14 Mei 5level of Prevention Drg Berni

7/28/2019 14 Mei 5level of Prevention Drg Berni

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Concepts of Prevention

and Control


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The goals of medicine are to promote

health, to preserve health, to restorehealth when it is impaired, and tominimize suffering and distress.

These goals are embodied in the

word "prevention"

(I) Prevention


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Actions aimed at eradicating (mengakhiri),eliminating or minimizing the impact of

disease and disability, or if none of these

are feasible, retarding the progress of thedisease and disability.

Prevention; Definition and Concept


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Pencegahan penyakit adalah

Tindakan yang ditujukan untuk mencegah,menunda, mengurangi, membasmi,mengeliminasi penyakit dan kecacatanmdgn menerapkan sebuah atau sejumlahintervensi yg telah dibuktikan efektif.(Kleinbaum, et al., 1982; Last, 2001).


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The concept of prevention is best definedin the context of levels, traditionally called

primary, secondary and tertiary prevention.A fourth level, called primordial prevention,

was later added.

Prevention; Definition and ConceptDeterminants of PreventionDeterminants of Prevention


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Determinants of Prevention Successful prevention depends upon: a knowledge of causation,

dynamics of transmission, identification of risk factors and risk groups,

availability of prophylactic or early detection

and treatment measures, an organization for applying these

measures to appropriate persons or groups,

and


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Preventable Causes of Disease

BEINGS

Biological factors and Behavioral

FactorsEnvironmental factors

Immunologic factors

Nutritional factorsGenetic factors

Services, Social factors, and Spiritualfactors


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Levels of prevention

Primordial prevention

Primary prevention

Secondary prevention

Tertiary prevention


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Tingkat

pencegahan

Fase penyakit Kelompok target

primordial Kondisi normal kesehatan Populasi total dan

kelompok terpilih

Primary Keterpaparan factorpenyebab khusus

Populasi total dankelompok terpilih danindividu sehat

secondary Fase patogenesitas awal Pasien

Tertiary Fase lanjut (pengobatandan rehabilitasi)

Pasien

Tingkat pencegahan dan kelompoktargetnya menurut fase penyakit

Sumber : Beoglehole, WHO 1993


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Riwayat

penyakit

Tingkat pencegahan Upaya pencegahan

Pre-patogenesis Primordial prevention

Primary prevention

Underlying condition

Health promotion

Specific protection

patogenesis Secondary prevention

Tertiary prevention

Early diagnosis and prompt

treatment

Disability limitation

Rehabilitation

Hubungan kedudukan riwayat perjalanan penyakit, tingkat pencegahan

dan upaya pencegahan


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Fase sebelum sakit

Fasepre -pathogenes is dengantingkat pencegahan yang disebut

pencegahan primer (primaryprevention). Fase ini ditandaidengan adanya keseimbanganantara agent(kuman penyakit/

penyebab), host(pejamu) danenvirontment(lingkungan).


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Fase selama proses sakit

Fasepathogenes is , terbagi dalam 2tingkatan pencegahan yang disebut

pencegahan sekunder (secondaryprevention) dan pencegahan tersier(tertiary prevention). Fase inidimulai dari pertama kali seorang

terkena sakit yang pada akhirnyamemiliki kemungkinan sembuh ataumati.


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Primordial prevention consists ofactions and measures thatinhibit the emergence of riskfactors in the form ofenvironmental, economic, social,and behavioral conditions andcultural patterns of living etc.


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(cont.) It is the prevention of the emergenceor development of risk factors incountries or population groups inwhich they have not yet appeared

For example, many adult healthproblems (e.g., obesity, hypertension)have their early origins in childhood,

because this is the time when


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Primordial prevention (cont.)

In primordial prevention, efforts aredirected towards discouraging childrenfrom adopting harmful lifestyles

The main intervention in primordial

prevention is through individual and masseducation


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Primary prevention Primary prevention can be defined as

the action taken prior to the onset of

disease, which removes thepossibility that the disease will everoccur.

It signifies intervention in the pre-pathogenesis phase of a disease orhealth problem.

Primary prevention may be

accomplished by measures of


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Primary prevention (cont.)

It includes the concept of "positivehealth", a concept that encourages

achievement and maintenance of"an acceptable level of health thatwill enable every individual to lead

a socially and economicallyproductive life".


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Primary prevention (cont.)

Primary prevention may beaccomplished by measuresdesigned to promote generalhealth and well-being, andquality of life of people or by

specific protective measures.


