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1、第二章 健康观 内容回顾,内容回顾,第一节 传统健康观和疾病观 第二节 整体健康观 第三节 整体健康的内容和测量,第三章 预防策略和措施,本章目录,第一节 三级预防 第二节 五层次预防 第三节 健康教育,第一节 三级预防,一、一级预防 二、二级预防 三、三级预防,预防医学的定义,预防医学（Preventive Medicine）是一门应用性学科，它以个体和确定的群体为对象，应用卫生统计学、流行病学、环境医学、社会行为科学等原理和方法，分析环境因素对健康的影响及疾病的发生、发展和分布规律，有针对性的采取三级预防措施，达到促进健康和预防疾病、防治残疾和夭折的目的。,第一级预防亦称病因预防，是针对致
2、病因素采取的预防措施，使健康人免受致病因素的危害。其目的是防止疾病发生，对疾病发生的生物、心理和社会等有关因素加以综合研究，提出增进健康的预防措施。,Primary prevention means taking action to build resilience and to prevent problems before they occur.,一、第一级预防 (primary prevention),主要包括改善环境措施和增进健康措施两方面。 (1)改善环境措施 : 防治和消除环境污染;减少或消除生产环境危害; 创造并维护有益于身心健康的社会条件,一级预防的内容,(2)增进健康措施,开
3、展健康教育，培养良好的行为与生活方式 预防接种 预防遗传性疾病 做好人群保健,Primary prevention measures include activities that help avoid a given health care problem. Examples include passive and active immunization against disease as well as health protecting education and counseling promoting the use of automobile passenger restrain
4、ts and bicycle helmets. Since successful primary prevention helps avoid the suffering, cost and burden associated with disease, it is typically considered the most cost-effective form of health care.,Primordial prevention,In primordial prevention, efforts are directed towards discouraging children f
5、rom adopting harmful lifestyles 健康教育从娃娃抓起 The main intervention in primordial prevention is through individual and mass education 个体和群体的健康教育很重要,Approaches for Primary Prevention,The WHO has recommended the following approaches for the primary prevention of chronic diseases where the risk factors are
6、 established: WHO认为慢性病的一级预防应从群体健康策略和高危人群健康策略两方面考虑 a. Population (mass) strategy b. High -risk strategy,Population (mass) strategy,“Population strategy“ is directed at the whole population irrespective of individual risk levels. 群体策略是指健康教育应针对所有人，无论个体健康水平如何 For example, studies have shown that even a
7、small reduction in the average blood pressure or serum cholesterol of a population would produce a large reduction in the incidence of cardiovascular disease The population approach is directed towards socio-economic, behavioral and lifestyle changes 具体措施包括社会经济、行为和生活方式等方面的改变,High -risk strategy,The
8、high -risk strategy aims to bring preventive care to individuals at special risk. 高危人群应注重个体危险因素 This requires detection of individuals at high risk by the optimum use of clinical methods. 通过检测危险因素和临床方法进行预防,Primary prevention,Primary prevention can be defined as the action taken prior to the onset of
9、 disease, which removes the possibility that the disease will ever occur. It signifies intervention in the pre-pathogenesis phase of a disease or health problem. 一级预防属于疾病发生前的防护，是病因预防 Primary prevention may be accomplished by measures of “Health promotion” and “specific protection”,Primordial prevent
10、ion,Many adult health problems (e.g., obesity, hypertension) have their early origins in childhood, because this is the time when lifestyles are formed (for example, smoking, eating patterns, physical exercise). 积行成习,二级预防：（临床前期预防）即在临床前期及时采取早发现早诊断早治疗的预防措施，其目的是控制或减缓疾病病程的进展，促使疾病向痊愈的方向转化，提高治愈率。,secondar
11、y prevention measures as those that “identify and treat asymptomatic persons who have already developed risk factors or preclinical disease but in whom the condition is not clinically apparent.”,二、二级预防(secondary prevention),(1)早期发现 ：普查、筛检、定期检查、自我检 查、重点项目检查 (2)早期诊断 ：诊断技术，诊断水平 (3)早期治疗 ：早期、合理用药；心理治疗等,二
12、、二级预防(secondary prevention),三早措施,传染病 慢性病 恶性病,三早措施流程示意图,办法： * 向群众进行健康教育，提高群众预防疾病的知识水平； * 加强医务人员的责任心，努力提高诊断水平； * 发展和研究疾病早期检测手段及技术； * 认真执行疾病报告制度。,二、二级预防(secondary prevention),These activities are focused on early case finding of asymptomatic disease that occurs commonly and has significant risk for neg
13、ative outcome without treatment. 在疾病无临床症状前就能发现疾病，特别是恶性疾病,二、二级预防(secondary prevention),Screening tests are examples of secondary prevention activities, as these are done on those without clinical presentation of disease that has a significant latency period such as hyperlipidemia(高脂血症), hypertension.
14、 筛检虽好也有限制，智能健康家用电器是未来家居必备。,二、二级预防(secondary prevention),婚检与优生优育,婚前的检查主要包括是否患有各种急、慢性传染病史，比如肝炎、活动性肺结核等；双方直系亲属是否有精神病史及各种遗传病史。另一重要内容是男女双方进行生殖器官检查，如发现生殖器官有缺陷或其他疾病，应及时进行相关治疗。 有的人会携带遗传病隐性基因，这些疾病一般的单位体检是检查不出来的，如果双方均患有某种遗传性疾病，其后代发病几率很高，不利于新生儿健康。 在婚检过程中，医生会问到与婚育有关的病史，比如女方的月经史，包括初潮年龄、月经周期等。,疑问,婚检到底是一级预防还是二级预防？
15、,三级预防(tertiary prevention)即临床预防。 对已经患病的病人采取及时有效的治疗措施,防止病情恶化,预防并发症,防止伤残,使之早日康复.,Tertiary prevention activities involve the care of established disease, with attempts made to restore to highest function, minimize the negative effects of disease, and prevent disease-related complications.,三、三级预防(tertia
16、ry prevention),(1)防止病残 主要是促进功能恢复、早日康复，力争病而不残，残而不废，防复发和防转移等。 (2)康复工作 主要是教育社会爱护病残。做好社会卫生服务，进行家庭护理指导，做好心理康复、调整性康复及功能性康复等工作。,三、三级预防(tertiary prevention),* 所有疾病强调一级预防 * 不同疾病类型采取不同的三级预防策略和措施 （1）病因 明确且人为的：一级预防 多因素：一级、二级 不明难以预料：三级 （2）疾病的可逆性：对不可逆的疾病应一级预防为主。,三、三级预防(tertiary prevention),Case 1,Ms. Leonard is a 72 year-old woman with chronic bronchitis who is a former cigarette smoker. Her medications include ipratropium bromide (Atrovent) and albuterol. Her primary prevention needs include: A. Review
