concepts of prevention
DESCRIPTION
CONCEPTS OF PREVENTIONTRANSCRIPT
• The goal of medicine is to promote, to preserve, to restore health when it is impaired & to minimize suffering & distress.
• These goals are embodied in the word “prevention”.
• Successful prevention depends upon a knowledge of causation, dynamics of transmission, identification of risk factors & risk groups, availability of prophylactic or early detection & treatment measures to appropriate persons, groups & continuous evaluation of & development of procedures applied.
• The objective of preventive medicine is to intercept or oppose the “cause” & thereby the disease process.
LEVELS OF PREVENTION • 1. Primordial prevention.• 2. Primary prevention.• 3. Secondary prevention.• 4. Tertiary prevention.
PRIMORDIAL PREVENTION• This primary prevention is purest
in its sense.
• It implies prevention of the emergence or development of risk factors in population groups in which they have not yet appeared.
• The main intervention in primordial prevention is through individual & mass education
PRIMARY PREVENTION• Primary prevention can be
defined as “action taken prior to the onset of disease, which removes the possibility that a disease will occur”.
• It signifies intervention in the pre pathogenesis phase of a disease or health problem.
• Primary prevention may be accomplished by measures designed to promote general health & well being, & quality of life of people or by specific protective measures.
• Primary prevention is far more than averting the occurrence of a disease & prolonging life.
• It includes the concept of “positive health”, a concept that encourages achievement & maintenance of “an acceptable level of health that will enable every individual to lead a socially & economically productive life”.
• It concerns an individual’s attitude towards life & health & the initiative he takes about positive & responsible measures for himself, his family & his community.
• The concept of primary prevention is now applied for the prevention of chronic disease such as heart disease, hypertension & cancer based on elimination or modification of “risk factors” of disease.
• WHO has recommended the following approaches for the primary prevention.
1. Population Strategy ( Mass strategy)
2. High risk strategy
POPULATION STRTEGY The population strategy is directed at
the whole population irrespective of individual risk levels.
• E.g., Even a small reduction in the Bp or serum cholesterol of a population would produce a large reduction in the incidence of cardio vascular disease.
HIGH RISK STATERGY• The high risk strategy aims to
bring preventive care to individuals at special risk.
• This requires detection of individuals at high risk by the optimum use of clinical methods.
• Primary prevention is a desirable goal.
• It is worthwhile to recall the fact that industrialized countries succeeded in eliminating communicable diseases by rising the standard of living (primary prevention)
• In summary, primary prevention is a holistic approach.
• It relies on measures designed to promote health or protect against specific disease “agents ” & hazards in the environment.
• It utilizes the knowledge of the pre pathogenesis phase of disease embracing the agent, host & the environment.
• The safety & low cost of primary prevention justifies its wider application. Primary prevention has become increasingly identifies with “health education” & the concept of individual & community responsibility for health.
SECONDARY PREVENTION
• Secondary prevention can be defined as “action which halts the progress of a disease at its incipient stage & prevents complications”.
• The specific interventions are early diagnosis & prompt treatment.
• Secondary prevention attempts to arrest the disease process, restore health by seeking out unrecognized disease & treating it before irreversible pathological changes have taken place & reverse communicability of infectious diseases.
• Secondary prevention is largely the domain of clinical medicine.
• The health programmes initiated by the government are at the level of secondary prevention.
• The drawback of secondary prevention is that the patient has already been subject to mental anguish, physical pain & the community to loss of productivity.
• Secondary prevention is an imperfect tool in the control of transmission of disease.
• It is more often expensive & less effective than primary prevention.
TERTIARY PREVENTION• When disease process has
advanced beyond its early stages, it is still possible to accomplish prevention by what might be called “tertiary prevention”.
• It signifies intervention in the late pathogenesis phase.
• Tertiary prevention can be defined as “all measures available to reduce or limit impairments & disabilities, minimize suffering caused by existing departures from good health & to promote the patient’s adjustment to irremediable conditions.
• The main interventions include disability limitation & rehabilitation.
• Tertiary prevention extends the concept of prevention into fields of rehabilitation.
THE THREE “C” OF PREVENTION
MODES OF INTERVENTION• Intervention is defined as any attempt
to intervene or interrupt the usual sequence in the development of disease in man.
• Five modes of intervention have been described depending upon the natural history of disease.
Modes of intervention1. Health Promotion.2. Specific protection.3. Early diagnosis &
treatment.4. Disability limitation. 5. Rehabilitation.
THE ICEBERG PHENOMENON
HEALTH PROMOTION• Health promotion is the process of
enabling people to increase control over & to improve health. It is not directed against any particular disease, but is intended to strengthen the host through a variety of approaches (interventions) .
