LEVELS OF DISEASE PREVENTION

In modern day the concept of prevention has become broad based on 4 levels. Primordial prevention Primary prevention Secondary prevention Tertiary prevention

Primordial

Primordial Prevention
It includes measures emergence of risk factor.

for

prevention

of

 This in strictest sense is primary prevention for evidence of development and continuation of such practices in the day to day life which will lead to initiation of disease.

 Here, efforts are directed discouraging children from harmful lifestyles

towards adopting

E.g.
Overeating, too much salt intake, smoking of tobacco, alcohol consumption, too much sedentary habits, creation of environmental pollution are some examples which function as risk factors for development of diseases like

obesity, hypertension cirrhosis of liver, coronary artery disease, and pulmonary diseases like chronic bronchitis, asthma and malignancies.

Intervention/Role of Nurse:
Health education of individual and mass in general right from childhood when the individual life style is acquired the result of these measures cannot be perceived immediately but are seen after years or decade have passed.

Primary Prevention
Primary prevention can be defined as action taken prior to the onset of disease, which removes the possibility that a disease will ever occur. It signifies intervention in the prepathogenesis phase of a disease of health problem (e.g., low birth weight) or other departure from health.

Primary prevention may be accomplished by measures designed to promote general health and well-being, and quality of life of people or by specific protective measures.

It includes the concept of positive health, that encourages the achievement and maintenance of an acceptable level of health that will enable every individual to lead a socially and economically productive life. A holistic approach

PRIMARY PREVENTION:
Health Promotion Specific Protection

 Health Promotion: The application of this level is costly because it is not directed towards specific disease problem but aims at improvement of general standard of living and the life style.

 Facilities for healthful environment are provided so that to a large extent the external environment and to a lesser extent the internal environment of man is manipulated in such a way that the growth and development will be better, resistance will improve and health consciousness and healthful habits are inculcate.

The Activities in this may be thought of as:

Health education to improve health consciousness and inculcate healthy habits Improvement in standard of nutrition with relation to age, sex, occupation, physiological condition and environment to promote and maintain growth and development and health Provision of sociocultural environment conducive for development of good personality

 Better physical environment through adequate housing, water supply and waste disposal facility. Conducive environment at the occupation Good, usable, feasible recreational facilities Marriage counseling

 Sex and population education. Application of principles of genetics to improve health, prevent disease and eliminate untoward characteristics related to man and extra human life. Periodic selective examination of general population and at risk population.

 Specific Protection: This level of prevention is specific, the actions are clearly identifiable, evaluation of action is more precise, benefit measurement is possible, is more appreciable for the population.

Different Interventions/Role of Nurse:

Use of specific immunizations - BCG and MMR Use of specific drugs as chemoprophylactic agents Use of specific nutrients e.g. vitamin A

 Protection against accidents by use of helmets, Protection against occupational hazards Protection from carcinogens - protective devices radiation exposure.

Avoidance of allergens Application of genetics consanguineous marriages Use of measures for environmental sanitation The legal provisions which make mandatory rules for pharmaceutical, industrial, agricultural food etc.,

Secondary Prevention
Can be defined as Action which halts the progress of a disease at its incipient stage and prevents complications. More expensive and less effective than primary prevention

 Interventions: Early diagnosis and prompt treatment:

Interventions:
To cure and prevent the disease process. To prevent the spread of communicable disease. To prevent the complications To shorten the period of disability.

 These interventions can be achieved through

Individual and mass case finding measures. Screening surveys e.g. diabetes, hypertension, chest X-Rays for tuberculosis. Selective examination e.g. antenatal mothers for VDRL, lead industry workers for anemia.

 This helps to control the disease process before it becomes severe, it controls and stops the spread of communicable disease in the community, leads to improved productivity, lesser dependency rate, better cost effective strategy; minimizes load on health services and conserves resources in general.

Tertiary Prevention
It signifies intervention in the late pathogenesis phase. an be defined as adjustment to conditions. all patients irremediable

 measures available to reduce or limit impairments and disabilities, minimise suffering caused by existing departures from good health and to promote the patient's adjustment to irremediable conditions

1. Disability limitation 2. Rehabilitation

1. Disability limitation When a patient reports late in the pathogenesis phase, the mode of intervention is disability limitation. The objective of this intervention is to prevent or halt the transition of the disease process from impairment to handicap.

Concept of disability:
Disease Impairment disability

handicap

Example Accident Disease (or disorder) Loss of foot Impairment (extrinsic or intrinsic) Cannot walk Disability (objectified) Unemployed .. Handicap (socialized)

 Impairment: any loss or abnormality of psychological, physiological or anatomical structure of function, e.g., loss of foot, defective vision or mental retardation. Impairment may be visible or invisible, temporary or permanent, progressive or regressive.

 Disability: Because of an impairment, the affected person may be unable to carry out certain activities considered normal for his age, sex, etc. This inability to carry out certain activities is termed disability. any restriction or lack of ability to perform an activity in the manner or within the range considered normal for a human being.

 Handicap: As a result of disability, the person experiences certain disadvantages in life and is not able to discharge the obligations required of him and play the role expected of him in society. This is termed handicap, and

 is defined as a disadvantage for a given individual, resulting from an impairment or a disability, that limits or prevents the fulfillment of a role that is normal (depending on age, sex, and social and cultural factors) for that individual.

Example Accident Disease (or disorder) Loss of foot Impairment (extrinsic or intrinsic) Cannot walk Disability (objectified) Unemployed .. Handicap (socialized)

 Disability Prevention: Another concept is disability prevention. It relates to all the levels of prevention:

 Reducing the occurrence of impairment, viz. immunization against polio (Primary prevention); Disability limitation by appropriate treatment (secondary prevention) Preventing the transition of disability into handicap (tertiary prevention).

 2. Rehabilitation the combined and coordinated use of medical, social, educational and vocational measures for training and retraining the individual to the highest possible level of functional ability.

 It includes all measures aimed at reducing the impact of disabling and handicapping conditions and at enabling the disabled and handicapped to achieve social integration.

 Social integration has been defined as the active participation of disabled and handicapped people in the mainstream of community life.

 The following areas of concern in rehabilitation have been identified: Medical rehabilitation Vocational rehabilitation Social rehabilitation Psychological rehabilitation

 Medical rehabilitation restoration of the capacity to earn a livelihood.

 Vocational rehabilitation restoration of family and social relationships

 Social rehabilitation restoration of family and social relationships.

 Psychological rehabilitation restoration of personal dignity and confidence.

Examples of rehabilitation are: Establishing school for the blind, provision of aids for the crippled, reconstructive surgery in leprosy, muscle re-education and graded exercise in neurological disorders like polio, change of profession for a more suitable one and modification of life in general in the case of