Three-level Prevention Research Articles

Call for attention to the prevention of perinatal death attributed to birth defect

Birth defect and perinatal death are major public issues threatening the health of women and children in China. However, perinatal death attributed to birth defects has not yet received sufficient attention. To minimize the occurrence of perinatal death caused by birth defects, this review article deeply analyzed the current status of epidemiology, clinical, and basic research on perinatal death attributed to birth defects both domestically and internationally, and proposed to encourage the conduct of national research on perinatal causes. We should also pay attention to the application of the perinatal cause of death classification system, and focus on accurate diagnosis and the three-level prevention and control of perinatal death attributed to birth defect.

Investigate of the etiology and prevention status of liver cirrhosis

Objective: To investigate the etiology, prevention and treatment status, and their corresponding regional differences of the patients with liver cirrhosis in China, in order to provide scientific basis for the development of diagnosis and control strategies in China. Methods: Clinical data of patients diagnosed with liver cirrhosis for the first time through January 1, 2018 to December 31, 2020 from 50 hospitals in seven different regions of China were collected and analyzed retrospectively, and the difference of etiology, treatment, and their differences in various regions were analyzed. Results: A total of 11 861 cases with liver cirrhosis were included in the study. Thereinto, 5 093 cases (42.94%) were diagnosed as compensated cirrhosis, and 6 768 cases (57.06%) had decompensated cirrhosis. Notably, 8 439 cases (71.15%) were determined as chronic hepatitis B-caused cirrhosis, 1 337 cases (11.27%) were alcoholic liver disease, 963 cases (8.12%) were chronic hepatitis C, 698 cases (5.88%) were autoimmune liver disease, 367 cases (3.09%) were schistosomiasis, 177 cases (1.49%) were nonalcoholic fatty liver, and 743 cases (6.26%) of other types of liver disease. There were significant differences in the incidence of chronic hepatitis B, chronic hepatitis C, alcoholic liver disease, fatty liver, schistosomiasis liver disease, and autoimmune liver disease among the seven regions (P<0.001). Only 1 139 cases (9.60%) underwent endoscopic therapy, thereinto, 718 cases (6.05%) underwent surgical therapy, and 456 cases (3.84%) underwent interventional therapy treatment. In patients with compensated liver cirrhosis, 60 cases (0.51%) underwent non-selective β receptor blockers(NSBB), including 59 cases (0.50%) underwent propranolol and 1 case (0.01%) underwent carvedilol treatment. In patients with decompensated liver cirrhosis, 310 cases (2.61%) underwent NSBB treatment, including 303 cases (2.55%) underwent propranolol treatment and 7 cases (0.06%) underwent carvedilol treatment. Interestingly, there were significant differences in receiving endoscopic therapy, interventional therapy, NSBB therapy, splenectomy and other surgical treatments among the seven regions (P<0.001). Conclusion: Currently, chronic hepatitis B is the main cause (71.15%) of liver cirrhosis in several regions of China, and alcoholic liver disease has become the second cause (11.27%) of liver cirrhosis in China. The three-level prevention and control of cirrhosis in China should be further strengthened.

Environment control and healthy education are the most important methods for prevention and treatment of allergic rhinitis

The almost all guidelines of allergic rhinitis (AR) diagnosis and treatment in the world agree the strategy of "combination of prevention and treatment, four in one". There are more descriptions about anti-allergic medications and allergen immunotherapy (AIT), but less contents of environmental control and health education. It is necessary to emphasize again that clinicians must attach great importance to environmental control and strengthen health education in order to realize the three-level prevention of AR and reduce its harm.

Early Identification and Intervention in Pediatric Obsessive-Compulsive Disorder.

