SubjectsSubjects(version: 875)
Course, academic year 2020/2021
  
Module of Preventive Medicine - CSRZKPL (Preventive Medicine, Public Health, General Hygiene, Nutrition, Occupational Medicine, Sport Medicine, Child and Adolescent Health, Epidemiology, Family Medicine)
Title: Modul oborů preventivního lékařství
Guaranteed by: Katedra preventivního lékařství (12-KPL)
Faculty: Third Faculty of Medicine
Actual: from 2016
Semester: winter
Points: 14
E-Credits: 14
Examination process: winter s.:
Hours per week, examination: winter s.:0/225 C [hours/week]
Extent per academic year: 6 [weeks]
Capacity: unknown / unknown (unknown)
Min. number of students: unlimited
State of the course: not taught
Language: Czech
Teaching methods: full-time
Level:  
Guarantor: doc. MUDr. Pavel Dlouhý, Ph.D.
prof. MUDr. Kamil Provazník, CSc.
MUDr. David Marx, Ph.D.
Classification: Medicine > Clinical Overview
Attributes: Modul oborů preventivního lékařství
Examination dates   Schedule   
Annotation - Czech
Last update: Mgr. Dana Hrnčířová, Ph.D. (04.02.2013)
Modul představuje hlavní poznatky a přístupy k ochraně a podpoře zdraví v rámci oborů veřejné zdravotnictví, obecná hygiena, pracovní lékařství, tělovýchovné lékařství, výživa, zdraví dětí a mládeže, epidemiologie a rodinné lékařství. TVL: Fyziologie odpovědi organismu na jednorázovou těesnou zátěž. Zátěžový test: provedeni a hodnocení. Preskripce pravidelné pohybové aktivity v primární a sekundární prevenci. Vliv pravidelné pohybové aktivity na organismus a jednotlivé systemy. Obezita: klinický obraz a zásady léčby. Metabolický syndrom: klinický obraz a zásady léčby. Výživa ve sportu. Doping. Svalové dysbalance: klinický obraz a stručně zásady léčby.
Aim of the course
Last update: prof. MUDr. Milena Černá, DrSc. (24.10.2008)

The aim of the module is to present basic knowledge on health prevention, protection and promotion and review of their applications in the primary health care and public health care.

Sports medicine:

To provide basic information on evaluation of physical fitness and prescription of regular physical activity in primary and secondary prevention of metabolic and cardiovasular diseases. Basic information on rational nutrition of sports populaton and on doping.

Literature -
Last update: prof. MUDr. Milena Černá, DrSc. (24.10.2008)

Cassens, B.J. Preventive medicine and public health. The National Medical Series for Independent Study. Harwal Publishing, Philadelphia, 1992.

Sports medicine:

Guidelines for exercise testing and prescription. American College of Sports Medicine Third Edition. .Williams and Wilkins: Baltimore. 1998

ACSM´s Manual for Exercise in Modern Medicíně for Guidelines for exercise testing and prescription. American College of Sports Medicine Third Edition. .Williams and Wilkins: Baltimore. 1998

Heyward VH. Advanced Fitness Assessement and exercise prescription. Human Kinetice Champaign 1998.

Franklin BS and al. Exercise in Modern medicíně. Williams and Wilkins: Baltimore. 1989

Kopelman PG. Clinical Obesity. Blackwell |Science. Oxford 1998

Teaching methods -
Last update: prof. MUDr. Milena Černá, DrSc. (24.10.2008)

Seminars - presentation of knowledge, case studies, discussions.

Exkursion to the factory, risk assessment.

Visit to the "Baby-Friendly hospital" focusing on breastfeeding support(Faculty Thomayer Hospital).

Visit to the primary school focusing on health risks related to stress in schoolchildren.

Exercise testing - sports medicine.

Sports medicine:

Practical seminars, seminars

Syllabus -
Last update: prof. MUDr. Milena Černá, DrSc. (24.10.2008)

PUBLIC HEALTH

Preventive medicine and public health

Definitions and methodology, primary, secondary and tertiary prevention, health promotion models and strategies (community mobilization, school and community education, social marketing, peer leadership, passive and active countermeasures, health planning, health activism).

Prevention and health promotion in the national health policy.

Implementation of the WHO Health 21 Programme in Czech Republic, National Health Programme, health promotion projects and programmes.

