Preventive medicine or preventive care consists of measures taken to prevent diseases,[1] (or injuries) rather than curing them or treating their symptoms. This contrasts in method with curative and palliative medicine, and in scope with public health methods (which work at the level of population health rather than individual health). Occupational medicine operates very often within the preventive medicine.
Increased use of preventive care (e.g., regular doctor visits) is one way of reducing health care spending. Official budget scores of U.S. [5]
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[edit] Levels
Preventive medicine strategies are typically described as taking place at the primary, secondary, tertiary and [9] sufficient leave time for both parents, and financial support if required. This includes parenting in infancy as well.
Simple examples of preventive medicine include Northern California Cancer Center, apply epidemiologic research towards finding ways to prevent diseases.
Prevention levels[10] | Doctor’s side | |||
Disease | ||||
absent | present | |||
---|---|---|---|---|
Patient’s side |
Illness | absent | Primary prevention illness absent disease absent |
Secondary prevention illness absent disease present |
present | Quaternary prevention illness present disease absent |
Tertiary prevention illness present disease present |
[edit] Definitions
Level | Definition |
---|---|
Primary prevention | Methods to avoid occurrence of disease.[11] Most population-based health promotion efforts are of this type. |
Secondary prevention | Methods to diagnose and treat existent disease in early stages before it causes significant morbidity.[12] |
Tertiary prevention | Methods to reduce negative impact of extant disease by restoring function and reducing disease-related complications.[13] |
Quaternary prevention | Methods to mitigate or avoid results of unnecessary or excessive interventions in the health system.[14] |
[edit] Universal, selective, and indicated
Gordon (1987) in the area of disease prevention,European Monitoring Centre for Drugs and Drug Addiction.
Tier | Definition |
---|---|
Universal prevention | Involves whole population (nation, local community, school, district) and aims to prevent or delay the abuse of drugs. All individuals, without screening, are provided with information and skills needed to prevent the problem. |
Selective prevention | Involves groups whose risk of developing problems of alcohol abuse or dependence is above average. Subgroups may be distinguished by traits such as age, gender, family history, or economic status. For example, drug campaigns in recreational settings. |
Indicated prevention | Involves a screening process, and aims to identify individuals who exhibit early signs of substance abuse and other problem behaviours. Identifiers may include falling grades among students, known problem consumption or conduct disorders, alienation from parents, school, and positive peer groups etc. |
Outside the scope of this three-tier model is environmental prevention. Environmental prevention approaches are typically managed at the regulatory or community level and focus on ways to deter drug consumption. Prohibition and bans (e.g. on alcohol advertising) may be viewed as the ultimate environmental restriction. However, in practice, environmental preventions programs embrace various initiatives at the macro and micro level, from government monopolies for alcohol sales through roadside sobriety or drug tests, worker/pupil/student drug testing, increased policing in sensitive settings (near schools, at rock festivals), and legislative guidelines aimed at precipitating punishments (warnings, penalties, fines).
[edit] Professionals
Professionals involved in the public health aspect of this practice may be involved in hygiene inspections and surveys.
In the American Osteopathic Association Bureau of Osteopathic Specialists (AOABOS). It encompasses three areas of specialization:
- General preventive medicine and public health
- Aerospace medicine
- Occupational medicine
To become board-certified in one of the preventive medicine areas of specialization, a licensed U.S. physician (public health (MPH) or equivalent. The board exam takes a full day: the morning session concentrates on general preventive medicine questions, while the afternoon session concentrates on the one of the three areas of specialization that the applicant has studied.
In addition, there are two subspecialty areas of certification:
- Medical toxicology (MT)
- Undersea and hyperbaric medicine (UHB), formerly “undersea medicine”
These certifications require sitting for an examination following successful completion of an MT or UHB fellowship and prior board certification in one of the 24 ABMS-recognized specialties or 18 AOABOS-recognized specialties.
[edit] Prophylaxis
Prophylaxis (public health procedure whose purpose is to prevent, rather than treat or cure a disease. In general terms, prophylactic measures are divided between primary prophylaxis (to prevent the development of a disease) and secondary prophylaxis (whereby the disease has already developed and the patient is protected against worsening of this process).
[edit] Examples
Some specific examples of prophylaxis include:
- Many vaccines are prophylactic, vaccines such as polio vaccine, smallpox vaccine, measles vaccine, mumps vaccine and others have greatly reduced many childhood diseases; HPV vaccines prevent certain cancers; influenza vaccine.[17]
- sexually transmitted infections.
- Daily and moderate physical exercise in various forms can be called prophylactic because it can maintain or improve one’s health. Cycling for transport appears to very significantly improve health by reducing risk of heart diseases, various cancers, muscular- and skeletal diseases, and overall mortality.[18]
- Eating plenty of fruits and vegetables each day may be prophylactic. It may reduce the risk of heart disease.[19]
- tooth cleaning, either at home or by a professional, are parts of dental prophylaxis or oral prophylaxis.
