concepts of disease control in medical and health.pptx

concepts of disease control for medical and nursing students

1. Concept of prevention Dr. Madhusudan Swarnkar 10:56 PM 1

2. what is the importance of sequences of action in the natural history of a disease? The importance is that it serves as the basis of planning the preventive activities. In fact, we take preventive actions throughout the entire sequence of the natural history of the disease. 10:56 PM 2

3. Goals of Preventive medicine are to promote health , to preserve health , to restore health when it is impaired , prolong life and minimize suffering by preventing the suffering of disease . 10:56 PM 3

4. Prevention Actions eradicating, eliminating or minimizing the impact of disease and disability, or if none of these are feasible, retarding the progress of the disease and disability. 10:56 PM 4

5. Levels of Prevention 10:56 PM 5 Stage of disease Level of prevention Type of response Pre-disease Primary Prevention Health promotion and Specific protection Latent Disease Secondary prevention Pre-symptomatic Diagnosis and treatment Symptomatic Disease Tertiary prevention Disability limitation for early symptomatic disease Rehabilitation for late Symptomatic disease There are four major levels of prevention, depending on the phase of the natural history of the disease :

6. Primordial prevention It consists of measures that inhibit the emergence of risk factors in the form of environmental, economic, social, and behavioral conditions and cultural patterns of living etc. It is the prevention of the emergence or development of risk factors in which they have not yet appeared. For example, many adult health problems (e.g., obesity, hypertension) have their early origins in childhood, because this is the time when lifestyles are formed (for example, smoking, eating patterns, physical exercise). 10:56 PM 6

7. Primordial prevention (cont.) In primordial prevention, efforts are directed towards discouraging children from adopting harmful lifestyles The main intervention in primordial prevention is through individual and mass education 10:56 PM 7

8. Health Promotion The process of enabling people to increase control over, and to improve health Interventions in this area are: Health Education Environmental Modifications eg : safe water, sanitary latrines, control of insects and improvement of housing. Nutritional interventions- comprise food distribution and nutrition improvement of susceptible group. eg ; child feeding programmes , food fortification, nutritional education etc Lifestyle & Behavioral changes 10:56 PM 8

9. Health Promotion It include all steps undertaken to improve the level of general health and well being so that conditions for initiation of disease process are prevented. these steps are not specific for any disease or a group of diseases. These actions include improvement in the overall socio-economic status of the population, health education on personal and oral hygiene, feeding programmes for mothers and children, Promotion of breast feeding, Promotion of small family norms, Education and motivation for healthy lifestyle Genetic counseling (premarital and marriage counseling) 10:56 PM 9

10. Primary Prevention These are all measures of prevention that are undertaken during the phase of pre-pathogenesis (phase of susceptibility), before the disease process has started. Primary prevention involves two sub-steps: Health Promotion and Specific Protection Both steps are undertaken during the stage of susceptibility (pre-pathogenesis), to avert the initiation of the disease process. 10:56 PM 10

11. Primary Prevention Health promotional approach improves the general health so that a number of diseases are aimed at not a single disease, from preventive point of view. Eg . when we promote breast feeding among children, we are trying to prevent general malnutrition, vitamin A deficiency, providing antibodies against various diseases, preventing diarrheal diseases (because artificial feeding carries the risk of infection) and so on. On the other hand when condom is used, it is for a very specific group of diseases i.e. STDs; when measles vaccine is given it is for a specific disease viz. measles. 10:56 PM 11

12. Specific Protection These include measures to prevent the initiation of specific diseases or a group of diseases. Examples immunization against vaccine preventable diseases, fortification of foods with specific nutrients (as salt with iodine), use of condoms to protect against sexually transmitted diseases (STDs) and HIV, use of chemoprophylactic drugs to protect against particular diseases (as malaria, meningococcal meningitis, plague, tuberculosis, leptospirosis , etc), use of helmets to protect against head injuries, etc . Use of insecticide treated bed-nets 10:56 PM 12

