Importance of Preventive

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Importance of Preventive Promotive care in
general
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• Prevention is better than cure
• The word prevention is derived from Latin Prae
  venire, to come before.
• The prevention is anticipatory medicine. It comes
  before the disease occurs.
• Most of the preventive measures are focused on
  Healthy people, to ensure that they stay
  healthy and do not contract or develop disease.
  The goal of prevention is to achieve health for
  all to ensure adequate level of health which
  permits them to lead a productive and socially
  useful life.
• Clearly the concern and focus of prevention is on
  healthy people to ensure that they stay
  healthy but the concept of prevention can be
  applied for sick also to restore their health at
  the earliest and prevent deaths and disability in
  sick persons

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LEVELS OF PREVENTION

• In modern day, the concept of prevention has
  become broad based. It has become customary to
  define prevention in terms of 4 levels.
• Primordial prevention
• Primary prevention
• Secondary prevention
• Tertiary prevention

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• 1. PRIMORDIAL PREVENTION
• Prevention of emergence or development of risk
  factors in countries or population groups in
  which they have not yet appeared.
• For ex many adult health problems (obesity,
  hypertension) have their early origins in
  childhood, because this is the time when
  lifestyles are formed (for example smoking,
  eating patterns, physical exercise).
• Efforts are directed towards discouraging
  children from adopting harmful lifestyles.
• The main intervention in primordial prevention
  is through individual and mass education.

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• 2.PRIMARY PREVENTION
• Action taken prior to the onset of disease
  which removes the possibility that the disease
  will ever occur.
• It signifies intervention in the pre-
  pathogenesis phase of a disease or health problem
  or other departure from health (example low birth
  weight).
• Primary prevention may be accomplished by
  measures designed to promote general health and
  well being and quality of type of people or by
  specific protective measures.

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• The concept of primary prevention is now
  being applied to the prevention of chronic
  diseases such as CHD, hypertension and cancer
  based on elimination or modification of risk
  factors of disease.
• The WHO has recommended the following
  approaches for the primary prevention of chronic
  diseases where the risk factors are established.
• Population (mass) strategy
• High risk strategy

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• Population (Mass) Strategy
• is directed at the whole population
  irrespective of individual risk levels.
• For Ex a small reduction in the average B.P
  or serum cholesterol of a population would
  produce a large reduction in incidence of
  cardiovascular disease. the population strategy
  is directed towards socio-economic, behavioural
  life style changes.

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• b) 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 holistic approach.
  It relies on measures designed to promote health
  or protect against specific disease agents
  hazards in the environment. The safety low cost
  of primary prevention justifies its wider
  application.

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• 3.SECONDARY PREVENTION
• Action which halts the progress of a disease at
  its incipient stage prevents complications.
  The specific interventions are early diagnosis
  adequate treatment.
• Ex screening tests , case finding programmes.
• 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 disease . It is often more expensive
  less effective than primary prevention.

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• 4. TERTIARY PREVENTION
• All measures available to reduce or limit
  impairments disabilities , minimise suffering
  caused by existing departures from good health
  to promote the patients adjustment to
  irremediable conditions.
• When defect disability are more or less
  stabilized, rehabilitation may play a preventable
  role.

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• MODES OF INTERVENTION
• Intervention can be defined as any attempt to
  intervene or interrupt the usual sequence in the
  development of disease in man. They are
• 1. Health promotion
• 2. Specific protection
• 3. Early diagnosis and treatment
• 4. Disability limitation
• 5. Rehabilitation

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• 1) HEALTH PROMOTION
• Is the process of enabling people to
  increase control over and 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 well known interventions in this area are
• Health education
• Environmental modifications
• Nutritional interventions
• Life style and behavioural changes

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• HEALTH EDUCATION
• is one of the most cost effective
  interventions. A large no. of diseases could be
  prevented with little or no medical
  interventions, if people were adequately informed
  about them and encouraged to take necessary
  precautions in time.

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• b) ENVIRONMENTAL MODIFICATIONS
• A comprehensive approach to health promotion
  requires environmental modifications such as
  provision of safe water, installation of sanitary
  latrines, control of insects and rodents,
  improvement of housing etc.
• Environmental interventions are non clinical
  and do not involve the physician.

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• c). NUTRITIONAL INTERVENTIONS
• These comprise food distribution and
  nutritional improvement of vulnerable groups.
  Child feeding programmes, food fortification,
  nutrition, education etc.

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• d). LIFESTYLE AND BEHAVIOURAL CHANGES
• The conventional public health measures or
  interventions have not been successful in making
  in roads into lifestyle reforms. It is of
  paramount importance in changing the views,
  behaviour and habits of people.

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• 2. SPECIFIC PROTECTION Available interventions
  aimed at specific protection are
• Immunization
• Use of specific nutrients
• Chemoprophylaxis
• Protection against occupational hazards
• Protection against accidents.
• Protection from Carcinogens.
• Avoidance of allergens
• The control of specific hazards in the general
  environment. e.x air pollution, noise control.
• Control of consumer product quality safety of
  foods, drugs, cosmetics etc.

