Dr.

Muhammad Khotibuddin

Tindakan yang ditujukan untuk mencegah, menunda, mengurangi, membasmi, mengeliminasi penyakit dan kecacatan dgn menerapkan sebuah atau sejumlah intervensi yg telah dibuktikan efektif. (Kleinbaum, et al., 1982; Last, 2001).
SEHAT PENCEGAHAN SAKIT

a state of complete physical, mental, and social wellbeing and not merely the absence of disease or infirmity a state characterized by anatomic, physiologic, and psychological integrity; ability to perform personally valued family, work, and community roles; ability to deal with physical, biologic, psychological, and social stress
Stokes, J. III; Noren, J. J.; and Shindell, S. (1982).
WHO (1948)

Definitions of Terms and Concepts Applicable to Clinical Preventive Medicine. Journal of Community Health 8:33 41.

the extent to which an individual or group is able to realize aspirations and satisfy needs, and to change or cope with the environment. Health is a resource for everyday life, not the objective of living; it is a positive concept, emphasizing social and personal resources, as well as physical capacities
WHO (1984)

a word used by behavioral scientists to describe a state of dynamic physical, mental, social, and spiritual well-being that enables a person to achieve full potential and an enjoyable life
Last JM. A dictionary of public health. New York:

Oxford University Press; 2007.

Disease implies a focus on pathological processes that may or may not produce symptoms and that result in a patients illness. illness to refer to the subjective sense of feeling unwell; illness does not define a specific pathology, but refers to a persons subjective experience of it, such as discomfort, tiredness, or general malaise. sickness to refer to socially and culturally held conceptions of health conditions, which in turn influence how the patient reacts. The social perceptions of disease that Illich described modify the ways a patient perceives and presents his symptoms.

Susser M. Causal thinking in the health sciences. New York:

Oxford University Press; 1973.

Prevention levels absent absent Patients illness side

present

Doctors side Disease present Secondary prevention

Primary prevention Primordial prevention

Quaternary prevention

Tertiary prevention

Quaternary prevention, Methods to mitigate or avoid results of unnecessary or excessive interventions in the health system.
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.

Riwayat Alamiah Penyakit adalah perjalanan penyakit mulai dari sebelum sakit (masa Pre Patogenesa), masa sakit (masa Patogenesa) dan masa sesudah sakit (masa Post Patogenesa) Hal ini berguna untuk:
Mengetahui perjalanan penyakit Melakukan pencegahan disetiap tingkat perjalanan penyakit, supaya tidak jadi lebih berat, baik sakitnya, maupun kecacatan yang diakibatkannya

Schematic representation of the natural history of disease

Minimize future hazards to health and Inhibit the establishment factors increasing the risk of disease

Addresses to public rather than personal exposure to risk factors Strategy

Population (mass) strategy outlaw and health policy High risk strategy screening non communicable disease

environmental, economic, social, behavioral, cultural

improving sanitation (such that exposure to infectious agents does not occur), establishing healthy communities, promoting a healthy lifestyle in childhood (for example, through prenatal nutrition programs and supporting early childhood development programs), or developing green energy approaches. outlawing alcohol

a campaign against drinking would be an example of

primary prevention.

Reduces the incidence of disease:

Approaches: against dental caries
water to harden tooth enamel
by addressing disease risk factors or by enhancing resistance. active participation, regular tooth brushing and flossing Passive participation, adding fluoride to the municipal drinking

Targets:

Strategy: Modify the agent-host-environment model of causation

specific causes and risk factors for specific diseases to promote healthy behaviors improve host resistance foster safe environments that reduce the risk of disease

Primary Prevention

Health Promotion
Health education Environmental modifications Nutritional intervention Life style and behavioral changes

Specific Protection
Immunization & seroprophylaxis Chemoprophylaxis Use of specific nutrients or supplementations Protection againts occupational hazards Safety of drugs and foods Control of environmental hazards, e.g. pollution

To detect and treat pre-clinical pathological changes

Screening procedures
Mammography to detect early stage breast cancer Routine blood sugar testing for people over 40 to detecting diabetes early. Usually undertaken by health professionals.
Doctor-patient encounters (e.g., routine blood pressure checks) Public health screening programs (e.g., mammography screening).

