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Points of Intervention

An intervention is any action taken to reduce the impact of a disease, including interventions to prevent disease, cure or reduce the mortality Mortality All deaths reported in a given population. Measures of Health Status and morbidity Morbidity The proportion of patients with a particular disease during a given year per given unit of population. Measures of Health Status of a disease, or influence public behavior that increases the risk of disease. Interventions can be classified as preventive, therapeutic, or other public health interventions. In clinical studies, interventions are tested on subject groups to assess their effects on a disease or condition. The particular implementation of these interventions has considerable influence on the study design that will be ultimately chosen to assess them.

Last updated: Aug 8, 2022

Editorial responsibility: Stanley Oiseth, Lindsay Jones, Evelin Maza

Preventive Interventions

Preventive interventions are actions that prevent a disease and reduce the incidence Incidence The number of new cases of a given disease during a given period in a specified population. It also is used for the rate at which new events occur in a defined population. It is differentiated from prevalence, which refers to all cases in the population at a given time. Measures of Disease Frequency of new cases, including education, vaccines, nutritional interventions, maternal and neonatal interventions, behavioral interventions, and environmental interventions.

Vaccines

  • Non-infectious antigens given to provoke an immune response that conveys protection against infection by a specific pathogen
  • Often the most cost-effective interventions
  • Employed as part of public health programs

Nutritional interventions

  • Provide appropriate nutrition to prevent health problems related to malnutrition Malnutrition Malnutrition is a clinical state caused by an imbalance or deficiency of calories and/or micronutrients and macronutrients. The 2 main manifestations of acute severe malnutrition are marasmus (total caloric insufficiency) and kwashiorkor (protein malnutrition with characteristic edema). Malnutrition in children in resource-limited countries and/or nutrient deficiencies
  • Applicable to all age groups (fetal development to adults)
  • Often ongoing and long term
  • Can target whole populations or specific subgroups 

Maternal and neonatal interventions

  • Tests and care applied before/during pregnancy Pregnancy The status during which female mammals carry their developing young (embryos or fetuses) in utero before birth, beginning from fertilization to birth. Pregnancy: Diagnosis, Physiology, and Care, antepartum, and postpartum to prevent disease in both mother and child
  • Examples:
    • Family planning 
    • Antenatal visits and routine screening tests Screening tests Screening tests are used to identify people in the early stages of a disease and enable early intervention with the goal of reducing morbidity and mortality. Epidemiological Values of Diagnostic Tests
    • Antenatal monitoring (e.g., ultrasound)
    • Treatment of gestational infections Infections Invasion of the host organism by microorganisms or their toxins or by parasites that can cause pathological conditions or diseases. Chronic Granulomatous Disease
    • Nutritional recommendations and supplements
    • Access to adequate care during delivery

Educational and behavioral interventions

  • Attempts to change behaviors linked to disease, often through widespread community education programs (e.g., educational campaigns, public awareness efforts, public service announcements)
  • Efficacy dependent on individual willingness and effort
  • Often must be implemented for years to demonstrate results

Environmental interventions

  • Alterations to the environment of a population to reduce the risk of infection or disease
  • Alterations often widespread, involving large-scale, costly changes to public spaces
  • Success requires significant lifestyle changes and the co-operation of multiple individuals.
  • Examples: 
    • Infrastructure changes (e.g., construction of proper sewage and clean water supplies)
    • Vector control (e.g., reduction of habitats and breeding sites) 
    • Pharmacological prophylaxis Prophylaxis Cephalosporins (e.g., antimalarial medication in endemic zones)

Therapeutic Interventions

Therapeutic interventions alleviate or prevent mortality Mortality All deaths reported in a given population. Measures of Health Status (reduce case fatality rate Case fatality rate Defined as the number of deaths of individuals with a certain disease or condition divided by the total number of people diagnosed with that same disease or condition over a specific time period. Measures of Health Status) and morbidity Morbidity The proportion of patients with a particular disease during a given year per given unit of population. Measures of Health Status of a disease once established, including the management of infectious Infectious Febrile Infant disease, surgical and radiation Radiation Emission or propagation of acoustic waves (sound), electromagnetic energy waves (such as light; radio waves; gamma rays; or x-rays), or a stream of subatomic particles (such as electrons; neutrons; protons; or alpha particles). Osteosarcoma treatment, diagnostics to guide therapy, and control of chronic diseases.

