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第二章健康观内容回顾内容回顾•第一节传统健康观和疾病观•第二节整体健康观•第三节整体健康的内容和测量第三章预防策略和措施本章目录•第一节三级预防•第二节五层次预防•第三节健康教育第一节三级预防一、一级预防二、二级预防三、三级预防预防医学的定义预防医学（PreventiveMedicine）是一门应用性学科，它以个体和确定的群体为对象，应用卫生统计学、流行病学、环境医学、社会行为科学等原理和方法，分析环境因素对健康的影响及疾病的发生、发展和分布规律，有针对性的采取三级预防措施，达到促进健康和预防疾病、防治残疾和夭折的目的。范畴工作对象目的措施方法第一级预防亦称病因预防，是针对致病因素采取的预防措施，使健康人免受致病因素的危害。其目的是防止疾病发生，对疾病发生的生物、心理和社会等有关因素加以综合研究，提出增进健康的预防措施。Primarypreventionmeanstakingactiontobuildresilienceandtopreventproblemsbeforetheyoccur.一、第一级预防(primaryprevention)主要包括改善环境措施和增进健康措施两方面。(1)改善环境措施:防治和消除环境污染;减少或消除生产环境危害;创造并维护有益于身心健康的社会条件一级预防的内容(2)增进健康措施•开展健康教育，培养良好的行为与生活方式•预防接种•预防遗传性疾病•做好人群保健Primarypreventionmeasuresincludeactivitiesthathelpavoidagivenhealthcareproblem.Examplesincludepassiveandactiveimmunizationagainstdiseaseaswellashealthprotectingeducationandcounselingpromotingtheuseofautomobilepassengerrestraintsandbicyclehelmets.Sincesuccessfulprimarypreventionhelpsavoidthesuffering,costandburdenassociatedwithdisease,itistypicallyconsideredthemostcost-effectiveformofhealthcare.Primordialprevention•Inprimordialprevention,effortsaredirectedtowardsdiscouragingchildrenfromadoptingharmfullifestyles健康教育从娃娃抓起•Themaininterventioninprimordialpreventionisthroughindividualandmasseducation个体和群体的健康教育很重要ApproachesforPrimaryPrevention•TheWHOhasrecommendedthefollowingapproachesfortheprimarypreventionofchronicdiseaseswheretheriskfactorsareestablished:WHO认为慢性病的一级预防应从群体健康策略和高危人群健康策略两方面考虑–a.Population(mass)strategy–b.High-riskstrategyPopulation(mass)strategy•“Populationstrategyisdirectedatthewholepopulationirrespectiveofindividualrisklevels.群体策略是指健康教育应针对所有人，无论个体健康水平如何•Forexample,studieshaveshownthatevenasmallreductionintheaveragebloodpressureorserumcholesterolofapopulationwouldproducealargereductionintheincidenceofcardiovasculardisease•Thepopulationapproachisdirectedtowardssocio-economic,behavioralandlifestylechanges•具体措施包括社会－经济、行为和生活方式等方面的改变High-riskstrategy•Thehigh-riskstrategyaimstobringpreventivecaretoindividualsatspecialrisk.高危人群应注重个体危险因素•Thisrequiresdetectionofindividualsathighriskbytheoptimumuseofclinicalmethods.通过检测危险因素和临床方法进行预防Primaryprevention•Primarypreventioncanbedefinedastheactiontakenpriortotheonsetofdisease,whichremovesthepossibilitythatthediseasewilleveroccur.•Itsignifiesinterventioninthepre-pathogenesisphaseofadiseaseorhealthproblem.一级预防属于疾病发生前的防护，是病因预防•Primarypreventionmaybeaccomplishedbymeasuresof“Healthpromotion”and“specificprotection”PrimordialpreventionManyadulthealthproblems(e.g.,obesity,hypertension)havetheirearlyoriginsinchildhood,becausethisisthetimewhenlifestylesareformed(forexample,smoking,eatingpatterns,physicalexercise).