Followed by early interventions (Prompt treatment),

More cost effective than intervening once symptoms appear.

It is used when the disease process has advanced beyond its early stages. It is defined as all the measures available to reduce or limit impairments and disabilities, and to promote the patients adjustment to irremediable conditions. Intervention that should be accomplished in the stage of tertiary prevention are disability limitation, and rehabilitation.

Disability Limitation, prevent chronicity, sequelle, and handicap, even death.

Host Adequate treatment Drug of choice and rational prescribing Evidence based treatment Agent (causation) Culture and sensitivity Lingkungan Ergonomic site

Rehabilitation is 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.

Rehabilitation

Medical rehabilitation

Vocational rehabilitation

Social rehabilitation

Psychological rehabilitation

Modify Existing Intervention Programs

Identify Populations at High Disease Risk

(based on demography / family history, host factors..)

Evaluate Intervention Programs

Assess Exposure

Apply Population-Based Intervention Programs

Conduct Research on Mechanisms

(including the study of genetic susceptibility)

Epidemiology Division

Tertiary prevention seeks to soften the impact caused by the disease on the patients function, longevity, and quality of life. Examples include cardiac rehabilitation following a myocardial infarction, seeking to alter behaviours to reduce the likelihood of a reinfaction. Tertiary prevention can include modifying risk factors, such as assisting a cardiac patient to lose weight, or making environmental modifications to reduce an asthmatic patients exposure to allergens. Where the condition is not reversible, tertiary prevention focuses on rehabilitation, assisting the patient to accommodate to his disability. For reversible conditions, such as many types of heart disease, tertiary prevention will reduce the population prevalence, whereas for incurable conditions it may increase prevalence if it prolongs survival. The key goal for tertiary prevention is to enhance quality of life.

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Disease

Intervention Primary level Colorectal Individual Counselling on healthy lifestyles: dietary cancer counselling for people at risk of colorectal cancer, etc.

Secondary Hemoccult stool testing to detect colorectal cancer early

Tertiary

Population

Infectious Individual diseases: hepatitis C Population

Metabolic Individual syndrome Population

Follow-up exams to identify recurrence or metastatic disease: physical examination, liver enzyme tests, chest x-rays, etc. Publicity campaigns alerting the public to the Organized Implementation of health benefits of lifestyle changes in preventing colonoscopy services organizational colorectal cancers; promotion of high fibre diets; screening programs models that improve access subsidies to help people access exercise to high-quality care programmes; anti-smoking campaigns Counselling on safe drug use to prevent Screening for HCV HCV therapy to cure hepatitis C virus (HCV) transmission; counselling infection of patients infection and prevent on safer sex with a history of transmission injection drug use HCV prevention includes safer sex practices, Establish a universal (Similar to primary programmes to discourage needle sharing testing system for prevention): ensuring close among intravenous drug users, etc. HCV in high risk control of high risk sites groups such as tattoo parlours that have been associated with outbreaks Nutrition and exercise counselling Screening for Referral to cardiac diabetes rehabilitation clinics Built environment favourable for active Community level Implementation of transport (walking, bicycling rather than using a weight loss and multidisciplinary clinics car) exercise programs to control metabolic syndrome

Terdiagnosis CA cervix stadium IV

Chronical inflamation of cervix (stadium <3) CIN konisasi
Disability limitation histerektomi radikal Pap smear dan biopsi Skrining Sekunder prevensi Tertier meningkatkan kualitas hidupnya

Wanita dengan faktor risiko Ca cervix:

Blabla bla. Modifikasi perilaku gaya hidup Primer prevention Specific protection: imunisasi HPV, kondom.

Kultur, keluarga, pendidikan, spiritual

Primordial prevention Pengajian ,