13. Secondary Prevention include all actions undertaken at early pathogenesis stage (asymptomatic disease) to halt the progress of disease at it’s earliest or incipient stage, by “early diagnosis and prompt treatment”. It is like stamping off a fire when it has just started rather than call the fire brigade after the fire has become voluminous. The person is not aware of any signs or symptoms and the routine clinical methods also may not be able to detect a disease at this stage, since the disease process is in the very preliminary stage. The classical example of this level of prevention is “screening for disease” as for breast cancer (using mammography) and cervical cancer (using pap smear). 10:56 PM 13

14. Early diagnosis and treatment Helps in recovery from disease(restoration) Reduce the duration of illness in the individual Minimize the suffering Prevents the development of complications Prevents further spread of disease in community Prevents or postpones the death of the individual 10:56 PM 14

15. Tertiary Prevention all measures undertaken when the disease has become clinically manifest or advanced, to prevent or delay death, reduce or limit the impairments and disabilities, minimize suffering and to promote the subject’s adjustment to irremediable conditions Tertiary prevention has two types of approaches disability limitation and rehabilitation. 10:56 PM 15

16. Disability Limitation : These include all measures to prevent the occurrence of further complications, impairments, disabilities and handicaps or even death. Examples: When we apply plaster cast to a patient who has suffered Colle’s fracture, we are actually trying to prevent complications and further disability like mal-union or non-union. When we give complete rest, morphine, oxygen and streptokinase to a patient of Acute MI, we are actually trying to prevent death or complications like arrhythmias / CHF. 10:56 PM 16

17. Disease : This is a pathological process and it’s manifestations which indicate a departure from the state of perfect health. Impairment is “any loss or abnormality of psychological, physiological or anatomical structure or function.” Disability is “any restriction or lack of ability to perform an activity in the manner or within the range considered normal for the human being.” Handicap is termed as “a disadvantage for a given individual, resulting from an impairment or disability, that limits or prevents the fulfillment of a role in the community that is normal for that individual (depending on age, sex, and social and cultural factors).” 10:56 PM 17

18. Disability limitation Disease Impairment (Accident) (Loss of foot) Disability (Can’t walk) Unemployed ( Handicap) 10:56 PM 18

19. For example, an agricultural worker gets acute myocardial infarction. This is the disease. Because of this disease, he would have inadequacy in the pumping action of the heart with a compromise in the oxygenation of the blood. These are the “impairments” due to the disease. Due to these impairments he will not be able to undertake hard manual labour , which an otherwise healthy male of his age would have undertaken - this is the disability, resultant to the impairment. Finally because of this disability, he will lose his job of an agricultural worker and hence not able to earn adequate livelihood - this is the handicap, consequent to the disability. 10:56 PM 19

20. Rehabilitation : “Rehabilitation” (Re =restore into, habitat = the original home or environment of the person). Rehabilitation is the combined and coordinated usage of all the available medical, social, educational and vocational measures, for training and retraining the person to the highest level of functional ability. It emphasizes that the duty and obligation of a Doctor who cares for a patient does not end simply by curing the patient. It is also an obligation to assist the patient in getting rehabilitated so hat he/she gets fully adjusted in the family and social environment and lives a happy and productive life. 10:56 PM 20

21. Rehabilitation The combined & coordinated use of medical, social, educational, psychological and vocational measures for training & retraining the individual to the highest possible level of functional ability . Identify the remaining capacities in individual and adopt measures to make him fit independent, productive, useful and active member in family and community 10:56 PM 21

22. Dimensions of Rehabilitation Medical rehabilitation : This is done by medical/surgical procedures to restore the anatomy, anatomical and physiological functions to as near normal as possible. Vocational rehabilitation : This includes training and education so as to enable the person to earn a livelihood. Social rehabilitation : This involves steps for restoration of the family and social relationships. Emotional and Psychological rehabilitation : This involves steps to restore the confidence, and personal dignity 10:56 PM 22

