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Disease Prevention and Control

Basic Concepts, Natural History, and


Principles of Disease Prevention and Control

June 21, 2011


Dr. Paredes

COURSE INTRODUCTION
Course Objective:

Acquired knowledge and skills related to the basic principles


and strategies in health promotion and maintenance, disease
prevention, and control
Course Specific Objectives:

Explain the natural history of disease

Discuss the factors contributing to the initiation and progress of


the disease process

Discuss various prevention and control strategies applicable at


the different stage of a disease process, for the individual, for
the family and the community

Assess the state of health of families and communities, using


appropriate measurements tools

Discuss selected government programs relevant to current


public health concerns of our country
Definitions:
1. Preventive Medicine

The science and the art of prolonging life, promoting &


maintaining health, and preventing the occurrence of
diseases. improving the health of groups of people

Basic science used in Preventive Medicine is Epidemiology.

Is this a specialty? Yes. There are schools offering courses on


preventive medicine and masters of public health (specialty in
the states ). It is also incorporated in all specialties.
2. Curative Medicine

Part of medicine that restores health and rehabilitates


individual patients
3. Public Health

The art and science of preventing disease, prolonging life and


promoting physical health and efficiency through organized
community effort & systematic social action. with the
participation of the groups of people

In public health, we are more concerned with HEALTHY


individuals
4. Community Medicine

Concerned with the social, cultural, biologic and environmental


factors that determine the state of health and problems of the
community, propose sollutions and services

Common concern: promotion of health and prevention of


illness

concerned with people who are healthy: how we can keep


them healthy for the rest of their lives
5. Family medicine

a medical specialty concerned with the comprehensive and


continuing health care for individuals and their family,
encompassing all ages, sexes, each organ system and every
disease entity American Academy of Family Physicians (2005)

family is the basic unit of community medicine

considered a specialty
LECTURE PROPER
I. Preventive Medicine
II. Epidemiology
III. Public Health
A. Concerns of Public Health
B. modern Public Health
C. 10 essentials of public health
service
IV. Community Medicine

1.
2.
3.
4.
5.

Group 3

I. PREVENTIVE MEDICINE
The science and the art of prolonging life, promoting &
maintaining health, and preventing the occurrence of diseases.
Applicable to the individual, family and the community. (each
has its own strategies)
What are its origins? Is this a specialty? What are its concerns?

Historical Accounts: Prevention


Time
Event
Disease is considered a Wrath of God
1000 BC
Health is a blessing
: when sick, exorcisms were used
Miasma Theory
o Implicated bad air, polluted water, wastes &
other environmental factors
1700s
o but nobody knew about levels of CO2, sulfur,
nitrous products, or other materials in the air
yet.
Germ Theory (brought by discovery of microscope,
germs could be seen)
1800s
o John Snows epidemic investigation
o Microbes and vaccine era
Shift of focus from communicable(germs, etc) to
non-communicable diseases (personal factors such
th
19 century
as exposure to cigarettes, carcinogenic/ dangerous
materials)
Modern public health - focus on chronic diseases,
th
20 century intervention programs(healthy diet, warning in
cigarette packages about lung cancer, heart disease)
Re-emerging diseases, new diseases AIDS, SARS,
H1N1
mosquitoes have become fiercer:some bacteria
st
21 century
became resistant to medicine, higher generation
medicines are needed; AIDS was unknown until the
80s, still no cure; diseases easily spreads worldwide

Outline
V. Health
A. Ecologic Concept
B. Ecologic Concept Premises
VI. Disease
A. Models of Disease
B. Natural History of Disease
C. Determinants of Disease
VII. Principles of Disease Prevention and
Control

OBJECTIVES
Define basic concepts and elements.
Differentiate important features of community medicine from
clinical practice.
Explain the natural history of a disease process and its stages.
Define the factors contributing to disease occurrence & the
principles of its prevention and control.
Explain the various concepts of disease causation.

