Di A A Thy Ppt

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Di A A Thy Ppt

  1. 1. ÐÏࡱá> þÿ [1]±°þÿÿÿ¦- ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿ ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿ ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿ ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿ ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿ ÿÿ1 è ÿÿ é ,€à;ß´ãb‹3Pã ò ÿÿæ'ëÿÿ†Ø[1]áØ[1]áØ[1]á[1]âá Èÿÿ4Ò (ºÿÿ ºÿÿÖÿÿ,âá¼ÿÿ| ÅÿÿlÆ $ Á8 œ &-ÿÿÿÿ Word Microsoft Word [1] [1]� ì û[1] - [1]û[1]'ÿ� Times New RomanH - [1]2 <
  2. 2. ì� PreventionyH`m`m<<mm [1] [1] -2 < ì� Strategyy<H`<`mm [1] [1] - [1] [1]û[1]õþ¼[1] Times New Roman) -[1]2 Æ ì� Primary£wJÞ†w†û[1]õþ� Times New Roman% - [1] [1] -
  3. 3. 2 Dl ì� prevention†Yw†w†JJ†† [1] [1] -[1]2 ² ì� Secondary”ww†””†w† - [1] [1] - 2 DÏ ì� prevention†Yw†w†JJ†† [1] [1] - 2 w[1]² ì� (screening)YhwYww†J††Y
  4. 4. [1] [1] -[1]2 ‚ ì� Tertiary²wwYJ†w† - [1] [1] - 2 D) ì� prevention†Yw†w†JJ†† [1]ü[1] - !ð ü[1]ÿÿÿ - - !ð - -
  5. 5. !ð - - !ð - - !ð - - !ð5 - - !ð¢; - - !ðÝ - - !ðã
  6. 6. - - !ð™ - - !ð™ - - !ð™ 5 - - !ð™ Ý - [1] -2 ® <
  7. 7. ì� Disease <T``T`� [1] [1] -2 « < ì� Statusy<`<mT [1] [1]û[1]ÿ� Times New Roman - 2 ¯ G ì� Susceptible‚u[gguAAuAg [1] [1] - 2 ¯ e ì� Undiagnosed¨uuAguuu[gu [1]
  8. 8. [1] -2 ¯ ì� Diagnosed¨Aguuu[gu [1] - !ðŸ - - !ð Ÿ - - !ðŸ - - !ðŸ
  9. 9. - - !ðŸ 5 - - !𢟠; - - !ðŸ Ý - - !ðŸ ã - - !ð3[1]¥
  10. 10. - - !ð3[1]¥ - - !ð3[1]¥ 5 - - !ð3[1]¥ Ý - [1] -2 ç< ì� Effect…HH``< [1] [1] -2 èG
  11. 11. ì� Reduced›guuggu [1] [1] -2 øG ì� incidenceAugAugugg [1] [1] -2 èe ì� Reduced›guuggu [1] [1] - 2 øe ì� prevalence.uNgugAgugg: [1] [1] -2 e ì�
  12. 12. EarlyŽgNAu [1] [1] -2 e ì� treatment.ANggA´guA: [1] [1] -2 è ì� Reduced›guuggu [1] [1] - 2 ø ì� disability.uA[guAAAAu: [1] [1] -2 ì�
  13. 13. IncreasedNugNgg[gu [1] [1] -2 ì� function.NuugAAuu: [1] - !ðØ - - !ð Ø - - !ðØ - - !ðØ -
  14. 14. - !ðØ5 - - !ð¢Ø; - - !ðØÝ - - !ðØã - - !ð@ Þ - - !ð- - -
  15. 15. !ð- - - !ð - - - !ð@ Þ - - !ð- - - !ð- - - !ð@ Þ5
  16. 16. - - !ð- 5 - - !ð¢- ; - - !ð@ ÞÝ - - !ð- Ý - - !ð- ã - [1]û[1]øÿ� Times New Roman-
  17. 17. - [1] [1]û[1]ÿ� Times New Roman< - [1] - Ëáâá[1]âá âá °ÿÿŒåÿÿT ³4ØÔ Ð[1]@[1]ð ` € @[1]æËáåÿÿT ³4 @[1]@[1]` ` € € @[1]æËáåÿÿT ³4“Ð[1]@[1]ð ` € 0
  18. 18. @[1]æËá[1]Õÿÿt¶ÿÿL ·< Times New RomanÊá¶ÿÿL� ·< "ArialÊá¶ÿÿL� ·<¼[1]Times New RomanÊá[1]Õÿÿï$Ìäÿÿ) ÿÿB* žÔØ @utri[1], [1], b[1], ÷¿[1], V�[1], Pÿÿ[1]ÿý•ÿÿ[1]ddâý•ÿÿ[1]ddíý•ÿÿ[1]d[1]d5ý•ÿÿ[1]d dý•ÿÿ[1]d dâÿÿÿ[1]ÔØ @utri[1] [1] b[1]÷¿[1]V�[1]Pÿÿ[1]ÿxd3Pý•ÿÿ[1]ddâý–ÿÿ[1]ddíý•ÿÿ[1]d[1]d5ý–ÿÿ[1]d dý•ÿÿ[1]d dnâÿn.ÿÿ[1]new entation.ÔØ @utri[1] [1] b[1] ÷¿[1] V�[1] Pÿÿ[1]owerÿt7.ý•ÿÿ[1]dd-âý•ÿÿ[1]dd-íý•ÿÿ[1]d[1]d-5ý•ÿÿ[1]d d-ý•ÿÿ[1]d d-âÿÿÿ[1]ÔØ[1]