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Primary prevention

Specific protectionHealth promotion

Achieved by

He alth educ ation

Environmental modifications

Nutritional interventions

Life style and behavioral changes

Immunization and seroprophylaxis

chemoprophylaxis

Use of specific nutrients or supplementations

Protection against occupational hazards

Safety of drugs and foods

Control of environmental hazards,

e.g. air pollution


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Health promotion

Health promotion is the process of

enabling people to increase control over

the determinants of health and thereby

improve their health.


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Approaches for Primary Prevention

The WHO has recommended the followingapproaches for the primary prevention ofchronic diseases where the risk factors

are established:

a. Population (mass) strategy b. High -risk strategy


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Population (mass) strategy

Population strategy" is directed at the wholepopulation irrespective of individual risk levels.

For example, studies have shown that even asmall reduction in the average blood pressure orserum cholesterol of a population would producea large reduction in the incidence of

cardiovascular disease

The population approach is directed towardssocio-economic, behavioral and lifestyle

changes


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High -risk strategy

The high -risk strategy aims to bring

preventive care to individuals atspecial risk.

This requires detection ofindividuals at high risk by theoptimum use of clinical methods.


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Secondary prevention It is defined as action which halts

the progress of a disease at itsincipient stage and prevents

complications.

The specific interventions are: early

diagnosis (e.g. screening tests, andcase finding programs.) andadequate treatment.


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Secondary prevention attempts toarrest the disease process, restore

health by seeking outunrecognized disease and treatingit before irreversible pathologicalchanges take place, and reverse

communicability of infectiousdiseases.


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It thus protects others from inthe community from acquiringthe infection and thus provide atonce secondary prevention forthe infected ones and primaryprevention for their potentialcontacts.


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Early diagnosis andtreatment

WHO Expert Committee in 1973defined early detection of health

disorders as the detection ofdisturbances of homoeostatic andcompensatory mechanism while

biochemical, morphological andfunctional changes are stillreversible.


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Early diagnosis andtreatment

The earlier the disease isdiagnosed, and treated the betterit is for prognosis of the case andin the prevention of the

occurrence of other secondarycases.


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Tertiary prevention It is used when the disease process

has advanced beyond its earlystages.

It is defined as all the measures

available to reduce or limitimpairments and disabilities, and topromote the patients adjustment toirremediable conditions.


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Disability limitation

disease

impairment

disability

handicap


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Impairment

Impairment is any loss orabnormality of psychological,physiological or anatomicalstructure or function.


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Disability

Disability is any restriction or lack of

ability to perform an activity in the manner

or within the range considered normal for

the human being.


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Handicap

Handicap is termed as a

disadvantage for a given individual,resulting from an impairment ordisability, that limits or prevents the

fulfillment of a role in the communitythat is normal (depending on age,sex, and social and cultural factors)for that individual.


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Rehabilitation

Rehabilitation is the combined

and coordinated use of medical,social, educational, andvocational measures for trainingand retraining the individual to

the highest possible level offunctional ability.


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Rehabilitation

Medical

rehabilitation

Vocational

rehabilitation

Social

rehabilitation

Psychological

rehabilitation


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Strategy for Prevention

AssessExposure

Identify

Populationsat High

Disease Risk(based on demography /

family history,

host factors..)

Conduct

Research on

Mechanisms(including the study ofgenetic susceptibility)

ApplyPopulation-Based

Intervention

Programs

Evaluate

Intervention

Programs

Modify Existing

Intervention

Programs

Inter

ven

tio

n

Assessment

Epidemiology Division


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(II) Control


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Control Concept of control:

The term disease control describes

ongoing operations aimed at

reducing:

The incidence of disease

The duration of disease and

consequently the risk of transmission

The effects of infection, including both

the h sical and s chosocial


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Control activities focus on primary

prevention or secondary prevention,

but most programs combine both.

control

elimination

eradication


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Disease Elimination Between control and eradication, an

intermediate goal has been

described, called "regionalelimination"

The term "elimination" is used to

describe interruption of transmissionof disease, as for example,elimination of measles, polio anddiphtheria from large geographic

regions or areas


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Disease Eradication

Eradication literally means to "tear out by roots".

It is the process of Termination of all transmission

of infection by extermination of the infectiousagent through surveillance and containment.

Eradication is an absolute process, an "all or

none" phenomenon, restricted to termination of aninfection from the whole world. It implies thatdisease will no longer occur in a population.

