1、Prevention MedicineIntroduction partWenhua LingMedicine Medicine has been developing in human process of the survival. Promoting health, prevention and treatment of diseases. Medicine is also a permanent theme of human development and scientific and technological progress and the inexhaustible drivi

2、ng force of social development. MedicineBasic medicineClinical medicine (nursing, imaging ect)Rehabilitation MedicinePreventive medicine (public health)healthillnessPrevention and Clinical medicinePreventive medicinePublic healthClinical medicineWhat is public Healtha casePublic health in the news S

3、ARS, ADISAIDS epidemicAIDS controlAIDS epidemicJuly 3,1981 New York Times ran a story “rare cancer seen in 41 homosexuals”, Kaposis a; Aug 29, 1981, 60% killed by pneumonia.May 1982, gay-related immune deficiency syndrome (GRID);Acquired Immune Deficiency Syndrome (AIDS)By mid-1983, the public began

4、 to panic. That scared a lot of people. AIDS was a fatal disease,With its large gay population, the police officers demanded special masks and gloves for handling people suspected of having AIDS. School refused to allow children with AIDS into the classroom.In 1984, AIDS as a virus disease.July 3, 1

5、981New York TimeRare cancer in 41 homosexualsAug 28, 198160% killed by pneumoniaMay 1982 GRIDSummer, 1982 AIDSMid, 1983Could be spread by routine household conductEpidemiologyBiomidical scienceAgents GovermentSocial behaviour1985年1989年1995年1998年Epidemic of HIV in ChinaBy the end of 2015, the existin

6、g living HIV-infected people were 571000. 58% cases infected via heterosexual transmission;20% via homosexual transmission; 14% via IDU.The number of newly diagnosed HIV cases over 15 years old was 115000 in 201566.7%, heterosexual transmission, 28.4% MSM, 4.4% IDUChinas national AIDS epidemic dataH

7、IV shapeEtiology of HIV窗口期HIV Serology Dynamics After InfectionAnti-P24HIV RNAInfection 1 2 3 4 wk 1 y 2 y 3 y. .1 0 y.acute infectious incubationAnti-gp41/120(anti-gp36)Ag ADISAbconcHIV AbCD 4+ T 350/mm3Prevention Risk population Sexual workers Addics four frees and one care medical treatments dete

8、ction Maternal and child block Orphans free translation to go to school Appropriate subsidiesKey components of Public HealthSCIENCEPOLITICSPREVENTIONPublic Health definitionCharles-Edward A. Winslow, in 1920, defined public health as: the science and art of preventing disease, prolonging life, and p

9、romoting physical health and efficiency through organized community efforts for the sanitation of the environment, the control of community infections, the education of the individual in principles of personal hygiene, the organization of medical and nursing service for the early diagnosis and preve

10、ntive treatment of disease, and the development of the social machinery which will ensure to every individual in the community a standard of living adequate for the maintenance of health.“ Key points of the definition by WinslowPublic health is scienceThe aim of public healthThe measures of public h

11、ealth hygiene, prevention and clinical actionsAn organized body behaviorIOMs definitionThe Institute of Medicine (IOM) (1988), in its seminal report on the Future of Public Health, proposed one of the most influential contemporary definitions: “Public health is what we, as a society, do collectively

12、 to assure the conditions for people to be healthy”.HygienePrevention MedicinePublic Health The evolution of public healthHygieneHygiene: Hygiene first studies the relationship between the external environment factors (bacteria, polluted industrial wastes) and people health.Hygiene means cleaning or

13、iginally.The aim is to prevent diseases.Hygiene is given priority with the study of natural environment, and artificially can be divided into living environment (air, water, food and geology and soil) and professional environment. HygieneMedical hygieneMedical hygiene pertains to the hygiene practic

14、es related to the administration of medicine and medical care that prevents or minimizes disease and the spreading of disease.Medical hygiene practices include:Isolation or quarantine of infectious persons or materials to prevent spread of infection. Sterilization of instruments used in surgical pro

15、cedures. Use of protective clothing and barriers, such as masks, gowns, caps, eyewear and gloves. Proper bandaging and dressing of injuries. Safe disposal of medical waste. Disinfection of reusables (i.e. linen, pads, uniforms) Most of these practices were developed in the 19th century and were well

16、 established by the mid-20th century. Personal hygienePersonal hygiene pertains to hygiene practices performed by an individual to care for ones bodily health and well being through cleanliness. Motivations for personal hygiene practice include reduction of personal illness, healing from personal il

17、lness, optimal health and sense of well being, social acceptance and prevention of spread of illness to others.Personal hygiene practices include: seeing a doctor, regular washing (bathing or showering) of the body, regular hand washing, brushing and flossing of the teeth, basic manicure and pedicur

18、e and healthy eating. Personal grooming extends personal hygiene as it pertains to the maintenance of a good personal and public appearance which need not necessarily be hygienic.HygieneHealth sub-health illness disability deathPreventive MedicineAim at population, to study the disease distribution,