  19. 19. @utri[1]-[1]-b[1]-÷¿[1]-V�[1]-Pÿÿ[1]ÿ•[1]ddþÿÿÿâ•[1]ddþÿÿÿí•[1]d[1]dþÿÿÿ5•[1]d dþÿÿÿ•[1]d dþÿÿÿâÿÿÿ[1]ÔØ @utri[1][1]b[1]÷¿[1]V�[1]Pÿÿ[1]ÿý•ÿÿ[1]ddâý•ÿÿ[1]ddíý•ÿÿ[1]d[1]d5ý•ÿÿ[1]d dý•ÿÿ[1]d dâÿÿÿ[1]ÔØÿÿÿÿ@utriÿÿ[1]ÿÿÿ[1]ÿbÿÿ[1]ÿ÷¿ÿÿ[1]ÿV ÿÿ� [1]ÿPÿÿ[1]ÿÿÿÿ[1]âÿÿÿ[1]íÿÿÿ[1]5ÿÿÿ[1 ]ÿÿÿ[1]âÿÿÿ[1]ÔØÿÿÿÿ@utriÿÿ[1]ÿÿÿ[1]ÿbÿÿ[1]ÿ÷¿ÿÿ[1]ÿV ÿÿ� [1]ÿPÿÿ[1]ÿÿÿÿ[1]âÿÿÿ[1]íÿÿÿ[1] 5ÿÿÿ[1]ÿÿÿ[1]âÿÿÿ[1]ÔØÿÿÿÿ@utriÿÿ[1]ÿÿÿ[1]ÿbÿÿ[1]ÿ÷¿ÿÿ[1]ÿV ÿÿ� [1]ÿPÿÿ[1]ÿÿÿÿ[1]âÿÿÿ[1]í ÿÿÿ[1]5ÿÿÿ[1]ÿÿÿ[1]âÿÿÿ[1]ÔØÿÿÿÿ@utriÿÿ[1]ÿÿÿ[1]ÿbÿÿ[1]ÿ÷¿ÿÿ[1]ÿV ÿÿ� [1]ÿPÿÿ[1]ÿÿÿÿ[1]â ÿÿÿ[1]íÿÿÿ[1]5ÿÿÿ[1]ÿÿÿ[1]âÿÿÿ[1]Ä ÿÿ[1]Å [1]Á (ýÿÿÿýÿÿÿ‡½ 8 ÿ[1]00¡ÿÿt- :ÀnPàb¢ÿÿD£$ €ÿÿµ àÿÿìã42áý•ÿÿ[1]ddâ3[1]î5ìÿÿ/î/ìÿÿ0î0ìÿÿ1î1Ðÿÿ4Ï Ñ î ÿÿºï €í Àôÿÿ ÷ÿÿ@� p÷ ÙÿÿHÚºÿÿ.ºÿÿ/ºÿÿ0ô ÿÿ4xï$ÿÿÿ–––Ì™33ÌÌÌÿ²²²À ÿÿ€ Á (ýÿÿÿÀôÿÿ ÷ÿÿ@� pýÿÿÿ‰½
  20. 20. 8ÿŒÿ[1]00âb¸ ÿÿ" ÿÿX[1]à bÁ (ýÿÿÿ3P öÿÿÐùÿÿÀ üÿÿýÿÿÿŒ½ 8ÿÿ ÿ[1]‰00áb¡ÿÿ°- :ÄnPàb¢ÿÿ€£$ €ÿÿÚöÿÿíùÿÿ† ƒüÿÿµ àÿÿ(î 5Prevention and Mental Healthìÿÿ</î,/ âÈoˆ[1][1], bìÿÿX0îH0 ã4Èoˆý•ÿÿ[1]d3dìÿÿ(1î1 á Èoˆÿÿÿÿ ÿÿª à bÁ (ýÿÿÿ3PÀ÷ÿÿ°þÿÿ€ ýÿÿÿŒ½ 8ÿÿ ÿ[1]‰00áb¡ÿÿ[1] - :ÄnP àb¢ÿÿÒ £$ €ÿÿú÷ÿÿÍþÿÿFã[1]µ àÿÿz î‚5Mens Sana in Corpore Sano (A Healthy Mind in a Healthy Body) ….living in a healthy community Major Vincent Fonseca, MD, MPH
  21. 21. OPHSAìÿÿÀ/î°/â€ÿˆ[1]$b$â€ÿˆ[1] bâ€ÿˆ[1]$b&â€ÿˆ[1] bìÿÿÀ0î°0ã4€ÿˆý•ÿÿ[1]d0d#ã4€ÿˆý•ÿÿ[1]d0d ã4€ÿˆý•ÿÿ[1]d0dã4€ÿˆý•ÿÿ[1]d0d- ã4€ÿˆý•ÿÿ[1]d0dã4€ÿˆý•ÿÿ[1]d0dìÿÿ(1î1‚á €ÿˆÿÿÿÿî ÿÿ ï €í Àôÿÿ ÷ÿÿ@� pâb÷ ÙÿÿHÚºÿÿ.ºÿÿ/ºÿÿ0ô ÿÿ4xï$ÿÿÿ–––Ì™33ÌÌÌÿ²²²À ÿÿ€ Á (ýÿÿÿÀôÿÿ ÷ÿÿ@� pýÿÿÿˆ½ 8ÿŒÿ[1]00âb¸ ÿÿv ÿÿR[1]à bÁ (ýÿÿÿ3Ppöÿÿùÿÿ àûÿÿýÿÿÿŒ½� 8ÿÿ ÿ[1]‰00áb¡ÿÿª- :ÄnPàb¢ÿÿz£$ €ÿÿªöÿÿ-ùÿÿV Ãûÿÿµ àÿÿ"î5Prevention---Treatmentìÿÿ</î,/â$Aˆ[1], bìÿÿX0îH0ã4$Aˆý•ÿÿ[1]ddìÿÿ(1î1á $Aˆÿÿÿÿ ÿÿ Ã
  22. 22. bÁ (ýÿÿÿ3Ppöÿÿpüÿÿ ýÿÿÿŒ½� � 8ÿÿ ÿ[1]‰00áb¡ÿÿ - :ÄnP àb¢ÿÿ, £$D €ÿÿªöÿÿ üÿÿV� sµ àÿÿÔ[1]îÄ5Asklepios-deity of medicine and health 2 daughters Panacea: represented treatment of people who are ill (“sickness care”) Hygeia: represented living wisely and preserving health (“wellness care”)ìÿÿh/îX/3âÜFˆ[1] b‘âÜFˆ[1] bìÿÿ00î 0'ã4ÜFˆý•ÿÿ[1]dd ã4ÜFˆý•ÿÿ[1]ddGã4ÜFˆý–ÿÿ[1]ddJã4ÜFˆý–ÿÿ[1]ddìÿÿ(1î1Äá ÜFˆÿÿÿÿî ÿÿ9ï [1]€í Àôÿÿ ÷ÿÿ@� pâb÷ ÙÿÿHÚºÿÿ.ºÿÿ/ºÿÿ0ô ÿÿ4xï$ÿÿÿ–––Ì™33ÌÌÌÿ²²²À ÿÿ€ Á (ýÿÿÿÀôÿÿ ÷ÿÿ@� pýÿÿÿˆ½ 8ÿŒÿ[1]00âb¸ ÿÿ¡Â ÿÿR[1]à bÁ (ýÿÿÿ3Ppöÿÿùÿÿ àûÿÿýÿÿÿŒ½� 8ÿÿ
  23. 23. ÿ[1]‰00áb¡ÿÿª- :ÄnPàb¢ÿÿz£$D€ÿÿªöÿÿ-ùÿÿV Ãûÿÿµ àÿÿ"î5Public Health Approachìÿÿ</î,/â Oˆ[1], bìÿÿX0îH0ã4 Oˆý•ÿÿ[1]ddìÿÿ(1î1á Oˆÿÿÿÿ ÿÿ/ à bÁ (ýÿÿÿ3Ppöÿÿpüÿÿ ýÿÿÿŒ½� � 8ÿÿ ÿ[1]‰00áb¡ÿÿ‡ - :ÄnP àb¢ÿÿW £$D €ÿÿªöÿÿ üÿÿV� sµ àÿÿÿ[1]îÓ5“Surveillance:” What is the problem? Risk Factor Identification: What are the causes? Intervention Evaluation: What works? Implementation: How should we do what works? Evaluate impact and modify interventionìÿÿ</î,/ÓâDRˆ[1] bìÿÿx0îh0&ã4DRˆý•ÿÿ[1]dd2ã4DRˆý•ÿÿ[1]dd&ã4DRˆý•ÿÿ[1]dd.ã4DRˆý•ÿÿ[1]dd'ã4DRˆý•ÿÿ[1]ddìÿÿ (1î1Óá DRˆÿÿÿÿî ÿÿøï €í
  24. 24. Àôÿÿ ÷ÿÿ@� pâb÷ ÙÿÿHÚºÿÿ.ºÿÿ/ºÿÿ0ô ÿÿ4xï$ÿÿÿ–––Ì™33ÌÌÌÿ²²²À ÿÿ€ Á (ýÿÿÿÀôÿÿ ÷ÿÿ@� pýÿÿÿˆ½ 8ÿŒÿ[1]00âb¸ ÿÿ` ÿÿd[1]à bÁ (ýÿÿÿ3Ppöÿÿùÿÿ àûÿÿýÿÿÿŒ½� 8ÿÿ ÿ[1]‰00áb¡ÿÿ¼- :ÄnPàb¢ÿÿŒ£$D€ÿÿªöÿÿ-ùÿÿV Ãûÿÿµ àÿÿ4î(5Goals of Noncommunicable Disease Controlìÿÿ</î,/(âl ˆ[1], bìÿÿX0îH0(ã4l ˆý•ÿÿ[1]ddìÿÿ(1î1(á l ˆÿÿÿÿ ÿÿÜ Ã bÁ (ýÿÿÿ3Ppöÿÿpüÿÿ ýÿÿÿŒ½� � 8ÿÿ ÿ[1]‰00áb¡ÿÿ4 - :ÄnP àb¢ÿÿ £$D €ÿÿªöÿÿ üÿÿV� sµ àÿÿ¬[1]îÈ5Reduce the incidence of disease