- Antibiotics are sometimes used prophylactically: For example, during the 2001 anthrax attacks scare in the United States, patients believed to be exposed were given ciprofloxacin. In similar manner, the use of antibiotic ointments on burns and other wounds is prophylactic. Antibiotics are also given prophylactically just before some medical procedures such as pacemaker insertion.[20]
- Tricyclic antidepressants (TCAs) may, with caution, be an example of a chronic migraine preventive (see amitriptyline and migraines’ prevention by medicine).
- malaria.
- Mechanical measures (such as [23]
- Risk reducing or prophylactic breast cancer.
- Early and exclusive breastfeeding provides immunological protection against infectious diseases and well as reduced risk of chronic diseases for both mother and child.[24]
- cardiovascular disease.
- Potassium iodide is used prophylactically to protect the thyroid gland from absorbing inhaled or ingested radioactive iodine, which may lead to the development of thyroid cancer; radioactive iodine may be released into the environment in the event of an accident at a nuclear power plant, or the detonation of a nuclear explosive (see thyroid protection due to nuclear accidents and emergencies).
- Prophylaxis may be administered as oral medication. Oral prophylaxis includes: PEP, nPEP, or PrEP. PEP stands for post-exposure prophylaxis used in an occupational setting e.g., to prevent the spread of HIV or Hepatitis C from patient to staff following an accidental needlestick. nPEP is non-occupational post-exposure prophylaxis. nPEP may be used in a sexual or injection exposure to HIV, hepatitis, or other infectious agents; for example, during intercourse, if the condom breaks and one partner is HIV-positive, nPEP will help to decrease the probability that the HIV-negative partner becomes infected with HIV. (An nPEP is sometimes known as a PEPse – i.e. post-exposure prophylaxis sexual encounter.) PrEP is a measure taken daily (before, during, and after) possible exposure; for example, by a person who inconsistently uses condoms during sex with a partner who may have an HIV infection.
[edit] Limitations
Since preventive medicine deals with healthy individuals or populations the costs and potential harms from interventions need even more careful examination than in treatment. For an intervention to be applied widely it generally needs to be affordable and highly cost effective.
For instance, [27]
Preventive solutions may be less profitable and therefore less attractive to makers and marketers of pharmaceuticals and medical devices. Birth control pills which are taken every day and may take in a thousand dollars over ten years may generate more profits than an IUD, which despite a huge initial markup only generates a few hundred dollars over the same period.[25]
[edit] Leading cause of preventable death
Cause | Deaths caused (millions per year) |
---|---|
Hypertension | 7.8 |
Smoking | 5.0 |
High cholesterol | 3.9 |
Malnutrition | 3.8 |
Sexually transmitted infections | 3.0 |
Poor diet | 2.8 |
obesity | 2.5 |
Physical inactivity | 2.0 |
Alcohol | 1.9 |
Indoor air pollution from solid fuels | 1.8 |
sanitation | 1.6 |
Intervention | Percent of all child deaths preventable |
---|---|
Breastfeeding | 13 |
Insecticide-treated materials | 7 |
Complementary feeding | 6 |
Zinc | 4 |
Clean delivery | 4 |
Hib vaccine | 4 |
Water, sanitation, hygiene | 3 |
Antenatal steroids | 3 |
Newborn temperature management | 2 |
Vitamin A | 2 |
Tetanus toxoid | 2 |
Nevirapine and replacement feeding | 2 |
Antibiotics for premature rupture of membranes | 1 |
Measles vaccine | 1 |
Antimalarial intermittent preventive treatment in pregnancy | <1% |
Cause | Deaths caused | % of all deaths |
---|---|---|
Tobacco smoking | 435,000 | 18.1 |
Poor diet and physical inactivity | 365,000 | 15.2 |
Alcohol consumption | 85,000 | 3.5 |
Infectious diseases | 75,000 | 3.1 |
Toxicants | 55,000 | 2.3 |
Traffic collisions | 43,000 | 1.8 |
Firearm incidents | 29,000 | 1.2 |
Sexually transmitted infections | 20,000 | 0.8 |
Drug abuse | 17,000 | 0.7 |
[edit] See also
- American Board of Preventive Medicine
- American Osteopathic Board of Preventive Medicine
- Monitoring (medicine)
- Post-exposure prophylaxis
- Pre-exposure prophylaxis
- Preventive Medicine (journal)
- Prophylactic rule
[edit] References
- ^ Preventive+Medicine at the US National Library of Medicine Medical Subject Headings (MeSH)
- ^ Physicians for a National Health Program (2008) “Single Payer System Cost?” PNHP.org
- 15755330. //www.ncbi.nlm.nih.gov/pmc/articles/PMC1079830/.
