wat is quaternaire preventie

>> 23 0 obj << << /MediaBox [0 0 720 540] /Filter /FlateDecode Learn about these levels of care and how they affect you. 8 [170 0 R 171 0 R 172 0 R 173 0 R 174 0 R 175 0 R 176 0 R 177 0 R 178 0 R 179 0 R /Resources 33 0 R /K [109 0 R 110 0 R 111 0 R 112 0 R 113 0 R 114 0 R 260 0 R 116 0 R 261 0 R] 30 0 obj /Group 41 0 R 14 0 obj >> /Tabs /S /Length 288 0 R << /Contents 31 0 R /Tabs /S 9 0 obj 1 [96 0 R 97 0 R 98 0 R 99 0 R 100 0 R 101 0 R 102 0 R 103 0 R 104 0 R 105 0 R >> 7 [160 0 R 161 0 R 162 0 R 163 0 R 164 0 R 165 0 R 166 0 R 167 0 R 168 0 R 169 0 R Preventie: Vaccinatie op indicatie (bijvoorbeeld beroepsmatige blootstelling en reizigers) Ziekte & Besmettelijkheid ... (zeepwater, ether, chloroform, aceton), 70% ethanol, quaternaire ammoniumverbindingen (bijvoorbeeld 0.2% cetrimide) en 5-7% jodiumpreparaten. Prevention activities are typically categorized by the following three definitions: 1. /Parent 2 0 R The goal is the avoidance of overmedicalisation. The concept of quaternary prevention was initially proposed by Marc Jamoulle and the … /Count 11 /Endnote /Note /Contents 40 0 R Tertiary prevention aims to soften the impact of an ongoing illness or injury that has lasting effects. }��XO/��^�I+�5�#E��;M�}�@�^&'�Ӎ�r�ˆ��C�鴦�{�}>!Z��m��2�/�|F� l��RN�o�kx��Z�n#��C/�W۬j�\��i�˶��S�aC.Yf9yKH�0[?��.�B�B�*��"�Ć�V� vFi&�*�L��DS��H^Ge�|4�Er)*(ؠR �X�$�Q�2 ^9��fl��@��&�"�8��|5Z9/��Y#��[T�+*��ٚ��w�)fj��A��Vig��*�=� �ɣ딏dA>$H�DyH��b��$k�[rQ��. /Type /StructElem /Header /Sect /MediaBox [0 0 720 540] /Type /StructElem /Contents 43 0 R Quaternary prevention (P4) is a relatively recent concept (and practice), which means the identification of persons at risk of excessive medicalization and their protection from further unnecessary interventions, avoiding iatrogenic damages and proposing ethically acceptable measures 18. endobj endobj /Contents 69 0 R << /Tabs /S /P 3 0 R endobj /Type /Page << Tertiary prevention Methods to reduce negative impact of extant disease by restoring function and reducing disease‐related complications. 26 0 obj 6 0 obj >> P. 1 Quaternary Ammonium Compounds in Cleaning Products This information sheet reviews the recognition, assessment, and treatment of possible adverse health effects of prod- ... exposure to these materials and also covers the identification and prevention of exposure to QACs commonly found in com-mercial products. Preventive healthcare, or prophylaxis, consists of measures taken for disease prevention. Secondary Prevention—screening to identify diseases in the earliest << /Parent 2 0 R /Tabs /S /Macrosheet /Part Quaternary prevention is a well-devised concept that embeds three main points: risk of overmedicalisation, patients’ protection, and ethical alternatives. /Tabs /S 169 0 R] /Pg 10 0 R /MediaBox [0 0 720 540] /Parent 2 0 R /Type /StructElem 230 0 R 231 0 R 232 0 R 233 0 R 234 0 R 235 0 R 236 0 R 237 0 R 238 0 R 239 0 R 7 0 obj 29 0 R] Some of these symptoms stem from psychosocial circumstances. It refers to actions “taken to identify [a] patient at risk of overmedicalisation [= in the sense of medical overuse, author’s note], to protect him from new medical invasion, and to suggest to him interventions, which are ethically acceptable” [ 13 ]. /Type /Page 8 0 obj Defined as "action taken to identify patient at risk of over medicalization, … endobj endobj This definition is more comprehensive than the recent initiative to redefine it in terms of the harm/benefit ratio.3 P4 provides a platform that may help GPs to realise the vital task of