  25. 25. Delay the onset of disability Alleviate the severity of disease (increase function and improve the health-related quality of life) Prolong the individual’s healthy lifeìÿÿ</î,/Èâ¸9ˆ[1] bìÿÿ00î 0 ã4¸9ˆý•ÿÿ[1]dd-ã4¸9ˆý•ÿÿ[1]ddeã4¸9ˆý•ÿÿ[1]dd%ã4¸9ˆý•ÿÿ[1]ddìÿÿ(1î1Èá ¸9ˆÿÿÿÿî ÿÿ´ï €í Àôÿÿ ÷ÿÿ@� pâb÷ ÙÿÿHÚºÿÿ.ºÿÿ/ºÿÿ0ô ÿÿ4xï$ÿÿÿ–––Ì™33ÌÌÌÿ²²²À ÿÿ€ Á (ýÿÿÿÀôÿÿ ÷ÿÿ@� pýÿÿÿˆ½ 8ÿŒÿ[1]00âb¸ ÿÿ  ÿÿW[1]à bÁ (ýÿÿÿ3Ppöÿÿùÿÿ àûÿÿýÿÿÿŒ½� 8ÿÿ ÿ[1]‰00áb¡ÿÿ¯- :ÄnPàb¢ÿÿ£$D€ÿÿªöÿÿ-ùÿÿV Ãûÿÿµ àÿÿ'î5Increasing Healthy Lifespanìÿÿ</î,/âÄ€ˆ[1], bìÿÿX0îH0ã4Ä€ˆý•ÿÿ[1]ddìÿÿ(1î1á Ä€ˆÿÿÿÿÀ ÿÿ€Á (ýÿÿÿùÿÿàøÿÿ þÿÿp ÿÿÿýÿÿÿˆ½ 8 ÿ[1]00À ÿÿ€Á (ýÿÿÿùÿÿp þÿÿà ÿÿÿýÿÿÿˆ½ 8
  26. 26. [1]Ìþÿ[1]00À ÿÿ€Á (ýÿÿÿùÿÿàøÿÿ@[1]°À ýÿÿÿˆ½ 8 ÿ[1]00À ÿÿ€Á (ýÿÿÿùÿÿ°@[1]ÐÀ ýÿÿÿ‰½ 8 [1]Ìþÿ[1]00À ÿÿ0[1]Á (ýÿÿÿùÿÿVýÿÿ&ZFýÿÿÿˆ½ 8ÿÿ ÿ[1]00¡ÿÿ - :ÑnP àb¢ÿÿp£$ ‘ ð ýÿÿC )µ� àÿÿî 5Healthy lifeìÿÿ</î,/ ⌱ˆ[1]bìÿÿX0îH0 ã4Œ±ˆý•ÿÿ[1]ddìÿÿ(1î1 á Œ±ˆÿÿÿÿÀ ÿÿ-[1]Á (ýÿÿÿùÿÿö&u Fýÿÿÿˆ½ 8ÿÿ ÿ[1]00¡ÿÿ�- :ÑnP
  27. 27. àb¢ÿÿm£$ ‘ ð0C; )µ àÿÿî 5Morbidityìÿÿ</î,/ â؈[1]bìÿÿX0îH0 ã4؈ý•ÿÿ[1]ddìÿÿ(1î1 á ؈ÿÿÿÿÀ ÿÿD[1]Á (ýÿÿÿùÿÿÖõÿÿvþÿÿÏøÿÿ–ÿÿÿýÿÿÿˆ½ 8ÿÿ ÿ[1]00¡ÿÿ´- :ÑnP àb¢ÿÿ„£$ ‘ @ÿÿÿöÿÿ“þÿÿ•øÿÿyÿÿÿµ ×öÿÿÿÿÿàÿÿî570 yearsìÿÿ</î,/â|åˆ[1]bìÿÿX0îH0ã4|åˆý•ÿÿ[1]ddìÿÿ(1î1á |åˆÿÿÿÿÀ ÿÿ,[1]Á (ýÿÿÿùÿÿãõÿÿp[1]Üøÿÿ� ýÿÿÿˆ½ 8ÿÿ ÿ[1]00¡ÿÿœ- :ÑnP àb¢ÿÿl£$ ‘ : öÿÿ�[1]¢øÿÿs µ
  28. 28. àÿÿî580 yearsìÿÿ</î,/âÈÞˆ[1]bìÿÿX0îH0ã4ÈÞˆý•ÿÿ[1]ddìÿÿ(1î1á ÈÞˆÿÿÿÿÀ ÿÿX[1]Á (ýÿÿÿùÿÿûÿÿ–´ ¶ýÿÿÿˆ½ 8ÿÿ ÿ[1]00¡ÿÿÈ- :ÑnP àb¢ÿÿ˜£$ ‘ `Pûÿÿ³z ™µ ×j&àÿÿ(î 5(“Compression of Morbidity”)ìÿÿ</î,/ âðJ‰[1]bìÿÿX0îH0 ã4ðJ‰ý•ÿÿ[1]ddìÿÿ(1î1 á ðJ‰ÿÿÿÿî ÿÿ¥ï €í Àôÿÿ ÷ÿÿ@� pâb÷ ÙÿÿHÚºÿÿ.ºÿÿ/ºÿÿ0ô ÿÿ4xï$ÿÿÿ–––Ì™33ÌÌÌÿ²²²À ÿÿ€ Á (ýÿÿÿÀôÿÿ ÷ÿÿ@� pýÿÿÿ‰½ 8ÿŒÿ[1]00âb¸ ÿÿ  ÿÿq[1]à bÁ (ýÿÿÿ3Ppöÿÿùÿÿ àûÿÿýÿÿÿŒ½�
  29. 29. 8ÿÿ ÿ[1]‰00áb¡ÿÿÉ- :ÄnPàb¢ÿÿ™£$„€ÿÿªöÿÿ-ùÿÿV Ãûÿÿµ àÿÿAî55Continuum of Health and Distribution in a Population ìÿÿ</î,/5â€úˆ[1], bìÿÿX0îH05ã4€úˆý•ÿÿ[1]ddìÿÿ(1î15á €úˆÿÿÿÿÆ ÿÿzÇ €ûÿÿ[1]@[1]¿ [1]½ 8 ÿ ÿ[1]00ùÿÿÊ ÿÿŠË ðúÿÿ@ùÿÿ à° âb¿ [1]½ 8ÿˆ ÿ[1]00 Ê ÿÿŠË Pïÿÿ@ùÿÿ0àpê[1]âb¿ [1]½ 8[1]ÿˆ ÿ[1]00Ê ÿÿŠË S[1] ùÿÿ4 à´öÿÿŸ âb¿ [1]½ 8 ÿˆ ÿ[1]00È ÿÿ [1]É (€þÿÿ£þÿÿ` 0€þÿÿ£þÿÿ` / ¿ [1]½
  30. 30. 8[1]ÿ ÿ[1]00Û ÿÿz/€þÿÿšþÿÿÝÿÿÿ¬þÿÿÃÿÿÿ´þÿÿ±ÿÿÿÆþÿÿ©ÿÿÿàþÿÿ ÿÿÿúþÿÿ}ÿÿÿ� ÿÿÿlÿÿÿ&ÿÿÿcÿÿÿ7ÿÿÿQÿÿÿQÿÿÿ@ÿÿÿcÿÿÿ7ÿÿÿ}ÿÿÿÿÿÿ ÿÿÿÿÿÿ©ÿÿÿ� ÿÿÿÃÿÿÿúþÿÿÝÿÿÿéþÿÿïÿÿÿàþÿÿ Ïþÿÿ#½þÿÿ=´þÿÿO¬þÿÿi¬þÿÿƒ£þÿÿ¦£þÿÿÀ£þÿÿã£þÿÿ) £þÿÿC¬þÿÿf¬þÿÿ€½þÿÿ£Ïþÿÿééþÿÿ [1]úþÿÿ&[1]ÿÿÿ@[1]&ÿÿÿZ[1]7ÿÿÿl[1]@ÿÿÿ†[1]Qÿÿÿ [1]cÿÿÿº[1]tÿÿÿÌ[1]}ÿÿÿæ[1] ÿÿÿ� ©ÿÿÿ# Ãÿÿÿ= Ôÿÿÿ` ÐÿÿÿÀ ÿÿ’[1]Á (ýÿÿÿv–[1] œ ýÿÿÿ‰½ 8ÿÿ ÿ[1]ÿÿ00¡ÿÿ[1][1]- :ÑnP àb¢ÿÿÒ£$ Ñ ` °³[1]Ð  µ ׸h àÿÿbî 5Perfect Healthìÿÿ</î,/ â4^‰[1]bìÿÿ 0î 0ã44^‰ý•ÿÿ� [1]ddã44^‰ý•ÿÿ[1]ddìÿÿ(1î1 á