Obsessive-compulsive disorder (OCD) is a psychiatric disorder characterized by persistent thoughts with subsequent repetitive behaviors. Interventions that are effective for adult OCD cannot simply be generalized to pediatric OCD, since OCD in children and adolescents usually has a different clinical presentation, etiology and course from adult OCD. Delayed and inadequate treatment is associated with a worse prognosis, making the need for early identification and intervention in pediatric OCD very urgent. In this paper, we reflected on the current constraints that make early interventions for pediatric OCD unpromoted and reviewed the approaches with potential application for early identification and early intervention in pediatric OCD, categorized by three-level prevention stages corresponding to a clinical staging model. Since the etiology of pediatric OCD is still unclear, primary prevention is most lacking, and early interventions for pediatric OCD are currently focused on the secondary prevention stage, which aims to prevent the conversion of obsessive-compulsive symptoms into full-blown OCD; tertiary prevention mostly focuses on the alleviation of mild to moderate OCD, while interventions for co-morbidities are still in their infancy. We closed by considering the important research questions on this topic.

Application and thinking of acupuncture therapy in comprehensive management of hypertension

The theory of disease prevention with traditional Chinese medicine is introduced into the prevention of chronic diseases such as hypertension. In order to fully implement the advantages of acupuncture, the three-level prevention strategy is strengthened on the whole-process intervention with acupuncture for hypertension, including prevention before disease onset, starting intervention at the early phase, and prevention disease from exacerbating. Moreover, the comprehensive management scheme, multidisciplinary coordination and participation mechanism are investigated in the field of traditional Chinese medicine for preventive treatment of hypertension.

Expert consensus on diagnosis, treatment and prevention of allergic diseases(Part Ⅲ)

As the third part of the expert consensus on allergic diseases, this article includes efficacy evaluation, characteristics of allergic diseases in special populations, social and economic burden, psychological problems and prevention. The efficacy evaluation methods include symptom score, quality of life score and drug score. Allergic diseases of special populations have unique clinical characteristics and need special attention. The social and economic burden of allergic diseases is becoming heavier, which requires more attention. The three-level prevention of pollinosis can be completed through the "five in one" prevention and control strategies such as local vegetation survey, airborne pollen monitoring, epidemiological survey, standardized training of grassroots medical personnel, science popularization and academic lectures, which is more comprehensive and perfect than the "four in one" treatment strategy.

Research on the Risk of Inclusive Physical Education in Colleges and Universities and Construction of Safety Prevention and Control Mechanism

This study aims to promote the return of special physical education to the mainstream education system and ensure the normal advancement of inclusive physical education courses in colleges and universities. Consequently, all educatees can enjoy equal educational resources, obtain comprehensive development, and realize the fairness of education. Based on the grounded theory, the first-line physical education teachers from 6 inclusive and demonstrative colleges and universities in China were selected for in-depth interviews, and 20 pieces of interview materials were collected and sorted. The NVIVO12 software was employed to collate data and determine the risks of inclusive physical education. The results demonstrated that the factors causing school sports injury accidents mainly included human factors, material factors, and management factors. Under the guidance of the three-level prevention theory in the field of medical prevention and medicine, the three-level safety prevention and control concept of sports injury was introduced, and the theoretical model of the safety prevention and control mechanism of special physical education courses was constructed.

Application of the Prevention of Disease Concent in Traditional Chinese Medicine in Acupuncture Rehabilitation Treatment of Chronic Diseases： Take Vascular Dementia as an Example

The concept of rehabilitation prevention is one of the basic theories of rehabilitation medicine of traditional Chinese medicine (TCM), early rehabilitation intervention will help to prevent or reduce the loss of function or disability of patients. This is similar to the theory of preventive treatment of disease in TCM and three-level prevention in modern preventive medicine. Acupuncture and moxibustion has a long history and plays an important role in the preventive treatment of Alzheimer's disease (AD), vascular dementia (VD) and other senile diseases. Taking VD as an example, this paper discussed the rehabilitation treatment of acupuncture and moxibustion of VD and its possible mechanism, which explained that acupuncture and moxibustion therapy played a preventive and therapeutic role in the early stage of dementia, and embodied the TCM concent of "prevent before the disease arises and prevent disease from exacerbating". The early intervention of TCM rehabilitation technology can transform forward the focus of prevention and control of chronic diseases. To construct a new model of intelligent rehabilitation of TCM based on the theory of preventive treatment of disease, and develop a standardized acupuncture and moxibustion rehabilitation technology with the assistance of internet and information construction, which will help to improve the effectiveness, safety and patient compliance of TCM acupuncture and moxibustion rehabilitation services, and will contribute to advancing the healthy China.