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• Health protection The provision of conditions
  for normal , physical mental functioning of the
  human being individually in the group.
• It includes the promotion of health, the
  prevention of sickness curative restorative
  medicine in all aspects.

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• 3. EARLY DIAGNOSIS TREATMENT
• are the main interventions of disease
  control.
• The earlier a disease is diagnosed treated
  the better it is from the point of view of
  prognosis preventing the occurrence of further
  cases (secondary cases) or any long term
  disability. It is like stamping out the spark
  rather than calling the fire brigade to put out
  the fire.

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• Mass treatment A mass treatment approach is
  used in the control of certain conditions viz.
  yaws, pinta, bejel , trachoma malaria.
• The rationale for a mass treatment programme is
  the existence of atleast 4-5 cases of latent
  infection for each clinical case of active
  disease in the community.
• There are many variants of mass treatment , total
  mass treatment, juvenile mass treatment,
  selective mass treatment - depending upon the
  nature prevalence of disease in the community

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• 4.) Disability Limitation
• The sequence of events leading to disability
  handicap
• Disease Impairment Disability
  Handicap.
• Impairment Any loss or abnormality of
  psychological, physiological or anatomical
  structure or function ex loss of foot, defective
  vision or mental retardation
• Disability Any restriction or lack of ability to
  perform an activity in the manner or within the
  range considered normal for human being.

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• Handicap
• 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)

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• Disability Prevention
• Reducing the occurrence of impairment viz.
  immunization against polio (primary).
• Disability limitation by treatment (secondary).
• Preventing the transition of disability into
  handicap (tertiary prevention).

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• 5.REHABILITATION
• The combined co-ordinated use of medical,
  social, educational vocational measures for
  training retraining the individual to the
  highest level of functional ability.
• Medical rehabilitation restoration of function
• Vocational rehabilitation restoration of the
  capacity to earn a livelihood.
• Social rehabilitation restoration of family
  social relationships.
• Psychological rehabilitation restoration of
  personal dignity confidence.

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MODES OF INTERVENTION

• The preventive interventions carried out
  sequentially during the different stages of
  natural history of disease are
• HEALTH PROMOTION
• Supply of safe water.
• Sanitary waste disposal.
• Promotion of nutritional status.
• Slum clearance.
• Control of air, water soil pollution.
• Provision of recreational facilities.

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• Conducting classes in yoga, meditation body
  building
• Eradication of illiteracy.
• Control of insects of medical importance
• Pre-marital marriage counseling.
• Improvements of the Standard of living.
• Education about adopting healthy styles of
  living.

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• 2.SPECIFIC PROTECTION
• Vaccines against vaccine preventable diseases.
• Silver nitrate solution against opthalmia
  neonatorum.
• Nirodh against AIDS.
• Helmet against Head injury.
• Lead apron against radiational hazard.
• Mask against silicosis.
• Ear plug against noise- induced deafness.
• Iodized salt against I.D.D.S
• Iron Folic acid supplementation against
  anaemia.
• Barrier creams against occupational
  dermatosis.
• Topical fluoride application against dental
  caries.

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3. EARLY DETECTION

• Method of early detection
• Monthly recording of underweight
• Blood smear examination of fever cases
• Clinical examination of their contacts.
• B.P recording of pregnant women.
• HIV screening.
• Snellens chart reading by children.
• Fingering the anal opening of new born.
• Vaginal smear cytology.
• Urine analysis for sugar.
• Occult blood in stools.
• Monthly self palpation of breasts for nodules.

• Disease
• Underweight
• Malaria
• STDS
• Eclampsia
• AIDS
• Refractory errors
• of eye
• Imperforate anus
• Cancer cervix
• Diabetes
• Colonic cancer
• Breast cancer

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4. TREATMENT

• Modality
• Chemotheraphy
• Oral rehydration therapy
• Immuno therapy
• Hormone replacement
• therapy
• Physiotherapy
• Psychotherapy
• Radiotheraphy
• Surgical therapy

• Conditions for which it is used
• Infective diseases
• Diarrhoeas
• Snake bite
• Diabetes Hypothyroidism
• Poliomyelitis, Hemiplegia
• Stammering enuresis
• Cancers
• Peptic ulcer, Fibroid uterus,
• obstructed labour

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5.DISABILITY LIMITATION

• Disease Method Disability
  prevention
• Mumps Rest in bed Orchitis
• Diabetes Care of the feet
  Injuries
• Poliomyelitis Passive joint movements
  Deformities

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6. REHABILITATION

• Disability
• Visual defects
• Deafness
• Cataract
• Edentia
• Loss of a limb

• Methods of rehabilitation
• Wearing of spectacles.
• Training in lip reading.
• Intraocular lens implantation.
• Use of dentures.
• Fitting of an artificial prosthesis

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Occupational health
For every occupation.
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• Application of preventive medicine in all places
  of employment.
• Adaptation of work to man and of each man to his
  job.