  31. 31. 4^‰ÿÿÿÿÆ ÿÿzÇ À°À@[1]¿ [1]½ 8[1]ÿÿÿ ÿ[1]00Æ ÿÿzÇ €ûÿÿ[1]àøÿÿ[1]¿ [1]½ 8Ìþÿÿÿ ÿ[1]00Æ ÿÿzÇ €ûÿÿ°€ûÿÿ@[1]¿ [1]½ 8[1]ÿÿÿ ÿ[1]00À ÿÿ{[1]Á (ýÿÿÿöùÿÿö[1]¿üÿÿü ýÿÿÿ‰½ 8ÿÿ6P ÿ[1]ÿÿ00¡ÿÿë- :ÑnP àb¢ÿÿ»£$ Ñ À 0úÿÿ …üÿÿß µ àÿÿcî5Disease Cut-offìÿÿ</î,/âD‘‰[1]bìÿÿ 0î 0ã4D‘‰ý•ÿÿ� [1]ddã4D‘‰ý•ÿÿ[1]ddìÿÿ(1î1á D‘‰ÿÿÿÿÀ ÿÿ-[1]Á (ýÿÿÿÖþÿÿ&
  32. 32. [1]F ýÿÿÿ‰½ 8ÿÿ6P ÿ[1]ÿÿ00¡ÿÿ�- :ÑnP àb¢ÿÿm£$ Ñ ð ÿÿÿC E[1]) µ àÿÿî 5“Average”ìÿÿ</î,/ â°™‰[1]bìÿÿX0îH0 ã4°™‰ý•ÿÿ[1]ddìÿÿ(1î1 á °™‰ÿÿÿÿî ÿÿEï €í Àôÿÿ ÷ÿÿ@� pâb÷ ÙÿÿHÚºÿÿ.ºÿÿ/ºÿÿ0ô ÿÿ4xï$ÿÿÿ–––Ì™33ÌÌÌÿ²²²À ÿÿ€ Á (ýÿÿÿÀôÿÿ ÷ÿÿ@� pýÿÿÿ‰½ 8ÿŒÿ[1]00âb¸ ÿÿ ÿÿQ[1]à bÁ (ýÿÿÿ3Ppöÿÿùÿÿ àûÿÿýÿÿÿŒ½�
  33. 33. 8ÿÿ ÿ[1]‰00áb¡ÿÿ©- :ÄnPàb¢ÿÿy£$Ä€ÿÿªöÿÿ-ùÿÿV Ãûÿÿµ àÿÿ!î5Implications of Modelìÿÿ</î,/âÌ ‰[1], bìÿÿX0îH0ã4Ì ‰ý•ÿÿ[1]ddìÿÿ(1î1á Ì ‰ÿÿÿÿ ÿÿ< à bÁ (ýÿÿÿ3Ppöÿÿpüÿÿ ýÿÿÿŒ½� � 8ÿÿ ÿ[1]‰00áb¡ÿÿ” - :ÄnP àb¢ÿÿd £$Ä €ÿÿªöÿÿ üÿÿV� sµ àÿÿ î(5Simple linear model of disease or health progression Individuals move in either direction Physical, mental and social manifestations result from a complex interaction of factors at different stages along continuum As individuals move, so does the population distribution (health of the community)ìÿÿ</î,/(âô‰[1] bìÿÿ00î 05ã4ô‰ý•ÿÿ[1]dd%ã4ô‰ý•ÿÿ[1]dd|ã4ô‰ý•ÿÿ[1]ddRã4ô‰ý•ÿÿ[1]ddìÿÿ(1î1(á ô‰ÿÿÿÿî ÿÿ÷ï €í
  34. 34. Àôÿÿ ÷ÿÿ@� pâb÷ ÙÿÿHÚºÿÿ.ºÿÿ/ºÿÿ0ô ÿÿ4xï$ÿÿÿ–––Ì™33ÌÌÌÿ²²²À ÿÿ€ Á (ýÿÿÿÀôÿÿ ÷ÿÿ@� pýÿÿÿ‰½ 8ÿŒÿ[1]00âb¸ ÿÿ_  ÿÿR[1]à bÁ (ýÿÿÿ3Ppöÿÿùÿÿ àûÿÿýÿÿÿŒ½� 8ÿÿ ÿ[1]‰00áb¡ÿÿª- :ÄnPàb¢ÿÿz£$Ä€ÿÿªöÿÿ-ùÿÿV Ãûÿÿµ àÿÿ"î5Prevention and Controlìÿÿ</î,/âD/‰[1], bìÿÿX0îH0ã4D/‰ý•ÿÿ[1]ddìÿÿ(1î1á D/‰ÿÿÿÿ ÿÿíà bÁ (ýÿÿÿ3P öÿÿpüÿÿ rýÿÿÿŒ½ 8ÿÿ ÿ[1]‰00áb®ÿÿõ¯ÌÿÿÅÍÃ[1][1]ºÿÿObject2ºÿÿ[1]Documentºÿÿ Word.Document.6ºÿÿ-Microsoft Word DocumentÄ èÿÿ@ Ç[1] ÿÿÿÿºÿÿ î ÿÿwï €í Àôÿÿ ÷ÿÿ@� pâb÷
  35. 35. ÙÿÿHÚºÿÿ.ºÿÿ/ºÿÿ0ô ÿÿ4xï$ÿÿÿ–––Ì™33ÌÌÌÿ²²²À ÿÿ€ Á (ýÿÿÿÀôÿÿ ÷ÿÿ@� pýÿÿÿˆ½ 8ÿŒÿ[1]00âb¸ ÿÿß ÿÿQ[1]à bÁ (ýÿÿÿ3Ppöÿÿùÿÿ àûÿÿýÿÿÿŒ½� 8ÿÿ ÿ[1]‰00áb¡ÿÿ©- :ÄnPàb¢ÿÿy£$ €ÿÿªöÿÿ-ùÿÿV Ãûÿÿµ àÿÿ!î5Prevention Strategiesìÿÿ</î,/⨉[1], bìÿÿX0îH0ã4¨‰ý•ÿÿ[1]ddìÿÿ(1î1á ¨‰ÿÿÿÿ ÿÿn à bÁ (ýÿÿÿ3Ppöÿÿpüÿÿ ýÿÿÿŒ½� � 8ÿÿ ÿ[1]‰00áb¡ÿÿÆ[1]- :ÄnP àb¢ÿÿ–[1]£$ €ÿÿªöÿÿ üÿÿV� sµ àÿÿ>[1]îv5Primary: before disease develops risk (or protective) factors must be known modify factors to reduce disease incidenceìÿÿh/îX/!â :‰[1] bUâ
  36. 36. :‰[1] bìÿÿè0îØ0!ã4 :‰ý•ÿÿ[1]dd+ã4 :‰ý–ÿÿ[1]dd*ã4 :‰ý–ÿÿ[1]ddìÿÿ(1î1vá :‰ÿÿÿÿî ÿÿØï €í Àôÿÿ ÷ÿÿ@� pâb÷ ÙÿÿHÚºÿÿ.ºÿÿ/ºÿÿ0ô ÿÿ4xï$ÿÿÿ–––Ì™33ÌÌÌÿ²²²À ÿÿ€ Á (ýÿÿÿÀôÿÿ ÷ÿÿ@� pýÿÿÿ‰½ 8ÿŒÿ[1]00âb¸ ÿÿ@ ÿÿQ[1]à bÁ (ýÿÿÿ3Ppöÿÿùÿÿ àûÿÿýÿÿÿŒ½� 8ÿÿ ÿ[1]‰00áb¡ÿÿ©- :ÄnPàb¢ÿÿy£$ €ÿÿªöÿÿ-ùÿÿV Ãûÿÿµ àÿÿ!î5Prevention Strategiesìÿÿ</î,/â w‰[1],
  37. 37. bìÿÿX0îH0ã4 w‰ý•ÿÿ[1]ddìÿÿ(1î1á w‰ÿÿÿÿ ÿÿÏ Ã bÁ (ýÿÿÿ3Ppöÿÿpüÿÿ ýÿÿÿŒ½� � 8ÿÿ ÿ[1]‰00áb¡ÿÿ' - :ÄnP àb¢ÿÿ÷ £$ €ÿÿªöÿÿ üÿÿV� sµ àÿÿŸ îÿ5Secondary: reduce disease consequences detects at an earlier, more treatable stage natural history allows early detection accurate screening tool early treatment can alter consequences screening tool is acceptable to populations at highest risk of diseaseìÿÿh/îX/'âàR‰[1] bØâàR‰[1] bìÿÿÀ0î°0'ã4àR‰ý•ÿÿ[1]dd,ã4àR‰ý–ÿÿ[1]dd'ã4àR‰ý–ÿÿ[1]ddã4àR‰ý–ÿÿ[1]dd'ã4àR‰ý– ÿÿ[1]ddFã4àR‰ý–ÿÿ[1]ddìÿÿ(1î1ÿá àR‰ÿÿÿÿî ÿÿ¾ï