Clinical application and reflection of molecular biology technology in the tertiary prevention of birth defects

Genetic factors are the main causes in occurrence of birth defects. With deep research in the field of genomics and application of molecular biology technology, the carrier status, fetal genetic variation and postpartum screening are respectively detected from pre-pregnancy, pregnancy and post-natal screening (before onset of disease) under perfect three-level prevention and control system for birth defects. Prospective detection, early diagnosis and intervention can prevent the occurrence of birth defects related to genetic diseases at multiple levels. This article describes and analyzes current clinical application and existing challenge of molecular biology techniques in prevention of birth defects related to genetic diseases.

Discussion on primary closed-loop management mode of chronic diseases in Ningxia

The pre-during-post hospital closed-loop management of chronic diseases is an efficient way to upgrade the current chronic disease management level. The authors described the feasibility, what to build and imperative problems in implementing such a closed-loop management in primary level in Ningxia. The introduction focused on the construction of a chronic disease management path for multiple diseases, the implementation of a closed-loop management model for chronic diseases based on the three in one model(specialist-family physician-health manager) , the promotion of primary physician training and standardization management level, as well as the establishment of a community-centered three-level prevention and treatment system for chronic diseases. These efforts aim at promotion of chronic disease management outcomes, elevation of patients′ health and quality of life, and minimization of people′s economic burden. Key words: Chronic disease management; Primary level; Closed-loop management; Ningxia

Environmental Risk Assessment of Accidental Pollution Incidents in Drinking Water Source Areas: A Case Study of the Hongfeng Lake Watershed, China

Accidental pollution incidents have caused a major threat to water safety of drinking water sources. However, few studies have focused on quantitative risk assessment of pollution incidents in a watershed which contains drinking water sources. A coupling model consisting of the Seveso III Directive, SWAT, and MIKE21 models was constructed for risk assessment of sudden pollution incidents at the watershed scale. The potential hazard of risk sources (e.g., industrial enterprises), the vulnerability of risk receptors (e.g., drinking water intakes), and the environmental risk of different sub-regions of the watershed were evaluated by this model. In addition, a case study was applied in Hongfeng Lake watershed (HLW), where the Hongfeng Lake drinking water source is located. The results showed that about 68% of the industrial enterprises in the HLW were potentially hazardous according to the Seveso III Directive, including 5 high hazard enterprises, 13 medium hazard enterprises, and 37 low hazard enterprises, most of which were concentrated in the coal mining, chemical production, and building material industries. The HLW was divided into the Yangchang River watershed (YRW), the Maiweng River watershed (MRW1), the Maxian River watershed (MRW2), the Houliu River watershed (HRW), and the lake area by the hydrological characteristics, among which, the vulnerability index of YRW was the largest. Besides, it was essential to consider the vulnerability assessment of drinking water intakes when conducting an environmental risk assessment in the HLW. Regional environmental risk grade of YRW, MRW1, MRW2, HRW, and the lake area was high, medium, low, low, and none, respectively. The environmental risk assessment results showed good consistency with the pollution characteristics and spatial distribution of industrial enterprises in the HLW. Furthermore, the theory of a three-level prevention system for “risk sources–water body connection–water intakes” was proposed for environmental risk management in the HLW. Overall, the case study in the HLW indicated that the coupling model proposed in this study had a good compatibility for environmental risk assessment of sudden water pollution incidents in a watershed.

