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Disease Prevention&Wellness Promotion Dr. Loh Keng Yin B(Med Sc), MD[UKM] MMed(FamMed),AM Department of Family Medicine International Medical University Malaysia
Disease Prevention • Encompasses the philosophy, credo (believe), programs, and practices that aim to defer or eliminate diseases, disability, and other forms of human suffering. Wellness promotion • Encompasses interventions and behaviors that prevent diseases
Aim: • Highest levels of physical, mental, emotional and social well-being are attained. • Most positive functional performances
DiseasePathological condition or process which lead to degeneration, death of tissues or loss of function. Illness Symptoms experienced by a person include pain, discomfort, stress and anxiety. Health/Wellness A state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity." ….WHO
In 1840s Hungarian physician Ignaz Phillipp Semmelweis reduced the rates of puerperal sepsis among pregnant women through attendant hand washing. --------"Father of Infection Control • In the 1850s, British physician John Snow helped abort an outbreak of cholera in London that was due to a contaminated water supply.
Factors determining Illnesses’ functional burden on societies • Acts of nature: such as meteorological and climatic catastrophes; • Human factor: war and other forms of interpersonal violence; • Adverse effects of advancing technology or occupational exposures; • Adverse effects of health interventions • the uncontrollability of individual behavior • consequences of health-giving interventions (eg: antibiotic resistance)
Socioeconomic status and health • Higher income levels are a measure of a safer physical environment, including occupational exposures and the general environment; • Higher income purchases more effective personal and family health services; • Higher income and wealth levels are literal markers of social status • Income and wealth are markers of increased education and healthy behaviors.
The Positive and Negative Effects of Preventive Interventions • Chronic use of medicines -established adverse drug reactions that can limit their use. • Screening for early and asymptomatic diseases will often lead to decreased morbidity and mortality from those diseases but carry risks. • False positive vs false negative resluts • Inappropriate use of mechanical devices might lead to occasional injuries.
Good Chronic use of medicines control medical condition Screening for early and asymptomatic diseases Improves survival Use of mechanical devices improve activity of daily living in handicap Bad Side effects Cost, False positive and false negative, Anxiety Injury & fall if used inappropriately The Positive and Negative Effects of Preventive Interventions
Conclusion: • it is important for preventive interventions not only to be effective, but also that the cost-effectiveness and benefits of these interventions be understood. • Without this, the net health change may not necessarily be positive.
Some preventive interventions are controversial 1. Needle exchange programs • Intended to supply drug addicts with uncontaminated needles that would decrease the risk of blood-borne infections may be beneficial. Argument: may allow more needles to be available to others. How these needles would be used by others is sometimes uncertain. ***The existing evidence suggests that needle exchange programs do not promote illicit drug use. 2. Distribution of condoms to groups at high risk of sexually transmitted diseases and unwanted pregnancies Argument: • May promote increased sexual activity, with its own health and moral dimensions. • Cultural, moral & religious issue.
Childhood Immunization Healthy life style Food hygiene Smoking cessation Pap smear Colorectal screening Genetic diseases Antenatal mothers General Public Health prevention Program: Prevention of diseases can be implemented on :1. General public 2. Individual Individual/targeted group Prevention program:
Preventive health Primary Prevention Tertiary Prevention Secondary Prevention
Primary prevention “ intervention provided to individuals to prevent the onset of a targeted condition.” Example: Passive and active immunization Health education and counseling Injury prevention (promoting the use of automobile passenger restraints and bicycle/motocycle helmets) Significance: Helps avoid the suffering, cost and burden associated with disease, it is typically considered the MOST cost-effective form of health care. The U.S. Preventative Services Task Forces’ Guide to Clinical Preventive Services (2d edition, 1996)
The U.S. Preventative Services Task Forces’ Guide to Clinical Preventive Services (2d edition, 1996) Secondary prevention • “identify and treat asymptomatic persons who have already developed risk factors or preclinical disease but in whom the condition is not clinically apparent.” • Focused on early case finding of asymptomatic disease that occurs commonly and has significant risk for negative outcome without treatment. • Screening tests are examples of secondary prevention. • Significance: With early case finding, the natural history of disease, or how the course of an illness unfolds over time without treatment, can often be altered to maximize well-being and minimize suffering.
The U.S. Preventative Services Task Forces’ Guide to Clinical Preventive Services (2d edition, 1996) Tertiary prevention • Activities involve the care of established disease, • To restore to highest function, minimize the negative effects of disease, and prevent disease-related complications. • Early detection through secondary prevention may have minimized the impact of the disease. • Example: Rehabilitation program. • Significance: Limitation of handicap and disability.
Example of Prevention Madam L is a 62 year-old woman with diabetes mellitus and hypertension on antihytpertensive treatment and oral hypoglycemic agents. Her primary prevention needs include: • A. Reviewing appropriate use of her medications • B. Use of aspirin in prevention of stroke. • C. Pap smear screening • D. Regular exercise Madam G is a 55 year-old woman with past history of genital herpes on followup. Important secondary prevention strategies include: • A. Stop smoking. • B. Discussion on STD • C. Screening for HIV • D. Pap smear Ans: 1.B,D 2 C,D
Example of Prevention MK is an 18 month Down Syndrome baby boy who has a mild ventricular septal defect. Currently he is asymptomatic. Identify the various level preventive needs for him: 10 20 30 NA • Childhood immunization. • Developmental assessment. • Good and balanced nutrient. • Regular follow up with cardiologist. • Special education • Safe home environment Ans: 1,3,6 Primary Prevention 2,4 Secondary 5 Tertiary