JC130 (Family Medicine) - Health Promotion & Disease Prevention in Primary Care

Question 1

Differentiate primary, secondary, tertiary and quaternary prevention of disease

Answer 1

Primary - Avoid disease by reducing susceptibility and control risk factors

Secondary - Avoid irreversible damage by early detection, therapy

Tertiary - Avoid complication, disability, dependence from chronic disease

Quaternary - Identify patient at risk of over-medicalisation, avoid consequences of unnecessary or excessive intervention

Question 2

Examples of primary disease prevention

Answer 2

Immunisation

o Birth control/ contraception
o Sexually transmitted diseases
o Mental health
o Smoking, alcohol
o Screening: for chronic illnesses and cancers

Question 3

Example of secondary prevention of disease

Answer 3

 Case finding: hypertension, diabetes, Ca cervix, Ca breast, squint, hearing, oral hygiene, child abuse

 Periodic health examination

Question 4

Example of quaternary prevention of disease

Answer 4

Health activities to mitigate or avoid the consequences ofunnecessary or excessive intervention of the health system

Question 5

List all childhood immunization in HK

Answer 5

 Tuberculosis (BCG)
 Hep B
 Diphtheria, tetanus, pertussis and polio (DTaP-IPV)
 PCV13
 MMR
 Chickenpox/ zoster
 Flu vaccine
 Hemophilus influenza type b
 Rotavirus
 Meningococcus

Question 6

List adult immunizations: repeat vaccines and travel immunisations

Answer 6

Repeat:
o Tetanus, diphtheria
o Pneumococcus
o Influenza

Travel immunisations:
o Hepatitis A
o Japanese encephalitis
o Meningococcus (Haj)
o Typhoid
o Cholera
o Yellow fever

Question 7

Criteria for ideal screening program

Answer 7

Wilson and Jungner criteria

o Long pre-clinical phase & prevalent disease
o Treatment available to improve outcome
o Test sensitive
o Test acceptable to patient
o Cost-effective

Question 8

Chronic conditions screened in primary care

Answer 8

Cardiovascular: DM, HTN, HL, Coronary artery disease, stroke, peripheral vascular disease

Screening methods:
Past history: CVD disease, diabetes, cholesterol
Blood pressure every 2 years
Diabetes every 3 years aged 30 or above
Behaviour: smoking, diet, exercise, alcohol, sex
Family history
Obesity: BMI, waist/hip ratio, waist size

Question 9

Cancer screened in primary care

Answer 9

Cervical (HPV pap smears)

Breast: mammography age 50-70

Colorectal: Fecal occult blood

(Others with uncertain efficacy: Lung cancer: low dose PECT scan; Nasopharyngeal cancer: EBV; PSA Prostate cancer PSA; Liver cancer: AFP and US abdomen, Fibroscan)

Question 10

How to delivery health promotion activities in primary care setting

Answer 10

Better office tools to enhance prevention of diseases e.g. better testing kits and machines

Acquire knowledge and skills for timely intervention and long-term management of diseases

Office system development: protocols, equipments, reminders, staff delegation…etc

Act as role models of healthcare in local society

Question 11

Causes of death abroad in foreign countries for HK residents

Answer 11

o Traffic accident (number 1)
o Other external disease
o Acute myocardial infarction
o Cerebrovascular accident (stroke)
o Coronary artery disease
o CA lung
o Other carcinoma
o DM
o Cardiac disorder

Question 12

Outline the scope of pre-travel healthcare consultation

Answer 12

Pre-travel advice, vaccinations

Prevention of Tropical diseases

Sex tourism precautions - STI, HIV…

Food precautions: diarrhea, dysentery…etc

Protection from environment: frostbites, altitude sickness, depressurisation, climate change, disasters…etrc

Rescue protocols

Special medical needs: pregnancy, cancer, chronic diseases…etc

Question 13

Most common illnesses a/w foreign travel

Answer 13

 Diarrhoea (42%)
 Fever (17%)
 Abdominal pain (10%)
 Others: flu, headache, rash, vomiting, dizziness, shortness of breath, car accident
(without injury), abrasion, skin allergy

Question 14

General preventative measures against gastroenteritis during foreign travels

Answer 14

Fluids: always Heated/ filtered/ bottled/ purified

Diet: select sanitary location, sanitary preparation of food, packaged/ manufactured food

Vaccination against enteric infections: e.g. HAV, Typhoid

Question 15

Vaccinations available against endemic diseases before travels

Answer 15

Japanese Encephalitis (triple vaccine)

Yellow Fever

Typhoid

Meningococcal meningitis

TB

Tetanus

Cholera

No vaccines for malaria*

Question 16

Prevention against mosquito-borne/ insect-borne diseases

Answer 16

 Long sleeve shirt, long pants
 Mosquito nets (impregnated)
 Avoid going out at night (e.g. Dengue fever mosquitoes has high activity in early morning)
 Barriers, e.g. window netting/ air-con
 Knock-down measures, e.g. coils, vaporisers, sprays
 Repellents e.g. DEET, plant extracts citronella

Question 17

Chemoprophylaxis against diseases a/w foreign travel

Answer 17

 Rehydration (more important)
 Malaria: chemoprophylaxis can cause birth defects in first trimester
 Antibiotics
 Antisecretory/ antiperistalsis for traveller’s diarrhoea

Question 18

General healthcare advice for immunocompromised traveller

Answer 18

Immunocompromised E.g. Haematological malignancy, Splenectomy, Solid organ cancers

 Normal vaccine + pneumovax/ H. influenzae type b (avoid live vaccine for 6/12 post-Rx)
 Consider stand-by antibiotics
 Standard malaria advice: chemoprophylaxis and prevention against bites
 Check Hep A IgG levels

Question 19

General healthcare advice for pregnant travelers

Answer 19

 Avoid travel to difficult areas

 Avoid all vaccines in the first trimester, otherwise avoid live vaccines

 Detailed advice about avoidance of bites

 Safety of chemoprophylaxis/ treatment against malaria (chloroquine/proguanil…mefloquine)
o Malarial chemoprophylaxis can cause birth defects in first trimester
o hydroxychloroquine = the only DMARD that can be given to
pregnant women

Question 20

Risk factors of thrombosis during travel

Time lapse between travel and thrombosis

Answer 20

Risk factors:
 >5 hrs of flight duration; typically >12
 Age >50
 Malignancy, congenital haematological disorders
 Pregnancy, obesity
 CHF, MI
 OCP, HRT
 Dehydration
 Deficiencies of anticoagulants such as antithrombin, protein C/ S

Time lapse:
within 3 days, up to 2 weeks after travel

Question 21

Prevention of thrombosis during long-haul travel

Answer 21

Postpone 3/12 after major surgery
In-flight leg exercises, seats with more room
Avoid sedatives or hypnotics, avoid diuretics
Ensure adequate hydration
Compression stacking

Aspirin to prevent recurrent thrombo-embolism (ASPIRE)

Question 22

Sources of travel-related healthcare information

Answer 22

Internet:
o Current Information: MMWR(CDC); Weekly epidemiological record (WHO); DH website
o Full-text: WHO’s International Travel and Health Guidelines
o Database: Pubmed/ Medline
o Interest groups: International Society of Travel Medicine (www.istm.org)

 Telephone hotlines: DH Portal Health service

 Journals: BMJ; Journal of Travel Medicine

 Malaria Prophylaxis: BNF

 Books on Travellers’ Health