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  <head>
    <title>065-02 Population measurement, screening trade-offs, vaccine strategy, and equitable prevention</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Population measurement, screening, vaccines, and equity">
      <outline text="The population frame">
        <outline text="Attention moves to distributions"/>
        <outline text="Air, work, housing, income decide patient numbers"/>
        <outline text="Who reaches it, who bears the burden"/>
      </outline>
      <outline text="Measuring occurrence">
        <outline text="Cumulative incidence: probability over interval"/>
        <outline text="Incidence rate: events per person-time"/>
        <outline text="Prevalence rises with incidence or duration">
          <outline text="Treatment extends survival, raises prevalence"/>
        </outline>
        <outline text="Case fatality changes with milder diagnosis"/>
        <outline text="Crude rates reflect age and sex structure"/>
        <outline text="Direct standardisation: common reference population"/>
        <outline text="Indirect: observed versus expected events">
          <outline text="Not the actual local burden"/>
        </outline>
      </outline>
      <outline text="Causation and effect size">
        <outline text="Association is not causation"/>
        <outline text="Confounder links exposure and outcome"/>
        <outline text="Randomisation averages known and unknown confounding">
          <outline text="Loss to follow-up and crossover remain"/>
        </outline>
        <outline text="Observational adjustment leaves unmeasured confounding"/>
        <outline text="Relative risk looks impressive for rare events"/>
        <outline text="Number needed to treat inherits time horizon">
          <outline text="Changes with baseline risk"/>
        </outline>
      </outline>
      <outline text="Screening justification and biases">
        <outline text="Offered without symptoms for patient-important outcomes"/>
        <outline text="Earlier finding alone is not justification"/>
        <outline text="Assay with poor follow-up is not a programme"/>
        <outline text="Lead-time bias: death unchanged"/>
        <outline text="Length bias finds slower lesions"/>
        <outline text="Overdiagnosis: real but harmless pathology">
          <outline text="Better confirmation cannot correct it"/>
          <outline text="Overtreatment follows"/>
        </outline>
        <outline text="Randomised harm reduction beats stage or survival"/>
      </outline>
      <outline text="Screening thresholds and decisions">
        <outline text="Low prevalence magnifies false positives">
          <outline text="Imaging, biopsy, anxiety, labels"/>
        </outline>
        <outline text="Higher threshold: specificity up, disease missed">
          <outline text="Delayed diagnosis versus unnecessary follow-up"/>
        </outline>
        <outline text="Same period and denominator for all outcomes"/>
        <outline text="Symptomatic testing is not screening"/>
        <outline text="Declining is legitimate and revisable"/>
        <outline text="Uptake easiest among the well served">
          <outline text="Outreach, interpreters, navigation needed"/>
        </outline>
        <outline text="Track confirmation and outcomes by group"/>
      </outline>
      <outline text="Vaccine platforms and effectiveness">
        <outline text="Live attenuated: broad response">
          <outline text="Unsafe in cellular immunodeficiency, pregnancy"/>
        </outline>
        <outline text="Non-live platforms cannot replicate infection"/>
        <outline text="Conjugation enables memory in young children"/>
        <outline text="Efficacy in trials, effectiveness in practice"/>
        <outline text="Severe disease better protected than infection"/>
        <outline text="Herd threshold rarely exact"/>
      </outline>
      <outline text="Vaccine delivery and safety">
        <outline text="Right product, person, and interval"/>
        <outline text="Cold chain deviation not judged by appearance"/>
        <outline text="Temporal association is not causation">
          <outline text="Stimulated reporting creates clusters"/>
          <outline text="Compare observed with expected rates"/>
        </outline>
        <outline text="Contraindications narrower than myths"/>
        <outline text="Non-live vaccines before immunosuppression"/>
        <outline text="Catch-up continues, not restarts"/>
      </outline>
      <outline text="Cardiovascular prevention">
        <outline text="Based on absolute risk">
          <outline text="Same lipid fall prevents more at high risk"/>
        </outline>
        <outline text="Confirm blood pressure before long-term labels"/>
        <outline text="Risk calculators are not individual probability">
          <outline text="Miss structural disadvantage"/>
        </outline>
        <outline text="Lifestyle is not a precondition for drugs"/>
        <outline text="Aim: fewer infarcts, strokes, kidney failure"/>
        <outline text="Overtreatment if benefit lies beyond life expectancy">
          <outline text="Frailty, falls, polypharmacy, bleeding"/>
        </outline>
        <outline text="Neither stop by age nor continue automatically"/>
      </outline>
      <outline text="Cancer, infection, and dependence">
        <outline text="Screening differs by organ and risk">
          <outline text="Ovarian markers, thyroid ultrasound overdiagnose"/>
        </outline>
        <outline text="Interrupt the actual transmission route"/>
        <outline text="Resistance prevention starts with fewer infections"/>
        <outline text="Nicotine replacement separates nicotine from combustion"/>
        <outline text="Relapse prompts another treatment attempt"/>
        <outline text="Opioid harm reduction keeps abstinence access"/>
      </outline>
      <outline text="Equity and implementation">
        <outline text="Social categories are not fixed biology"/>
        <outline text="Equity modifies resources for comparable benefit"/>
        <outline text="Averages conceal worsening minorities"/>
        <outline text="Separate invited, participating, lost, harmed">
          <outline text="Absolute and relative gaps may diverge"/>
        </outline>
        <outline text="Examine system mechanisms, not culture"/>
        <outline text="Process measures matter only with outcomes"/>
        <outline text="Transition plan preserves care and data"/>
      </outline>
    </outline>
  </body>
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