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Levels of Prevention

الكلية كلية التمريض     القسم قسم التمريض العام     المرحلة 4
أستاذ المادة سلمى كاظم جهاد الابراهيمي       17/03/2014 19:44:32


Levels of Prevention
The definition of epidemiology encompasses preventing and controlling diseases in human populations. This is usually accomplished using three levels of prevention. Primary prevention seeks to reduce the frequency of new cases of disease occurring in a population and, thus is most applicable to persons who are in the stage of susceptibility. Secondary prevention attempts to reduce the number of existing cases in a population and, therefore, is most appropriately aimed those in the stage of presymptomatec disease or the early stage of clinical disease. Tertiary prevention tries to limit disability and improve functioning following disease or its complications, often through rehabilitation. Therefore, it is most applicable during the late clinical stage or the stage of diminished capacity. The natural history of disease and the levels of prevention are closely linked. As illustrated in figure 3-4, appropriate levels of prevention may be applied at each stage of the natural history of disease.
Primary Prevention
Primary prevention strategies emphasize general health promotion, risk factor reduction, and other health protective measures. These strategies include health education and health promotion programs designed to foster healthier lifestyles and environmental health programs designed to improve environmental quality. Specific examples of primary prevention measures include immunization against communicable diseases; public health education about good nutrition, exercise, stress management, and individual responsibility for health; chlorination and filtration of public water supplies; and legislation requiring child restraints in motor vehicles.
Secondary Prevention
Secondary prevention focuses on early detection and swift treatment of disease. Its purpose is to cure disease, slow its progression, or reduce its impact on individuals or communities. A common approach to secondary prevention is screening for disease, such as the noninvasive computerized test for the early detection of heart disease. This test uses computerized tomography scans to look for calcium deposition in the arteries, which can signal previously undetected heart disease. Other examples of screening include mammography for breast cancer detection; eye tests for glaucoma; blood tests for lead exposure; occult blood tests for colorectal cancer; the Pap test for cervical concrete breath test for Helicobacter pylori, the bacterium implicated in duodenal and gastric ulcers; and the Prostate-Specific Antigen(PSA) test for prostate cancer. In each case, screening is performed to detect disease early so prompt treatment can be initiated. Examples of other secondary prevention methods include treatment of hypertension to prevent complications and removal of skin cancer lesions as they occur.
Tertiary Prevention
Tertiary Prevention strategies involve both therapeutic and rehabilitative measures once disease is firmly established. Examples include treatment of diabetics to prevent complication of the disease and the ongoing management of chronic heart disease patients with medication, diet, exercise, and periodic examination. Other examples include improving functioning of stroke patients through rehabilitation by occupational and physical therapy, nursing care, speech therapy, counseling, and so forth, and treating those suffering from complications of diseases such as meningitis, multiple sclerosis, or Parkinson’s disease.
On community level, providing high quality, appropriate, and accessible health care and public health resources is critical to assuring satisfactory primary, secondary, and tertiary prevention. Table 3-1 summarizes the three levels of prevention and provides examples of their applications at the community level.

Preventive healthcare strategies are typically described as taking place at the primary, secondary, tertiary and quaternary prevention levels. In addition, the term primal prevention has been used to describe all measures taken to ensure fetal well-being and prevent any long-term health consequences from gestational history and/or disease. The rationale for such efforts is the evidence demonstrating the link between fetal well-being, or "primal health", and adult health. Primal prevention strategies typically focus on providing future parents with: education regarding the consequences of epigenetic influences on their child. sufficient leave time for both parents or, for lack of it, at least some kin care giving.
Simple examples of preventive healthcare include hand washing, breastfeeding, immunizations, proper nutrition and exercise promotion. Preventive care may include examinations and screening tests tailored to an individual s age, health, and family history. For example, a person with a family history of certain cancers or other diseases would begin screening at an earlier age and/or more frequently than those with no such family history. On the other side of preventive healthcare, some nonprofit organizations, such as the Northern California Cancer Center, apply epidemiological research towards finding ways to prevent diseases.
Universal, selective, and indicated
Gordon (1987) in the area of disease prevention, and later Kumpfer and Baxley in the area of substance use. proposed a three-tiered preventive intervention classification system: universal, selective, and indicated prevention. Amongst others, this typology has gained favor and is used by the U.S. Institute of Medicine, the NIDA and the European Monitoring Centre for Drugs and Drug Addiction.
Level Definition
Primary prevention Methods to avoid occurrence of disease. Most population-based health promotion efforts are type.

Secondary prevention Methods to diagnose and treat existent disease in early stages before it causes significant morbidity.
Tertiary prevention Methods to reduce negative impact of existent disease by restoring function and reducing disease-related complications.


Tier Definition
Universal prevention Involves whole population (nation, local community, school, district) and aims to prevent or delay the abuse of alcohol, tobacco, and other drugs. All individuals, without screening, are provided with information and skills needed to prevent the problem.
Selective prevention Involves groups whose risk of developing problems of alcohol abuse or dependence is above average. Subgroups may be distinguished by traits such as age, gender, family history, or economic status. For example, drug campaigns in recreational settings.
Indicated prevention Involves a screening process, and aims to identify individuals who exhibit early signs of substance abuse and other problem behaviours. Identifiers may include falling grades among students, known problem consumption or conduct disorders, alienation from parents, school, and positive peer groups etc.
Outside the scope of this three-tier model is environmental prevention. Environmental prevention approaches are typically managed at the regulatory or community level and focus on ways to deter drug consumption. Prohibition and bans (e.g. on smoking, alcohol advertising) may be viewed as the ultimate environmental restriction. However, in practice, environmental preventions programs embrace various initiatives at the macro and micro level, from government monopolies for alcohol sales through roadside sobriety or drug tests, worker/pupil/student drug testing, increased policing in sensitive settings (near schools, at rock festivals), and legislative guidelines aimed at precipitating punishments (warnings, penalties, fines).















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