Prevention and promotion Flashcards
What is health?
A state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity
In what fields are health influenced?
- Biology (genetics
- Environment, little or no control
- Lifestyle: personal decisions
- Health care organization: medical practice, nursing, hospitals, nursing homes, drugs, public health service, paramedic service, dental treatment
What are the environmental determinants of health?
- Socioeconimic: 1) income 2) employment, working conditions 3) housing 4) food insecurity 5) education 6) disability 7) race 8) early life
- Cultural
- Physical environment
Coordination action of health promotion?
Governments, health & other social & economic sectors, nongovernmental & voluntary organisation, local authorities, industry, media, health care systems
What is the definition on disease prevention?
Averting the development of pathological state. It includes all measures, definitive therapy that limit the progression of disease.
What is primordial prevention
Actions and measures inhibiting emerge of risk factors. In the form of environmental, economic, social, behavioral conditions and cultural patterns of living. Eks: discourage children from adopting harmful lifestyles. Main intervention is individual and mass education.
Primary prevention
- Action taken prior to onset of disease
- Intervention in prepathogenesis phase
- Health promotion and specific protection
- Population mass strategy: directed to whole population
- High risk strategy: to individuals at special risk
Secondary prevention
- Action which halts the progress of a disease at its incipient stage and prevent complication
- Arrest disease process, restore health, treat before irreversibly pathology takes place
Tertiary prevention
Measures in symptomatic patients to prevent complication. All interventions in pat who are/have been symptomatic
Quaternary prevention
Action taken to identify a pat at risk of overmedication, to protect him from new medical invasion, and to suggest to him interventions which are ethically acceptable
Primordial target
general population
Primordial goal
Reduce risk
Primary target
Susceptible
Primary goal
Reduce disease incidence
Secondary target
Asymptomatic
Secondary goal
Reduce prevalence of consequence
Tertiary target
Symptomatic
Tertiary goal
Reduce complication or diasbility
What are the Wilson and Junger criteria
- Knowledge of disease: an important health problem with latent period or predecease marker
- Knowledge of test: simple, safe, precise and validated, test values in population and cutoff levels, accepted
- Treatment: effective treatment for pat identified through early detection, evidence that early tx is better than late
- Cost: balanced against expenditures on medical care as a whole
What are the problems with screening?
- Lead time bias
- Length time bias
- Overdiagnosis
- Selection bias
Methods of screening
- Opportunistic: when they go to doctor for something else, simple easy, not reliant on patient compliance
- Systematic: deliberately seek out all patients, more comprehensive, require organization, time and commitment.
What are the recommended screenings for cancer?
- Breast: mammography 50-74y
- Cervical cancer: women 21-65 w pap smear and combined w HPV testing 30-65
- Colorectal: everyone 50-75y, FOB, sigmoid/coloscopy
- Lung cancer: low dose CT, 55-80 w 30 pack year smoking history, who currently smoke or have quit within the past 15 y (CT)
What is A and B recommendations?
A: applies to all persons in age/risk factor based group
B: not universal, but in context of clinical patient encounter
AAA screening
- B
- one time screening for men 65-75y/old who have ever smoked
Alcohol misuse
B, All aged 18 and older
High BP
A, All aged 18 and older
Chlamydia
Sexually active women aged 24 and younger, or older women at risk, A
Cholesterol
A, All men aged 35y and older, and women aged 45 years and older if at increased risk of coronary heart disease
Depression
B, MDD for all adults
DM
B, Type 2 for asymptomatic adults w sustained BP over 135/80
Gonorrhea
B, Sexually active women if increased risk of infection
HepC
B, High risk adults, one time screening
HIV (?)
A, All adults aged 65 and over and at increased risk
Osteoporosis
B, women aged 65 and older
Tobacco use
A, Ask about use and provide cessation interventions, all adults
What cause chickenpox?
VZV
How does chickenpox transmit?
A sick person, droplet infection and by direct contact. Incubation 11-21d. Infectivity until vesicles are crusted.