23. Modes of Interventions Intervention- any attempt to intervene or interrupt the usual sequence in the development of disease. This may be by the provision of treatment, education, help or social support. Health promotion Specific protection Early Diagnosis and Treatment Disability limitation Rehabilitation 10:56 PM 23

24. Disease control In this disease agent is permitted to persist in the community at a level where it ceases to be a public health problem according to tolerance of the local population. It is a state of equilibrium established b/w agent, host, and environmental components of disease process. Eg . malaria control 10:56 PM 24

25. Aims Reducing the incidence of disease Reducing the duration of disease as well risk of transmission eg. tubercuolsis, leprosy Reducing the effects of infection(physical and psychosocaial ) Reducing the financial burden to the community 10:56 PM 25

26. Control activities focus on primary prevention or secondary prevention, but most programs combine both. 10:56 PM 26 control elimination eradication

27. Disease Elimination Also known as regional elimiantion Intruption of transmission of disease from large geographic region/areas Or reduction of disease to zero without total removal of infectious agent Eg. elimination of measles, polio, diptheria, guneaworm . It is an imp. precurssor of eradication. 10:56 PM 27

28. Disease Eradication Tear out by roots. Termination of all transmission of infection by extermination of the infectious agent. It is all or none phenomenon. This imply that infectious agent as well as disease has also been completely reduced to zero Till now only Smallpox has been eradicated. It is an absolute process not a relative goal. Three diseases are entrant for global eradication in near future. Polio Measles Dracunculosis/Guinea worm 10:56 PM 28

29. Evaluation of Control It is the process by which results are compared with intended objectives or Simply the assesment of how well a programme is performing It should always be considerd during the planning and implementation stages of programme or activity It can also be useful in identifying performance difficulties 10:56 PM 29

30. The Iceberg of disease Symptomatic disease (what the physician sees) - - - - - - - - - - - - - - - - - - - carriers, undiagnosed -------------------------------- What the physician - - - - - - - - - - - - - - ---- - does not see -- - -- - - - -- - - - - - -- - - - ---- --- latent, inapparent - - -- -- - -- - - -- - -- - - - - - - - - - pre-symptomatic 10:56 PM 30

31. 1. Fortification of foods with specific nutrients as salt with iodine, is an example of : (a) Primordial prevention (b) Primary prevention (c) Secondary prevention (d) Tertiary Prevention 2. Primary Preventive measure can be applied at which stage of the natural history of disease : (a) stage of positive health (b) asymptomatic (early pathogenesis) (c) early, discernible disease (d) full - blown (classical) disease 3. Use of chemoprophylactic drugs to protect against malaria is (a) Primordial prevention (b) Primary prevention (c) Secondary prevention (d) Tertiary Prevention 10:56 PM 31

32. 1. Education and motivation for healthy lifestyle is : (a) Primordial prevention (b) Secondary prevention (c) Health Promotion (d) Specific Protection 2. The inability to carry out certain function or activity which is otherwise expected for that age / sex is known as : (a) Disease (b) Impairment (c) Disability (d) Handicap 3. Disability Limitation is part of : (a) Primordial prevention (b) Primary prevention (c) Secondary prevention (d) Tertiary Prevention 4. Screening for breast cancer using mammography is : (a) Primordial prevention (b) Primary prevention (c) Secondary prevention (d) Tertiary Prevention 10:56 PM 32

33. Quiz Match the following statements. Each option may be selected once, more than once, or not at all: 10:56 PM 33 performing carotid endarterectomy in a patient with transient ischemic attack primary prevention recommending regular physical activity to a patient with no known medical problem Secondary prevention vaccinating a health care worker against hepatitis B Tertiary prevention giving isoniazid for 1 yr to a 28-year-old medical student with a positive tuberculin skin test. Health promotion

34. Thanks 10:56 PM 34