•The interventions are : • 1. Health Education.• 2. Environmental modifications.• 3. Nutritional interventions.• 4. Life style & behavioral
changes
HEALTH EDUCATION• Is one of the most cost
effective interventions.
• A large number of diseases could be prevented with little or no medical intervention if people were adequately informed about them & if they were encouraged to take necessary precautions in time.
ENVIRONMENTAL MODIFICATIONS
• A comprehensive approach to health promotion requires environmental modifications such as provision of safe water, installation of sanitary latrines, control of insects & rodents, improvement of housing etc.
• Environmental interventions are non clinical & does not require physician.
• History has shown that many developed countries have made remarkable progress in health of its people through environmental modification.
NUTRITIONAL INTERVENTION
• These comprise of food distribution & nutrition improvement of vulnerable groups; child feeding programmes; food fortification; nutrition education.
LIFE STYLE & BEHAVIOURAL CHANGES
• The conventional public health measures or interventions have not been successful in making inroads in to lifestyle reforms.
• Health education is a basic element of all health activity, in changing the views, behaviors & habits of people.
• A well conceived health promotion programme identifies the target groups & directs appropriate message to them.
• It involves organizational, political, social & economic interventions designed to facilitate environmental & behavioural adaptation that will improve or protect health.
SPECIFIC PROTECTION• The following are some of the
currently available interventions aimed at the specific protection.
• 1. Immunization.• 2. Use of specific nutrients.
• 3. Chemoprophylaxis.
• 4. Protection against occupational hazards.
• 5. Protection against accidents.
• 6. Protection from carcinogens
• 7. Avoidance of allergens.
• 8. Control of specific hazards.
• 9. Control of consumer product quality & safety of foods,
drugs, & cosmetics.
• It also protects others in the community from acquiring the infection & thus provide secondary prevention for the infected individuals & primary prevention for their potential contacts.
• Secondary prevention is largely the domain of clinical medicine.
• The health programmes initiated by the governments are usually at the level of secondary prevention
• Health protection is defined as “the provision of conditions for normal & physical functioning of the human being individually & in the group.
• Health protection is considered as an integral part of the overall community development.
EARLY DIAGNOSIS & TREATMENT
• WHO defines early detection as the detection of disturbances of homoeostatic & compensatory mechanism while bio chemical, morphological & functional changes are still reversible.
• Early detection & treatment are the main interventions of disease control.
MASS TREATMENT APPROACH • A mass treatment approach of
used in the control of certain diseases (yaws, pinta, trachoma, malaria).
• There are many variants in mass treatment. They are ; total mass treatment, juvenile mass treatment; selective mass treatment; depending upon the nature & prevalence of disease in the community.
DISABILITY LIMITATION• The objective of this intervention is
to prevent or halt the transition of the disease process from impairment to handicap.
CONCEPT OF DISABITLITY
DISEASE IMPAIRMENT DISABILITY HANDICAP
IMPAIRMENT : Any loss or abnormality of psychological, physiological or anatomical structure or function.
• E.g., loss of foot, defective vision.• An impairment may be visible or
invisible, temporary or permanent & may or may not lead to secondary impairment.
• (In case of leprosy damage to nerves – primary limitation may lead to plantar ulcers – secondary impairment).
• DISBILITY : Because of an impairment the affected person may be unable to carry out certain activities considered normal for his age, sex. Disability has been defined as “ any restriction or lack of ability to perform an activity in the manner or within the range considered normal for a human being
• HANDICAP : As a result of disability, the person experiences certain disadvantages in life & is not able to discharge the obligations required of him & play the role expected of him in the society.
• “Handicap” may be defined as a disadvantage for a given individual, resulting from an impairment or a disability, that limits or prevents the fulfillment of a role that is normal for that individual.
• Accident------Disease or disorder.• Loss of foot-----Impairment
(extrinsic or intrinsic)• Cannot walk-----Disability
(objectified)• Unemployed----- Handicap
(socialized)
DISABILITY PREVENTION• “Disability prevention” relates to
all levels of prevention.
• Reducing occurrence of impairment---immunization.
• Disability limitation by appropriate treatment (secondary prevention).
• Preventing the transition of disability into handicap (tertiary Prevention)
REHABILITATION• Rehabilitation has been defined as “
the combined & coordinated use of medical, social, educational & vocational measures for training the individual to the highest possible level of functional ability.
• It includes all measures aimed at reducing the impact of disabling & handicapping conditions & at enabling the disabled & handicapped to achieve social integration.
• Rehabilitation has emerged in recent years as a medical specialty.
• The following areas of concern in rehabilitation have been identified :
• 1. Medical rehabilitation --- Restoration of function.
• 2. Vocational rehabilitation --- Restoration of the capacity to Earn a livelihood.
• 3. Social rehabilitation --- Restoration of family & social relationships.
• 4. Psychological rehabilitation --- Restoration of personal
dignity & confidence.
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