预防医学 绪论-傅华版

1、预防医学Preventive medicine,绪 论,学习目标 描述预防医学的概念及其特点(definition and characteristic) 讨论健康组成和作用 健康的定义 讨论健康的影响因素以及健康生态学模型(health ecological model) 解释三级预防(preventions at three levels)的内容和要点 比较高危人群策略（high-risk strategy of prevention）和全人群策略（population strategy of prevention ）的优缺点 了解预防医学的价值,Prevention and Cure，

2、which one is more important?,我国早在易经里就提出“君子以思患而豫防之（豫同预）”。 黄帝内经中提出“圣人不治已病，治未病”。,Prevention is better than cure!,A sound mind is in a sound body!,第一节 预防医学概念与健康生态学模型 一、预防医学的定义、内容和特点 是医学的一门应用学科，它以个体和确定的群体为对象，目的是保护、促进和维护健康，预防疾病、失能和早逝。,Preventive Medicine is that specialty of medical practice which focuses

3、 on the health of individuals and defined populations in order to protect, promote, and maintain health and well-being and prevent disease, disability, and premature death.,第一节 预防医学概念与健康生态学模型 预防医学的工作模式:“健康生态学模型” 了解健康和疾病问题在人群的分布情况，找出对人群健康影响的主要致病因素，制订防制对策；并通过临床预防服务和社区预防服务，达到促进人群健康、预防疾病和防制伤残和早逝的目的。,Hea

4、lth ecological model is its working model.,The field of preventive medicine and public health share the goals of promoting general health, preventing specific diseases. While preventive medicine seeks to enhance the lives of individuals by helping them improve their own health, public health attempt

5、s to promote health in population through the application of organized social efforts. 通过组织社会的力量来保护和促进全人群的健康,预防医学的内容 包括医学统计学、流行病学、环境医学、社会医学、行为科学与健康促进、卫生管理学以及在临床医学中运用三级预防措施。,预防医学的特点 工作对象：个体及确定的群体 着眼于：健康和无症状患者 研究方法：注重微观和宏观相结合 研究重点：影响健康的因素与人群健康的关系 采取的对策：具有较临床医学更大的人群健康效益,健,轻病,预防医学和临床医学与人群健康关系的比较,康,病,患者（

6、治疗）,痊愈、无效、死亡、伤残吸取教训 摄生预防,仅使病人受益,？,四苗(卡介苗、脊灰疫苗、麻疹疫苗、百白破疫苗)：100元左右。 六病（结核、脊髓灰质炎、麻疹、百日咳、白喉、破伤风）：？元 口服降压药：1天1元左右，10年3650元； 高血压并发症：血压不能有效控制时，10年内高发，治疗费用数千元至几十万元，往往失去健康甚至丧命。,预防的费用远低于治疗的费用,二、健康的概念 WHO对健康的定义：“健康是身体、心理和社会适应的完好状态，而不仅是没有疾病和虚弱。” According to the definition by WHO, health is a state of complete

7、physical, mental and social well being, and not merely the absence of disease or infirmity.,1. 健康的组成 3驾马车 （1）身体 （2）心理 1）智力 2）情绪 3）精神 （3）人际交往和社会适应 是否真正地欣赏和接纳他人？很好地化解人际冲突？,Health is the essential foundation that supports and nurtures growth, learning, personal well being, social fulfillment, enrichmen

8、t of others, economic production, and constructive citizenship. 在日复一日的人生经历中积极地扮演不同生命阶段所需要的角色。 在这一过程中，是否对生活满意？快乐？幸福？是判断健康的主观感受。,2. 健康的作用,二、健康决定因素及健康生态学模型 1. 社会经济环境（social and economic environment） （1）个人收入和社会地位 （2）文化背景和社会支持网络 （3）教育 （4）就业和工作条件,2. 物质环境（physical environment） （1）按有害物的性质分 生物因素 化学因素 物理因素,Ph

9、ysical factor,微小气候,microclimate,噪声,noise,振动,vibration,ionizing radiation,电离辐射,nonionizing radiation,非电离辐射,X-ray,atom bomb,ionizing radiation,Nonionizing radiation,Chemical factor,环境介质的固有物质 人为施加的污染物质 有机氯化合物 毒杀酚 重金属 内分泌干扰物,二噁英,物质环境（physical environment） （2）按物质的来源分 自然、工业、农业环境 （3）按所存在的载体分 空气、水、土壤、食物 （4）

