Community Medicine Lecture 1 PDF

Community medicine - lecture 1 Prepared by : Dr Muniba Shamshad DPT, MSPT-OMPT HISTORY OF COMMUNITY MEDICEN & REHABILITATION  MEDICINE Study of evolution of man & of human knowledge down the ages; of the biographies of eminent...

Community medicine - lecture 1 Prepared by : Dr Muniba Shamshad DPT, MSPT-OMPT HISTORY OF COMMUNITY MEDICEN & REHABILITATION  MEDICINE Study of evolution of man & of human knowledge down the ages; of the biographies of eminent induvial who developed medicine; of discoveries & inventions in different historical periods 20 century expulsion of knowledge made medicine more th complex, treatment more costly but the benefits of modern have not yet penetrated the social periphery in many countries. Goal : prevention, promotion of health, improvement of quality of life ( groups, individuals or communities).  Medicine in antiquity In ancient times, health & illness were interpreted in a cosmological & anthropological perspective. Dominated by magical & religious belief. Henry siegerist ‘’every culture had developed a system of medicine & medical history is but one aspect of history of culture’’. Dubos ‘’ ancient medicine was the mother of science & played a large role in integration of early cultures.’’ There is an organic relationship between medicine & human advancement, at a given period it should be viewed against the civilization & human advancement at that time i-e philosophy, religion, economic condition, form of government, education, science & aspirations of the people.  Primitive medicine Evil spirits Supernatural theory of disease. Herbs administration. Instrument : stone/ flint  amputation, trephining of skull. India : snake bite  mantra , leprosy  past sins Traditional healers.  Indian medicine Ayurveda : knowledge of life  throughout India. Siddha system  Tamil. Father of Indian surgery: susruta Samhita  British learned rhinoplasty. Hygiene : Harappa/mohenjo- daro = sanitation. 600 AD : Moghuls Ayurveda decline  lack of state support Asia – Indian medicine West - greek  Unani-tib & homeopathy Treatment – disease = drugs Chinese medicine 1st organized body of medical knowledge. Yang-yin ; equilibrium. Hygiene, dietetics, hydrotherapy, massage, drugs, accupunture, immunization (small pox)  EGYPTIANS MEDICINE Oldest civilization. Medicine was mingled with religion. Disease was due to absorption from intestine of harmful substances – gave rise to putrefaction of blood & pus formation. Pulse= speech of heart Treatment : cathartics, enema, blood letting, drugs. Edwin smith papyrus : surgery, partial paralysis, cerebral lesions , skull fractures (800 prescription = 700 drugs) , diseases : worms, eye, DM, rheumatism, polio, schistosomiasis. Public health: bath, drain, inoculation, nets.  Mesopotamian medicine Cradle of civilization (part of Iraq) Concept: religious  taught/practiced by doctors. Causes of disease Hammurabi: laws govern  conduct of physician /HCP. DR  THEORY  wrong  kill First codification of medical practice. Scientific foundation  Greek medicine Why & how Reject: supernatural theory Matter: 4 element earth , air , fire, water = cold/hot/dry/moist. These are present in body by 4 humors : phlegm, yellow bile, blood, black bile. Hygiea (prevention) Body : power restoration – healing process Hippocrates : father of medicine Observation/reasoning  challenge – traditional method New approach : application of clinical method. OATH : ‘’where there is love for mankind, there is love for art of healing’’ – milestone = medical ethics. Epidemiologist : epidemic/endemic Causes of disease. Climate, water, clothing, diet, habits of eating & drinking , effect they had in producing disease BOOK: air , water & places – social medicine & hygiene.  Roman medicine Practical mind. Sense of sanitation – public health = pure water, combating malaria Establish hospital Galen (medical dictator): anatomy/experimental physiology About health he stated ‘’ since both in importance & time, health precede diseases, so we ought to consider first how health may be preserved & then how one may best cure disease’’ 3 factors disease: predisposing, exciting, environmental Conflict to Hippocrates : synthetic/analytic  Middle age (500-1500 AD) DARK AGE OF MEDICINE Primitive medicine back Small pox, leprosy, TB, plague During middle age: religious institutions – monasteries  headed by saint, monks = preserve ancient knowledge also rendered acrive medical & nursing care to sick ARABS CHRISTIANITY Unani system of medicine Ibn e sina – cannon of medicine / Abu becr Turbulent middle age: influence Pupillary reaction to light/ use mercurial Establish hospital purgatives/ 1st children disease book/pharma 1st hospital New York 937 AD pioneer Introduce : syrups, oils, poultices, plasters, pills, powders, alcoholates aromatic waters Words: drug, alcohol, syrup, sugar = Arabian Golden age of Arabic medicine: between 800- 1300 AD  DAWN OF SCIENTIFIC MEDICINE 1500 AD revolutions : political, religious, medical, industrial. Revival pf medicine Sanitary awakening Rise of public health  Germ theory of disease Causation of disease Louis pasture: bacteria – air , theory ‘’spontaneous generation’’. Robert Koch : anthrax- bacterial Golden age of bacteriology Etiological concepts  Birth of preventive medicine 18th century Firm foundation – P.MED after discovery of causative agent/germ theory. Control of infectious disease Blocking channels of transmission Protection of food Proper disposal of sewage Destruction of insects & disinfectant  Modern medicine 