demedicalising by sorting out what can or should be demedicalised in clinical care. This is the task of therapy and rehabilitation. /S /Slide Menu. '��N1��/��H��4�!X��R[ϕ��&Y��,d܀B�Y�C��`Zwiv��LZ{@v"#� /S /Transparency << >> Regarding P2, there are lots of instances of overmedicalisation due to non-evidence-based screening for thyroid, prostate, and ovarian cancers. /K [96 0 R 97 0 R 98 0 R 99 0 R 100 0 R 101 0 R 102 0 R 103 0 R 256 0 R 105 0 R endobj /MediaBox [0 0 720 540] /Pg 9 0 R /K [118 0 R 119 0 R 120 0 R 121 0 R 122 0 R 123 0 R 262 0 R 263 0 R 264 0 R 129 0 R 22 0 obj /Textbox /Sect /Parent 2 0 R /Tabs /S 5 [141 0 R 142 0 R 143 0 R 144 0 R 145 0 R 146 0 R 147 0 R 148 0 R 148 0 R 149 0 R This consists of avoiding overtreatment, avoiding pointless practices, and providing moral alternate options. << 'http':'https';if(!d.getElementById(id)){js=d.createElement(s);js.id=id;js.src=p+"://platform.twitter.com/widgets.js";fjs.parentNode.insertBefore(js,fjs);}}(document,"script","twitter-wjs"); BJGP Journal Office 126 0 R 127 0 R 128 0 R 128 0 R 129 0 R 130 0 R 130 0 R] /StructParents 6 << A paradigmatic shift from a chronological to a relationship-based prevention organisation offers new insights into the work and, specifically, into the preventive activities of doctors, and brings to light the concept of quaternary prevention, a critical look at medical activity with an emphasis on the need not to harm. Online ISSN: 1478-5242. After an average of two decades of breast cancer screening in Canada8 and the US,9 there are considerable overdiagnosis rates (roughly 30%), minimal (if any) impacts on mortality,10 but known potential harms such as an increase in heart disease (27%) and lung cancer (78%) mortality.11. /P 3 0 R /Pg 6 0 R Tel: +44 (0)20 3188 7679 89 0 R 90 0 R 91 0 R 92 0 R 93 0 R 94 0 R 94 0 R 95 0 R] /Group 32 0 R << (Wikipedia) P4 *NB*: Be careful not to confuse Jamoulle's term P4 with the more popular P4; predictive, preventive, personalized, and participatory (P4) medicine, with a focus on detecting and dealing with disease before it even … /Contents 49 0 R /StructParents 4 10 [210 0 R 211 0 R 212 0 R 213 0 R 214 0 R 215 0 R 216 0 R 217 0 R 218 0 R 219 0 R >> >> This is done by helping people manage long-term, often-complex health problems and injuries (e.g. Quaternary Prevention: Action taken to identify patient at risk of overmedicalisation, to protect him from new medical invasion, and to suggest to him interventions, which are ethically acceptable. /Pg 13 0 R /CS /DeviceRGB /Group 56 0 R /Pattern 285 0 R III Tertiary prevention . >> 257 0 R 258 0 R 259 0 R] 10 0 obj /Pg 12 0 R /Group 53 0 R 21 0 obj >> /Chartsheet /Part /Pages 2 0 R x��X�n7}��X4��AZ��A�:��}جײ /Contents 37 0 R /StructParents 10 P4 must also question the tendency to excessively highlight the principle of nonmaleficience … /Kids [6 0 R 7 0 R 8 0 R 9 0 R 10 0 R 11 0 R 12 0 R 13 0 R 14 0 R 15 0 R 3 [118 0 R 119 0 R 120 0 R 121 0 R 122 0 R 123 0 R 124 0 R 125 0 R 125 0 R 126 0 R /Type /Page << /Group 59 0 R /Resources 51 0 R /Type /StructElem /Footer /Sect /CreationDate (D:20151027081158+01'00') endobj << /K [131 0 R 132 0 R 133 0 R 134 0 R 135 0 R 136 0 R 137 0 R 266 0 R 139 0 R 267 0 R] /Length 293 0 R /MediaBox [0 0 720 540] /XObject 289 0 R endobj /Tabs /S ‘... to offer their patients the occasion to de-medicalize their own attitude to pain, disability, discomfort, ageing, birth and death.’ 