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)
- Prevent (Primary prevention: Prevent disease)
Normal (No problem)
—> Early stage (Just beginning) - Screening + Early diagnosis (Secondary prevention: Prevent symptoms)
No S/S, Established disease process
—> Symptoms (Reversible / Irreversible) - Rehabilitation + Prevent complications (Tertiary prevention: Prevent complications)
Interference with activity
—> Complications
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)
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
4
Q
Potential in every general practice consultation
A
- Prevention, early detection, health promotion
- Presenting complaint overt / covert
- Continuing care
- Coordination of care with hospital
- Modification of abnormal help-seeking behaviour
5
Q
Prevention in Primary care: Individual activities
A
Most important —> Less importance
- ***Immunisation
- ***Birth control (contraception)
- ***STD (Chlamydia, Gonorrhoea, Syphilis)
- Mental health
- Smoking
- Alcohol
- Screening (Ca cervix, Ca breast, CRC)
- Dental care
6
Q
- Immunisation
A
Childhood:
- ***Diphtheria, Tetanus, Pertussis, Polio (DTaP-IPV)
- Haemophilus influenzae
- ***Hep B
- Rotavirus
- ***MMR
- TB
- Meningococcus (new)
- ***Chicken pox / Zoster (new)
- Flu vaccine (new)
Adult:
- Repeat Tetanus, Diphtheria, Influenza, ***Pneumococcus
- Travel vaccination:
- **HepA
- **Japanese encephalitis
- Meningococcus (Haj)
- ***Typhoid
- Cholera
- Yellow fever
7
Q
Screening
A
5 Criteria:
- Long pre-clinical phase + Disease prevalent
- Test sensitive
- Test acceptable to patient
- Cost-effective
- 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
8
Q
Controversial / Uncertain screening in Cancer
A
- Breast self-examination
- low sensitivity
- can only detect lumps >1 cm (often already malignant —> make no difference to death i.e. Lead-time bias) - Liver cancer: AFP, USG of abdomen
- Cirrhotic liver often progress to HCC quickly (∴ no use screening for cirrhotic liver) —> HBV better - Nasopharyngeal cancer: EBV
- EBV not specific enough - Prostate: PSA
- Non-specific: BPH can have high PSA, Ca Prostate can have low PSA - Lung cancer: Low dose PET-CT scan
- Only effective in heavy smoking but not general public
9
Q
Problems with Mental health screening
A
- Depression
- Dementia
- Suicide
- Eating disorders
- Family violence
- Do not change outcome since ***no effective measures available
- Awareness but not case-identification —> Treating rather than Screening
10
Q
Recommend against
A
- Static ECG, Stress ECG
- Urinalysis
- Ovarian cancer: USG, CA125
- Uterine cancer: Endometrial sampler
- Testicular cancer
- Skin cancer
11
Q
Travel medicine
A
- Pre-travel advice + ***vaccinations
- ***Tropical diseases (e.g. malaria)
- ***STI / HIV / Flu / Diarrhoea (more vulnerable when travel)
- Health risk during air / sea / land travel
- Special needs
- Climate changes (e.g. dengue fever)
- Natural disasters
- Frost bites / Mountain sickness / Depressurisation (exotic / adventurous)
- Rescue medicine
- Long term expatriates (e.g. Africans losing protection against malaria)
12
Q
Causes of death during travel
A
HK people:
- ***Traffic accidents (mainland china)
- Other external cause
- ***Acute MI
- ***Cerebral vascular accident
- Coronary artery disease
UK people:
- CVS disease
- Accidents and injuries (relatively less people ∵ travel to European countries)
High risk:
- ***Young travellers
- Those perceived lower risks (e.g. Long term expatriates)
13
Q
Distribution of travel illnesses
A
Mostly self-limiting:
- Diarrhoea
- Fever
- Abdominal pain
- Flu
- Headache
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)
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:
- Fluid
- heat / filtration / bottled / purification agents
- ***beware of ice
- effects of drinks - Diet
- boil, cook, peel
- eat what looks good, smells good, tastes good - Location of food consumption
- Prevention of more serious enteric infections
- **Hep A: Vaccination
- **Typhoid vaccination