- ^ Nicholas Kristof (October 17, 2012) “Scott’s Story and the Election” New York Times
- ^ David Brown, “In the Balance: Some Candidates Disagree, but Studies Show It’s Often Cheaper To Let People Get Sick,” The Washington Post, April 8, 2008
- ^ Primal Research Centre, London
- ^ Primal Health Research Databank
- ^ Effect of In Utero and Early-Life Conditions on Adult Health and Disease, by P.D.Gluckman et al., N ENGL J MED 359;1
- ^ Origins: How the nine months before birth shape the rest of your life, by Annie Murphy Paul, Time magazine, 176.14, 2010
- ^ Kuehlein T, Sghedoni D, Visentin G, Gérvas J, Jamoule M. Quaternary prevention: a task of the general practitioner. PrimaryCare. 2010; 10(18):350-4.
- ^ Primary+Prevention at the US National Library of Medicine Medical Subject Headings (MeSH)
- ^ Secondary+Prevention at the US National Library of Medicine Medical Subject Headings (MeSH)
- ^ Tertiary+Prevention at the US National Library of Medicine Medical Subject Headings (MeSH)
- ^ Gofrit ON, Shemer J, Leibovici D, Modan B, Shapira SC. Quaternary prevention: a new look at an old challenge. Isr Med Assoc J. 2000;2(7):498-500.
- ^ Gordon, R. (1987), ‘An operational classification of disease prevention’, in Steinberg, J. A. and Silverman, M. M. (eds.), Preventing Mental Disorders, Rockville, MD: U.S. Department of Health and Human Services, 1987.
- ^ Kumpfer, K. L., and Baxley, G. B. (1997), ‘Drug abuse prevention: What works?’, National Institute on Drug Abuse, Rockville.
- ^ Jamie Michelle Womack (2010) “Safety and adherence: Issues that hinder childhood vaccinations” Journal of the American Academy of Physician Assistants
- 10847255.
- ^ United States Department of Agriculture. “Why is it important to eat fruit?”. United States Department of Agriculture. http://www.choosemyplate.gov/food-groups/fruits-why.html. Retrieved 8 February 2012.
- 19808441.
- http://www.annals.org/content/155/9/625.abstract.
- http://www.annals.org/content/155/9/602.abstract.
- 22315261.
- ^ Ip S, Chung M, Raman G, ChewP, Magula N, DeVine D, Litt M, Trikalinos T, Lau J. Breastfeeding and maternal and infant health outcomes in developed countries. Evidence Report/Technology Assessment Number 153. 2007 April; AHRQ Publication No. 07-E007.
- ^ http://www.arhp.org/publications-and-resources/contraception-journal/september-2008.
- ^ 19041435.
- 21651707.
- 16731270.
- ^ Jones G, Steketee R, Black R, Bhutta Z, Morris S, and the Bellagio Child Survival Study Group* (July 5, 2003 2003). “How many child deaths can we prevent this year?”. Lancet 362 (9524): 1747–57.
- http://www.csdp.org/research/1238.pdf.
- Sackett DL. The arrogance of preventive medicine. CMAJ. 2004;167:363-4.
- Gérvas J, Pérez Fernández M. Los límites de la prevención clínica. AMF. 2007; 3(6):352-60.
- Gérvas J, Pérez Fernández M, González de Dios J. Problemas prácticos y éticos de la prevención secundaria. A propósito de dos ejemplos de pediatría. Rev Esp Salud Pública. 2007;81:345-52.
- Starfield B, Hyde J, Gérvas J, Heath I. The concept of prevention: a good idea gone astray? J Epidemiol Community Health. 2008;62(7):580-3.
- Gérvas J, Starfield B, Heath I. Is clinical prevention better than cure? Lancet. 2008;372:1997-9.
- Gérvas J, Pérez Fernández M. Los daños provocados por la prevención y por las actividades preventivas. RISAI. 2009; 1(4).
- Gérvas J. Abuso de la prevención clínica. El cribaje del cáncer de mama como ejemplo. Rev Espaço Saùde. 2009; 11(1):49-53.
- Gérvas J, Heath I, Durán A, Gené J; Members of the Seminar of Primary Health Innovation 2008. Clinical prevention: patients’ fear and the doctor’s guilt. Eur J Gen Pract. 2009; 15(3):122-4.
- Heneghan C. Considerable uncertainty remains in the evidence for primary prevention of cardiovascular disease (editorial). The Cochrane Library 2011 (19 Jan).
[edit] External links
- US Preventive Medicine Task Force
- US Preventive Medicine
- The Prevention Plan
- Health-EU Portal Prevention and Promotion
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This article uses material from the Wikipedia article Prophylaxis, which is released under the Creative Commons Attribution-Share-Alike License 3.0.