Preventative Notes Wk1-8 PDF

LECTURE 1 Concepts of Health - Historical Perspective: Hippocrates, the "Father of Medicine," emphasized kindness and dedication in healing. Medical understanding has grown through both accurate and inaccurate theories, observations, and discoveries. - Cultural Influence: Definitions of health var...

LECTURE 1 Concepts of Health - Historical Perspective: Hippocrates, the "Father of Medicine," emphasized kindness and dedication in healing. Medical understanding has grown through both accurate and inaccurate theories, observations, and discoveries. - Cultural Influence: Definitions of health vary culturally and historically, often limited to the "absence of disease." - Broader Perspective: True health is more than disease-free status; it involves a balance with one’s environment and incorporates physical, mental, and social well-being. Healthy habits, such as exercise, hygiene, diet, mental balance, and social skills, support overall health. Changing Concepts of Health 1. Biomedical Concept: Traditionally, health was viewed merely as the absence of disease, which does not account for chronic conditions and lifestyle-related health issues. 2. Ecological Concept: Health as a dynamic balance between individuals and their environments, where poor adaptation can result in illness. 3. Psychosocial Concept: Health is shaped by psychological, social, cultural, economic, and political factors. 4. Holistic Concept: This approach considers all societal sectors (agriculture, industry, education, etc.) as influencing health. Dimensions of Health According to WHO, health encompasses multiple dimensions: 1. Physical Dimension: Proper functioning of body systems, measurable by statistics like mortality rates, life expectancy, etc. 2. Mental Dimension: Inner harmony with oneself and the environment, often assessed through questionnaires. 3. Social Dimension: Quality of relationships, community involvement, and societal integration. Additional Dimensions: - Spiritual: Values, beliefs, and purpose in life. - Emotional: Connection between feelings and mental well-being. - Other Dimensions: Vocational, cultural, socioeconomic, environmental, educational, nutritional, and preventive aspects. Indicators of Health Health indicators provide measurable metrics for assessing community and national health, identifying healthcare needs, and evaluating progress. 1. Mortality Indicators: - Crude Death Rate: Deaths per 1,000 population annually. - Life Expectancy: Average years remaining at birth. - Infant Mortality Rate: Deaths under one year per 1,000 live births. - Child Mortality Rate: Deaths at ages 1–4 per 1,000 children. 2. Morbidity Indicators: - Incidence and prevalence of diseases. - Healthcare utilization, such as admission rates and hospital stay lengths. 3. Disability Rates: - Event-based and individual-based measures of disability. 4. Nutritional Status Indicators: - Anthropometric measurements like height, weight, and low birth weight prevalence. 5. Health Care Delivery Indicators: - Ratios such as doctor-to-population, health facility access, and traditional healthcare services. 6. Utilization Rates: - Proportion of people accessing necessary healthcare. 7. Social and Mental Health Indicators: - Indicators include rates of suicide, homicide, violence, substance use, and obesity. 8. Environmental Indicators: - Quality of water, air, food safety, and exposure to pollution and toxic substances. 9. Socioeconomic Indicators: - Indicators like population growth, unemployment, and family size provide context for health. 10. Health Policy Indicators: - Resource allocation reflects political commitment to health. 11. Quality of Life Indicators: - Measured by infant mortality rate, life expectancy, and literacy rate. 12. Other Indicators: - Social indicators and indicators of basic needs reflect broader well-being. LECTURE 2 Concepts of Health and Disease - Disease Definition: Disease is any condition impairing normal body functions, defined simply as a deviation from physical or mental well-being. - Causation Theories: Early theories of disease causation included supernatural and humoral beliefs. The Germ Theory shifted focus to microbes as primary disease causes but has limitations, as multiple factors contribute to disease development. Disease Causation Models 1. Germ Theory of Disease: Established in the late 19th century, this theory links specific infectious agents to diseases but is insufficient for multifactorial diseases. 2. Epidemiological Triad: This model includes agent, host, and environment factors, highlighting the importance of host susceptibility and environmental conditions in disease onset. Factors in Disease Causation 1. Agent Factors: Biological (e.g., viruses, bacteria), nutritional, physical, chemical, mechanical, and social agents (e.g., lifestyle and social conditions). 2. Host Factors: Characteristics like age, sex, and genetics that affect susceptibility to disease. 