To-date, only one disease has been eradicated,


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Monitoring Monitoring is "the performance andanalysis of routine measurementsaimed at detecting changes in the

environment or health status ofpopulation" (Thus we havemonitoring of air pollution, waterquality, growth and nutritional

status, etc).


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Monitoring It also refers to on -going

measurement of performance of ahealth service or a healthprofessional, or of the extent towhich patients comply with oradhere to advice from healthprofessionals.


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Surveillance surveillance means to watch over

with great attention, authority and

often with suspicion

According to another, surveillance isdefined as "the continuous scrutiny(inspection) of the factors thatdetermine the occurrence and

distribution of disease and other


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Objectives of Surveillance The main objectives of surveillance are:

(a) to provide information about newand changing trends in the healthstatus of a population, e.g., morbidity,mortality, nutritional status or other

indicators and environmentalhazards, health practices and otherfactors that may affect health


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Objectives of Surveillance The main objectives of surveillance are:

(b) to provide feed-back which may be

expected to modify the policy and thesystem itself and lead to redefinition ofobjectives, and

(c) provide timely warning of publichealth disasters so that interventionscan be mobilized.


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Control of infectious diseases (the

4 CsControl

Cases Contacts Carriers Community

Diagnosisnotification

isolation

disinfection

treatment

follow up

release

observation detectionEpidemiological

Investigation &

containment

standard

strict

protective


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Evaluation of control Evaluation is the process by which

results are compared with theintended objectives, or more simplythe assessment of how well aprogram is performing.

Evaluation should always beconsidered during the planning andimplementation stages of a programor activity.


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Evaluation of control Evaluation studies may also be

carried out to generate informationfor other purposes, e.g., to attractattention to a problem, extension ofcontrol activities, training andpatient management, etc.


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Evaluation of control Evaluation can be useful

inidentifying performance difficulties.

Evaluation studies may also becarried out to generate information

for other purposes, e.g., to attractattention to a problem, extension ofcontrol activities, training andpatient management, etc.


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To summarize The goals of medicine are to promote

health, to preserve health, to restore

health when it is impaired, and tominimize suffering and distress.

These goals are embodied in theword "prevention"


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To summarize Successful prevention depends upon

a knowledge of causation, dynamics

of transmission, identification of riskfactors and risk groups, availability ofprophylactic or early detection andtreatment measures, an organizationfor applying these measures toappropriate persons or groups, andcontinuous evaluation of anddevelopment of procedures applied


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To summarize

The objective of preventive medicine

is to intercept or oppose the "cause"and thereby the disease process.

This epidemiological concept permitsthe inclusion of treatment as one of

the modes of intervention


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Thank You


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Pencegahan mengambil tindakan terlebihdahulu sebelum kejadian

Peran epidemiologi dalam pencegahan:

identifikasi faktor risiko yang dapatdimodifikasi konsep dasar penyakit

upaya pencegahan sesuai dengan riwayatalamiah penyakit r a p


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Riwayat alamiah penyakit

dan tingkat pencegahan

Periode prepatogenesis

Tingkat pencegahan primer

Promosi kesehatan

Perlindungan khusus

Periode patogenesis Tingkat pencegahan sekunder

Diagnosis dini dan pengobatan segera

Pembatasan ketidakmampuan (disability)Riwayat Alamiah Penyakit 58


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Tahap Pencegahan

Tingkat pencegahan disesuaikan denganriwayat alamiah penyakit:

1. Pencegahan primordial

2. Pencegahan primer

3. Pencegahan sekunder

4. Pencegahan tersier

h i di l


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1. Pencegahan Primordial

Tujuan: menghindari terbentuknya pola hidupsosial ekonomi dan kultural yang diketahuimempunyai kontribusi untuk meningkatkan

risiko penyakit Pencegahan primordial yang efektif

memerlukan adanya peraturan yang ketat dari

pemerintah Contoh:

P h i di l


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Pencegahan primordial

Fase penyakit

Misal: Kondisi yang mengarah penyebab

penyakit jantung koroner

Target

Populasi

kelompok terseleksi

Riwayat Alamiah Penyakit 61

2 P h P i


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2. Pencegahan Primer

Adl Upaya pencegahan yg dilakukan saatproses penyakit belum mulai (pd periodepre-patogenesis) dengan tujuan agar tidakterjadi proses penyakit

Tujuan: mengurangi insiden penyakit dengancara mengendalikan penyebab penyakit danfaktor risikonya

