Preventive medicine
Preventive medicine or preventive care refers to measures taken to prevent diseases,[1] (or injuries) rather than curing them or treating their symptoms. The term 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).
Levels
This takes place at primary, secondary, tertiary and quaternary prevention levels.
| Level |
Definition |
| Primary prevention |
avoids the development of a disease.[2] Most population-based health promotion activities are primary preventive measures. |
| Secondary prevention |
activities are aimed at early disease detection, thereby increasing opportunities for interventions to prevent progression of the disease[3] and emergence of symptoms. |
| Tertiary prevention |
reduces the negative impact of an already established disease by restoring function and reducing disease-related complications.[4] |
| Quaternary prevention |
is the set of health activities that mitigate or avoid the consequences of unnecessary or excessive interventions in the health system.[5] |
Simple examples of preventive medicine include hand washing and immunizations. Preventive care may include examinations and screening tests tailored to an individual's age, health, and family history. For example, a person with a family history of certain cancers or other diseases would begin screening at an earlier age and/or more frequently than those with no family history. On the other side of preventive medicine, some non-profit organizations, such as the Northern California Cancer Center, apply epidemiological research towards finding ways to prevent diseases.
Universal, selective, and indicated
Gordon (1987) in the area of disease prevention,[6] and later Kumpfer and Baxley in the area of substance use[7] proposed a three-tiered preventive intervention classification system: universal, selective, and indicated prevention. Amongst others, this typology has gained favour and is used by the U.S. Institute of Medicine, the NIDA and the European Monitoring Centre for Drugs and Drug Addiction.
| Tier |
Definition |
| Universal prevention |
addresses the entire population (national, local community, school, district) and aim to prevent or delay the abuse of alcohol, tobacco, and other drugs. All individuals, without screening, are provided with information and skills necessary to prevent the problem. |
| Selective prevention |
focuses on groups whose risk of developing problems of alcohol abuse or dependence is above average. The subgroups may be distinguished by characteristics 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 interventions to deter drug consumption. Prohibition and bans (e.g. smoking workplace bans, alcohol advertising bans) may be viewed as the ultimate environmental restriction. However, in practice environmental preventions programmes 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).
Professionals
Professionals involved in the public health aspect of this practice may be involved in entomology, pest control, and public health inspections. Public health inspections can include recreational waters, pools, beaches, food preparation and serving, and industrial hygiene inspections and surveys.
In the United States, preventive medicine is a medical specialty, one of the 24 recognized by the American Board of Medical Specialties (ABMS). It encompasses three areas of specialization:
- General preventive medicine and public health
- Aerospace medicine
- Occupational medicine
In order to become board-certified in one of the preventive medicine areas of specialization, a licensed U.S. physician (M.D. or D.O.) must successfully complete a preventive medicine medical residency program following a one-year internship. Following that, the physician must complete a year of practice in that special area and pass the preventive medicine board examination. The residency program is at least two years in length and includes completion of a master's degree in public health (MPH) or equivalent. The board exam takes an entire 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.
Prophylaxis
Prophylaxis (Greek "προφυλάσσω" to guard or prevent beforehand) is any medical or 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).
Examples
Some specific examples of prophylaxis include:
- Influenza vaccines are prophylactic.[8]
- 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.[9]
- Tricyclic antidepressants (TCAs) may, with caution, be an example of a chronic migraine preventative (see Amitriptyline and migraines' prevention by medicine).
- Antimalarials such as chloroquine are used both in treatment and as prophylaxis by visitors to countries where malaria is endemic to prevent the development of the parasitic Plasmodium, which cause malaria.
- Condoms are sometimes referred to as "prophylactics" because of their use to prevent pregnancy as well as the transmission of sexually transmitted infections.
- Low-molecular-weight heparin is used as a prophylaxis in hospital patients, as they are at risk for several forms of thrombosis due to their immobilisation.
- Professional cleaning of the teeth is dental prophylaxis.
- Risk Reducing or Prophylactic Mastectomies may be carried out for carriers of the BRCA mutation gene to minimise the risk of developing Breast Cancer
- 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[10].
- Prophylaxis may be administered as vaccine. Prophylactic vaccines include: PEP, nPEP, PREP, or nPREP. PEP stands for post-exposure prophylaxis used in an occupational setting. nPEP is non-occupational post-exposure prophylaxis. nPEP may be used in a recreational setting; for example, during intercourse, if the condom breaks and one partner is HIV-positive, nPEP will help to decrease the probability of spread of infection of HIV. PREP is often used in occupational settings, e.g., in hospital staff to prevent the spread of HIV or Hepatitis C from patient to staff. nPREP is a measure taken before exposure but in a non-occupational setting (non-occupational Pre-exposure prophylaxis); for example, injection drug users may seek nPREP vaccinations.
Leading cause of preventable death
Leading causes of preventable death worldwide as of the year 2001.[11]
Leading causes of preventable deaths in the United States in the year 2000.[12]
| Cause |
Number of deaths resulting |
| Tobacco Smoking |
435,000 deaths or 18.1% of the total deaths |
| Overweight and Obesity |
365,000 deaths or 15.2% of the total deaths. |
| Alcohol consumption |
85,000 deaths or 3.5% of the total deaths. |
| Infectious diseases |
75,000 deaths or 3.1% of the total deaths. |
| Toxicants |
55,000 deaths or 2.3% of the total deaths. |
| Traffic collisions |
43,000 deaths or 1.8% of the total deaths. |
| Incidents involving firearms |
29,000 deaths or 1.2% of the total deaths. |
| Sexually transmitted diseases |
20,000 deaths or 0.8% of the total deaths. |
| Drug abuse |
17,000 deaths or 0.7% of the total deaths. |
See also
- Pre-exposure prophylaxis
- Post-exposure prophylaxis
- Prophylactic rule
References
- ↑ MeSH Preventive+Medicine
- ↑ MeSH Primary+Prevention
- ↑ MeSH Secondary+Prevention
- ↑ MeSH Tertiary+Prevention
- ↑ 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.
- ↑ How should influenza prophylaxis be implemented?
- ↑ de Oliveira JC, Martinelli M, D'Orio Nishioka SA, et al. (2009). "Efficacy of antibiotic prophylaxis prior to the implantation of pacemakers and cardioverter-defibrillators: Results of a large, prospective, randomized, double-blinded, placebo-controlled trial". Circ Arrhythmia Electrophysiol 2 (1): 29–34. doi:10.1161/CIRCEP.108.795906. PMID 19808441.
- ↑ Lars Bo Andersen et al. (June 2000). "All-cause mortality associated with physical activity during leisure time, work, sports, and cycling to work.". Arch Intern Med. 160 (11): 1621–8. doi:10.1001/archinte.160.11.1621. PMID 10847255.
- ↑ Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJ (May 2006). "Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data". Lancet 367 (9524): 1747–57. doi:10.1016/S0140-6736(06)68770-9. PMID 16731270.
- ↑ Mokdad AH, Marks JS, Stroup DF, Gerberding JL (March 2004). "Actual causes of death in the United States, 2000". JAMA 291 (10): 1238–45. doi:10.1001/jama.291.10.1238. PMID 15010446. http://www.csdp.org/research/1238.pdf.
Notations
- 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.
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