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JC WCS > Family Medicine JC130: Health Promotion And Disease Prevention In Primary Care > Flashcards

Family Medicine JC130: Health Promotion And Disease Prevention In Primary Care Flashcards

1
Q

Stages of prevention

A

50% of deaths are due to preventable causes (e.g. smoking)

  1. Prevent (Primary prevention: Prevent disease)
    Normal (No problem)
    —> Early stage (Just beginning)
  2. Screening + Early diagnosis (Secondary prevention: Prevent symptoms)
    No S/S, Established disease process
    —> Symptoms (Reversible / Irreversible)
  3. Rehabilitation + Prevent complications (Tertiary prevention: Prevent complications)
    Interference with activity
    —> Complications
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2
Q

Prevention

A

Primary prevention:

  • Avoiding disease by reducing susceptibility / controlling risk factors
  • ***Patient education: diet, smoking, drinking, exercise, accidental injury, safe sex, personal hygiene, parenthood, breastfeeding
  • ***Immunisation

Secondary prevention:

  • Avoiding ***irreversible damage through early detection + therapy
  • ***Case finding: HT, DM, Ca cervix, Ca breast, squint, hearing, oral hygiene, child abuse
  • ***Periodic health examination

Tertiary prevention:

  • Avoiding ***complications, disability / dependence in irreversible states
  • ***Continuous care of chronic illness (e.g. Risk Assessment and Management Programme in HK for chronic disease patients)
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3
Q

Quaternary prevention

A
  • Action taken to identify patient at risk of ***over-medicalisation, to protect him from new medical invasion, and suggest to him interventions that are ethically acceptable
  • Set of health activities to mitigate / avoid the consequences of unnecessary / excessive intervention
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4
Q

Potential in every general practice consultation

A
  1. Prevention, early detection, health promotion
  2. Presenting complaint overt / covert
  3. Continuing care
  4. Coordination of care with hospital
  5. Modification of abnormal help-seeking behaviour
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5
Q

Prevention in Primary care: Individual activities

A

Most important —> Less importance

  1. ***Immunisation
  2. ***Birth control (contraception)
  3. ***STD (Chlamydia, Gonorrhoea, Syphilis)
  4. Mental health
  5. Smoking
  6. Alcohol
  7. Screening (Ca cervix, Ca breast, CRC)
  8. Dental care
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6
Q
  1. Immunisation
A

Childhood:

  1. ***Diphtheria, Tetanus, Pertussis, Polio (DTaP-IPV)
  2. Haemophilus influenzae
  3. ***Hep B
  4. Rotavirus
  5. ***MMR
  6. TB
  7. Meningococcus (new)
  8. ***Chicken pox / Zoster (new)
  9. Flu vaccine (new)

Adult:

  1. Repeat Tetanus, Diphtheria, Influenza, ***Pneumococcus
  2. Travel vaccination:
    - **HepA
    - **    Japanese encephalitis
    - Meningococcus (Haj)
    - ***Typhoid
    - Cholera
    - Yellow fever
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7
Q

Screening

A

5 Criteria:

  1. Long pre-clinical phase + Disease prevalent
  2. Test sensitive
  3. Test acceptable to patient
  4. Cost-effective
  5. Treatment available to improve outcome
  • Only a few conditions suitable for screening (∵ ALL 5 criteria have to be met)
  • Huge pressure from public to screen
  • Ethical / Legal issues (when unsuitable tests ruled out)

What should we screen?
Chronic illnesses
- CVS (CAD, Stroke, Peripheral vascular disease) —> BP (every 2 years), BG (every 3 years above 30 yo), BMI, WHR, Cholesterol, Family history, Lifestyle
- Cancers —> **Cervical smear (90% efficacy), Mammography age 50-70 (25%), Occult blood for CRC (20%), **Colonoscopy
- Degeneration
- Disability of ageing

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8
Q

Controversial / Uncertain screening in Cancer

A
  1. Breast self-examination
    - low sensitivity
    - can only detect lumps >1 cm (often already malignant —> make no difference to death i.e. Lead-time bias)
  2. Liver cancer: AFP, USG of abdomen
    - Cirrhotic liver often progress to HCC quickly (∴ no use screening for cirrhotic liver) —> HBV better
  3. Nasopharyngeal cancer: EBV
    - EBV not specific enough
  4. Prostate: PSA
    - Non-specific: BPH can have high PSA, Ca Prostate can have low PSA
  5. Lung cancer: Low dose PET-CT scan
    - Only effective in heavy smoking but not general public
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9
Q

Problems with Mental health screening

A
  1. Depression
  2. Dementia
  3. Suicide
  4. Eating disorders
  5. Family violence
  • Do not change outcome since ***no effective measures available
  • Awareness but not case-identification —> Treating rather than Screening
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10
Q

Recommend against

A
  1. Static ECG, Stress ECG
  2. Urinalysis
  3. Ovarian cancer: USG, CA125
  4. Uterine cancer: Endometrial sampler
  5. Testicular cancer
  6. Skin cancer
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11
Q

Travel medicine

A
  1. Pre-travel advice + ***vaccinations
  2. ***Tropical diseases (e.g. malaria)
  3. ***STI / HIV / Flu / Diarrhoea (more vulnerable when travel)
  4. Health risk during air / sea / land travel
  5. Special needs
  6. Climate changes (e.g. dengue fever)
  7. Natural disasters
  8. Frost bites / Mountain sickness / Depressurisation (exotic / adventurous)
  9. Rescue medicine
  10. Long term expatriates (e.g. Africans losing protection against malaria)
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12
Q