3. Environmental Factors: Physical (e.g., air, water), biological (e.g., other living organisms), and psychosocial (e.g., economic, cultural) conditions. Multifactorial Causation - Many modern diseases (e.g., cancer, heart disease) result from multiple interacting factors. The Web of Causation model explains this interconnectedness, showing how different factors can collectively lead to chronic diseases. Natural History of Disease - The natural history describes disease progression from prepathogenesis (before disease onset) to pathogenesis (disease development and outcomes like recovery or death). This model includes risk factors that increase disease likelihood. Models of Disease Manifestation 1. Spectrum of Disease: Shows severity range, from subclinical (no symptoms) to severe cases. 2. Iceberg Model: Many cases of disease are "hidden" (undiagnosed or subclinical) and not immediately observable, emphasizing the importance of identifying and managing these cases in preventive medicine. Disease Control and Prevention 1. Disease Control: Aims to reduce incidence, duration, transmission, and impact through strategies like primary (prevention) and secondary (early intervention) measures. 2. Disease Elimination: Focuses on stopping disease transmission within specific regions. 3. Disease Eradication: Seeks to remove a disease entirely from the world; smallpox is the only disease eradicated so far. Screening for Diseases - Screening detects unrecognized diseases in asymptomatic individuals, aiming for early intervention. Effective screening tests should meet criteria such as test acceptability, repeatability, and validity (sensitivity, specificity, predictive values). Infection and Immunity 1. Infection: Occurs when an infectious agent enters and establishes itself in the host. Transmission involves reservoirs (humans, animals, objects) and various modes (direct and indirect). 2. Stages of Infection: Include incubation, prodromal (onset), fastigium (peak), defervescence (decline), and convalescence. 3. Immunity Types: - Active Immunity: Develops after infection or vaccination, producing long-lasting antibodies. - Passive Immunity: Temporary protection through transfer of pre-formed antibodies, such as maternal antibodies or antisera. LECTURE 3 Levels of Prevention Prevention can be divided into four levels: 1. Primordial Prevention: Prevents the emergence of risk factors in populations or regions where they haven’t appeared yet. - Main Intervention: Education at both individual and community levels to prevent lifestyle and environmental risks. 2. Primary Prevention: Aims to prevent disease before it occurs by addressing risk factors. - Interventions: Health promotion, specific protections (e.g., immunizations, nutrition). 3. Secondary Prevention: Detects disease in its early stages to stop or slow progression and prevent complications. - Interventions: Early diagnosis and treatment, regular screenings. 4. Tertiary Prevention: Aims to reduce the impact of an already advanced disease by managing complications and improving quality of life. - Interventions: Rehabilitation, disability limitation. Modes of Intervention 1. Health Promotion: Empowers people to take control of their health through: - Health education, environmental changes, nutrition, lifestyle, and behavior modifications. 2. Specific Protection: Protects individuals from specific health risks, including: - Immunizations, proper nutrition, and protective measures against hazards or allergens. 3. Early Diagnosis and Treatment: Focuses on identifying health disturbances early to improve outcomes and prevent disease progression. 4. Disability Limitation: Prevents impairments from becoming severe disabilities or handicaps by using appropriate treatments and interventions. 5. Rehabilitation: Enhances functional abilities and quality of life through comprehensive support, including: - Medical: Treatment to manage health conditions. - Vocational: Helping individuals return to work or adapt to new roles. - Social and Psychological: Providing support for mental and social adjustments.  LECTURE 4 Critical Issues in Healthcare and Public Health 1. Health Financing: Ensuring adequate funding for healthcare services is a major challenge. 2. Human Resources: There is a need for skilled healthcare professionals to deliver quality care. 3. Mental Health: Rising mental health conditions require greater attention and resources. 4. Climate Change: It poses significant risks to human health and the environment. 5. Poverty: Acts as a barrier to accessing healthcare, affecting health outcomes. 6. Reproductive Health: Access to reproductive health services faces various challenges. 7. Infodemic: The spread of misinformation, especially during pandemics like COVID-19, complicates public health efforts. 8. Humanitarian Crises: Healthcare provision in crisis situations is critical but challenging. Integrated Science Model and Epidemiology - Integrated Science Model: Uses an interdisciplinary approach (biology, behavior, social sciences) to understand health issues. - Epidemiology: The study of health event distribution and determinants in populations, which informs disease control and health interventions. It includes descriptive, analytical, and experimental methods. Disease Measurement and Prevention - Disease Measurement: Involves calculating rates, ratios, proportions, incidence, and prevalence to quantify disease frequency. - Key Concepts: The epidemiological triad, risk and prevention factors, and the biopsychosocial model, which incorporates biological, psychological, and social factors in health. Objectives and Methods of Epidemiology - Objectives: To describe health issues' distribution and magnitude, identify risk factors, and provide data for health planning and evaluation. - Methods: Divided into observational (descriptive and analytical) and experimental (randomized controlled trials, field trials, community trials). Types of Epidemiological Studies 1. Descriptive Studies: Describe health conditions' distribution across variables like age, sex, and location. They identify trends and generate hypotheses for further research. 