預防醫學導論.pptVIP

預防醫學導論 季瑋珠 預防醫學研究所 Public Health Public health is the science and art of 1) preventing disease； 2) prolonging life； 3) promoting health and efficiency through organized community efforts 什麼是預防醫學 John M. Last的定義： Preventive medicine is the branch of medicine that is primarily concerned with preventing physical, mental, and emotional disease and injury, in contrast to treating the sick and injured. It may be thought of as more person oriented than population oriented. It comprises many of the same sciences, skills, and attitudes as public health, with an added clinical dimension. Of course, prevention is often inseparable from treatment and cure, ... Individual vs. population This could be seen as an individual-level preventive medicine. To make it work, we need population or policy approach as well. 疾病自然史 易感受期 (susceptible stage) 臨床前期 (pre-clinical or pre-symptomatic stage) 臨床期 (clinical stage) 殘障期 (disable stage) 死亡 (death) 初段預防 (Primary prevention) preventing the occurrence of disease or injury. 針對易感受期。藉由改變個人的易感受性，或是降低暴露於病原的機會，以達到避免危險因子發生作用的目的。 健康促進 (health promotion) ：如營養、運動、個人衛生、健康社區及城市 特殊保護 (specific protection)：如預防接種、安全防護設施 實例：社區健康營造、預防接種卡、安全帽、安全帶等。 次段預防 (Secondary prevention) screening people with early, often pre-clinical, manifestations of diseases, to prevent its progression. 針對疾病初期，藉由早期診斷和適當 (迅速) 治療以防患或阻滯臨床前期和臨床初期的變化，以避免發生因治療過遲而導致的併發症、後遺症、殘障或死亡。包含疾病的篩檢 (screening) 及隨後的轉介治療。 實例：六分鐘護一生（子宮頸抹片）、三合一篩檢（高血壓、糖尿病、高血脂）、基隆市闔家歡篩檢服務（高血壓、糖尿病、高血脂、子宮頸癌、乳癌、大腸癌、結核病）、健保預防保健服務（成人、兒童、孕婦、子宮頸抹片）等。 末段預防 (Tertiary prevention) minimizing the effects of disease and disability by surveillance and maintenance aimed at preventing complications and premature deterioration. 藉各種臨床治療的方法，使患者早日康復，或使發生殘障者能恢復部份正長的機能。 限制殘障 (disability limitation)；殘障的壓縮（compression of disability） 復健 (rehabilitation) 實例：糖尿病共同照護、結核病短程直接觀察治療法、中風等疾病的復健。 Some myths: Is it always better prevention than cure? Are preventive medicine and clinical (curative) medicine against each other? 預防醫學的基本知識技能及方法 診斷與評估面 生物