BioStat 1 Prefinals Lesson 2 PDF

PREVENTIVE MEDICINE BioStat 1 Prefinals Lesson 2 Objectives Describe and define preventive medicine and its functions and/or benefits. Differentiate levels of prevention as well as the various routes of transmission of disease and be able to list down examples Discuss the factors that...

PREVENTIVE MEDICINE BioStat 1 Prefinals Lesson 2 Objectives Describe and define preventive medicine and its functions and/or benefits. Differentiate levels of prevention as well as the various routes of transmission of disease and be able to list down examples Discuss the factors that affect programs that aim for prevention of diseases and weigh the advantage and disadvantages Preventive Medicine seeks to enhance the lives of individuals by helping them improve their own health Preventive Medicine Common goals with public health: Promoting general health Reducing Risk Preventing specific disease Applying epidemiological concepts and Biostatistical techniques Public Health Attempts to promote health in population through the application of organized community efforts Preventive Medicine Targets the lives of the individuals BASIC CONCEPTS Health Defined WHO: “Health is a state of complete, physical, mental, and social well-being and not merely the absence of disease of infirmity.” Health as a successful adaptation Dublos: “Health... is success experienced by the organism in its efforts to respond adaptively to environmental challenges (Stress)” Stress denotes any response of an organism to demands, whether biologic, psychologic, or mental. Can either be: Eustress - helpful; required for good health in the form of exercise or infant stimulation Distress - harmful Health as satisfactory functioning Dublos: “Health and disease cannot be defined merely in terms of anatomical, physiological, or mental attributes. The real measure is the ability of the individual to function in a manner acceptable to himself and to the group of which he is a part.” Health as satisfactory functioning Health is Described as: The current state of a human organism’s equilibrium with the environment (“Health Status”) The potential to maintain balance Social Determinants of Health Employment and working conditions Social Exclusion Access to housing, clean water, and sanitation Social protection systems Access to health care, gender equity Early childhood development, globalization Urbanization Social Determinants of Health Social Impacts: 1. Direct Causation 2. Changing the likelihood of certain behaviors 3. Impacting Cellular funciton MEASURES OF HEALTH STATUS Life Expectancy Defined as the average number of years remaining at a given age. Metrics Accounting for Premature Mortality Years of Potential Life Lost (YPLL) - deaths weighted depending on how many years a person might have lived if he or she had not died prematurely in the developed worlds usually defined as death before age. Example: Health Status Index - summarizes a person’s health as a single score Health Profile - seeks to rate a person’s health on several separate dimensions Metrics Accounting for Premature Mortality Quality-Adjusting Life Years (QALY) - incorporates both life expectancy and “quality of life” Health Life Expectancy Measure that attempts to combine mortality and morbidity into one index Index reflects the number of years of life remaining that are expected to be free of serious disesae Combination of Several Measures General Well-being Adjustment Scale - index that measures anxiety, depression, general health, positive well-being, self-control, and vitality. Life Expectancy Free of Disability Health-Related Quality of Life Combination of Several Measures Activity of Daily Living (ADL) - measures a person’s ability to independently bathe, dress, toilet, transfer, feed and control his or her bladder and bowels. Instrumental Activities of Daily Living (IADL) - include shopping, housekeeping, handling finances, and taking responsibility in administering medications For Particular Paterns: Karnofsky Index - for cancer patients Barthel Index - for stroke patients NATURAL HISTORY OF DISEASE the disease’s normal course in the absence of intervention 3 Stages Pre-disease Stage: before a disease process begins in an individual Latent (Asymptomatic) Disease Stage: if the disease producing process is underway, but no symptoms of disease have become apparent Symptomatic Disease Stage: when the disease is advanced enough to produce clinical manifestations LEVELS OF PROTECTION Leavell Levels All the activities of clinicians and other health professionals have the goal of prevention. 3 Levels 1. Primary 2. Secondary 3. Tertiary Primary Keeps the disease process from becoming established by eliminating causes of disease or by increasing resistance to disease Examples: 1. Promoting over Health (Health Promotion) a. Change in Lifestyle b. Nutrition c. Environment d. Dietary Modification e. Exercise f. Access to clean water and food g. Proper waste management Primary Keeps the disease process from becoming established by eliminating causes of disease or by increasing resistance to disease Examples: 1. Promoting over Health (Health Promotion) 2. Preventing Particular Disease (Specific Protection) a. Immunization against Polio b. Aspirin to prevent cardiovascular disease c. Using seatbelts, airbags, and helmets Secondary Interrupts the disease process before it becomes symptomatic Examples: 1. Screening Tests - allow the detection of latent disease in individuals considered to be a high risk. 2. Presymptomatic diagnosis through screening program, along with subsequent treatment when needed Tertiary Limits the physical and socil consequences of symptomatic disease 1. Disability Limitation a. Describes medical and surgical measures aimed at correcting the anatomic and physiologic components of disease in symptomatic patients b. Goal: Halt or slow the disease process and prevent or limit complications, impairment, and disability 2. Rehabilitation Tertiary Limits the physical and socil consequences of symptomatic disease 1. Disability Limitation (Patients with Early Symptomatic Disease) 2. Rehabilitation (Patients with Late Symptomatic Disease) a. May avoid secondary conditions or diseases or disabilities if therapy or rehab was not conducted ECONOMICS OF PREVENTION Cost Benefit Analysis measures the costs and the benefits of a proposed course of action in terms of the same units, usually monetary units such as dollars. Cost-Effectiveness Analysis Provides a common measurement unit for comparing different proposed solutions and diseases This estimate is only useful for health services that are effective in the first place. This can be used to compare different interventions. Cost-Utility Analysis or Cost- Effectiveness Ratio Subtype of Cost-effectiveness analysis Allows comparisons of a wide range of interventions for different conditions. It will determine that an intervention actually brings more health benefits than it costs. FACTORS TO CONSIDER 1. Demonstration of Benefits a. there needs to be evidence that an intervention is beneficial 2. Delay of Benefits a. delay in time between the preventive measures are instituted and the time that positive health changes become discernible 3. Accrual of Benefits a. It is necessary to know to whom the benefits would accrue or accumulate b. “Wrong Pocket Problem” 4. Discounting a. If a preventive effort is made now by a government body, the costs are present day costs but any financial savings may not be evident until years from now. 5. Priorities a. It may be difficult to justify using money to prevent crises that have not yet occured. PREVENTIVE MEDICINE TRAINING Preventive Medicine Training Doctors who want to specialize need certification in preventive medicine and must have one of the following three subspecialty areas: 1. General Preventive Medicine and Public Health 2. Occupational Medicine 3. Aerospace Medicine