Comparative view on health care systems

The seminar will focus on health care systems in the perspective of international comparison. The students will get known the structure and institutions of the health care system, basic subjects and principles of their establishment. The modern history, social and cultural context and typology will be presented, as well as the basic dilemma between costs and values (economy and humanity). Special attention will be paid to "moral hazard", subsidiarity and regulation mechanisms of demand and supply. Three basic examples will be introduced: U.S. professional health care system as an example of a market-based model, British National Health Service as an example of a state-run system and German health care system as an example of a mandatory health insurance. Description and comparison of the models according to the health care systems indicators will be provided (costs, quality, accessibility, equity and acceptability). Market incentives and new forms of regulation will be discussed in the end.

Health Care System of the Czech Republic

Brief history of the health care system transformation after 1989 will be presented followed by a detailed presentation of the current structure and organization of the Czech health care system, institutions of payers and providers. Special attention will be paid to medical profession and to the view of users. Problem of distribution of expensive medical care will be discussed - explicit and implicit forms of rationing, as well as macro- and micro-level rationing will be exposed. A special attention will be paied to the development of population health status during the social transformation of the 1990´s.

Current problems of European health care systems

Aging population, health care costs, equity and access, copayments, quality of care as an essential part of the reform. European Convention on Human Rights and Biomedicine - practical implementation. Patients rights and medical duties ? ethical and legal aspects (consent to treatment, informed consent, duties of treatment, obligatory treatment and hospitalisation without consent, medical duties in emergencies, professional confidentiality, medical negligence and malpractice). Main information sources on health databases.

GENERAL HYGIENE

General environment and health of the population

Relationship between environment and health. Health measurement and evaluation. Environmental risks and strategies. Global problems of environmental pollution.

Lifestyle and health of the population

The lifestyle construct. The components of the lifestyle. Behavioral assessment. Social diagnosis, assessing a quality of life. Prevention and intervention strategies in tobacco smoking.

Health effects of air pollution

Sources of air pollution. Outdoor and indoor environment. Emissions, immisions. Basic forms of smog. Health effects of the most important air pollutants. Sick-building syndrome. Monitoring of the air pollution. Health indicators, biomarkers. Protection against air pollution. Preventive measures.

Water - health importance, sources of contamination

Drinking water supply. Drinking water quality. Health risks of drinking water from microbial and chemical contaminants. Chlorination by-products. Quantitative requirements and qualitative properties of drinking water. Health hazards of domestic equipments for treatment of drinking water. Packaged water.

Health impact of wastes

Solid and liquid municipal waste. Solid waste from industry and agriculture. Health risk of waste from health facilities. Liquidation of waste.

Physical factors and their health effects

Health effects of noise and vibrations. Physiological principles of the action of noise and vibrations on the organism. Thermal comfort and thermal balance. Lighting. Electromagnetic fields and their biological effects. Exposure of the population to electromagnetic waves. UV radiation - benefit and health risks.

Principles of radiation protection against ionizing radiation

Biologic effects of ionizing radiation. Sources of irradiation of the population. Dosimetric evaluation of the exposure and limits of irradiation for the population and workers. The principles of radiation protection.

OCCUPATIONAL MEDICINE

Harmful physical agents

Noise, vibrations, ionizing radiation, non-ionizing radiation, overloading, its measurement and assessment, physical load and its calculation, stochastic effect of ionizing radiation and its assessment.

Occupational lung disorders

Pneumoconioses (asbestosis, silicosis), asthma, extrinsic allergic alveolitis, malignancy, other lung disorders.

Occupational diseases caused by chemicals

General principles of toxicology, exposure, assessment, biological exposure tests, concentration of chemicals in the air, liver, nervous, bone marrow and kidneys, diseases caused by chemicals, benzene or a homoloque intoxication, poisoning by lead, mercury and cadmium.

Occupational diseases

Diagnosis, prevention, notification and treatment of occupational diseases, work-related diseases, accidents and their prevention, special problems in occupational medicine, workplace hazard control, protection of the worker case-records, types of occupational diseases.

SPORTS MEDICINE

Response of body systems to short-term physical exercise

Cardiovascular, respiratory, metabolic, hormonal systems responses. Energy substrates for physical work. Observation of cardiovascular, respiratory and metabolic variables during physical exercise.

Exercise testing

Indications, contraindications, types of load, laboratory testing, field testing. Dynamic exercise testing : sources of load, units of load, laboratory equipment, conditions for exercise testing. Protocols of ET. Physical fitness, physical capacity, maximal aerobic capacity, anaerobic threshold. Clinical significance of these variables. Pathological ET.