Analysis of the problems in the implementation of three-level prevention of coronary disease in community medical treatment

The three-level prevention of coronary heart was selected as the search term, the domestic medical literature from 2014 to 2018 was searched in the China Knowledge Network Journal Database, and the implementation and problems of the third-level prevention of coronary heart disease in community medical treatment was analyzed.The main problems are: (1)high-risk patients with coronary heart disease have limited knowledge of the disease and cannot be treated in time; (2)community medical personnel cannot regularly and regularly screen the high-risk groups of coronary heart disease in the area; (3)patients cannot fully understand the scheme and necessity of standardized tertiary prevention and treatment; (4)the economic cost of standardized third-level prevention is high, and the compliance of treatment is low; (5)community general practitioners and cardiovascular specialists cannot homogenize the cognitive knowledge of coronary heart disease.Recommendations: (1)In community health care, it is necessary to standardize the implementation of tertiary prevention and treatment of coronary heart disease.In addition to focusing on the health education of patients and regularly screening high-risk patients, cardiovascular specialists should also be designated to regularly conduct professional training for community doctors; (2)At the government level, appropriate policy assistance can be given to low-income patients who are unable to adhere to standardized treatment for economic reasons. Key words: Coronary disease; Hypertension; Diabetes; Hyperlipidemia; Risk factors; Community health services; Prevention; Problem solving

Review article: the prevention of hepatitis B-related hepatocellular carcinoma.

Ample evidence indicates an aetiological association of persistent hepatitis B virus (HBV) infection with hepatocellular carcinoma (HCC). Several viral, host and external risk factors for the development of HBV-related HCC have been documented. To summarise and discuss the risk stratification and the preventive strategies of HBV-related HCC. Recent published studies identified from PubMed were comprehensively reviewed. The key words included chronic hepatitis B, HBV, hepatocellular carcinoma, prevention and antiviral therapy. The incidence of HCC is extremely high in HBV hyperendemic areas. For HBV patients left untreated, significant risk factors for HCC include male gender, aging, advanced hepatic fibrosis, persistent serum transaminase elevation, specific HBV entry receptor (NTCP) genotype, PM2.5 exposure, HBeAg positivity, HBV genotype C/D/F, high proportion of core promoter mutation, pre-S deletion, high serum levels of HBV DNA and HBsAg as well as co-infection with HCV, HDV and HIV. Primary prevention of HBV-related HCC can be achieved through universal HBV vaccination and anti-viral prophylaxis for high viraemic mothers. The goal of secondary prevention has been reached by effective anti-viral therapy to reduce the risk of HCC development in chronic hepatitis B patients. However, whether HCC is prevented or delayed deserves further examination. Finally, several studies confirmed the tertiary preventive effect of anti-viral therapy in reducing risk of HCC recurrence after curative therapies. Through the strategies of three-level prevention, the global burden of HBV-related HCC should decline over time and even be eliminated in conjunction with HBV cure.

Prevalence of tooth wear and its associated risk factors among industrial workers in Daman, India: a cross-sectional study

Background: Tooth wear is an ever increasing problem. Therefore, the aim of the present study was to assess the prevalence of tooth wear and its associated risk factors among industrial workers in Daman, India. Methods: This cross sectional study was conducted among 613 industrial workers selected using simple random sampling. The clinical assessment of tooth wear was done using tooth wear index (TWI) developed by Smith &amp; Knight. A specifically designed questionnaire was used to seek information on risk factors of tooth wear. Data were analyzed using Pearson’s chi-square test, ANOVA and a multiple logistic regression model. Results: The overall prevalence of tooth wear was found to be greater in mandible (86.8%) as compared to maxilla (61.7%). In both maxilla and mandible, the most frequently affected teeth were incisors (55.8% and 83.7%) followed by canines (52.2% and 81.2%), pre molars (38.5% and 42.1%) and molars (37.8% and 38.8%). Among the risk factors, consumption of hard or acidic foods (p=0.01, OR=1.73) and use of hard toothbrush bristles (p=0.04, OR=0.04) in maxilla and clenching or grinding of teeth (p=0.01, OR=3.96) in mandible were significantly associated with tooth wear. However, work environment involving dust or acid gas was the only risk factor associated with tooth wear in both maxilla (p=0.004, OR=0.53) and mandible (p&lt;0.001, OR=0.35). Conclusions: There is a high prevalence of tooth wear among industrial workers. Thus, efforts should be made by dentists to increase awareness about tooth wear and plan a three-level prevention program based on analysis of risk assessment.