  38. 38. €í Àôÿÿ ÷ÿÿ@� pâb÷ ÙÿÿHÚºÿÿ.ºÿÿ/ºÿÿ0ô ÿÿ4xï$ÿÿÿ–––Ì™33ÌÌÌÿ²²²À ÿÿ€ Á (ýÿÿÿÀôÿÿ ÷ÿÿ@� pýÿÿÿŠ½ 8ÿŒÿ[1]00âb¸ ÿÿ& ÿÿQ[1]à bÁ (ýÿÿÿ3Ppöÿÿùÿÿ àûÿÿýÿÿÿŒ½� 8ÿÿ ÿ[1]‰00áb¡ÿÿ©- :ÄnPàb¢ÿÿy£$ €ÿÿªöÿÿ-ùÿÿV Ãûÿÿµ àÿÿ!î5Prevention Strategiesìÿÿ</î,/ât@Š[1], bìÿÿX0îH0ã4t@Šý•ÿÿ[1]ddìÿÿ(1î1á t@Šÿÿÿÿ ÿÿµ à bÁ (ýÿÿÿ3Ppöÿÿpüÿÿ ýÿÿÿŒ½� � 8ÿÿ ÿ[1]‰00áb¡ÿÿ - :ÄnP àb¢ÿÿÝ[1]£$D €ÿÿªöÿÿ üÿÿV� sµ
  39. 39. àÿÿ…[1]îu5Tertiary: prevent disability prevent complications of disease prevent progression of disease provide rehabilitationìÿÿh/îX/â”DŠ[1] bVâ”DŠ[1] bìÿÿ00î 0ã4”DŠý•ÿÿ[1]dd!ã4”DŠý–ÿÿ[1]ddã4”DŠý– ÿÿ[1]ddã4”DŠý–ÿÿ[1]ddìÿÿ(1î1uá ”DŠÿÿÿÿî ÿÿ¶ï €í Àôÿÿ ÷ÿÿ@� pâb÷ ÙÿÿHÚºÿÿ.ºÿÿ/ºÿÿ0ô ÿÿ4xï$ÿÿÿ–––Ì™33ÌÌÌÿ²²²À ÿÿ€ Á (ýÿÿÿÀôÿÿ ÷ÿÿ@� pýÿÿÿ‰½ 8ÿŒÿ[1]00âb¸ ÿÿ- ÿÿM[1]à bÁ (ýÿÿÿ3Ppöÿÿùÿÿ àûÿÿýÿÿÿŒ½� 8ÿÿ ÿ[1]‰00áb¡ÿÿ¥- :ÄnPàb¢ÿÿu£$D€ÿÿªöÿÿ-ùÿÿV Ãûÿÿµ àÿÿî5Information needsìÿÿ</î,/â 8‰� [1], bìÿÿX0îH0ã4 8‰ý•ÿÿ� [1]ddìÿÿ(1î1á 8‰ÿÿÿÿ�  ÿÿ± à bÁ
  40. 40. (ýÿÿÿ3Ppöÿÿpüÿÿ ýÿÿÿŒ½� � 8ÿÿ ÿ[1]‰00áb¡ÿÿ - :ÄnP àb¢ÿÿÙ[1]£$D €ÿÿªöÿÿ üÿÿV� sµ àÿÿ�[1]î 5Identify groups who are at risk of disease� Identify groups who experience benefits from interventions Measure effects of interventions Identify “new” factorsìÿÿ</î,/ â¸D‰� [1] bìÿÿ00î 0+ã4¸D‰ý•ÿÿ[1]dd;ã4¸D‰ý•ÿÿ[1]dd!ã4¸D ‰ý•ÿÿ[1]ddã4¸D‰ý•ÿÿ[1]ddìÿÿ(1î1 á� ¸D‰ÿÿÿÿî ÿÿ#ï €í Àôÿÿ ÷ÿÿ@� pâb÷ ÙÿÿHÚºÿÿ.ºÿÿ/ºÿÿ0ô ÿÿ4xï$ÿÿÿ–––Ì™33ÌÌÌÿ²²²À ÿÿ€ Á (ýÿÿÿÀôÿÿ ÷ÿÿ@� pýÿÿÿ‰½ 8ÿŒÿ[1]00âb¸ ÿÿ‹Â ÿÿP[1]à bÁ (ýÿÿÿ3Ppöÿÿùÿÿ àûÿÿýÿÿÿŒ½� 8ÿÿ ÿ[1]‰00áb¡ÿÿ¨- :ÄnPàb¢ÿÿx£$D€ÿÿªöÿÿ-ùÿÿV Ãûÿÿµ àÿÿ î5Types of Informationìÿÿ</î,/âÔ‰[1],
  41. 41. bìÿÿX0îH0ã4Ô‰ý•ÿÿ[1]ddìÿÿ(1î1á Ô‰ÿÿÿÿ ÿÿ à bÁ (ýÿÿÿ3Ppöÿÿpüÿÿ ýÿÿÿŒ½� � 8ÿÿ ÿ[1]‰00áb¡ÿÿs - :ÄnP àb¢ÿÿC £$D €ÿÿªöÿÿ üÿÿV� sµ àÿÿë[1]îw5Mortality Disability Morbidity (inpatient and outpatient) Risk Factors Health Related Quality of Life Functional Statusìÿÿ</î,/wâ4Ή[1] bìÿÿÀ0î°0 ã44Ήý•ÿÿ[1]dd ã44Ήý•ÿÿ[1]dd%ã44Ήý•ÿÿ[1]dd ã44Ήý•ÿÿ[1]ddã44Ήý•ÿÿ[1]ddã44Ήý•ÿÿ[1]ddìÿÿ(1î1wá 4Ήÿÿÿÿî ÿÿ!ï €í Àôÿÿ ÷ÿÿ@� pâb÷
  42. 42. ÙÿÿHÚºÿÿ.ºÿÿ/ºÿÿ0ô ÿÿ4xï$ÿÿÿ–––Ì™33ÌÌÌÿ²²²À ÿÿ€ Á (ýÿÿÿÀôÿÿ ÷ÿÿ@� pýÿÿÿˆ½ 8ÿŒÿ[1]00âb¸ ÿÿ  ÿÿL[1]à bÁ (ýÿÿÿ3Ppöÿÿùÿÿ àûÿÿýÿÿÿŒ½� 8ÿÿ ÿ[1]‰00áb¡ÿÿ¤- :ÄnPàb¢ÿÿt£$D€ÿÿªöÿÿ-ùÿÿV Ãûÿÿµ àÿÿ î5Information Loopìÿÿ</î,/âèˆ[1], bìÿÿX0îH0ã4èˆý•ÿÿ[1]ddìÿÿ(1î1á èˆÿÿÿÿÈ ÿÿdÉ (ýÿÿL +ÿÿÿIKüÿÿ<üÿÿ‹ÿÿÿ9þÿÿ ¿ [1]½ 8þˆ€€þÿÿÿþÿ[1]00Û ÿÿÂcýÿÿ9þÿÿKüÿÿoýÿÿcýÿÿ‘üÿÿcýÿÿ ýÿÿbþÿÿ[1]ýÿÿ þÿÿôüÿÿ¬þÿÿØüÿÿ¿þÿÿ³üÿÿÅþÿÿyüÿÿÅþÿÿ<üÿÿ‹ÿÿÿ<üÿÿŠÿÿÿœüÿÿƒÿÿÿÇüÿÿ{ÿÿÿôüÿ� ÿoÿÿÿýÿÿ^ÿÿÿ8ýÿÿLÿÿÿUýÿÿ.ÿÿÿvýÿÿ ÿÿÿ”ýÿÿêþÿÿ§ýÿÿÂþÿÿ¼ýÿÿ þÿÿÇýÿÿbþÿÿÉýÿÿcýÿÿÊýÿÿÈ� ÿÿdÉ ( ð ^[1]Kþÿÿ] Š ¿ [1]½ 8þˆ€€þÿÿÿþÿ[1]00Û ÿÿÂ] bÿÿÿ” Kþÿÿ´[1]bÿÿÿ'
  43. 43. bÿÿÿ& b ý� [1]«Ö[1]¾�[1]Ã^[1]Ã^[1]Š¾[1]‰é[1]‚ z9 o[ ]y K› ,¶ Ë èÞ Àé ì� bí bÿÿÿÈ ÿÿdÉ (ÑÌýÿÿçÑÿÿÿÑŒþÿÿç‘ ¿ [1]½ 8þˆ€€þÿÿÿþÿ[1]00 Û� ÿÿ‰ŒþÿÿÑQÿÿÿ‚4„Áÿÿÿ*ÅÿÿÿEÔÿÿÿXïÿÿÿdfOeŽæ‘ç1ãß×ÿÿÿصÿÿÿÍ“ÿÿÿÂuÿÿÿ¯Sÿÿÿš7ÿÿÿƒ"ÿÿÿj ÿÿÿJ ÿÿÿ-ÿþÿÿ‡ûþÿÿÈ ÿÿdÉ (·ÿÿÿ)þÿÿÈ7gYþÿÿx g ¿ [1]½ 8þˆ€€þÿÿÿþÿ[1]00 Û ÿÿÂg¨ÿÿÿ&[1]g ¾ÿÿÿœ[1]¸ÿÿÿ¦[1]ÿÿÿ¶[1]øþÿÿÑ[1]åþÿÿù[1]Ûþÿÿ2
