1. HW215: Models of Health & Wellness Unit 7: Health and Wellness Models Geo-political Influences

2. Agenda for the Unit 7 Seminar Unit 7 Learning Objectives Discussion of the Importance of the Efficacy of Screening Unit 7 Discussion Questions

3. Unit 7 Learning Objectives Recognize the effects of geography on health outcomes. Recognize the power politics holds on distribution of health resources which in turn affects health outcomes. Describe geo-political design components. Evaluate the impact of eHealth and the use of advanced technology related to geography on health and wellness models. Identify design components for incorporation into a geo-political model of health and wellness.

4. A Closer Look at Breast Cancer Screening.... Why? Recognize the power politics holds on distribution of health resources which in turn affects health outcomes (Unit 7 Learning Outcome) Evaluate Health and Wellness Information (US Preventive Services Task Force & American Cancer Society)

5. What is the Issue? 2002 Recommendations: - A “B” Recommendation for screening mammography for women 40 years or older. 2009 Recommendations: - A “C” Recommendation for screening mammography for women 40 years or older. B=Recommended Routinely C=Not Recommended Routinely Agency for Health Care Research and Quality. U.S. Preventive Services Task Force – About USPTF (n.d). Retrieved electronically on 4/7/10 from http://www.ahrq.gov/clinic/uspstfab.htmhttp://www.ahrq.gov/clinic/uspstfab.htm

6. U.S. Preventive Services Task Force “The mission of the USPSTF is to evaluate the benefits of individual services based on age, gender, and risk factors for disease; make recommendations about which preventive services should be incorporated routinely into primary medical care and for which populations; and identify a research agenda for clinical preventive care.” “Public Law Section 915 mandates that AHRQ convene the USPSTF to conduct scientific evidence reviews of a broad array of clinical preventive services, develop recommendations for the health care community, and provide ongoing administrative, research, technical, and dissemination support.” Agency for Health Care Research and Quality. U.S. Preventive Services Task Force – About USPTF (n.d). Retrieved electronically on 4/7/10 from http://www.ahrq.gov/clinic/uspstfab.htmhttp://www.ahrq.gov/clinic/uspstfab.htm

7. Why the Change? “The precise age at which the benefits from screening mammography justify the potential harms is a subjective judgment and should take into account patient preferences.” Benefits vs. Risks Beneficence, Non-Malfeasance Reduced chance of dying vs. false positives, unnecessary biopsies U.S. Preventive Services Task Force (2009). Screening for breast cancer: U.S. Preventive Services Task Force recommendation statement. Annals of Internal Medicine. 151(10):716-726.

8. Ann Intern Med 2009;151:716-726 ©2009 by American College of Physicians

9. American Cancer Society “With its new recommendations, the USPSTF is essentially telling women that mammography at age 40 to 49 saves lives; just not enough of them. The task force says screening women in their 40s would reduce their risk of death from breast cancer by 15 percent, just as it does for women in their 50s. But because women in their 40s are at lower risk of the disease than women 50 and above, the USPSTF says the actual number of lives saved is not enough to recommend widespread screening. The most recent data show us that approximately 17 percent of breast cancer deaths occurred in women who were diagnosed in their 40s, and 22 percent occurred in women diagnosed in their 50s. Breast cancer is a serious health problem facing adult women, and mammography is part of our solution beginning at age 40 for average risk women.” American Cancer Society. American Cancer Society Responds to Changes to USPSTF Mammography Guidelines (11/16/2009). Retrieved electronically on 4/7/10 from http://www.cancer.org/docroot/MED/content/MED_2_1x_American_Cancer_Society_Responds_to _Changes_to_USPSTF_Mammography_Guidelines.asp http://www.cancer.org/docroot/MED/content/MED_2_1x_American_Cancer_Society_Responds_to _Changes_to_USPSTF_Mammography_Guidelines.asp

10. Efficacy of a Screen? Validity – Is the test accurate? Reliability – Will the test produce the same result when repeated?

11. Validity of a Screen Sensitivity – false negatives - the extent to which those with the disease will be told they don’t have the disease. Specificity – false positives – the extent to which those without the disease will be told they do have the disease.

12. Unit 7 Seminar: Question #1 What are the benefits and negative consequences of using Web-based information for health and wellness education, medical diagnoses and treatment on the design of health and wellness models?

13. Evaluating Health Web Sites Accuracy Authority Bias/Objectivity Currency/Timeliness Coverage National Network of Libraries of Medicine. Evaluating Health Web Sites (n.d.). Retrieved electronically on 4/6/2010 from https://nnlm.gov/outreach/consumer/evalsite.html https://nnlm.gov/outreach/consumer/evalsite.html

14. Unit 7 Seminar: Question #2 What key advancements in health care technology occurred during the last few decades? How have these improvements affected health care?

15. Unit 7 Seminar: Question #2 a. Access to care b. Patient/family self-care c. Care management d. The future role of community hospitals and health centers e. The future role of physicians f. The future role of nurses g. Issues relating to minority health Ellis, D. (2003). The Impact of Technological Advances on Community Health and the Role of Foundations in Fostering Beneficial Use. Retrieved on 4/6/2010 from http://hfd.dmc.org/upload/docs/WKKF.pdfhttp://hfd.dmc.org/upload/docs/WKKF.pdf

16. Unit 7 Seminar: Question #3 What geographic and political considerations accompany the use of Web-based information for health and wellness, education, medical diagnoses and treatment?

17. Questions?

18. References American Cancer Society. American cancer society responds to changes to USPSTF mammography guidelines (11/16/2009). Retrieved electronically on 4/7/10 from http://www.cancer.org/docroot/MED/content/MED_2_1x_American_Cancer_Society_Respo nds_to_Changes_to_USPSTF_Mammography_Guidelines.asp http://www.cancer.org/docroot/MED/content/MED_2_1x_American_Cancer_Society_Respo nds_to_Changes_to_USPSTF_Mammography_Guidelines.asp Ellis, D. (2003). The Impact of Technological Advances on Community Health and the Role of Foundations in Fostering Beneficial Use. Retrieved on 4/6/2010 from http://hfd.dmc.org/upload/docs/WKKF.pdf http://hfd.dmc.org/upload/docs/WKKF.pdf National Network of Libraries of Medicine. Evaluating health web sites (n.d.). Retrieved electronically on 4/6/2010 from https://nnlm.gov/outreach/consumer/evalsite.htmlhttps://nnlm.gov/outreach/consumer/evalsite.html U.S. Preventive Services Task Force (2009). Screening for breast cancer: U.S. Preventive Services Task Force recommendation statement. Annals of Internal Medicine. 151(10):716-726. Agency for Health Care Research and Quality. U.S. Preventive Services Task Force – about USPTF (n.d). Retrieved electronically on 4/7/10 from http://www.ahrq.gov/clinic/uspstfab.htm http://www.ahrq.gov/clinic/uspstfab.htm