Work stress and cardiovascular disease: a life course perspective.

Individuals in employment experience stress at work, and numerous epidemiological studies have documented its negative health effects, particularly on cardiovascular disease (CVD). Although evidence on the various interrelationships between work stress and CVD has been accumulated, those observations have not yet been conceptualized in terms of a life course perspective. Using the chain of risk model, we would like to propose a theoretical model incorporating six steps: (1) work stress increases the risk of incident CVD in healthy workers. (2) Among those whose work ability is not fully and permanently damaged, work stress acts as a determinant of the process of return to work after CVD onset. (3) CVD patients experience higher work stress after return to work. (4) Work stress increases the risk of recurrent CVD in workers with prior CVD. (5) CVD patients who fully lose their work ability transit to disability retirement. (6) Disability retirees due to CVD have an elevated risk of CVD mortality. The life course perspective might facilitate an in-depth understanding of the diverse interrelationships between work stress and CVD, thereby leading to work stress management interventions at each period of the lifespan and three-level prevention of CVD.

Three-level maternal and child health services in the concept of general healthcare

The three-level prevention theory is called into play as guided by the contemporary medical model and combination of prevention and treatment,to classify the services into three levels.Services by maternal and child health care institutions are designed as Level-1,early discovery,early diagnosis and early treatment prevention as Level-2,while clinical prevention as Level-3.The paper also clarified misunderstandings and proposed the general healthcare concept for such institutions. Key words: Healthcare; Three-level healthcare; Maternal and child healthcare; Services

Integration of hospital and community services-the '686 Project'-is a crucial component in the reform of China's mental health services.

Integration of hospital and community services-the '686 Project'-is a crucial component in the reform of China's mental health services.

Effects of choleretics on bile compositions drained from patients with pigment gallstone

To provide evidence for three-level prevention of cholelithiasis by means of observing the effects of some choleretics on bile compositions drained from patients with pigment gallstone. Twenty-seven patients suffering from primary pigment gallstones and having received treatment of choledochostomies plus T-tube or endoscopic nasal bile drainage (ENBD) were divided equally into three groups, and administered respectively with Lidanling (the LDL group), ursodesoxycholic acid (the UDA group) and combination of LDL and UDA (the LDL + UDA group) through oral intake (7 patients in each group). Besides, 6 post-operational patients got no treatment with any drug were allocated in the control group. Bile of all the patients was collected before treatment and on the 1, 3, 5, 7 th day after the treatment started to detect levels of total bile acid (TBA), glycocholic acid (GCA), taurocholic acid (TCA), glycocholic cheno-desoxycholic acid (GCDCA), total bilirubin (TBIL), uncombined bilirubin (UCB), concentration of calcium ion (Ca(2+)) as well as the bacterio-genetic and endogenous beta-glucuronidase activity for comparing. Levels of TBA, GCA, TCA and GCDCA got gradually increased in the UDA group and the LDL + UDA group after treatment (P < 0.05), while those in the LDL group remained unchanged, showing an insignificant difference as compared with those in the control group. In the LDL group and the LDL + UDA group, TBIL gradually increased while UCB gradually decreased in the course of treatment (P < 0.05). Moreover, levels of Ca(2+) and endogenous beta-glucuronidase activity got significantly lowered (P < 0.05). Combined use of LDL and UDA could elevate levels of TBA, GCA, TCA, GCDCA, enhance the excretion of TBIL in patients with pigment gallstone after bile drainage, lower levels of UCB and Ca(2+) and the activity of endogenous beta-glucuronidase in the bile, so as to reduce the possibility of stone formation of bile, and therefore, it could be used to prevent the production of pigment gallstone, especially to prevent post-operative recurrence of stones.