  44. 44. Ûþÿÿq Þþÿÿx ]þÿÿ Yþÿÿí[1][þÿÿ¾[1]^þÿÿœ[1]dþÿÿy[1]mþÿÿ[[1]wþÿÿ8[1]‰þÿÿ [1] þÿÿ� [1]³þÿÿñÌþÿÿåëþÿÿàÿÿÿÖ®ÿÿÿÈ ÿÿdÉ (Þÿÿÿ5 ù4> Y[1] ¿ [1]½ 8þˆ€€þÿÿÿþÿ[1]00`úÿÿÛ ÿÿÂ¥ Y[1];¥[ ¥Î þÍ ã¿ Ï¥ Ã} ÀD À > @e D�
  45. 45. I¿ Qà g {B‘]¨r†á ÿ“¥•È� ÿÿdÉ (pýÿÿ þÿÿyÿÿÿ/ýÿÿlþÿÿÿÿÿ� ¿ [1]½ 8þˆ€€þÿÿÿþÿ[1]00ÀÛ ÿÿÂÿÿÿÍÿÿÿVþÿÿ qýÿÿÜÿÿÿãýÿÿ×ÿÿÿÜýÿÿ.ÿÿÿÎýÿÿÿÿÿ°ýÿÿþþÿÿ ýÿÿòþÿÿPýÿÿðþÿÿýÿÿóþÿÿýÿÿnþÿÿpý� � ÿÿlþÿÿ›ýÿÿoþÿÿÈýÿÿsþÿÿéýÿÿzþÿÿ þÿÿ„þÿÿ)þÿÿ þÿÿLþÿÿ¡þÿÿlþÿÿ¸þÿÿ~þÿÿÍþÿÿ•þÿÿèþÿÿ þÿÿÿÿÿ¤þÿÿ&ÿÿÿªþÿÿÐÿÿÿÈ� ÿÿdÉ (TöÿÿÕ Xøÿÿü„öÿÿ5 ˆøÿÿ ¿ [1]½ 8þˆ€€þÿÿÿþÿ[1]00ðÛ ÿÿ„öÿÿô K÷ÿÿ5 ,øÿÿì º÷ÿÿî ¾÷ÿÿ˜Í÷ÿÿµé÷ÿÿÉ øÿÿÕIøÿÿØ…øÿÿ׈øÿÿ[(øÿÿý÷ÿÿXÐ÷ÿÿT°÷ÿÿL‹÷ÿÿAn÷ÿÿ6M÷ÿÿ".÷ÿÿ ÷ÿÿö÷ÿÿÜúöÿÿ»÷öÿÿœóöÿÿò È ÿÿdÉ (ÌöÿÿìýÿÿüøÿÿåÿÿÿÌöÿÿìýÿÿüøÿÿåÿÿÿ ¿ [1]½ 8þˆ€€þÿÿÿþÿ[1]000 Û ÿÿÂDøÿÿìýÿÿüøÿÿºþÿÿ=øÿÿ•ÿÿÿ?øÿÿ#ÿÿÿ•÷ÿÿ! ÿÿÿw÷ÿÿ.ÿÿÿb÷ÿÿIÿÿÿV÷ÿÿnÿÿÿQ÷ÿÿ¨ÿÿÿO÷ÿÿåÿÿÿÌöÿÿãÿÿÿÍöÿÿƒÿÿÿÓöÿÿXÿÿÿÙöÿÿ+ÿÿÿâöÿÿ ÿÿÿîöÿÿçþÿÿúöÿÿËþÿÿ÷ÿÿªþÿÿ&÷ÿÿŒþÿÿ=÷ÿÿzþÿÿX÷ÿÿfþÿÿy÷ÿÿ[þÿÿ˜÷ÿÿYþÿÿBøÿÿ[þÿÿÀ ÿÿ…[1]Á (ýÿÿÿ†ýÿÿFO[1]L ýÿÿÿ‰½ 8ÿÿ
  46. 46. ÿ[1]ÿÿ00ÿÿÿ¡ÿÿõ- :ÑnP àb¢ÿÿÅ£$ ‘ [1]Àýÿÿc[1]/ µ àÿÿmî5Information Disseminationìÿÿ</î,/âŒÅ‰[1]bìÿÿ 0î 0� ã4ŒÅ‰ý•ÿÿ[1]dd ã4ŒÅ‰ý•ÿÿ[1]ddìÿÿ(1î1á ŒÅ‰ÿÿÿÿÀ ÿÿ–[1]Á (ýÿÿÿÆ[1]Výÿÿzÿÿÿýÿÿÿ‰½ 8ÿÿ ÿ[1]ÿÿ00ÿÿÿ¡ÿÿ[1]- :ÑnP àb¢ÿÿÖ£$ ‘ þÿÿ sýÿÿ@?ÿÿÿµ × (þÿÿàÿÿfî5Program Evaluationìÿÿ</î,/â¸Ó‰[1]bìÿÿ 0î 0ã4¸Ó‰ý•ÿÿ� [1]dd ã4¸Ó‰ý•ÿÿ[1]ddìÿÿ(1î1á ¸Ó‰ÿÿÿÿÀ ÿÿ”[1]Á (ýÿÿÿ¦[1] Åýÿÿÿ‰½ 8ÿÿ
  47. 47. ÿ[1]ÿÿ00ÿÿÿ¡ÿÿ [1]- :ÑnP àb¢ÿÿÔ£$ ‘ × à[1]* ‹öµ ×€ àÿÿdî5Program Planningìÿÿ</î,/â¨d‰[1]bìÿÿ 0î 0ã4¨d‰ý•ÿÿ� [1]ddã4¨d‰ý•ÿÿ[1]ddìÿÿ(1î1á ¨d‰ÿÿÿÿÀ ÿÿˆ[1]Á (ýÿÿÿ K ýÿÿÿ‰½ 8ÿÿ ÿ[1]ÿÿ00ÿÿÿ¡ÿÿø- :ÑnP àb¢ÿÿÈ£$ ‘ ×Q* ö[1]µ àÿÿpî 5 Program Implementationìÿÿ</î,/ â¬0‰[1]bìÿÿ 0î 0� ã4¬0‰ý•ÿÿ[1]dd ã4¬0‰ý•ÿÿ[1]ddìÿÿ(1î1 á
  48. 48. ¬0‰ÿÿÿÿÀ ÿÿ{[1]Á (ýÿÿÿùÿÿv šüÿÿ|ýÿÿÿ‰½ 8ÿÿ ÿ[1]ÿÿ00ÿÿÿ¡ÿÿë- :ÑnP àb¢ÿÿ»£$ ‘ @@ùÿÿ“ `üÿÿ_µ àÿÿcî5Data Collectionìÿÿ</î,/â {‰[1]bìÿÿ 0î 0ã4� {‰ý•ÿÿ[1]dd ã4 {‰ý•ÿÿ[1]ddìÿÿ(1î1á {‰ÿÿÿÿÀ ÿÿy[1]Á (ýÿÿÿÖõÿÿêøÿÿ ýÿÿÿ‰½ 8ÿÿ ÿ[1]ÿÿ00ÿÿÿ¡ÿÿé- :ÑnP àb¢ÿÿ¹£$ ‘ àöÿÿ3°øÿÿÿ[1]µ àÿÿaî 5Data
  49. 49. Analysisìÿÿ</î,/ â ,‰[1]bìÿÿ 0î 0ã4 ,‰ý•ÿÿ� [1]ddã4 ,‰ý•ÿÿ[1]ddìÿÿ(1î1 á ,‰ÿÿÿÿÀ ÿÿ~[1]Á (ýÿÿÿùÿÿ¶ýÿÿOýÿÿ¼ÿÿÿýÿÿÿ‰½ 8ÿÿ ÿ[1]ÿÿ00ÿÿÿ¡ÿÿî- :ÑnP àb¢ÿÿ¾£$ ‘ €þÿÿ@ùÿÿÓýÿÿýÿÿŸÿÿÿµ àÿÿfî5Data Intepretationìÿÿ</î,/â ‰[1]bìÿÿ 0î 0ã4� ‰ý•ÿÿ[1]dd ã4 ‰ý•ÿÿ[1]ddìÿÿ(1î1á ‰ÿÿÿÿî ÿÿ9ï €í Àôÿÿ ÷ÿÿ@� pâb÷ ÙÿÿHÚºÿÿ.ºÿÿ/ºÿÿ0ô
  50. 50. ÿÿ4xï$ÿÿÿ–––Ì™33ÌÌÌÿ²²²À ÿÿ€ Á (ýÿÿÿÀôÿÿ ÷ÿÿ@� pýÿÿÿŒ½ 8ÿŒÿ[1]00âb¸ ÿÿ¡Â ÿÿR[1]à bÁ (ýÿÿÿ3Ppöÿÿùÿÿ àûÿÿýÿÿÿŒ½� 8ÿÿ ÿ[1]‰00áb¡ÿÿª- :ÄnPàb¢ÿÿz£$Ä€ÿÿªöÿÿ-ùÿÿV Ãûÿÿµ àÿÿ"î5Public Health Approachìÿÿ</î,/â ÄŒ[1], bìÿÿX0îH0ã4 ÄŒý•ÿÿ[1]ddìÿÿ(1î1á ÄŒÿÿÿÿ ÿÿ/ à bÁ (ýÿÿÿ3Ppöÿÿpüÿÿ ýÿÿÿŒ½� � 8ÿÿ ÿ[1]‰00áb¡ÿÿ‡ - :ÄnP àb¢ÿÿW £$Ä €ÿÿªöÿÿ üÿÿV� sµ àÿÿÿ[1]îÓ5“Surveillance:” What is the problem? Risk Factor Identification: What are the causes? Intervention Evaluation: What works? Implementation: How should we do what works?
