Incorporating Quaternary Prevention: Understanding the Full Scope of Public Health Practices in Sexual Abuse Prevention

This discussion piece argues for a refinement in our understanding of prevention in sexual abuse, suggesting that we include quaternary prevention on the grounds that this concept from medical literature has potential and helpful application to criminal justice and particularly to work with those who cause sexual harm. Located within the paradigm of Epidemiological Criminology (EpiCrim), quaternary prevention extends the prevention spectrum to enable a stronger distinction between tertiary level responses and long-term safe, sustainable reintegration into communities, particularly of those who sexually abuse others. The key principles of quaternary prevention are adapted and refined from current medical literature, and the potential usefulness of quaternary prevention to crime and sex abuse prevention is explored.

The Use of Traditional Medicine in the Implementation of Quaternary Prevention From the Perspective of Experts in Traditional Medicine

Background: Traditional medicine includes a variety of disease treatments or prevention methods based on knowledge, skills, and practice that are rooted in indigenous beliefs and experiences. It also has a health-oriented and holistic view and considers measures following the characteristics of each individual. Patient harm can be prevented by using Traditional medicine and limiting the use of ineffective and harmful methods. Methods: This qualitative study with the phenomenological approach was carried out with the participation of 12 individuals who were selected using purposeful sampling and snowball sampling methods among the faculty members of the Faculty of Traditional Medicine of Kerman University of Medical Sciences between May and June 2019. The data collected through semi‑structured interviews based on the research objectives, review of texts. Data analysis performed using the content analysis method in MaxQDA software.Results: Data analysis provided six main categories of the necessity of services, patient benefit, complications, prevention, rules and regulations, the financial burden.Conclusion: Quaternary prevention is a concept derived from Traditional medicine. Health care providers must protect their clients from the harms and costs of unnecessary diagnostic, therapeutic, and preventive measures. By employing Traditional Medicine specialists and integrating the Traditional Medicine specialist program in the family doctor program, attending general and specialized hospitals, integrated medicine could use, and the harm to the patient could minimize.Trial registration: IR.KMU.REC.1400.032 date: 1400/1/17 (6 April 2021)

The Causes of Insulin Resistance in Type 1 Diabetes Mellitus: Is There a Place for Quaternary Prevention?

Diabetes mellitus was the first non-communicable disease that was recognized by the United Nations as a 21st-century pandemic problem. Recent scientific reports suggest that people with type 1 diabetes mellitus also develop insulin resistance, which is generally considered to be a distinctive feature of type 2 diabetes mellitus. The causes of insulin resistance in type 1 diabetes mellitus were explored, but there was a lack of publications that connected the risk factors of insulin resistance in type 1 diabetes mellitus with the proposition of repair mechanisms that are offered by quaternary prevention. Toward this end, the present review is an attempt to combine the previous reports on the causes of insulin resistance in type 1 diabetes mellitus and a brief review of quaternary prevention. The destructive effect of insulin resistance on many physiological processes that predisposes the individual to chronic diabetes complications creates an urgent need to introduce effective therapeutic methods for preventing the development and progression of this pathology.

Primary care in the time of COVID-19: monitoring the effect of the pandemic and the lockdown measures on 34 quality of care indicators calculated for 288 primary care practices covering about 6 million people in Catalonia

Background To analyse the impact of the COVID-19 epidemic and the lockdown measures on the follow-up and control of chronic diseases in primary care. Methods Retrospective study in 288 primary care practices (PCP) of the Catalan Institute of Health. We analysed the results of 34 indicators of the Healthcare quality standard (EQA), comprising different types: treatment (4), follow-up (5), control (10), screening (7), vaccinations (4) and quaternary prevention (4). For each PCP, we calculated each indicator’s percentage of change in February, March and April 2020 respective to the results of the previous month; and used the T-Student test for paired data to compare them with the percentage of change in the same month of the previous year. We defined indicators with a negative effect those with a greater negative change or a lesser positive change in 2020 in comparison to 2019; and indicators with a positive effect those with a greater positive change or a lesser negative change. Results We observed a negative effect on 85% of the EQA indicators in March and 68% in April. 90% of the control indicators had a negative effect, highlighting the control of LDL cholesterol with a reduction of − 2.69% (95%CI − 3.17% to − 2.23%) in March and − 3.41% (95%CI − 3.82% to − 3.01%) in April; and the control of blood pressure with a reduction of − 2.13% (95%CI − 2.34% to − 1.9%) and − 2.59% (95%CI − 2.8% to − 2.37%). The indicators with the greatest negative effect were those of screening, such as the indicator of diabetic foot screening with a negative effect of − 2.86% (95%CI − 3.33% to − 2.39%) and − 4.13% (95%CI − 4.55% to − 3.71%) in March and April, respectively. Only one vaccination indicator, adult Measles-Mumps-Rubella vaccine, had a negative effect in both months. Finally, among the indicators of quaternary prevention, we observed negative effects in March and April although in that case a lower inadequacy that means better clinical outcome. Conclusions The COVID-19 epidemic and the lockdown measures have significantly reduced the results of the follow-up, control, screening and vaccination indicators for patients in primary care. On the other hand, the indicators for quaternary prevention have been strengthened and their results have improved.

Quaternary prevention: a concept relevant to public health? A bibliometric and descriptive content analysis

According to the World Organization of Family Doctors (WONCA), quaternary prevention (P4) is a recent concept that aims to prevent medical overuse. Thus, this study aimed to measure and map research output on P4 as outline research trends, evaluating its current international status through a bibliometric and descriptive content analysis. We reviewed scientific articles on P4 recorded in PubMed, LILACS, SciELO or CINAHL with the outcomes: publication year, first authors’ name and nationality, journals’ name, country and ranking, publication language, used methods and main reported subjects. The analysis included 65 articles published in 33 journals of 16 countries between 2003 and 2018 with a peak of publications in 2015. The first authors came from 17 different countries, 23% Brazilian, with Uruguay as the leading nation in scientific production per capita. Q1 or Q2 journals amassed 28% of published papers. Bibliographic research comprised 88% of articles and 38% of all focused on specific examples of medical overuse. P4 represents an ethical and valid approach to prevent iatrogenic events and achieve equal and fair access to health services. Conceptual, geographical, and linguistic elements, as well as WONCA conferences and type of healthcare systems in the authors’ country were fundamental factors that affected research output. The available studies are still of limited quality and quantity, with further investigations needed to assess the effective impact of P4 on public health.