10、按接触的地点分 家庭、学校、工作场所 （5）按接触的途径分 呼吸道、消化道、皮肤,3. 个人因素（personal factor） （1）健康的婴幼儿发育状态 （2）个人的卫生习惯 （3）个人的能力和技能 （4）人类生物学特征和遗传因素 4. 卫生服务(health services) 卫生机构、服务网络、卫生资源配置等,Health determinants are identified as : income and social status, social support networks, education, employment and working conditions, b

11、iology and genetic endowment, personal health practices and coping skills, health child development, and health services.,longevity area- Bama Yao Autonomous County,Geographic location,The Guangxi Zhuang Autonomous Region locates in southern China covering 23.67 square kilometers and with a populati

12、on of 49 million. Guangxi has 12 ethnic groups including Han, Yao, Miao, Dong, Monao, Maonan, Hui, Yi, Jing, Shui, Gelao, ect.,The average life expectancy,Health level of urban and rural residents in Guangxi obviously improved in recent ten years. The average life expectancy was 71.29 in 2000, and u

13、p to 73.29 years in 2009, higher than the national average.,Based on the recent demographic data, the centenarian centenarian rate was 29.9/100 000 persons in Bama. But the aggregate centanarian rate is only 2.19/100 000 in mainland of China.,106 years old,longevity area- Bama Yao Autonomous County,

14、寿,a pond,woods,（二）健康生态学模型 （health ecological model） 健康生态学模型强调个体和人群健康是个体因素、卫生服务以及物质和社会环境因素相互依赖和相互作用的结果，且这些因素间也相互依赖和相互制约，以多层面的交互作用来影响着个体和群体的健康。,图1-2 健康生态学模型（结构）,第二节 三级预防策略一、疾病自然史与预防机会疾病从发生到结局（死亡或痊愈等）的全过程称为疾病自然史（natural history of disease）健康期病理发生期临床前期临床期结局,一个人从健康 疾病 健康（或死亡）可以认为是一个连续的过程，称为健康疾病连续带（health

15、-disease continuum，HDC）,危险因素作用于机体到疾病临床症状的出现，有一个时间的过程。根据危险因素的性质和接触的量，其导致疾病发生的时间有长有短，将为我们提供 预防的机会窗 window of opportunity for prevention,传染性非典型肺炎(Infection Atypicalpneumonias),又称严重急性呼吸道综合症（SARS），是由冠状病毒引起的一种新的呼吸系统传染性疾病。主要通过近距离空气飞沫传播，临床主要表现为肺炎，具有较强的传染性，在家庭和医院有显著的聚集现象。人群普遍易感，医护人员(health workers)是本病的高危人群。,

16、冠状病毒的新型变种,47,surveillance of SARS,二、三级预防（preventions at three levels ),表1-1 三级预防,1.第一级预防(primary prevention) 病因学预防 通过采取措施消除致病因素对机体危害的影响或提高机体的抵抗力来预防疾病的发生。 第一级预防包括保障全人群健康的社会和环境措施以及针对健康个体的措施。,Primary prevention is an etiological prevention including primordial prevention such as policies, laws, rules a

17、nd other measures for population or individuals.,保障全人群健康的社会和环境措施，是从全球性预防战略和各国政府策略及政策角度考虑所采取的公共卫生措施，如制定和执行各种与健康有关的法律及规章制度。 如提供清洁安全的饮用水和食品，针对保护大气、水源、土壤的环境措施等。,针对健康个体的措施： 个人的健康教育，注意合理营养和锻炼，培养良好的行为与生活方式； 有组织地预防接种，提高人群免疫水平； 做好婚检和禁止近亲结婚，预防遗传性疾病； 做好妊娠和儿童期卫生保健； 某些疾病的高危个体服用药物来预防疾病的发生，即化学预防。,Primary preventio

18、n, disease is stopped before it starts, often by reducing or eliminating risk factors for a health problem. Vaccinations, chemoprevention, and counseling are types of primary prevention. The type of primary preventive care given usually depends on the persons age and risk profile. For example , enco

19、uraging people to protect themselves from the suns ultraviolet rays is an example of primary prevention of skin cancer.,(1) Vaccinations to prevent infectious diseases (such as polio （脊髓灰质炎） and Measles（麻疹); (2)Chemoprevention (drug therapyfor example, Cholesterol-lowering drugs to prevent atheroscl

