available interventions aimed at
specific protection are:
⚫ Immunization
⚫ Use of specific Nutrients
⚫ Chemoprophylaxis
⚫ Protection against Occupational Hazards
⚫ Avoidance of Allergens
⚫ Control of specific hazards in general
environment
⚫ Control of Consumer Product Quality & Safety

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EARLY DIAGNOSIS & TREATMENT
⚫ Though not as effective and economical as ‘Primary Prevention’,
early detection and treatment are the main interventions of
disease control, besides being critically important in reducing the
high morbidity and mortality in certain diseases like
hypertension, cancer cervix, and breast cancer.
⚫ The earlier the disease is diagnosed and treated the better it is
from the point of view of prognosis and preventing the
occurrence of further cases (secondary cases) or any long term
disability.

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DISABILITY LIMITATIONS

⚫ The Objective is to prevent or halt the transition of the disease

process from impairment to handicap.

Sequence of events leading to disability & handicap:

⚫ Disease → Impairment → Disability→ Handicap

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⚫ Impairment: Loss or abnormality of psychological,
physiological/anatomical structure or function.
⚫ Disability: Any restriction or lack of ability to perform an
activity in a manner considered normal for one’s age
⚫ Handicap: Any disadvantage that prevents one from fulfilling
his role considered normal.

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 REHABILITATION
⚫ Rehabilitation has been defined as the ‘combined and coordinated
use of medical, social, educational and vocational measures for
training and retraining the individual to the highest possible level
of functional ability”
⚫ Areas of concern in rehabilitation:
⚫ Medical Rehabilitation
⚫ Vocational Rehabilitation
⚫ Social Rehabilitation
⚫ Psychological Rehabilitation

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 DR.SALSBEEL KHAN
ASSISTANT PROFESSOR
CONTENTS
Biggest Challenge in Preventive Medicine is to distinguish between
people who have the disease and those who do not..

ICEBEERG PHENOMENON
CLINICAL DISEASE
This gives an idea of
progress of a disease from its
subclinical stages to overt
disease

HIDDEN: Subclinical
cases, carriers,
undiagnosed cases. HIDDEN BURDEN
OF DISEASE
The Search for unrecognized disease or defect by means of
rapidly applied tests, examinations or the other procedures in
apparently healthy individuals.

 Earlier it was to conserve physicians time for diagnosis,

administer inexpensive lab tests etc,.
But Today, Screening is
considered a form of secondary
prevention.

It detects disease in its early

asymptomatic phase whereby
early treatment can be given
and disease can be cured or its
progression can be delayed.`
1. CASE DETECTION: Prescriptive screening
 Defined as “The presumptive identification of unrecognized
disease, which does not arise from a patients request”.
Neonatal screening.

The people are screened

primarily for their own benefit.

Heel Prick Blood Sample

 2. CONTROL OF DISEASE: Prospective screening
People are examined for the benefit of others.

- Screening of Immigrants from infectious diseases like

Ebola, Tb & Syphilis to protect the home population.
- Screening for HIV, STD’s etc,.

Screening programme
may, by leading to early
diagnosis permit more
effective treatment and
reduce the spread of
infectious disease and
mortality.

Ebola Check at Airports

 3. RESEARCH PURPOSES:

- To know the history of many chronic diseases like cancer, HTN etc.

-Screening may aid in obtaining more basic knowledge about

the natural history of such diseases.

Initial screening
provides a prevalence
estimate.

Subsequent screening
provides an incidence
figure.
4. EDUCATIONAL OPPORTUNITIES:

Screening programmes help in

- Acquisition of information of public health

relevance.
- Providing opportunities for creating public
awareness.
- For educating health professionals.
 1. MASS SCREENING

Application of screening test to large, unselected population.

Everyone in the group is screened regardless of the probability of
having the disease or condition.

a)Visual defects in all school

children
b) Mammography in women
c) Colonoscopy for occult
blood.
2. HIGH RISK / SELECTIVE / TARGETED SCREENING

The screening of selected high-risk groups in the population.

a) Screening fetus for Down’s syndrome in a

mother who already has a baby with Down’s
syndrome
b) Screening for familial cancers, HTN and DM
c) Screening for CA Cervix in low SES women
d) Screening for HIV in risk groups.
3. MULTIPURPOSE SCREENING
The screening of a population by more than one test done
simultaneously to detect more than one disease

a)screening of pregnant women for VDRL, HIV,

HBV by serological tests

4. MULTIPHASIC SCREENING
The screening in which various diagnostic procedures are
employed during the same screening program.

a) DM – FBS, Glucose tolerance test

b) Sickle cell anemia – CBC, Hb electrophoresis
Before initiating a Screening Programme, a decision must be
made whether it abides to all the ethical, scientific and
financial justification.