2. Case-Control Studies: Compare individuals with a disease (cases) to those without (controls) to assess past exposures, using odds ratios to estimate risk. 3. Cohort Studies: Follow a group with a common exposure over time to observe disease incidence, using measures like relative risk. 4. Randomized Controlled Trials (RCTs): Randomly assign participants to treatment or control groups to establish causation by minimizing bias. 5. Field Trials/Community Trials: Evaluate public health interventions in real-world settings to assess their effectiveness on a community level. Clinical Research and Ethics - Clinical Research Designs: Evaluate treatments' safety and effectiveness, requiring rigorous methods and ethical standards. - Ethics in Research: Protects participants' rights, safety, and well-being and ensures scientifically valid and socially responsible research. Ethical Guidelines and Principles - Guidelines: Include the Nuremberg Code, Declaration of Helsinki, Belmont Report, CIOMS, and U.S. Common Rule. - Ethical Principles: - Scientific Validity: Ensuring research is methodologically sound.  - Social and Clinical Value: Research should benefit society and have medical relevance. - Fair Subject Selection: Subjects should be chosen based on study goals, not vulnerability. - Favorable Risk-Benefit Ratio: Risks should be justified by potential benefits. - Independent Review: Ensures unbiased assessment of research. - Informed Consent: Participants should voluntarily agree to participate, understanding the study's risks and benefits. - Respect for Participants: Includes maintaining confidentiality and addressing conflicts of interest. Additional Issues in Clinical Research - External Validity: RCT results may have limited generalizability to broader populations. - Surrogate Outcomes: Used in trials as substitutes for actual clinical outcomes, which may limit real-world applicability. - Trial Design and Data Management: Proper design and secure data handling are essential for reliable results. - Financial Constraints: Limited funding poses challenges for conducting RCTs. - Communication of Findings: Effective dissemination to both the public and scientific communities is critical. Systematic Reviews and Meta-analyses - Purpose: Summarize the best available evidence, identify knowledge gaps, and inform clinical guidelines. - Process: Involves developing a research question, finding relevant studies, assessing quality, extracting data, and synthesizing results. - Advantages: Provide precise effect sizes, explore heterogeneity, and reconcile conflicting results. - Limitations: The quality of included studies, potential publication bias, and limitations in answering certain research questions.  LECTURE 5 Health Education - Definition: A process to inform and empower individuals to make informed health choices. - Principles: Interest, motivation, participation, and relationship building are essential to effective health education. Health Education Approaches and Methods - Approaches: Regulatory (laws, policies), service (providing services), health education, and primary health care. - Methods: Lectures, symposiums, group discussions, demonstrations, and role-playing. Health Education Levels 1. Individual Level: Direct, two-way communication that allows for persuasion but has a limited reach. 2. Group Level: Interactive methods like panel discussions, workshops, and seminars to engage groups. 3. General Public: Uses mass media, including TV, radio, newspapers, and exhibitions, to reach wider audiences. Education Theories - Behavioral Theory: Focuses on behavior change through rewards or punishments. - Social Learning Theory: Emphasizes learning through observation and social interactions. - Cognitive Theory: Highlights understanding and internalizing information. - Humanist Theory: Emphasizes personal growth and self-actualization. - Developmental Theory: Considers the developmental stages of individuals. - Critical Theory: Promotes critical thinking and questioning of societal norms. Characteristics and Barriers to Health Education - Characteristics: Targets influential community members, uses various channels, emphasizes short-term benefits, and facilitates open dialogue. - Barriers: Include physiological, environmental, psychological, and cultural obstacles that can hinder effective communication. Health Education vs. Propaganda - Health Education: Encourages critical thinking and reflective behavior. - Propaganda: Appeals to emotions and aims to manipulate behavior without encouraging informed decision-making. LECTURE 6 Concept and Origin of Primary Health Care - Conventional Health Model: Previously focused mainly on treating symptoms, neglecting