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  <head>
    <title>065-01 Foundations</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Epidemiology, screening, vaccination, and population health">
      <outline text="Orientation">
        <outline text="Why disease occurs unevenly"/>
        <outline text="Housing, income, education, food, work, access">
          <outline text="Determine illness and recovery"/>
        </outline>
        <outline text="Evidence with fairness, feasibility, trust, harm"/>
      </outline>
      <outline text="Measures of disease">
        <outline text="Incidence: new events among people at risk"/>
        <outline text="Prevalence: existing disease at point or period">
          <outline text="Depends on incidence and duration"/>
          <outline text="Chronic survivable disease: high prevalence"/>
        </outline>
        <outline text="Case fatality: diagnosed cases who die"/>
        <outline text="Risk is probability, rate uses person-time"/>
        <outline text="Absolute difference versus relative ratio">
          <outline text="Rare outcome: large relative, small absolute"/>
        </outline>
        <outline text="Number needed to treat: 1 / absolute reduction">
          <outline text="State time horizon and baseline risk"/>
        </outline>
        <outline text="Standardisation depends on chosen reference"/>
        <outline text="Ecological data cannot apply to individuals"/>
      </outline>
      <outline text="Prevention levels">
        <outline text="Primordial: prevents emergence of risk"/>
        <outline text="Primary: prevents disease before onset"/>
        <outline text="Secondary: early detection and prompt treatment"/>
        <outline text="Tertiary: limits complication and disability"/>
        <outline text="Quaternary: protects from unnecessary intervention"/>
        <outline text="Upstream measures reach more than counselling">
          <outline text="Safe water needs no repeated individual choice"/>
          <outline text="Taxes and labelling should avoid regressive burden"/>
        </outline>
      </outline>
      <outline text="Screening principles">
        <outline text="Aim is less morbidity or mortality"/>
        <outline text="Needs detectable preclinical phase">
          <outline text="Effective earlier treatment and defined pathway"/>
        </outline>
        <outline text="Low prevalence: false positives outnumber true"/>
        <outline text="Harms: anxiety, follow-up, overdiagnosis"/>
        <outline text="Length bias favours slow disease"/>
        <outline text="Lead-time bias lengthens apparent survival">
          <outline text="Randomised outcomes beat stage shift"/>
        </outline>
        <outline text="Sensitive test, then specific confirmation"/>
        <outline text="Programme can widen inequity"/>
        <outline text="Opportunistic testing without follow-up fails"/>
      </outline>
      <outline text="Vaccination and immune protection">
        <outline text="Antigen exposure creates memory B and T cells"/>
        <outline text="Conjugation recruits T-cell help"/>
        <outline text="Adjuvants enhance innate signalling"/>
        <outline text="Effectiveness varies with host and pathogen">
          <outline text="Severe disease prevented better than infection"/>
        </outline>
        <outline text="Herd threshold varies with transmissibility"/>
        <outline text="Events after vaccination not necessarily caused">
          <outline text="Compare background rates, timing, mechanism"/>
        </outline>
        <outline text="Live vaccines replicate">
          <outline text="Avoided in severe immune suppression, pregnancy"/>
        </outline>
        <outline text="Vaccinate before immune-suppressive treatment"/>
        <outline text="Missed doses continue, not restart"/>
      </outline>
      <outline text="Cardiovascular and metabolic prevention">
        <outline text="Estimate absolute cardiovascular risk">
          <outline text="Risk factors act together"/>
        </outline>
        <outline text="Accurate, repeated blood-pressure measurement"/>
        <outline text="Lipid benefit follows baseline risk"/>
        <outline text="Statin effects evaluated, prevention kept"/>
        <outline text="Antiplatelet: bleeding outweighs low-risk benefit"/>
        <outline text="Obesity care avoids stigma"/>
        <outline text="Adjust goals for frailty and life expectancy"/>
      </outline>
      <outline text="Cancer prevention and early detection">
        <outline text="Tobacco control prevents multiple cancers"/>
        <outline text="Papillomavirus and hepatitis B vaccination"/>
        <outline text="Chemoprevention only if risk justifies harm"/>
        <outline text="Cervical, breast, colorectal, lung programmes"/>
        <outline text="A test existing is not a reason to screen">
          <outline text="Thyroid, ovarian, pancreatic overdiagnosis"/>
        </outline>
      </outline>
      <outline text="Infectious-disease prevention">
        <outline text="Match precautions to transmission route"/>
        <outline text="Protective equipment is one layer only">
          <outline text="Fails with poor systems, ventilation, staffing"/>
        </outline>
        <outline text="Antimicrobial resistance from shared exposure">
          <outline text="Narrow therapy, correct dose and duration"/>
          <outline text="No antibiotics for viral illness"/>
        </outline>
        <outline text="One Health: shared ecosystems"/>
      </outline>
      <outline text="Tobacco, alcohol, and substance prevention">
        <outline text="Behavioural support plus pharmacotherapy"/>
        <outline text="Long-acting plus short-acting nicotine"/>
        <outline text="Relapse prompts support, not blame"/>
        <outline text="Alcohol risk varies by dose and pattern"/>
        <outline text="Naloxone and agonist treatment reduce death"/>
      </outline>
      <outline text="Health equity and implementation">
        <outline text="Equal gives same resource"/>
        <outline text="Equitable responds to barriers and need"/>
        <outline text="Identity is not biology"/>
        <outline text="Community co-design builds trust"/>
        <outline text="Evaluate reach, uptake, harm, distribution"/>
        <outline text="Healthier choices made practical and ordinary"/>
      </outline>
    </outline>
  </body>
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