Practical realization of maximum exercise test with complete spiroergometry

Examinations of the patient in primary and secondary prevention

Anthropometric measurements evaluations, body composition, risk scores, history of physical activity. Demonstrations of the use of submaximal exercise testing for the prescription of physical activity.

Method of spectral analysis of heart rate variability

Basic information, methodology, clinical use.

Rehabilitation

Muscle dysbalances in connection with spondylogenic back pain. Examination of muscle groups, therapy, stretching.

Prescription of PA in primary prevention

Choice of PA. Dynamics of PA - basic parameters of prescription intensity, duration, frequency. Motivation, adherence. Contemporary conception of ?Physical Activity for Health?. Field testing, monitoring in the field conditions. Strength training.

Prescription of PA in secondary prevention

Coronary heart disease, hypertension, ischemia of lower extremities, diabetes mellitus, obesity, lung diseases, osteoporosis, pregnancy.

Obesity

Current view on etiopathogenesis and therapy.

Rehabilitation

Rehabilitation of patients after stroke.

Doping and other pharmacological and nutritional support in sports

Adaptation of body systems to regular physical activity( training)

Effects on cardiovascular system, skeletal muscle, metabolism of substrate, hormonal balance, body composition.

Morbidity a mortality

Effects of physical activity on morbidity and mortality.

Metabolic syndrom

General characteristics, physiology, clinical significance, role of physical activity.

Nutrition in sports

NUTRITION

Risk from toxic contaminants in the food

Many environmental toxic contaminants may enter the food chain and can negatively influence human health. The most important are (1) persistent chlorinated organic compounds such as polychlorinated biphenyls, dioxins, and organochlorine pesticides with the potential carcinogenic, immunotoxic, endocrine-disrupting effects, and reproductive toxicity, (2) polycyclic aromatic hydrocarbons formed during incomplete combustion or pyrolysis of organic material including cooking processes, (3) mycotoxins with multiple toxic effects including carcinogenicity (aflatoxins), nefrotoxicity (ochratoxins), or estrogenicity (zearalenon), (4) heavy metals such as lead as a known developmental toxicant, or cadmium with its carcinogenicity and nefrotoxicity.

Chemical changes during food processing

Some toxic and genotoxic compounds can be formed during cooking and/or processing of muscle food. Cooking and other heat processing of protein-rich foods induce the formation of heterocyclic amines with strong mutagenic and potential carcinogenic effects. Free radicals may be involved in the etiology of cancer and cardiovascular diseases through lipid peroxidation. Partial depletion of vitamins, minerals and trace elements can occur during improper cooking processes. Some toxic compounds can be caused by means of microbial contamination of food such as histamin from histidin in the fish meat, or nitrosamines by bacterial reduction of nitrates to nitrites and further reaction with amines. Current problem represents genetically modified food.

Microbiological safety of the food

Hygienic microbiology must ensure warning signals in the form of so-called indicator microorganisms in food and to the potential risk of possible diseases with a mass incidence.

Attention is devoted also to the saprophytic microflora in foods and to its metabolic activity and to microorganisms which colonize the macroorganism.

Evaluation of nutritional status

A history and physical exam along with anthropometric measurements. Assessment of past and recent dietary and supplement intakes. Biochemical measurements of blood and urine.

Estimation of dietary intake

Dietary intake estimation involves the collection of information on foods eaten by individuals and computation of energy and nutrient contents of these foods by using values from food composition tables. The food intakes may be current or from the immediate, recent, or distant past.

Nutritional aspects of pregnancy

Fetal growth during pregnancy is nutrients requiring process.

Weight gain in healthy women is generally 10-12 kg during the course of pregnancy. Nutrient requirements of pregnant women and possible problems during pregnancy will be described.

Nutritional aspects of lactation

Nutritional status of breastfeeding women and its impact on the composition of breastmilk. Impact of nutrient intake on health of the breastfeeding woman and her child. Identification of risk groups, screening, assessment of nutritional status and intake in breastfeeding women. Nutritional guidelines for breastfeeding women.

Prevention and nutrition in children and adolescents

Current WHO/UNICEF recommendations on infant and young child feeding. Infant feeding and nutritional status in children in the Czech Republic. Intervention programmes related to nutrition in children and adolescents (iodine deficiency, health promotion in preschool and school children, cognitive behaviour approaches in prevention and treatment of obesity and eating disorders). Nutritional guidelines and counselling in children and youth.