  51. 51. Evaluate impact and modify interventionìÿÿ</î,/Óâ,ÈŒ[1] bìÿÿx0îh0&ã4,ÈŒý•ÿÿ[1]dd2ã4,ÈŒý•ÿÿ[1]dd&ã4,ÈŒý•ÿÿ[1]dd.ã4,ÈŒý•ÿÿ[1]dd'ã4,ÈŒý•ÿÿ[1]ddìÿÿ (1î1Óá ,ÈŒÿÿÿÿî ÿÿ ï� €í Àôÿÿ ÷ÿÿ@� pâb÷ ÙÿÿHÚºÿÿ.ºÿÿ/ºÿÿ0ô ÿÿ4xï$ÿÿÿ–––Ì™33ÌÌÌÿ²²²À ÿÿ€ Á (ýÿÿÿÀôÿÿ ÷ÿÿ@� pýÿÿÿŠ½ 8ÿŒÿ[1]00âb¸ ÿÿø ÿÿC[1]à bÁ (ýÿÿÿ3Ppöÿÿùÿÿ àûÿÿýÿÿÿŒ½� 8ÿÿ ÿ[1]‰00áb¡ÿÿ›- :ÄnPàb¢ÿÿk£$Ä€ÿÿªöÿÿ-ùÿÿV Ãûÿÿµ àÿÿî5Targetsìÿÿ</î,/â ê‰[1], bìÿÿX0îH0ã4 ê‰ý•ÿÿ[1]ddìÿÿ(1î1á ê‰ÿÿÿÿ ÿÿ• à bÁ
  52. 52. (ýÿÿÿ3Ppöÿÿpüÿÿ ýÿÿÿŒ½� � 8ÿÿ ÿ[1]‰00áb¡ÿÿí - :ÄnP àb¢ÿÿ½ £$Ä €ÿÿªöÿÿ üÿÿV� sµ àÿÿe î 5Population-based common risk factors present in a large proportion of the population most cases arise from intermediate or low-risk groups small changes in intermediate risk group result in large changes in disease reduction can be easier than changing high-risk groupsìÿÿh/îX/âŠ[1] büâŠ[1] bìÿÿx0îh0ã4Šý•ÿÿ[1]ddDã4Šý–ÿÿ[1]dd6ã4Šý–ÿÿ[1]ddVã4Šý–ÿÿ[1]dd,ã4Šý–ÿÿ[1]ddìÿÿ(1î1 á Šÿÿÿÿî ÿÿêï €í Àôÿÿ ÷ÿÿ@� pâb÷ ÙÿÿHÚºÿÿ.ºÿÿ/ºÿÿ0ô ÿÿ4xï$ÿÿÿ–––Ì™33ÌÌÌÿ²²²À ÿÿ€ Á (ýÿÿÿÀôÿÿ ÷ÿÿ@� pýÿÿÿ‰½
  53. 53. 8ÿŒÿ[1]00âb¸ ÿÿR ÿÿC[1]à bÁ (ýÿÿÿ3Ppöÿÿùÿÿ àûÿÿýÿÿÿŒ½� 8ÿÿ ÿ[1]‰00áb¡ÿÿ›- :ÄnPàb¢ÿÿk£$Ä€ÿÿªöÿÿ-ùÿÿV Ãûÿÿµ àÿÿî5Targetsìÿÿ</î,/âðŠ[1], bìÿÿX0îH0ã4ðŠý•ÿÿ[1]ddìÿÿ(1î1á ðŠÿÿÿÿ ÿÿï à bÁ (ýÿÿÿ3Ppöÿÿpüÿÿ ýÿÿÿŒ½� � 8ÿÿ ÿ[1]‰00áb¡ÿÿG - :ÄnP àb¢ÿÿ £$ [1] €ÿÿªöÿÿ üÿÿV� sµ àÿÿ¿ î5High-risk disease is a personal and not a collective event selective screening and care can be more cost-effective than mass screening selective screening improves benefit:risk ratio avoids interference with those who are at low risk
  54. 54. fits well with the traditional medical care frameworkìÿÿh/îX/ âp Š[1] bâp Š[1] bìÿÿÀ0î°0 ã4p Šý•ÿÿ[1]dd1ã4p Šý–ÿÿ[1]ddLã4p Šý–ÿÿ[1]dd0ã4p Šý–ÿÿ[1]dd3ã4p Šý–ÿÿ[1]dd5ã4p Šý–ÿÿ[1]ddìÿÿ(1î1á p Šÿÿÿÿî ÿÿÔï €í Àôÿÿ ÷ÿÿ@� pâb÷ ÙÿÿHÚºÿÿ.ºÿÿ/ºÿÿ0ô ÿÿ4xï$ÿÿÿ–––Ì™33ÌÌÌÿ²²²À ÿÿ€ Á (ýÿÿÿÀôÿÿ ÷ÿÿ@� pýÿÿÿŠ½ 8ÿŒÿ[1]00âb¸ ÿÿ< ÿÿV[1]à bÁ (ýÿÿÿ3Ppöÿÿùÿÿ àûÿÿýÿÿÿŒ½� 8ÿÿ ÿ[1]‰00áb¡ÿÿ®- :ÄnPàb¢ÿÿ~£$ [1]€ÿÿªöÿÿ-ùÿÿV Ãûÿÿµ àÿÿ&î5Principles of Inverventionìÿÿ</î,/â0AŠ[1], bìÿÿX0îH0ã40AŠý•ÿÿ[1]ddìÿÿ(1î1á 0AŠÿÿÿÿ ÿÿÆ
  55. 55. à bÁ (ýÿÿÿ3Ppöÿÿpüÿÿ ýÿÿÿŒ½� � 8ÿÿ ÿ[1]‰00áb¡ÿÿ- - :ÄnP àb¢ÿÿî[1]£$ [1] €ÿÿªöÿÿ üÿÿV� sµ àÿÿ–[1]îú5Changes in underlying community norms are the key to widespread and long-term changes in health Community-based approaches will contribute the most to reducing disease burden Priority (target) population should be involved in developing interventionìÿÿ</î,/úâøKŠ[1] bìÿÿè0îØ0`ã4øKŠý•ÿÿ[1]ddOã4øKŠý•ÿÿ[1]ddKã4øKŠý•ÿÿ[1]ddìÿÿ(1î1úá øKŠÿÿÿÿî ÿÿAï €í Àôÿÿ ÷ÿÿ@� pâb÷ ÙÿÿHÚºÿÿ.ºÿÿ/ºÿÿ0ô ÿÿ4xï$ÿÿÿ–––Ì™33ÌÌÌÿ²²²À ÿÿ€ Á (ýÿÿÿÀôÿÿ ÷ÿÿ@� pýÿÿÿˆ½ 8ÿŒÿ[1]00âb¸ ÿÿ©Â ÿÿV[1]à bÁ (ýÿÿÿ3Ppöÿÿùÿÿ àûÿÿýÿÿÿŒ½�
  56. 56. 8ÿÿ ÿ[1]‰00áb¡ÿÿ®- :ÄnPàb¢ÿÿ~£$ [1]€ÿÿªöÿÿ-ùÿÿV Ãûÿÿµ àÿÿ&î5Principles of Inverventionìÿÿ</î,/â¨Üˆ[1], bìÿÿX0îH0ã4¨Üˆý•ÿÿ[1]ddìÿÿ(1î1á ¨Üˆÿÿÿÿ ÿÿ3 à bÁ (ýÿÿÿ3Ppöÿÿpüÿÿ ýÿÿÿŒ½� � 8ÿÿ ÿ[1]‰00áb¡ÿÿ‹ - :ÄnP àb¢ÿÿ[ £$ [1] €ÿÿªöÿÿ üÿÿV� sµ àÿÿ î×5Actively involve community organizations Clearly define intervention objectives Base strategies on needs of the specific priority population Use multiple intervention strategies Adjust strategies based on evaluationìÿÿ</î,/×âDüˆ[1] bìÿÿx0îh0)ã4Düˆý•ÿÿ[1]dd'ã4Düˆý•ÿÿ[1]dd=ã4Düˆý•ÿÿ[1]dd%ã4Düˆý•ÿÿ[1]dd %ã4Düˆý•ÿÿ[1]ddìÿÿ(1î1×á
  57. 57. Düˆÿÿÿÿî ÿÿ÷ï €í Àôÿÿ ÷ÿÿ@� pâb÷ ÙÿÿHÚºÿÿ.ºÿÿ/ºÿÿ0ô ÿÿ4xï$ÿÿÿ–––Ì™33ÌÌÌÿ²²²À ÿÿ€ Á (ýÿÿÿÀôÿÿ ÷ÿÿ@� pýÿÿÿ‰½ 8ÿŒÿ[1]00âb¸ ÿÿ_ ÿÿF[1]à bÁ (ýÿÿÿ3Ppöÿÿùÿÿ àûÿÿýÿÿÿŒ½� 8ÿÿ ÿ[1]‰00áb¡ÿÿž- :ÄnPàb¢ÿÿn£$ [1]€ÿÿªöÿÿ-ùÿÿV Ãûÿÿµ àÿÿî 5Strategiesìÿÿ</î,/ â˜w‰[1], bìÿÿX0îH0 ã4˜w‰ý•ÿÿ[1]ddìÿÿ(1î1 á ˜w‰ÿÿÿÿ ÿÿù à bÁ (ýÿÿÿ3Ppöÿÿpüÿÿ ýÿÿÿŒ½� � 8ÿÿ
  58. 58. ÿ[1]‰00áb¡ÿÿQ - :ÄnP àb¢ÿÿ! £$D[1] €ÿÿªöÿÿ üÿÿV� sµ àÿÿÉ[1]î 5Modify community conditions and norms� Establish and enforce health policies Establish incentives Enhance knowledge and skills Provide screening and follow-upìÿÿ</î,/ âà‹‰� [1] bìÿÿx0îh0&ã4à‹‰ý•ÿÿ[1]dd&ã4à‹‰ý•ÿÿ[1]ddã4à‹‰ý•ÿÿ[1]ddã4à‹‰ý•ÿÿ[1]dd- ã4à‹‰ý•ÿÿ[1]ddìÿÿ(1î1 á� à‹‰ÿÿÿÿÐÿÿÍ Ñ ø ÿÿ©ï €í Àôÿÿ ÷ÿÿ@� pãbï$7ÿÿÿ–––Ì™33ÌÌÌÿ²²²ï$7ÿÿÿÿÿÿÿ™ÿÿÿ3–––ï$7ÿÿÌ€ €™™33™3€3ÌÿÌfï$7ÿÿÿ999Ëˈ††MMMêêêï$7ÿÿÿŸŸŸÿÌfÿÌÌÀÀÀï$7ÿÿÿ†††ËËËfÿÿ3™ï$7ÿÿÿ––– 3™ÿ™ÿÌÌ̲²²÷ [1]ÙÿÿHÚºÿÿ.ºÿÿ/ºÿÿ0ô ÿÿ4xï$ÿÿÿ–––Ì™33ÌÌÌÿ²²²À ÿÿ€ Á (ýÿÿÿÀôÿÿ ÷ÿÿ@� pýÿÿÿ‡½ 8ÿŒÿ[1]00âb¸ ÿÿ•  ÿÿ[1]Ã
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  61. 61. ̇ý•ÿÿ[1]ddìÿÿ(1î1á ̇ ÿÿ=[1]à [1]b Á (ýÿÿÿ3Pà ð ýÿÿÿŒ½� 8ÿÿ ÿ[1]‰00áb¡ÿÿ•- :ÀnPàb¢ÿÿe£$ @[1]€ÿÿ V óµ àÿÿ î5*ìÿÿ</î,/âøЇ[1] €bìÿÿX0îH0ã4øЇý•ÿÿ[1]d[1]dìÿÿ(1î1á øЇ[1]ºÿÿŒÐÿÿb Ñ ÿ ÿÿD ºÿÿ _VBA_PROJECTºÿÿ ú ÿÿ–´þ [1]êÿÿ0û û ý 47d7d4d4dØ ÷ÿÿûÿÿ‡ ÿÿDý
  62. 62. 42d2d2d2dØ ‡[1] ÿÿ$dãÿÿeé ,ê à PowerPoint Document Ð X ä [1]ä -On-screen Show 1 w -ArialTimes New RomanDefault Design Prevention and Mental HealthPrevention---TreatmentPublic Health Approach,Goals of Noncommunicable Disease Control Increasing Healthy Lifespan8Continuum of Health and Distribution in a Population Implications of ModelPrevention and ControlPrevention StrategiesPrevention StrategiesPrevention StrategiesInformation needsTypes of InformationInformation LoopPublic Health ApproachTargetsTargets Principles of Invervention Principles of Invervention Strategies - Fonts Used [1]-Design Template -Embedded OLE Servers
  63. 63. -Slide Titles -usafm?F'/N [1][1]û[1] ÿ Times New Roman4� � - ð[1] . [1] [1][1][1]àÃ"? [1]-2 íÿSýMens Sana in Corpore Sanof49-@3:3 9M9'9:&4 @49: [1][1]û[1]šÿ Times New Roman� -[1] ð û[1]šÿ Times New Roman4� - ð[1] . [1] [1][1][1]àÃ"? [1]:2 „åü"(A Healthy Mind in a Healthy Body)"JJ--33Z33 3.J.- 33D343" [1][1]û[1] ÿ Times New Roman� � -[1] ð
  64. 64. . [1] [1][1][1]àÃ"? [1]62 &Ûü….living in a healthy communitys : 9: 93:33 :939ZZ9: 9 [1][1]û[1]šÿ Times New Roman4� - ð[1]û[1]šÿ Times New Roman� -[1] ð . [1]û[1]šÿ Times New Roman4� - ð[1] . [1] [1][1][1]àÃ"? [1]42 P[1] ý-Major Vincent Fonseca, MD, MPH[-3"J 4--4 843(-.-I8J [1][1]û[1]šÿ Times New Roman� -[1] ð .