II. EPIDEMIOLOGY
Basic science in preventive medicine
The study that deals with patterns of disease occurrence, injury,
disabilities and their determinants among populations or
groups of people.
Quantitative, applied science, systematic & orderly methods.
how it occurs; any type of health conditions
uses scientific method: define problem, observe, generate
hypothesis, testing to prove
need to assess whether evidences are valid
III. PUBLIC HEALTH
The art and science of preventing disease, prolonging life and
promoting physical health and efficiency through organized
community effort & systematic social action. -C.A.Winslow
A social movement for the promotion & protection of the
communitys health.
A. CONCERNS OF PUBLIC HEALTH
Sanitation of the environment basis is the 1700s belief of bad
air
Control of community infections
Health, personal hygiene education

ANASTACIO A., ANG A., ANG J.,

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Early diagnosis and treatment of diseases to prevent the


spread of disease to community
Adequate standards of living all for the maintenance of health
-Charles Edward A. Winslow (1920)

B. MODERN PUBLIC HEALTH


Mission: the fulfillment of societys interest in assuring
conditions in which people can be healthy.
Substance: organized community efforts aimed at the
prevention of disease and promotion of health
Organization framework: includes activities undertaken by the
government and the private, voluntary organizations and
individuals
Core functions: Assessment of communities, Policy
Development, Assurance of quality for health services
A coalition of profession united by their shared missions, their
focus on disease prevention and health promotion, their
approach - prospective in contrast to the reactive focus of
therapeutic medicine, and their common science,
epidemiology US Institute of Medicine, The Future of Public
Health
includes lifestyle
healthcare should be cost efficient, high quality

C. 10 ESSENTIAL PUBLIC HEALTH SERVICES


Monitor health status
Diagnose and investigate health problems, hazards(ex.
Epidemics: dont let it spread to other countries)
3. Inform, educate, empower people about health issues
4. Mobilize community partnerships
5. Develop policies and plans(ex. in airports, check if passenger
has fever)
6. Enforce regulations that protect health and ensure safety
7. Assure provision of health care
8. Assure competent health care teams
9. Evaluate services: Efficiency, Acceptability, Quality (EAQ)
10. Research for new and innovative solutions to health
problems
1.
2.

IV. COMMUNITY MEDICINE


Concepts, methods & approaches adopted from preventive
medicine.
Central to its approach is its concern for the social, cultural,
environmental and biological features that influence the health
of the community.
Community Medicine
Focus of
Attention

Disease
Approaches
Employed

Interventions

Outcome

Community/groups of
people (towns,
barangays, et)
Epidemiologic tools e.g.
indices, rates and
ratios(morbidity rates,
mortality rates;
frequency of occurrence
of a disease); surveys
Health program plans
Prospective outlook
seek out whos sick to
prevent spreading;
maintaining health
Evaluation studies,
monitoring

Clinical Medicine
Individual Patients

Medical History, PE,


Laboratory exam

-Medical, surgical,
palliative, treatment
-Reactive outlook
Follow up clinic visits

A. ECOLOGIC CONCEPT
Concerned with the total complex interrelationships among
living organisms: the HOST, DISEASE AGENT & THE
ENVIRONMENT.

B. ECOLOGIC CONCEPT PREMISES


Interaction between the host and the disease agent
Host & disease agents interaction is influenced by
environmental factors

Equilibrium or balance among these three forces should be


attained.

disease agent: can be biologic or nonbiologic

host should be in equilibrium/ balance with disease and


environment
Health results from the attainment of this equilibrium. Imbalance
results to disease.

VI. DISEASE
Imbalance between the forces found in the host, disease agent
& the environment.
Failure of the adaptive mechanisms of an organism to
counteract adequately the stimuli and stresses to which it is
subject, resulting in disturbance in function or structure of any
part, organ or system of the body. -Blakistons New Gould
Medical Dictionary
can include physical, social, mental factors
there is no one cause of disease, its always multifactorial

A. MODELS OF DISEASE
1. Multiple Causation or Multiactorial Etiology

The occurrence of disease is attributed to more than one


factor:
o Intrinsic factors host factors influencing susceptibility
o Extrinsic factors biologic, social, physical factors in the
environment that are relevant to health
2. Ecologic Models

Interrelations of: Host, Disease Agent & Environmental factors

Disease results from a potentially harmful change in any of the


components of the system leading to disturbance of
equilibrium.
3. Epidemiologic Triangle