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• Occupational health should aim at the promotion
  and maintenance of the highest degree of
  physical, mental and social well being of workers
  in all occupations.

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Ergonomics

• Greek word ergon- work nomos- law.
• Fitting the job to the worker.
• Objective- to achieve the best mutual adjustment
  of man and his work, for the improvement of human
  efficiency and well being an to reduce
  industrial accidents and overall health and
  efficiency of the workers.
• Training designing of machines, toos,
  equipments, manufacturing process, method of
  work,.

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Occupational environment

• Sum of external conditions and influences which
  prevail at the place of work and which have a
  bearing on the health of the working population .

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3 levels of interaction

• 1. Man and physical, chemical and biological
  agents.
• 2. Man and Machine.
• 3. Man and man.

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Man and physical, chemical and biological
agents

• Physical agents- heat, cold, humidity, air
  movement, heat radiation, light, noise,
  vibration, ionizing radiation. Also breathing
  space, , bathing, toilet, washing facilities.
• Chemical agents- chemicals, toxic dusts, gases
• Biological agents- viral, rickettsial, bacterial,
  parasitic agents due to contact with the
  animals, contaminated water , soil or food.

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Man and machine

• Unguarded machines
• Protruding or moving parts
• Poor installation of the plant
• Lack of safety measures
• Working for long hours in unphysiological
  postures fatigue, back ache, jt diseases

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Man and man

• Human relation with employees and employers.
• Type and rhythm of work, work stability, service
  conditions, job satisfaction, leadership style,
  security, workers participation, communication,
  system of payment, welfare conditions, degree of
  responsibility, trade union activities,
  incentives.
• Domestic environment and occupational environment
  are complementary to each other.

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Occupational hazards .

• Physical hazards.
• 1. Heat - heat- burns, heat exhaustion, heat
  stroke, heat cramps, indirect effects- decreased
  efficiency, increased fatigue, enhanced accident
  rates. Radiant heat- foundry, glass and steel
  industry Heat stagnation- jute and cotton
  textile industry

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• Hence a good physical environment is essential.
• Temperature of 20-27 deg celsius or 69-80 degree
  F, is comfort zone in this country.

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Cold hazards.

• Chilblains, erythrocyanosis, immersion foot,
  frost bite,, general hypothermia.

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Light ..

• Poor illumination eye strain, headache, eye
  pain, lachrymation, congestion around the cornea
  and eye fatigue. Miners nystagus due to chronic
  effect.
• Excessive brightness- discomfort, annoyance,
  visual fatigue, blurring of vision, accidents.

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Noise ..

• Auditory effects- temp or perman hearing loss.
• Non auditory effects- nervousness, fatigue,
  interference with communication by speech,
  decreased efficiency, annoyance.

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Vibration .

• Frequency- 10-500 Hz work with pneumatic tools
  such as drills and hammers.
• Injury to jts, hands and elbows.

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Ultraviolet radiation

• Arc welding.
• Eyes- intense conjunctivitis, keratitis, damage
  to deeper structures of the eyes.

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Ionizing radiation.

• Medicine and industry.
• Radio isotopes- co 60 and phos 32.
• Genetic changes, malformation, cancer, leukemia,
  sterility,.
• Maximum permissible level of occupational
  expsoure is 5 rem/year to the whole body.

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CHEMICAL HAZARDS.

• Chemical hazards are due to local action,
  inhalation and ingestion.
• LOCAL ACTION- dermatitis, eczema, ulcers,
  cnacers.
• INHALATION- dusts- size ranging from 0.1-150
  microns. Mine, foundry, pottery, textile, wood,
  stone .

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• Dust particle larger than 10 microns settle down
  from the air rapidly while the smaller ones
  remain suspended indefinitely.
• Particles smaller than 5 microns are inhaled
  directly an retained there. This is called
  respirable dust and is responsible for
  pneumoconiosis.

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Dusts

• Inorganic silica, mica, coal, asbestos.
• Organic cotton and jute

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gases

• Simple gases- O2,hydrogen.
• Asphyxiating gases- chlorine, CO, cyanide,
  sulphur dioxide.
• Anaesthetic gases- chloroform, ether,
  trichloroethylyne.

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Metal and their compounds

• Pb, Antimony, Ars, beryl, zn, chrm, phos, Hg,

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Biological hazards

• Workers may be exposed to infective and parasitic
  agents at the place of work
• Brucellosis, leptospirosis, anthrax, psittacosis,
  tetanus, encephalitis, fungal infections,.

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Mechanical hazards

• Machinery -

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Psychological hazards

• Frustration
• Job satisfaction
• Insecurity
• Poor IPR
• Emotional tension

• Hostility, aggressiveness, anxiety, dep, drug
  abuse, alcoholism,.
• Headache, neck pain, htn, dm, psych.