20、erosis（动脉粥样硬化）Aspirin to prevent heart attacks or strokes, antihypertensive drugs to reduce blood pressure and prevent strokes); (3) Counseling aimed at helping people make healthy lifestyle choices (such as not smoking, wearing seat belts, and eating a healthy diet).,vaccination,endemic disease exa

21、mination,Dental fluorosis examination,第二级预防 (secondary prevention) 临床前期预防 特点：有病早治；做好早发现、早诊断、早治疗的“三早”工作。（传染病还需早报告、早隔离）,仍有大量未被发现的人由于高血压、糖尿病、高血脂、吸烟、体育活动少和不合理的饮食结构而处于心脑血管疾病的危险之中,在这冰山的顶尖是每年3200万心脑血管疾病患者,第二级预防 (secondary prevention) 临床前期预防,Secondary prevention is also called pre-clinical prevention. The m

22、ain task of secondary prevention that focuses on pre-clinical stage is early detection, early diagnosis and early treatment of the disease by screening, periodical health examination and case finding in health service.,Secondary prevention, disease is detected and treated early, often before symptom

23、s are present, thereby minimizing adverse outcomes. Secondary prevention can involve screening programs, such as for high blood pressure, diabetes, and cancer), testing to detect prostate cancer（前列腺癌）, and tracking down the sex partners of a person diagnosed with a sexually transmitted disease (cont

24、act tracing) to treat these people, if necessary, and to minimize spread of the disease. A doctor checking for suspicious skin growths is an example of secondary prevention of skin cancer. The goal of secondary prevention is to find and treat disease early. In many cases, the disease can be cured.,u

25、rine,Fingertip draw blood,Draw blood,脑卒中即急性脑血管病，中医称之为“中风（stroke）”，临床表现以猝然昏扑、不省人事或突然发生口眼歪斜、半身不遂、舌强言蹇、智力障碍为主要特征。已得过脑卒中的患者，还易再复发，每复发一次，加重一次。脑卒中的复发相当普遍，首次卒中后6个月内是卒中复发危险性最高的阶段，所以在卒中首次发病后有必要尽早开展二级预防工作。,辨认脑中风的症候,脸部下垂：要求患者微笑，如果单侧的脸部有下垂或脸部不动，怀疑有脑中风。,脑中风的症候 -手臂无力,脑中风的危险因素,obesity,hypertension,excessive drinki

26、ng, 第三级预防(tertiary prevention) 临床预防 特点：既病防残，已残者，促使功能恢复、心理康复,Tertiary prevention is also called clinical prevention including prompt and effective treatment, prevention of the complication（并发症） of disease and disability, and rehabilitation.,Tertiary prevention, an existing, usually chronic disease is

27、 managed to prevent further functional loss. For example, tertiary prevention for people with diabetes focuses on tight control of blood sugar, excellent skin care, and frequent exercise to prevent heart and blood vessel disease. Tertiary prevention can involve providing supportive and rehabilitativ

28、e services to maximize quality of life, such as rehabilitation from injuries, heart attack, or stroke. It also includes preventing complications among people with disabilities， such as preventing bed sores（褥疮） among those confined to bed.,三、高危人群策略与全人群策略高危人群的预防策略（high-risk strategy of prevention）是指针对

29、疾病高风险的个体采取预防干预措施来降低其将来发病的风险。全人群的预防策略（population strategy of prevention ）是指针对影响整个群体的健康危险因素，尤其是病因链上那些远端的因素进行干预来降低整个人群疾病的风险。,高危人群策略重点关注病因链的近端，干预针对性强和效果明显；全人群策略干预病因链的远端因素（即原因背后的原因），使整个人群受益。,How to prevent wrinkles, blotches or spots on your skin?,How to prevent skin cancer?,How to prevent skin cancer?,W

30、ear a long-sleeved shirt and long pants or a long skirt. Wear wrap-around sunglasses to help protect your eyes and your skin from sun damage. Stay in the shade between 10 a.m. and 4 p.m.,through the application of organized social efforts,focus on the health of high-risk population,Long sleeves, a h

31、at, and sunglasses were handed out to the people.,the Way to Protect the Skin screening programs,Strategies to decrease the incidence,How to prevent skin cancer?,Rose预防医学策略关注个体的高危策略即便能够有效降低该群组个体的发病危险，但对整个人群疾病风险的降低作用有限。关注整个人群的群体预防策略，即便只是将健康（疾病）的风险分布向左移动较小的程度，产生的健康收益就很巨大。,预防措施的落实，可根据干预对象是群体或个体，分为社区预防服务和临床预防服务。社区预防服务是以社