1, In other words, ‘unhooking [patients] from the health system’.1 This article presents WONCA’s definition of Quaternary Prevention (P4) as a unifying framework that organises GPs’ scope on demedicalisation.2, Devised in 1986 by Marc Jamoulle, a Belgian GP, P4 is: We can consider the debate ethically. /P 3 0 R 81 0 R 82 0 R 82 0 R 83 0 R 84 0 R 84 0 R 85 0 R 86 0 R 87 0 R 88 0 R The health industry has many times The concept of quaternary prevention is nothing more than used secondary results to write papers, with no protocol the systematization of the concept of “primum non nocere” information and no possibility of pear review. In 1982, the Journal of the Royal College of General Practitioners published Ivan Illich’s article ‘Medicalization in Primary Care’.1 Illich held a paradoxical belief that GPs could contribute to the healthy process of demedicalisation, that is: It requires a critical appraisal of current biomedical knowledge, inviting GPs to be more autonomous, proactive, and to follow protocol less slavishly. /Tabs /S /MediaBox [0 0 720 540] 2. /Creator Email: journal@rcgp.org.uk, British Journal of General Practice is an editorially-independent publication of the Royal College of General Practitioners /Type /Catalog >> Moscato G et al. In 1999, the quaternary prevention concept was also integrated in the Wonca International Dictionary for General/Family Practice and was defined as: ‘Action taken to identify patient at risk of overmedicalization, to protect him from new medical invasion, and to suggest to him interventions, which are ethically acceptable’ . See other Vocabulary Questions. /Group 44 0 R It’s a way of thinking about the job which applies in the other fields too (as shown by the arrow), covering such items as overmedicalisation by overinformation, overscreening, overdiagnosis, overtreatment, as well as avoidable care, protection of the patient and more generally the limits of /Type /Page 180 0 R 180 0 R 181 0 R 182 0 R 183 0 R 183 0 R 184 0 R 185 0 R 186 0 R 186 0 R NOTE: We only request your email address so that the person to whom you are recommending the page knows that you wanted them to see it, and that it is not junk mail. x��V�n�F}'��G*�V;{'��uk�y0��д-�]Yqп��T�@� �fΜ9sv(^�Ǐ��'��? /Group 70 0 R Breast cancer screening also needs to be readdressed. /Resources 60 0 R First Care or Do Not Harm. /Contents 34 0 R /P 3 0 R stream /StructTreeRoot 3 0 R %PDF-1.5 /Type /Page Discover the meaning of primary, secondary, tertiary, and quaternary care in medicine. /Type /StructElem This is termed as quaternary prevention. In their recent article ‘Quaternary prevention: a balanced approach to demedicalisation’,1 Norman and Tesser (N&T) presented Kuehlein et al’s original definition of quaternary prevention as: ‘An action taken to identify a patient at risk of over-medicalization, to protect him from new medical invasion, and to suggest to him interventions which are ethically acceptable.’ 2 They concluded that this … /MarkInfo 4 0 R Both groups of patients are subjected to overmedicalisation.4. >> << /InlineShape /Sect ‘... an action taken to identify a patient at risk of over-medicalization, to protect him from new medical invasion, and to suggest to him interventions which are ethically acceptable.’ 