Card no.

16
I. kinds of population movement in demographical statistics. Mechanical
movement of population and its main indicators
1. kinds of population movement in demographical statistics
Mechanical movement: transition of people or migration, it may be
due to
growing urbanization
Natural movement: defined according to birth & death rates, this is
important for
estimation of social health
2. mechanical movement of population: 2 groups of factors. Global trends of
migration
Factors of mechanical movement
Pushing factors
factors which made people leave a place
E.g: war, poverty, unemployment
E.g. in refugee, poor health is due to problem with medical
care, vaccination, nutrition, income
Pulling factors
Factors that attract people
E.g. job, tourism, education, good level of health
Global trends of migration
3. characterize different kinds of migration and the effect they have on
population size and composition
Internal migration
Within country
Move to capital
External migration
Move from a less developed to a more developed country
Temporary migration
Migrate for temporarily
E.g: job, education
Permanent migration
Ethnical
Have relatives in other places

 Typical in Israel: Israel attracts jewish (doesnt matter

weather u are rich or poor)
International marriage
In asian countries, Germany, GB
Usually occurs if male population more than female
Seasonal migration
agricultural, tourism
Pendula migration
People will come and leave the place after certain time
E.g. education, job, embassy
4. the role of migration in morbidity
5. the influence of mechanical movement of population on health care
planning and organization
Health care facility is adjusted according to movement of population
For higher number of population, the health care facilities need to be more
II. screening and diagnostics in preventive medicine
1. concept of screening
To lower morbidity & mortality of disease in a population
Aim to control the disease rather than elimination of disease
Screening provides access to medical care system, which is not the
actual goal of screening, but is a benefit of screeing
2. differences between screening and diagnostics tests. Give the examples
Screening test
Diagnostics test
Patient is asymptomatic
Patient is symptomatic
Patient is healthy
Patient is at risk
There is 2 outcome: positive or
Outcome: we interested in the outcome
negative
obtained, outcome contain useful
information
Not for all diseases, usually
transmittable disease or common
disease
Initiated by health care authority
Easy administration, not time,
resource, cost consuming

3. requirements for screening test

For early detection of disease, with more favourable prognosis, due
to early treatment, as compared to delayed treatment
Pre-clinical disease that left untreated, and it progresses to clinical
evident disease. E.g. disease with no spontaneous regression
Serious disease, which related to cost effectiveness, ethnics &
prognosis
There is high prevalence of pre-clinical disease among those
screened
4. validity of the screening test (refer screening, pg 4)
Validity of screening test: is how good is the screening test if compared
with the confirmatory diagnostic test
Validity is judged according to its sensitivity or specificity
Sensitivity: identification of a diseased person to have the disease
Is the probability of sreening positive if the disease is
really present
Specificity: identification of a non-diseased person to have the disease
Is the probability of screening negative if the disease is
really absent
Result of screening test
a
c

true disease status

+
b
d

Sensitivity: a/ (a+c)
Specificity: d/ (b+d)
Relationship between sensitivity & specificity
i. Sensitivity is higher if lower the criteria for positive result, but
decrease specificity ( criteria sensitivity specificity)
ii. Specificity is higher if criteria for positive result become more strict,
but this decrease sensitivity ( criteria specificity sensitivity)
iii. Goal of screening test is to have both high sensitivity & specificity,
but this is often not possible or feasible
iv. The decision for cutpoint involves: weighing the consequences of
leaving cases undetected (false negatives) against erroneously
classifying healthy person as diseased (false positives)
v. In general, specificity must be at least 98% to be effective, because
misclassifying 2% of population will lead to many false positives, this
false positive is also be detected in sensitivity test

vi.

vii.

Increase sensitivity when penalty associated with missing case is high:

When its an infectious disease
When the subsequent diagnostic evaluations are with minimal
cost & risk
( e.g. minimize false negatives)
Increase specificity when the costs or risks associated with further
diagnostic techniques are substantial
Minimize false positive
e.g. positive screen requires a biopsy

5. strategies of screening and their use.

mass strategy
good
dont missed even 1 people or only missed a few people
e.g. in TB outbreak regardless of risk
high risk group or selective
screen according to people who are at risk
e.g. HIV screening in those who are exposed or in
contact with blood
multi-phasic
conducted in several stages
stage I: screen everyone who are negative
stage II: screen those who are positive with another test