Common Goal: HEALTHY individuals, families, and communities

V. HEALTH
Absence of disease, no impediments to an individuals
functioning or survival.
Soundness of body; that condition in which its functions are
duly and efficiently charged Oxford English Dictionary
State of complete physical, mental & social well-being and not
merely the absence of disease or infirmity. WHO
all aspects of the human person: relationship with people in his
environment, and the environment itself
Group 3

**Each of these components must be analyzed for comprehension


and prediction of disease patterns
4. Web of Causation

Disease never depends on a single isolated cause, but rather


develops as a result of chains of causation web. -MacMahon
& colleagues (1960)

ANASTACIO A., ANG A., ANG J.,

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o
o

5. Wheel Model of Man-Environment Interactions


2.

B. NATURAL HISTORYE OF DISEASE


Disease process or life story of a disease (without intervention)
starting from without or within the individual resulting in
changes in body form and functions until recovery or death.

Stages
1. Pre-pathogenesis/Pre-disease: happens in the environment;
Disease agent havent entered the host yet; interaction of host
and disease agent, together with the relationship of host and
environment
Host Disease Agent Environment Interaction
2. Pathogenesis: happens when balance is altered. Subclinical and
clinical stages
i. Subclinical stage/Latent Stage no apparent manifestations yet
*Clinical Horizon: divides apparent from inapparent stage of
disease
ii. Prodrome: nonspecific manifestations
iii. Frank Illness: when organism has entered the indicative organ
e.g. in hepatitis liver
iv. Chronic/Complicated Stage
3. Outcome
i. Recovery
ii. Disability
iii. Death

1.

C. DETERMINANTS OF DISEASE
HOST Factors
o Age, gender, race, ethnic group, occupation, education,
marital status, family history, socioeconomic group
AGENT Factors
o Infectious agents: virulence, infectivity, mode of
transmission, immunogenicity
o Physical, chemical, nutrient
ENVIRONMENTAL Factors
o Socio-cultural factors, physical & biologic environment :
fauna & flora
D. INTERVENTIONS: applied at various stages
Primary Prevention: during Pre-pathogenesis stage
Objective:
o To prevent the initiation or onset of diseases.
Maintain health healthy practices, lifestyle, and habits =
Primordial prevention
(keeping person healthy, keeping environment clean,
maintaining equilibrium)
Various measures aimed at:
o Promotion of general health & well being
o Maintenance of healthy practices
o Intercepting factors before they involve the human host
directly
General Health Promotive Measures:
o Health education
o Proper nutrition
o Healthful habits, personality development
o Adequate housing & environment
o Personal hygiene
Specific Protective Measures:
o Prophylaxis: Immunization and chemograph
o Isolation & quarantine
o Water, food, milk sanitation
o Proper waste disposal

Group 3

3.

Vector & vermin control


Risk factor control & prevention

Secondary Prevention: applied during Pathogenesis stage


Objectives:
o To recognize the disease process at its earliest stage to
prevent its dissemination to other hosts.
o To start treatment early in order to prevent disease
progression and its sequelae or prolonged disability.
o To prevent its dissemination to other host
Early diagnosis and prompt treatment
o Case finding
o Surveillance of contacts
o Medical, surgical & other interventions
o Adequate care for the sick
Disability limitation institution of continued care & treatment
in order to prevent further progression, complications and
sequelae of the disease
Tertiary Prevention: apply during Outcome stage
Objectives:
o Application of rehabilitative measures in order to
maximize the use of the remaining functions.
o To pave the way for the individuals return to a useful
place in society.
Measures: Rehabilitation
o Physical rehabilitation
o Psychosocial rehabilitation
o Occupational rehabilitation
VII. PRINCIPLES OF DISEASE PREVENTION & CONTROL

SCHEMA

Increase host resistance


Avoidance of exposure
Eliminate disease agent
Modify environment:
o unsuitable for biologic disease agents existence
o Interrupt transmission of disease agents from a source to
susceptible hosts
o Allow healthful living of hosts

ANASTACIO A., ANG A., ANG J.,

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