CONCEPTS OF PREVENTION
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• 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”.
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• 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.
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• The objective of preventive medicine is to intercept or oppose the “cause” & thereby the disease process.
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LEVELS OF PREVENTION • 1. Primordial prevention.• 2. Primary prevention.• 3. Secondary prevention.• 4. Tertiary prevention.
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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.
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• The main intervention in primordial prevention is through individual & mass education
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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”.
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• 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.
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• 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”.
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• It concerns an individual’s attitude towards life & health & the initiative he takes about positive & responsible measures for himself, his family & his community.
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• 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.
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• WHO has recommended the following approaches for the primary prevention.
1. Population Strategy ( Mass strategy)
2. High risk strategy
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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.
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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.
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• 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)
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• 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.
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• It utilizes the knowledge of the pre pathogenesis phase of disease embracing the agent, host & the environment.
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• 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.
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SECONDARY PREVENTION
• Secondary prevention can be defined as “action which halts the progress of a disease at its incipient stage & prevents complications”.
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• 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.
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• Secondary prevention is largely the domain of clinical medicine.
• The health programmes initiated by the government are at the level of secondary prevention.
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• The drawback of secondary prevention is that the patient has already been subject to mental anguish, physical pain & the community to loss of productivity.
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• Secondary prevention is an imperfect tool in the control of transmission of disease.
• It is more often expensive & less effective than primary prevention.
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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”.
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• 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.
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• The main interventions include disability limitation & rehabilitation.
• Tertiary prevention extends the concept of prevention into fields of rehabilitation.
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THE THREE “C” OF PREVENTION
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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.
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Modes of intervention1. Health Promotion.2. Specific protection.3. Early diagnosis &
treatment.4. Disability limitation. 5. Rehabilitation.
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THE ICEBERG PHENOMENON
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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) .
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•The interventions are : • 1. Health Education.• 2. Environmental modifications.• 3. Nutritional interventions.• 4. Life style & behavioral
changes
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HEALTH EDUCATION• Is one of the most cost
effective interventions.
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• 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.
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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.
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• 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.
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NUTRITIONAL INTERVENTION
• These comprise of food distribution & nutrition improvement of vulnerable groups; child feeding programmes; food fortification; nutrition education.
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LIFE STYLE & BEHAVIOURAL CHANGES
• The conventional public health measures or interventions have not been successful in making inroads in to lifestyle reforms.
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• Health education is a basic element of all health activity, in changing the views, behaviors & habits of people.
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• 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.
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SPECIFIC PROTECTION• The following are some of the
currently available interventions aimed at the specific protection.
• 1. Immunization.• 2. Use of specific nutrients.
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• 3. Chemoprophylaxis.
• 4. Protection against occupational hazards.
• 5. Protection against accidents.
• 6. Protection from carcinogens
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• 7. Avoidance of allergens.
• 8. Control of specific hazards.
• 9. Control of consumer product quality & safety of foods,
drugs, & cosmetics.
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• 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.
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• Secondary prevention is largely the domain of clinical medicine.
• The health programmes initiated by the governments are usually at the level of secondary prevention
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• 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.
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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.
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• Early detection & treatment are the main interventions of disease control.
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MASS TREATMENT APPROACH • A mass treatment approach of
used in the control of certain diseases (yaws, pinta, trachoma, malaria).
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• 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.
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DISABILITY LIMITATION• The objective of this intervention is
to prevent or halt the transition of the disease process from impairment to handicap.
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CONCEPT OF DISABITLITY
DISEASE IMPAIRMENT DISABILITY HANDICAP
IMPAIRMENT : Any loss or abnormality of psychological, physiological or anatomical structure or function.
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• 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).
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• 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
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• 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.
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• “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.
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• Accident------Disease or disorder.• Loss of foot-----Impairment
(extrinsic or intrinsic)• Cannot walk-----Disability
(objectified)• Unemployed----- Handicap
(socialized)
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DISABILITY PREVENTION• “Disability prevention” relates to
all levels of prevention.
• Reducing occurrence of impairment---immunization.
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• Disability limitation by appropriate treatment (secondary prevention).
• Preventing the transition of disability into handicap (tertiary Prevention)
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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.
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• 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.
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• 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.
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• 3. Social rehabilitation --- Restoration of family & social relationships.
• 4. Psychological rehabilitation --- Restoration of personal
dignity & confidence.
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THANK YOU