Upaya yang dilakukan adalah untuk memutusmata rantai infeksi agent host -environment


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Terdiri dari:

1. Health promotion

2. Specific protection

Dilakukan melalui 2 strategi: populasi danindividu


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Perlindungan khusus

Imunisasi

Kebersihan perorangan

Sanitasi lingkungan

Perlindungan thdp kecelakaan akibat

kerja


Ti k t h i


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Perlindungan khusus

Penggunaan gizi tertentu

Perlindungan terhadap zat yang dapatmenimbulkan kanker

Menghindari zat-zat alergenik


P h i


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Pencegahan primer

Fase penyakit

Faktor-faktor penyebab khusus

Target Total populasi

kelompok terseleksi

Individu sehat



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Promosi kesehatan

Pendidikan kesehatan, penyuluhan

Gizi yang cukup sesuai dengan

perkembangan

Penyediaan perumahan yg sehat

Rekreasi yg cukup

Pekerjaan yg sesuai

Konseling perkawinanRiwayat Alamiah Penyakit 67


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3. Pencegahan Sekunder

Adl Upaya pencegahan yg dilakukan

saat proses penyakit sudah berlangsung

namun belum timbul tanda/gejala sakit(patogenesis awal) dengan tujuan

proses penyakit tidak berlanjut

Tujuan: menghentikan proses penyakit lebihlanjut dan mencegah komplikasi

Bentuknya berupa deteksi dini dan

pemberian pengobatan (yang tepat)

P h k d


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Pencegahan sekunder

Fase penyakit

tahap dini penyakit

Target pasien


Tingkat pencegahan sek nder


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Tingkat pencegahan sekunder

Diagnosis dini dan pengobatan segera

Penemuan kasus (individu atau masal)

Skrining Pemeriksaan khusus dengan tujuan

Menyembuhkan dan mencegah penyakit berlanjut

Mencegah penyebaran penyakit menular Mencegah komplikasi dan akibat lanjutan

Memperpendek masa ketidakmampuan




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Pengobatan yang cukup untuk

menghentikan proses penyakit

mencegah komplikasi dan sekuele yg

lebih parah

Penyediaan fasilitas khusus untuk

membatasi ketidakmampuan dan

mencegah kematianRiwayat Alamiah Penyakit 71


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Contoh PMS kultur rutin bakteriologis utk

infeksi asimtomatis pd kelompok

risti

Sifilis tes serologis utk infeksi

preklinis pd kelompok risti

Kanker leher rahim hapusan pap

Kanker payudara skrining dgn

mammografi

4 P h T i


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4. Pencegahan Tersier

Adl Pencegahan yg dilakukan saat prosespenyakit sudah lanjut (akhir periodepatogenesis) dengan tujuan untukmencegah cacad dan mengembalikanpenderita ke status sehat

Tujuan: menurunkan kelemahan dan kecacatan,memperkecil penderitaan dan membantu

penderita-penderita untuk melakukanpenyesuaian terhadap kondisi yang tidak dapatdiobati lagi

Terdiri dari:

Pencegahan tersier


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Pencegahan tersier

Fase penyakit

penyakit tahap lanjut (pengobatan dan

rehabilitasi)

Target

pasien


Tingkat pencegahan tersier


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Rehabilitasi

Penyediaan fasilitas untuk pelatihan hingga

fungsi tubuh dapat dimanfaatkan sebaik-

baiknya

Pendidikan pada masyarakat dan

industriawan agar menggunakan mereka

yang telah direhabilitasi




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Rehabilitasi

Penempatan secara selektif

Mempekerjakan sepenuh mungkin

Terapi kerja di Rumah Sakit

Menyediakan tempat perlindungan khusus



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Contoh Peny vaskuler diabetik pd kaki

perawatan kaki (podiatric cure) rutin

pasien diabetes Fraktura & cedera memasang rel

pegangan tangan (handrails) di

rumah orang yg mudah jatuh

Ulserasi kulit kronis penyediaan

matras khusus utk penyandang

cacat berat

Latihan


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Latihan

Seorang ibu membawa bayinya untuk

diimunisasi Polio.

Tindakan imunisasi Polio tersebut termasuk

pencegahan apa?

Tahap yang mana dari riwayat alamiah

penyakit yang akan dicegah dengantindakan imunisasi tersebut? Mengapa?

Jelaskan!

14 Mei 5level of Prevention Drg Berni

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Transcript of 14 Mei 5level of Prevention Drg Berni