2 branches : curative/ public health – preventive. Curative: removal of disease , 2oth century allopathic –neutralize disease. Fields in medicals grows - specialization Preventive: applied to healthy people (prevention/ health promote) Concept: disease eradication Vaccines/ quarantine /nutrition/ insecticides / gene counselling. screening (risk factor) / old ages/degenerative /chronic diseases Control of infectious disease. Factors cause disease: social, psychological, economic, genetic, environmental  multi factorial causation Risk factors  epidemiologist  Modern preventive medicine Art & science of health promotions , disease prevention , disability limitation & rehabilitation. Preventive medicine- anticipatory medicine  Levels of prevention Primary prevention (health promotions, specific protection) Primordial prevention: It is also a primary level of prevention of the disease but it is with reference to non- communicable diseases, such as Obesity, hypertension, diabetes, cancer, coronary artery disease, etc. This consists of elimination or modification of ‘risk factors’ of the disease. Population (mass) strategy High-risk strategy. Secondary prevention (‘Early diagnosis and treatment.’) Tertiary prevention: disease process is sufficiently advanced, (i.e. in the late pathogenesis phase).  Social medicine Pioneer – Neumann Orientation of medicine to changing needs of man & society. Emphasize strong relationship between medicine & social sciences. CHANGE: CONCEPT IN PUBLIC HEALTH Disease control phase 1880-1920 Health promotion phase 1920-1960 Social engineering phase 1960-1980 Health for all 1981-2000 AD  FAILURE OF MEDICINE ? Cost Low coverage Elite-oriented health services Efficacy questioned - research  Community medicine Success Public health/ community health/preventive/social medicine. Defined (royal college of physician) ‘’ Speciality deals with population, comprises those doctors who try to measure needs of population both sick & well who plan & administer services to meet those needs & those who are engaged in research & teaching field. CONCEPT OF HEALTH AND DISEASE  HEALTH ‘’ State of complete physical, mental & social well-being & not merely an absence od disease or infirmity’’. (WHO) DIMENSIONS: physical: functioning of body Mental: balance between individual & surrounding Social: interpersonal ties & community involvement Spiritual: strive for meaning & purpose of life Emotional: cognition, emotional health, feeling Vocational: goals, capacities, limitations  True health : Who is enjoying health in all physical, mental & social plans Positive health: notion of perfect functioning of body & mind. ICEBERG of disease Floating tip: physician see ( clinical cases) Submerged: hidden mass of disease Water line ; demarcation between apparent & unapparent disease.  illness It is a phenomenon in which one or more natural functions of body ar so disturbed that the effected individual cannot meet natural requirement of everyday life. Acute / chronic SICKNESS State of social dysfunction i-e role that individual assume when ill (sick role)  Concept of disease control Aim at reducing: Incidence of disease Duration , risk of transmission Effect of infection Financial burden to community  disease Elimination: it is regional process, describe interruption of transmission of disease. example measles, polio (large geographical area). Eradication: it is an absolute term. Means tear out by roots, termination of all transmission of infectious agent example small pox  Natural history of disease: Disease result from complex interaction between host & agent or environment. It is the way of going to unfold itself, in the absence of treatment & prevention. PHASE: Pre-pathogenesis: preliminary to onset of disease (agent/host/environment required-epidemiological triad) Pathogenesis: begins with the entery of disease agent into susceptible human host  Incubation period: Period between entry of disease agent into host & appearance of sign & symptoms. Apparently patient healthy. Pathophysiological changes begins. The sequence of events in a disease process are: Disease → Impairment → Disability → Handicap Impairment: This means defect in the structures and function of an organ or a part of the body. The impairment may led to the development of secondary impairment as in leprosy, where damage to nerves (primary impairment) may lead to plantar ulcers (secondary impairment). Disability: This means inability to carry out certain routine, expected activities, considered normal for the age, sex etc, due to impairment. Handicap: This means experiencing disadvantage in the life and not able to play the role, expected out of her/him, resulting from the impairment or disability. Disease Impairment Disability Handicap  Accident Loss of foot inability to Loss of job  Vitamin A Corneal work because Blindness and deficiency xerosis of claw hand loss of job  leprosy Involvement Blurring of unemploymen of nerve vision t Inability to walk Rehabilitation is defined as: ‘Combined and co-ordinated use of physical, social, vocational and psychological measures for training and retraining the individual to the highest possible level of functional ability’, so that the individual becomes useful to himself, to the family and to the community at large  Physical rehabilitation: Restoration of function  Vocational rehabilitation: Restoration of earning capacity  Social rehabilitation: Restoration of relationship in the society  Psychological rehabilitation: Restoration of personal dignity and confidence THE END 