social, political, economic, educational, and psychological determinants of health. The high costs and lack of attention to these broader factors led to criticisms. - Chronic Diseases: Issues like drug addiction, alcoholism, and cardiovascular diseases, often linked to lifestyle, poverty, and dependency, highlighted the limitations of the conventional model. - WHO-UNICEF Alma-Ata Conference (1978): This international conference, held in Alma-Ata, former Soviet Union, formally established the concept of Primary Health Care. It emphasized integrating community-level factors to improve health and aimed for “Health for all by 2000,” positioning PHC as central to achieving this goal. Criticisms of the Alma-Ata Declaration - The declaration was viewed as overly broad, idealistic, and impractical. Many critics argued that the slogan “Health for all by 2000” was unachievable within the proposed timeframe. Definition of Primary Health Care (WHO/UNICEF, 1978) Primary Health Care is defined as: - Essential health care based on practical, scientifically sound, and socially acceptable methods and technology. - Universally accessible to individuals and families within the community. - Affordable and sustainable throughout the community’s and country’s development. - Based on self-reliance and self-determination, encouraging communities to take charge of their health. Components of Primary Health Care 1. Education: Awareness of prevalent health issues and methods for prevention and control. 2. Food Promotion: Ensuring a balanced diet and adequate food supply. 3. Water and Sanitation: Providing safe water and basic sanitation facilities. 4. Maternal and Child Health: Delivering care for mothers and children, including family planning services. 5. Immunization: Protecting against major infectious diseases. 6. Treatment: Offering treatment for common illnesses and injuries. 7. Essential Drugs: Ensuring access to necessary medicines. 8. Prevention and Control: Managing locally endemic diseases to reduce their spread. Principles of Primary Health Care 1. Equitable Distribution: Governments should ensure fair distribution of healthcare resources. 2. Community Involvement and Participation: Involve non-professional community members in health planning and implementation. 3. Focus on Prevention and Health Promotion: Emphasize identifying risk factors and empowering individuals to make health-positive choices, rather than only providing treatment. 4. Appropriate Technology: Utilize resources and technology affordable for the community. 5. Multisectoral Approach: Collaborate across sectors like social services, education, agriculture, and economy to address health determinants comprehensively. Implications of Primary Health Care 1. Community Partnerships: Encourages community involvement in health initiatives, increasing participation and fostering development. 2. Evaluation and Research: Data collection and research help inform effective health policies and practices. 3. Healthcare Education Reform: Shifts focus toward achieving health outcomes over simply delivering services. 4. Personal Accountability: Health professionals are encouraged to promote health equity and community health initiatives actively. Issues and Considerations - Impact on Health Indicators: Countries with robust primary care systems generally report higher patient satisfaction and improved health outcomes, often at a lower cost. - Resource Distribution: Despite available resources, many rural and inner-city areas, especially in developing countries, still lack adequate primary care providers, limiting access to essential health services. Lecture 7 Definition of Public Oral Health - Dental Public Health: - The science and practice of preventing oral diseases, promoting oral health, and improving quality of life through organized community efforts. - Focuses on the community as a patient, unlike clinical dentistry, which targets individuals. Relevance of Public Health to Clinical Practice - Dentistry is undergoing rapid change due to social, epidemiological, and demographic shifts, as well as changes in healthcare organization. - Public health concepts directly impact clinical practice by emphasizing: - Prevention of oral diseases. - Care and cure approaches that integrate community needs. - Using population health data and identifying risk factors to inform clinical decisions. Millennium Development Goals (MDGs) The Millennium Development Goals (MDGs) were established to address global socio-economic challenges by 2015. They include: 1. Eradicating extreme poverty and hunger. 2. Achieving universal primary education. 3. Promoting gender equality and empowering women. 4. Reducing child mortality. 5. Improving maternal health. 6. Combating HIV/AIDS, malaria, and other diseases. 7. Ensuring environmental sustainability. 8. Developing a global partnership for development. Oral Health Status Worldwide and in Turkey - Global Oral Health: - Approximately 50% of the global population suffers from oral diseases, making it a significant public health concern. - The WHO's Global Oral Health Status Report (2022) highlights: - Disease burden. - Risk factors. - Distribution of dental practitioners. - Health benefits and national responses to oral health crises.