积行成习二级预防：（临床前期预防）即在临床前期及时采取早发现早诊断早治疗的预防措施，其目的是控制或减缓疾病病程的进展，促使疾病向痊愈的方向转化，提高治愈率。secondarypreventionmeasuresasthosethat“identifyandtreatasymptomaticpersonswhohavealreadydevelopedriskfactorsorpreclinicaldiseasebutinwhomtheconditionisnotclinicallyapparent.”二、二级预防(secondaryprevention)(1)早期发现：普查、筛检、定期检查、自我检查、重点项目检查(2)早期诊断：诊断技术，诊断水平(3)早期治疗：早期、合理用药；心理治疗等二、二级预防(secondaryprevention)三早措施传染病慢性病恶性病三早措施流程示意图办法：*向群众进行健康教育，提高群众预防疾病的知识水平；*加强医务人员的责任心，努力提高诊断水平；*发展和研究疾病早期检测手段及技术；*认真执行疾病报告制度。二、二级预防(secondaryprevention)Theseactivitiesarefocusedonearlycasefindingofasymptomaticdiseasethatoccurscommonlyandhassignificantriskfornegativeoutcomewithouttreatment.在疾病无临床症状前就能发现疾病，特别是恶性疾病二、二级预防(secondaryprevention)Screeningtestsareexamplesofsecondarypreventionactivities,asthesearedoneonthosewithoutclinicalpresentationofdiseasethathasasignificantlatencyperiodsuchashyperlipidemia(高脂血症),hypertension.筛检虽好也有限制，智能健康家用电器是未来家居必备。二、二级预防(secondaryprevention)婚检与优生优育•婚前的检查主要包括是否患有各种急、慢性传染病史，比如肝炎、活动性肺结核等；双方直系亲属是否有精神病史及各种遗传病史。另一重要内容是男女双方进行生殖器官检查，如发现生殖器官有缺陷或其他疾病，应及时进行相关治疗。•有的人会携带遗传病隐性基因，这些疾病一般的单位体检是检查不出来的，如果双方均患有某种遗传性疾病，其后代发病几率很高，不利于新生儿健康。在婚检过程中，医生会问到与婚育有关的病史，比如女方的月经史，包括初潮年龄、月经周期等。疑问•婚检到底是一级预防还是二级预防？三级预防(tertiaryprevention)即临床预防。对已经患病的病人采取及时有效的治疗措施,防止病情恶化,预防并发症,防止伤残,使之早日康复.Tertiarypreventionactivitiesinvolvethecareofestablisheddisease,withattemptsmadetorestoretohighestfunction,minimizethenegativeeffectsofdisease,andpreventdisease-relatedcomplications.三、三级预防(tertiaryprevention)(1)防止病残主要是促进功能恢复、早日康复，力争病而不残，残而不废，防复发和防转移等。(2)康复工作主要是教育社会爱护病残。做好社会卫生服务，进行家庭护理指导，做好心理康复、调整性康复及功能性康复等工作。三、三级预防(tertiaryprevention)*所有疾病强调一级预防*不同疾病类型采取不同的三级预防策略和措施（1）病因明确且人为的：一级预防多因素：一级、二级不明难以预料：三级（2）疾病的可逆性：对不可逆的疾病应一级预防为主。三、三级预防(tertiaryprevention)Case1•Ms.Leonardisa72year-oldwomanwithchronicbronchitiswhoisaformercigarettesmoker.Hermedicationsincludeipratropiumbromide(Atrovent)andalbuterol.Herprimarypreventionneedsinclude:•A.Reviewingappropriateuseofhermedications•B.Receivinganannualinfluenzaimmunization•C.Obtainingspirometrymeasurement•D.Periodicsigmoidoscopy•ThecorrectresponseinMs.Leonard’sscenarioisB.Influenzavaccineistheonlyactivitythatisaimedatdiseaseprevention.Medicationteachingandassessmentofpulmonaryfunctionarepartoftreatingherestablisheddisease.Periodicsigmoidoscopyisanexampleofsecondarypreventionasitisascreeningtestforcolorectalcancer.Case2•Ms.Giordanoisa68year-oldwomanwithhypertensionwhoresidesaloneinaprivatehome.Hersecondarypreventionneedsi