  65. 65. [1] [1][1][1]àÃ"? [1]2 ä[1]1ÿOPHSAJ9J9J [1][1]&TNPP &ÿÿÿÿ -ü[1] - û[1] ¼[1][1][1]"Systemn - ð[1] - vfonsecaþÿ [1][1]ÕÍÕœ.“—+,ù®0 ` h €ˆ ˜� ¨° ¸ [1]ä -On-screen Show 1 w
  66. 66. -ArialTimes New RomanDefault DesignPrevention and Mental HealthPrevention---TreatmentPublic Health Approach)Goals of Noncommunicable Disease Control Increasing Healthy Lifespan6Continuum of Health and Distribution in a Population Implications of ModelPrevention and ControlPrevention StrategiesPrevention StrategiesPrevention StrategiesInformation needsTypes of InformationInformation LoopPublic Health ApproachTargetsTargetsPrinciples of InverventionPrinciples of Invervention Strategies - Fonts Used [1]-Design Template -Embedded OLE Servers - Slide Titles Prevention and Mental Health Mens Sana in Corpore Sano (A Healthy Mind in a Healthy Body) ….living in a healthy community Major Vincent Fonseca, MD, MPH OPHSA Prevention---Treatment Asklepios-deity of medicine and health 2 daughters Panacea: represented treatment of people who are ill (“sickness care”) Hygeia: represented living wisely and preserving health (“wellness care”) Public Health Approach “Surveillance:” What is the problem? Risk Factor Identification: What are the causes? Intervention Evaluation: What works?
  67. 67. Implementation: How should we do what works? Evaluate impact and modify intervention Goals of Noncommunicable Disease Control Reduce the incidence of disease Delay the onset of disability Alleviate the severity of disease (increase function and improve the health-related quality of life) Prolong the individual’s healthy life Increasing Healthy Lifespan Healthy life Morbidity 70 years 80 years (“Compression of Morbidity”) Continuum of Health and Distribution in a Population Perfect Health Disease Cut-off “Average” Implications of Model Simple linear model of disease or health progression Individuals move in either direction Physical, mental and social manifestations result from a complex interaction of factors at different stages along continuum As individuals move, so does the population distribution (health of the community) Prevention and Control Prevention Strategies Primary: before disease develops risk (or protective) factors must be known
  68. 68. modify factors to reduce disease incidence Prevention Strategies Secondary: reduce disease consequences detects at an earlier, more treatable stage natural history allows early detection accurate screening tool early treatment can alter consequences screening tool is acceptable to populations at highest risk of disease Prevention Strategies Tertiary: prevent disability prevent complications of disease prevent progression of disease provide rehabilitation Information needs Identify groups who are at risk of disease Identify groups who experience benefits from interventions Measure effects of interventions Identify “new” factors Types of Information Mortality Disability Morbidity (inpatient and outpatient) Risk Factors Health Related Quality of Life Functional Status Information Loop Information Dissemination
  69. 69. Program Evaluation Program Planning Program Implementation Data Collection Data Analysis Data Intepretation Public Health Approach “Surveillance:” What is the problem? Risk Factor Identification: What are the causes? Intervention Evaluation: What works? Implementation: How should we do what works? Evaluate impact and modify intervention Targets Population-based common risk factors present in a large proportion of the population most cases arise from intermediate or low-risk groups small changes in intermediate risk group result in large changes in disease reduction can be easier than changing high-risk groups Targets High-risk disease is a personal and not a collective event selective screening and care can be more cost-effective than mass screening
  70. 70. selective screening improves benefit:risk ratio avoids interference with those who are at low risk fits well with the traditional medical care framework Principles of Invervention Changes in underlying community norms are the key to widespread and long-term changes in health Community-based approaches will contribute the most to reducing disease burden Priority (target) population should be involved in developing intervention Principles of Invervention Actively involve community organizations Clearly define intervention objectives Base strategies on needs of the specific priority population Use multiple intervention strategies Adjust strategies based on evaluation Strategies Modify community conditions and norms Establish and enforce health policies Establish incentives Enhance knowledge and skills Provide screening and follow-up [1] - !"#$%&'()*+,-./0123456789:;<=>? @ABCDEFGHIJKLMNOPQRSTUVWXYZ[]^_`abcdefghijklmnopqrstuvwxyz{|}~€Microsoft (R) PowerPoint (R) Windows ð _À‘ãþÿ [1]à…ŸòùOh«‘+'³Ù0Ô h[1]p
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  74. 74. . [1]û[1]šÿ Times New Roman4� - ð[1] . [1] [1][1][1]àÃ"? [1]42 P[1] ý-Major Vincent Fonseca, MD, MPH[-3"J 4--4 843(-.-I8J [1][1]û[1]šÿ Times New Roman� -[1] ð . [1] [1][1][1]àÃ"? [1]2 ä[1]1ÿOPHSAJ9J9J [1][1]&TNPP &ÿÿÿÿ -ü[1] - û[1] ¼[1][1][1]"Systemn -
  75. 75. ð[1] -vincent.fonsecaþÿ [1][1]ÕÍÕœ.“—+,ù®0ô x € ˜ ¨° ¸ ÀÈDocumentSummaryInformation8[1]ÿÿÿÿÿÿÿÿÿÿÿÿ6$ PersistentStorage Directory8[1] ÿÿÿÿÿÿÿÿ†Current User[1]ÿÿÿÿÿÿÿÿÿÿÿÿ Object2 [1]ÀF€j€˜º¼€j€˜º¼ ‚ƒ„…þÿÿÿ‡ˆ� ‰Š‹Œ þÿÿÿ þÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿŸ ¡¢£¤� � ¥þÿÿÿýÿÿÿ¨©ª«Ž®ýÿÿÿ¯þÿÿÿþÿÿÿ¬³§µ¶·¸¹º»þÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿ ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿ ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿ ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿOle [1]ÿÿÿÿÿÿÿÿÿÿÿÿCompObj[1] ÿÿÿÿ jWordDocument[1]ÿÿÿÿÿÿÿÿÿÿÿÿ´SummaryInformation([1] ÿÿÿÿèDocumentSummaryInformation8[1]ÿÿÿÿÿÿÿÿÿÿÿÿÐHeader [1]ÿÿÿÿÿÿÿÿÿÿÿÿ9ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿþÿÿÿ[1] þÿÿÿ þÿÿÿ þÿÿÿþÿÿÿþÿÿÿ - !"#$%&'()*+,-./012345þÿÿÿ789:;<=>? @ABCDEFþÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿ ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿ ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿRoot Entryÿÿÿÿÿÿÿÿ p®{ê;ûÍ© ªQ £vֳɲÀText_Content[1]ÿÿÿÿÿÿÿÿžSummaryInformation([1]ÿÿÿÿÿÿÿÿ
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  78. 78. ½ ¾ j j ¨ ¨ ¾ ¾ ¾ ¨ j ¨ j ¨ ¾ Àgbë º¼~ † j j j j ¨ ¾ ¾ ¾ Prevention Strategy Primary preventionSecondary prevention (screening)Tertiary preventionDisease StatusSusceptibleUndiagnosedDiagnosedEffectReduced incidenceReduced prevalence. Early treatment.Reduced disability. Increased function. ¤Ð/¥ 2¦§¨©ª
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