Sx of VZV
- Flu like: increased temp
- Rash: cold- bubble - scab (including scalp and mucus membranes)
Dx of VZV
Serology and virus isolation
Complications of VZV
- Bacterial skin inf (group A Strep, Staph aureus)
- Encephalitis, meningitis
- Pneumonia pneumonitis
- Inflammation of the brain ans cerebellum
- Keratitis and blindness
- Death (imm.comp)
Tx of VZV
Antiviral drugs, acyclovir, valacyclovir or famcyclovir amy shorten the course of illness in pat >2yrs if stated within 24h of exanthem
Prevention of VZV
- Patient isolation
- Vaccination: 12- 18 m w booster at 4- 6 y. Breakthrough inf can occur. Live attenuated virus are not given to imm.comp of pregnant pat.
What is causing Rubella?
Rubivirus
What is Ddx of rubella
Inf. mononucleosis and drug induced allergic reaction
Source of rubella
Sick man, droplet. Incubation 11-21d. Infective about 1 week before the rash and one week after the rash
sx of rubella
- Flu like symptoms w increased temp
- Swollen LN in the neck and occipital area
- Redness of the conjunctiva
- Rash: delicate, pale pink, maculopapular, throat w Forsheimer spots (petechie)
Dx of rubella
Serological test and virus isolation
Complication of rubella
- Thrombocytopenia
- Arthritis
- Encephalitis
Tx of rubella
symptomatic
Prevention of rubella
Isolation and vaccination, MMR 13-14 mc + 10y
What cause measles
Morbilivirus
How do measles spread?
Sick person w droplets. Incubation 7 -14 d. Infective from warning signs to 5 days after the appearance of the rash
Sx of measles
- Incubation period, asymptomatic 3-5d
- Usually mild fever, conjunctivitis and rhinitis, dry cough, Kopliks spots in mouth
- Rash: increased fever up to 40C, maculopapular, malaise, rash starting at the forehead and moving down the body
Dx of measles
serology and virus isolation
Ddx of measles
other inf w rash, allergic reaction
complications of measles
- middle ear inflammation 2. pneumonia 3. transverse myelitis 4. encephalitis (acute or subacute subsclerosing)
Tx of measles
symptomatic
Prevention of measles
Isolation + vaccination MMR at 13-14 m + 10y
What causes Lyme disease
Borrelia burgdorferi through a bite from infected tick, mainly a nymph. Unlikely to transmit organism in early hrs of feed, but increasing risk w increased duration of the blood meal
Sx of Lyme
- Fever, headache, fatigue
- Rash: erythema migrans (60-80%) after 3-30d. Gradually expands peripherally over days. Not significantly raised or painful
dx of Lyme
- Not w erythema migrans!
- Abs to B- burgdorferi are detectable within 4-8 w
- Abs + DNA detection on CSF w suspected neuroborreliosis
- DNA detection from skin biopsy when erythema migrants and acrodermatitis chronic atrophicans or testing synovial fluid in suspected lyme arthritis
tx of Lyme
- ABs: amoxicillin, sephalosporin, macrolides
- Early tx can prevent the risk of developing late stage complications
complications of lyme
- Malaise
- Neuroborreliosis: facial palsy, lymphocytic meningitis and radiculoneuritis (6-12w)
- Arthritis, affects a large joint, most commonly the knee
- Carditis, heart block
Prevention of Lyme
- Avoiding tick bite and early removal of attached ticks, protective clothing, tick repellants
- Check skin periodically
- Remove tick w fine-pointed forceps, grasp it as close as possible to the skin and gently upwards (trying not to break of the mouth part, risk is not increased if mouth part are left behind)
- Skin disinfectant after, prevent pyogenic infection
- Special attention to: groins, armpits, under breast, waist band area, backs of knees, head and neck
What is the role of the doctor and nurse in prevention of infection of children regarding vaccines
- Doctor: individualized advise, qualification for vaccine w history and physical examination
- Nurse: administration and education
What are the contraindications for vaccine?
Absolute: 1) Severe systemic reaction after previous vaccine or substance in the vaccine 2) Admin of live vaccine in pat w impaired immune system 3) admin of live vaccine in pregnant women
Special situation: risk of given clinical situation exceed benefit of vaccine