3, P4 was initially oriented to those patients who were feeling ill, but who had no clinically established disease: the worried well and those presenting with medically unexplained symptoms.3 The former are concerned about their health status and usually demand check-ups; the latter present with symptoms that lack pathophysiological explanations. /ParentTree 18 0 R /Type /StructElem 190 0 R 191 0 R 192 0 R 276 0 R 195 0 R 196 0 R 277 0 R 278 0 R] Primary Prevention—intervening before health effects occur, through measures such as vaccinations, altering risky behaviors (poor eating habits, tobacco use), and banning substances known to be associated with a disease or health condition.8,9 2. >> century. /S /Slide << >> >> This problem appeared to have been solved when Sackett 3 devised the concept of evidence-based medicine, which claims that good research evidence and … Staff need … >> endobj 31 0 obj /Pg 11 0 R Point-of-care tools, such as BMJ Best Practice and Practical Approach to Care Kit (PACK), are ideally placed to educate, support clinical decision making and help practitioners to rapidly identify the medical issues related to … RCGP Thank you for recommending British Journal of General Practice. Department of Public Health, Federal University of Santa Catarina, Santa Catarina, Brazil. The belief in ‘the lower the better’ Hb1Ac levels has potentially done more harm than good due to polypharmacy, reduction in quality of life, and an increase in mortality.12 Therefore, distinction between clinical and preventive activities is essential to circumvent the excesses of biomedicine. /Resources 48 0 R /Type /StructTreeRoot 81 0 R 253 0 R 254 0 R 255 0 R 95 0 R] /Pattern 291 0 R << Differences Between Primary, Secondary, Tertiary, and Quaternary Care. /StructParents 3 Overdiagnosis is ‘the diagnosis of a condition that would have remained indolent in the patient’s lifetime if left undetected’.5 Thus, patients end up dying from competing diseases and not gaining in longevity. 106 0 R 107 0 R 108 0 R 108 0 R] Quaternary prevention is a well-devised concept that embeds three main points: risk of overmedicalisation, patients’ protection, and ethical alternatives. /ProcSet [/PDF /Text /ImageB /ImageC /ImageI] endobj /Artifact /Sect /K [200 0 R 201 0 R 202 0 R 203 0 R 204 0 R 279 0 R 280 0 R 281 0 R] 1 0 obj 196 0 R 197 0 R 198 0 R 198 0 R 199 0 R 199 0 R] >> << /Resources 42 0 R endobj Eur ... • Langzaam (bijv. Quaternary prevention has been outlined as actions which are carried out to keep away from an overuse of medical sources by well being professionals and by sufferers. 265 0 R] endobj Concerning P3, diabetes care provides a good example. endobj /Contents 55 0 R We do not capture any email address. 24 0 obj Its clockwise-arrow at the centre indicates that P4 impacts the other three preventive levels: primary prevention (P1), secondary prevention (P2), and tertiary prevention (P3). Examples include screening … << /StructParents 9 /Parent 2 0 R The journal’s scope is global, building on its 50-year history in advancing the understanding of Earth and … 28 0 obj /P 3 0 R /StructParents 1 Box 1 also differentiates two demedicalisation scenarios: 1) P1 and P2, which deals with symptomless individuals; and 2) P3 and P4, which comprises disease/illness dimensions, merging clinical care with preventive activities. /Type /StructElem /Contents 52 0 R However, as this example shows, prevention experts say that the further “upstream” one is from a negative health outcome, the likelier it is that any intervention will be … [�)$#� �%K�M"��ԶN'�JJ/�`�E�n^��Px��Y�� q��, /Type /Page i��$G+�k� H��̜�ù�f��3&޽c'g��~O0��R)�W�Y#X]�{_߰�ߣ��Ֆh1��/g��l�>�{��ꔱ y0��u�4e]�b�- /Resources 39 0 R /Annotation /Sect 15 249 0 R 16 250 0 R 17 251 0 R 18 252 0 R] /Parent 2 0 R /Contents 58 0 R /StructParents 8 11 245 0 R 12 246 0 R 13 247 0 R 14 248 0 R What comes after primary, secondary, tertiary? << Health A-Z COVID-19; Arthritis; Type 2 Diabetes; Heart Disease; Digestive