Nutrition and cardiovascular diseases

Etiology and development of coronary heart disease. Risk factors (genetic predisposition, age, smoking, obesity, hyperlipidemia, hyperhomocysteinemia, hypertension, diabetes mellitus, stress, social class). Diet-related risk factors (caloric intake, dietary fat - saturated fatty acids, trans fatty acids, dietary cholesterol). Dietary factors in the prevention of coronary heart disease (n-3 fatty acids, fibre, antioxidants).

Nutrition in prevention of tumor diseases

Stages in cancer development. Relationship between diet and cancer. Diet-related risk factors (caloric intake, dietary fat, alcohol, toxic contaminants). Possible protective factors (antioxidants, fibre). Dietary guidelines for prevention of tumor diseases.

Starvation and malnutrition

Etiology, epidemiology. Clinical, metabolic and biochemical features.

EPIDEMIOLOGY

For the state examination, knowledge of basic epidemiological characteristics of infectious diseases (infectious agents, sources of diseases, incubation period, modes of transmission, susceptibility), their distribution in the Czech Republic and in the world, specific preventive measures, clinical symptoms and diagnostic methods is required. Questions on epidemiology of cancer and injuries are focused to a longterm trend of these diseases (incidence, mortality), risk factors, age distribution and prevention.

Epidemiology of influenza and Reye's syndrome

Characteristics of acute respiratory illnesses of viral and mycoplasmal etiology, epidemiology of influenza, Reye's syndrome, bird's influenza, vaccination strategy.

Epidemiology of HIV/AIDS

History, description and case definition, epidemiological features of HIV/AIDS infection, occurrence in the Czech Republic and worldwide, trends and perspectives of therapy and control.

Immunization programs

Strategy of active and passive immunization in the Czech Republic and new valid vaccination schedule. Contraindications and complications of vaccination.

Epidemiology of injuries

Home and leisure injuries frequency, mechanisms, trafic accidents. Age distribution of injuries, risk groups ? children and seniors.

Epidemiology of cardiovascular diseases

Age and sex distribution of cardiovascular diseases, trends, mortality in the Czech Republic and worldwide.

Intestinal bacterial infections (food-borne bacterial diseases)

Epidemiological characteristics of etiological agents, differential diagnosis, epidemic measures. Epidemic of thyphoid fever, practical example.

Geographic distribution of infection

Characteristics, spectrum of infections, etiologic agents, vectors, reservoir of infectious agents, host, endemicity, ecology. Examples from the Czech Rrepublic and world.

Viral hepatitis

Epidemiological features, diagnostics, preventive and epidemic measures, occurrence. Infectious agents, epidemiological characteristics and differences of viral hepatitis A, B,C,D, E. Differential diagnostics of viral hepatitis.

Cancer epidemiology

Most frequent cancer incidence and mortality in the Czech Republic, secular trends and their analysis. Epidemiologic study - practical exercise.

Surveillance of the disease

Definition, aims, aspects and elements of surveillance. National surveillance programme of measles, polio, diphteria, tetanus, pertussis etc.

CHILD AND ADOLESCENT HEALTH

Breastfeeding promotion, protection and support in the Baby-Friendly Hospital

WHO/UNICEF recommendation on breastfeeding and infant feeding, prevalence of breastfed infants in CR, WHO/UNICEF Baby-Friendly Hospital Initiative - 10 steps to successful breastfeeding, physiology of lactation, lactation management and counselling in maternity hospital (incl. intensive care unit), follow-up care for breastfeeding mothers, International Code of Marketing of Breastmilk Substitutes.

Health promotion in schoolchildren

Health risks in schoolchildren, school readiness, sources of stress in school and its impact on health, screening and management of anxiety, learning and behavioural disorders, Health Promoting School Programme, health promotion and health education, collaboration with parents, specialists.

Prevention of social pathology in children and youth

Personality and social development, emotional and social needs in children and youth, emotional and behavioural disturbances, role of the family and school in prevention of mental health and social problems in children and adolescents.

Prevention of drug abuse in children and adolescents

Classification of psychoactive drugs, predictors of drug abuse, categories of youth at risk, psychosocial and environmental risk factors, primary, secondary, tertiary prevention, principal models of health and drugs education.

Family doctor - general practitioner - system of primary care in Czech Republic,

system of education in Czech Republic and other countries in Europe.

How to become - general practitioner in Czech Republic, communication with other subjects of - health system, communication with health insurances.

Private office - how to lead it.

How to get to diagnosis - specific way of thinking ? differential diagnosis.

 
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