Causes of death during travel

A

HK people:

  1. ***Traffic accidents (mainland china)
  2. Other external cause
  3. ***Acute MI
  4. ***Cerebral vascular accident
  5. Coronary artery disease

UK people:

  1. CVS disease
  2. Accidents and injuries (relatively less people ∵ travel to European countries)

High risk:

  • ***Young travellers
  • Those perceived lower risks (e.g. Long term expatriates)
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13
Q

Distribution of travel illnesses

A

Mostly self-limiting:

  • Diarrhoea
  • Fever
  • Abdominal pain
  • Flu
  • Headache
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14
Q

Traveller’s diarrhoea

A
  • 20-50% depending on destination, pre-travel, risks assessment
  • Transmission by faecal contaminated food / liquid (including ice)
  • Mostly lasted between 1-4 days
  • Mostly by ***bacteria (50%)
  • virus (20%), others: parasites, protozoa, acute food poisoning
  • Huge economic implications (Medical costs + Work force lost)
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15
Q

Typhoid

A
  • Salmonella Typhi
  • Incubation: 1 week (3-60 days)
  • Fever, headache, abdominal pain, constipation, less frequently diarrhoea
  • > 80 HR with High fever —> Delirium
  • Antibiotics: ***Ciprofloxacin, Azithromycin

Prevention:

  1. Fluid
    - heat / filtration / bottled / purification agents
    - ***beware of ice
    - effects of drinks
  2. Diet
    - boil, cook, peel
    - eat what looks good, smells good, tastes good
  3. Location of food consumption
  4. Prevention of more serious enteric infections
    - **Hep A: Vaccination
    - **    Typhoid vaccination
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16
Q

Other infectious disease

A
  • ***Japanese encephalitis (Live vaccine: recommended for travel in paddy fields >6 weeks) (1st dose: 30%, 2nd dose: 60%, 3rd dose: 90% efficacy)
  • Meningococcal meningitis
  • TB
  • Yellow fever
  • Tetanus
  • Cholera
  • Typhoid

Need to balance Cost, SE, Complications, Effectiveness

17
Q

Groups at risk

A
  1. Immunocompromised (malignant diseases, haematological malignancy (No spleen, Neutropenic, T-cell deficient), solid organ cancers (T-cell / Neutrophil deficient if no chemotherapy))
    - **avoid live vaccine for 6 months post-Rx
    - normal vaccine + Pneuomovax / Hib
    - consider **    stand-by antibiotics
    - check Hep A IgG levels
    - standard malaria advice
  2. Pregnant travellers
    - **avoid ALL vaccines in 1st trimester
    - otherwise avoid **    live vaccines (yellow fever may be given if high risk)
    - detailed advice about avoidance of bites
    - safety of chloroquine / proguanil / mefloquine
    - avoid travel to difficult areas
18
Q

Prevention of insect bites

A
  1. Long sleeve shirt, long pants
  2. Mosquito nets (impregnated)
  3. Avoid going out at night
    - **Dengue fever: Morning
    - **    Malaria: Evening
  4. Barriers such as window netting / air-con
  5. Knock-down measures e.g. coils, vaporisers, sprays
  6. Repellents e.g. DEET (safe for pregnancy, immunocompromised, babies), plant extracts citronella
    - must be repeated
19
Q

Chemoprophylaxis

A
  1. ***Malaria (NO vaccination!!!)
  2. Antibiotics
  3. Anti-secretory / Anti-peristalsis for traveller’s diarrhoea

Most importantly: Rehydration

20
Q

Non-infectious risks

A

Air travel and thrombosis

  • usually >5 hours of flight duration and typically >12
  • more likely with older subjects (>50)
  • other risk factors: malignancy, congenital haematological disorders, pregnancy, CHF, MI, OCP, HRT, obesity, dehydration
  • usually not during / immediately after flight but within 3 days - 12 weeks
  • PE rather than DVT can be first presenting complaint (20% sudden death on flights)
  • recent air travel >4 hours makes DVT 4x more likely
  • ***Heparin some effect (Aspirin only help MI)

Prevention of thrombosis:

  1. Fit to fly? Postpone 3 months after ***major surgery
  2. ***In-flight leg exercises
  3. Deep breath
  4. Hand luggage
  5. Seats with more room (“Economy class syndrome”)
  6. ***Adequate hydration + avoid diuretics
  7. Avoid sedatives
  8. For people at risk, below-knee elasticated ***stockings
21
Q

Communication in Travel medicine

A

Resources: Internet

  • current information: MMWR (CDC), weekly epidemiological record (WHO), DH website
  • full-text: WHO’s international travel and health guidelines
  • database: Pubmed / Medline
  • interest groups: International society of travel medicine

Other resources:

  • telephone hotlines: DH portal health service
  • journals: BMJ, Journal of travel medicine
  • malaria prophylaxis: BNF
  • books: Traveller’s health by R Dawood
22
Q

Successful preventive care in Family medicine

A
  1. Knowledge
  2. Skill
  3. Office tools to enhance prevention
  4. Office system development (e.g. multidisciplinary team in primary care setting)
    - Protocols
    - Equipment
    - Record systems: Reminder (label for smoker) + Recall (3-yearly mail out for pap smears)
    - Staff delegation
  5. Role models

JC WCS (134 decks)

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