The principles that should govern the introduction of screening

programmes were first enunciated by Wilson and Junger (1968)

 The Criteria for Screening is based on two considerations:

- DISEASE

- SCREENING TEST.
1. DISEASE

The Disease should be important Health problem (High

Prevalence)- TB

 Disease should have Long & Detectable Preclinical stage.

The Natural history of disease should be adequately

understood.

Appropriate test must be available for early detection of

disease (before signs and symptoms appear)
Facilities must be available for diagnosis of disease

 Early detection of disease and treatment should be able to

reduce mortality & morbidity.

The disease should be treatable, and there should be a

recognized treatment for lesions identified following screening.

 Expected benefits must exceed risks and costs.

A Policy should be agreed on, concerning whom to treat as

patients.
2. SCREENING TEST

a) Inexpensive & Easy to Apply- (Simplicity)

b) Acceptable

c) Valid

d) Reliable

e) Yielding
 SIMPLICITY

The test should be simple to perform, easy to interpret and,

where possible, capable of use by paramedics and other
personnel.

.
Ex: Blood and urine tests
and ECG for early
detection of
hypertension
 ACCEPTABILITY

• Since participation in screening is voluntary, the test must be

acceptable to those undergoing it.

• In general tests that are painful, discomforting or

embarrassing are not likely to be acceptable.

Ex: Screening for prostrate cancer might not be acceptable to a

large proportion of the community.
 WHAT IS VALID AND RELIABLE?

VALIDITY IS THE ACCURACY OF A TEST.

RELIABILITY IS THE PRECISION OF A TEST.

ACCURACY: “how close is result of a test to its true value?”

PRECISION: “how close are the results of a test on repetition?”

LA,HP HA,HP

LA,LP HA,LP
 Validity determines the Accuracy of the Test.

-It expresses the ability of a test to separate those who have the
disease from those who do not.

- A test with little systematic error is a valid test.

Sensitivity
Components
of Specificity
VALIDITY
Predictive Accuracy
 SENSITIVITY

The ability of a test to correctly identify those who have the

disease (True Positives)-
“Proportion of Truly Ill Population”

GOLD STANDARD
Ds present Ds absent

Test positive

Test negative

Expressed as percentage….. TP/ TP+FN.

 SPECIFICITY

The ability of a test to correctly identify those who do not have the
disease. (True Negatives)

Proportion of Truly Healthy Population.

GOLD STANDARD
Ds present Ds absent

Test positive

Specificity- TN/TN+FP

Test negative
 Calculating

An Ideal Screening Test should have 100% Sensitivity, and 100%

Specificity. (Not Practically Possible)
FALSE NEGATIVES: If a Person with disease is labeled Negative:

- False reassurance
- Ignores any disease signs and symptoms Low Sn
- Postponement of treatment. High Sp
- Detrimental to overall health

FALSE POSITIVES: If a Person without disease is labeled Positive:

- Further testing with long, expensive tests.

- Discomfort, inconvenience, anxiety High Sn
- Burden on health facilities Low Sp
- Emotional trauma
- Difficulty in “de-labeling”
 PREDICITVE ACCUARCY

Positive Predictive Value:

The Proportion of the people who is screened positive

that actually have the disease. (Are the people with disease
correctly identified?)

Negative Predictive Value:

The Proportion of the people who is screened negative

that are actually FREE of the disease. (Are the people without
disease correctly identified?)

These Values are not fixated for a particular test.

Calculating…

PPV= TP/TP+FP NPV= TN/TN+FN

  Predictive accuracy depends on-
Prevalence of the Disease.
Specificity of the Test.

More prevalent diseases has high PPV, that’s why SCREENING

is more efficient & productive, If done in High risk population.

Increase in Sensitivity causes a

modest increase in PPV, but
increase in Specificity raises PPV
markedly.
 Reliability determines the Precision of the Test. (Repeatability)

 It means that all the results of the test should be similar

(Cluster at one place), when conducted each and every time.

 This is not possible because of the Variations that cause the

test to not yield same results every time (like
Lab equipment failure etc.)

- Intrasubject Variation
3 types of Variation - Intraobserver Variation
- Interobserver Variation
 1. INTRA-SUBJECT VARIATION

This is the Variation in the results of the test conducted

over time (short periods) on the same individual.

The difference is due to the changes that occur to the individual

over that time period.

Variation in BP during a 24 hour period.

2. INTRA-OBSERVER VARIATION

 This is the Variation in the results of the test due to the

same observer examining the result at different times.

EX: Two readings of Blood pressure by the Same observer.

3. INTER-OBSERVER VARIATION

 This is the Variation in the results of the test due to the

multiple observers examining the result.

EX: Chest X ray read by two different Radiologists.

Yield is the amount of previously unrecognized disease that is
detected and brought to treatment as a result of Screening.

YIELD = TP + FP / TP + FP + TN + FN

It depends on prevalence of the disease and sensitivity

of the screening test.

Hence, yield of a screening test is high in high – risk

screening.