Management of infectious Infectious Febrile Infant disease

  • Use of pharmacologic agents that seek to kill or inhibit the replication of pathogens to prevent their spread and reduce associated mortality Mortality All deaths reported in a given population. Measures of Health Status and morbidity Morbidity The proportion of patients with a particular disease during a given year per given unit of population. Measures of Health Status
  • Studies of these agents often involve:
    • Case detection: the ability to accurately diagnose and identify new cases 
    • Case holding: the ability to regularly follow and treat cases over a sufficient period of time to eliminate the pathogen

Surgical and radiation Radiation Emission or propagation of acoustic waves (sound), electromagnetic energy waves (such as light; radio waves; gamma rays; or x-rays), or a stream of subatomic particles (such as electrons; neutrons; protons; or alpha particles). Osteosarcoma management

  • Direct surgical or radiation Radiation Emission or propagation of acoustic waves (sound), electromagnetic energy waves (such as light; radio waves; gamma rays; or x-rays), or a stream of subatomic particles (such as electrons; neutrons; protons; or alpha particles). Osteosarcoma interventions to reduce morbidity Morbidity The proportion of patients with a particular disease during a given year per given unit of population. Measures of Health Status and mortality Mortality All deaths reported in a given population. Measures of Health Status of disease 
  • Often seen as part of randomized control trials (RCTs)

Diagnostics to guide therapy

  • Application of diagnostic tests Diagnostic tests Diagnostic tests are important aspects in making a diagnosis. Some of the most important epidemiological values of diagnostic tests include sensitivity and specificity, false positives and false negatives, positive and negative predictive values, likelihood ratios, and pre-test and post-test probabilities. Epidemiological Values of Diagnostic Tests to accurately identify new cases and assess the effectiveness of management 
  • Studies are performed to assess specificity and sensitivity of diagnostic tests Diagnostic tests Diagnostic tests are important aspects in making a diagnosis. Some of the most important epidemiological values of diagnostic tests include sensitivity and specificity, false positives and false negatives, positive and negative predictive values, likelihood ratios, and pre-test and post-test probabilities. Epidemiological Values of Diagnostic Tests to increase diagnostic accuracy, leading to a reduction in disease impact.

Control of chronic diseases

  • Clinical care in addition to management:
    • Screening Screening Preoperative Care to identify new cases, clinical assessment of each stage of disease
    • Monitoring and management of complications of disease 
  • Studies often require years to decades to evaluate.

Other Interventions

Other interventions also affect Affect The feeling-tone accompaniment of an idea or mental representation. It is the most direct psychic derivative of instinct and the psychic representative of the various bodily changes by means of which instincts manifest themselves. Psychiatric Assessment disease burdens, including governmental and healthcare system Healthcare System The complexity of health systems and the delivery of healthcare has resulted in the growing field of health systems science, which has now joined basic and clinical sciences as the 3rd pillar of medical education. Health systems science allows for an understanding of the framework in which care providers practice, and in comprehension of the interconnected components of care delivery. Healthcare System changes.

Governmental changes

  • Widespread changes in policy, legislation Legislation Works consisting of the text of proposed or enacted legislation that may be in the form of bills, laws, statutes, ordinances, or government regulations. Patient-Doctor Confidentiality, or taxes that seek to change public behavior that leads to or exacerbates disease 
  • Assessment studies are difficult because implementation is often nationwide, and it is difficult to find a control group.

Healthcare system Healthcare System The complexity of health systems and the delivery of healthcare has resulted in the growing field of health systems science, which has now joined basic and clinical sciences as the 3rd pillar of medical education. Health systems science allows for an understanding of the framework in which care providers practice, and in comprehension of the interconnected components of care delivery. Healthcare System changes

  • Include changes in health sector training, healthcare organization, healthcare education, financing, and decentralization of care 
  • Studies often involve a “step approach,” where phased implementations are evaluated over time to assess efficacy.

References

  1. Smith, P., Morrow, R. & Ross, D. (2015). Field trials of health interventions: a toolbox. Oxford University Press.

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