19、 influence factors by applying biomedical , enviromental medicine and social medicine, making up the preventive measures for population health.Public Health Preventive medicine Academic ScienceSocial practice and collectivesPublic health Hygiene Population health Objective: preventionCleaning: excre

20、tes of humansOr industrial wastesObjective: healthTo all levels of populationKey theory:EpidemiologyStatisticsInfectious diseaseEngineering EducationPersonal hygieneLife styleKey theory:EpidemiologystatistichumanitiesDecision scienceRegulationPolicylawThe main task of preventive medicineTo study the

21、 effect of environmental factors on healthEnvironment: Refers to the human survival space and contains a variety of factors. natural and social environment factors.Natural one refers: atmospheric environment, water environment, soil environment, biological environment, geological environment.Great c

22、hanges of environmental settings According to the environmental setting attributes: Chemicals , physical, and biological.Social factors: settlement environment, traffic environment, cultural environment.Genetic factorSpontaneous mutation of DNA is 0.5%/ 1 million years.Over the past ten thousand yea

23、rs of human genes change very littleNowadays human genes and 40 million years ago paleolithic ancestors are very similar.Disease profileIn recent years, new infectious diseases and the resurgence of infectious diseases is still the important problem of harm to peoples health, such as HIV, SARS, tube

24、rculosis. Are all these infectious disease is caused by the external environment of pathogenic microorganisms.NCDs-major health problemSocial development, and the change of the lifestyle, environmental changes led to change of disease profile as great increase of chronic municable (cancer, CVD, DM).

25、Attributed to 68% and 86% of total death in world and China, respectively. Human survival environment in constant change, these changes in environmental factors cause the occurrence and development of human diseases.Preventive medicine are mainly focusing on environmental factor related to health or

26、 diseases.Interaction of environmental and geneticsWith the deepening of genome research, human understanding of disease has entered a new stage. Human diseases, especially in NCDs is the result of the interaction between environmental factors and genetic.Individual nutrition gene interaction - nutr

27、ition, nutrition and epigenetic NutrigenomicsNutrigeneticsASThe individualInteraction of of diet with genesPrevention strategiesindividualization of Chronic disease prevention LIPC-514 C/T）HDLNature Reviews Genetics (2006)35Public health vs medical careThere are many distinctions between public heal

28、th and the clinical health professions.Public health is comprised of many professional disciplines such as medicine, dentistry, nursing, optometry, nutrition, social work, environmental sciences, health education, health services administration, and the behavioral sciences, its activities focus on e

29、ntire populations rather than on individual patients. Medicine is concerned with individual patients, Public Health regards the “community” as its patientDoctors usually treat individual patients one-on-one for a specific disease or injury.Public health professionals monitor and diagnose the health

30、concerns of entire communities and promote healthy practices and behaviors to assure our populations stay healthy. ItemsPublic healthMedical careSubjectiveCommunity populationIndividual patientsQuestionStatus, eventssymptomMethodsStatistics, epidemiology,behaviorsAnalysis on pathogenesisData originC

31、ommunityResidentsHealthy fileRegular recordsInvestigationDisease historyPhysical exam Lab examObjective resultsHealth problems of community resourcesRisk factorsCommunity health promoting planDisease diagnosisCause of diseases Individual health promoting planPublic health diagnoses and treats the co

32、mmunitys ill by way of assessment, policy development and assurance.Public health relies on the tools of science and politics.Medicine individual patients, healing illness doctor-patientPublic health community as patients preventing illness public health-government- population Public health contribu

33、tes a great deal more to the health of a population than medicine doesLife expectancy increased from 45 to 75 years over the past century. Only 5 of those 30 additional years can be contributed to medical care system.Rescue the persons who fall into water like clinical doctor find out why do the per

34、sons fall into water by themselves, pushed by someone, or accident that likes prevention medicineScience of public healthSix areas:Epidemiology StatisticsBiomedical sciencesEnvironmental scienceSocial and behavior scienceHealth policy and management or health administration Epidemiology Epidemiology

35、 as basic science of public health;focus on human populationcommon exposurecausative factorsProvide first indication of new disease such as HIV in 1980 smoke and cancer lipids and cardiovascular diseases AssessmentDetermine a probable cause or reasonInstitute methods to prevent and control diseases4

36、7Doll and Hill: smoke and lung cancer 1945-1950 case control Then, cohort study, 40,000 doctors follow-up 10 year, 1964 published the article StatisticsPopulation study depend heavily on statistics data on births, deaths, cause of death, outbreaks of communicable diseases, cause of cancer, occupatio

37、nal injuries, and other health-related issues. Probability to answer uncertainty (p value)Statistics of screening testsRatesRisk assessment and risk perceptionBiomedical sciencesPublic health and medicine depend on the biomedical sciences: infectious disease: how spread, how affect human, how contro

38、l; Rabies,smallpox, measle and polio Chronic diseases: cancer, heart diseaseEnvironmental health sciencesWater, air, soil and food;Microorganism, chemicals, RadiationProfessional exposuresClean air (particulate matter, sulfur dioxide, CO, Ozone layer, lead)Indoor air quality (smoke, radon, formaldehyde).Clean water Wastes (inorganic and organic chemicals) Food and