Health; Multiple Sclerosis; View All Prevention & Treatment COVID-19 Vaccines; … << /Type /Page /Annots [61 0 R 62 0 R 63 0 R 64 0 R 65 0 R 66 0 R 67 0 R 68 0 R] 2 [109 0 R 110 0 R 111 0 R 112 0 R 113 0 R 114 0 R 115 0 R 115 0 R 116 0 R 117 0 R 29 0 obj endobj /S /Slide /P 3 0 R 208 0 R 209 0 R 209 0 R] /Type /Page /Parent 2 0 R >> 33 0 obj /S /Slide /K [19 0 R 20 0 R 21 0 R 22 0 R 23 0 R 24 0 R 25 0 R 26 0 R 27 0 R 28 0 R >> defined quaternary prevention as ‘‘debriefing, quality assurance, and improvement processes’’, which ‘‘complete the cycle of preven-tion by collecting information about the processes, multi-disciplinary analysis of the data, deriving conclusions, and distributing them to all the involved bodies’’.6 Quaternary prevention has also been defined by 34 0 obj /MediaBox [0 0 720 540] >> /Title (What is Quaternary prevention ?) /Pg 16 0 R Disease and disability are affected by environmental factors, genetic predisposition, disease agents, and lifestyle choices and are dynamic processes which begin before individuals realize they are affected.Disease prevention relies on anticipatory actions that can be categorized as primal, primary, secondary, and … /ExtGState 290 0 R /K [170 0 R 171 0 R 172 0 R 173 0 R 174 0 R 175 0 R 272 0 R 273 0 R 274 0 R 275 0 R << endobj Secondary prevention: routine screening for major forms of cancer now exists in many countries, but not in all of them. /K [210 0 R 211 0 R 212 0 R 213 0 R 214 0 R 282 0 R 283 0 R] 150 0 R 150 0 R] /S /Slide Primary, secondary and tertiary prevention Provided by : iwh.on.ca FREE For many health problems, a combination of primary, secondary and tertiary interventions are needed to achieve a meaningful degree of prevention and protection. 240 0 R 241 0 R 242 0 R 243 0 R 244 0 R 244 0 R] /K [151 0 R 152 0 R 153 0 R 154 0 R 155 0 R 156 0 R 157 0 R 158 0 R 270 0 R] /Type /StructElem 1d��L��30E�v)`��1��F5�rH!��Ӕw��ɐ��ʵF?Q�K�F^��ۋ${ �� 4ߣJ ��;��B5��N�q솺&��E��ǀ �d7��s蓍--�pK��eAb0+ٯ�y3)��d��z��1o��H�*��h��.�J�@� �Ϋ_��Bx�mc�ޕ�%Tmp��H��Vt׶`��F��ݫ �SMM$�ihD��o��|��׼��J��fP�S�bC)��X��dNU��#��ώ\�y�G�W�-�͊I�� ҃"��7C��˂"�Wwe]VEyDoD��̿�u�F��e��=��#�ٍ�Uˣ� ��oo�j�#(��N#��}�g1��Lm�v�-6�ϒ�Vqo��݁��@��B"�yB�Bت��u?,K��Z�_��,ՃI��GRăoK��zO�I̫I�dԍZ��}z_�~�Շ��/��T� C��^7�Y��m��&��G�9#w.+:5R��*�lp:��ݪ��f�R��3[h��&Aܨh�)˄65�? /MediaBox [0 0 720 540] 27 0 obj /Tabs /S Screening programmes are not always evidence-based and systemic health checks for noncommunicable diseases are not routine in most countries. /Pg 14 0 R /S /Slide /Type /StructElem /Type /Page To realise this task, as paradoxically envisioned by Illich, P4 needs support and further research to be globally disseminated in primary care. The 3 Levels of Prevention: Primary Prevention – an intervention that prevents the disease process from ever beginning Secondary Prevention – an intervention that identifies and stops a disease early on in the disease process before the patient even realizes anything is wrong (before any clinical signs arise) Tertiary Prevention – an intervention that is used for patients who already have clinical signs of the … Examples include routine Papanicolaou tests and screening for hypertension, diabetes mellitus, or hyperlipidemia. 140 0 R 140 0 R] endobj /Resources 30 0 R endobj >> << /P 3 0 R Box 1 provides a framework that organises the scope of P4. << Guidelines for the management of work-related asthma. /ProcSet [/PDF /Text /ImageB /ImageC /ImageI] /MediaBox [0 0 720 540] /MediaBox [0 0 720 540] /Resources 54 0 R /S /Slide /Resources 57 0 R /Filter /FlateDecode /Group 35 0 R Gofrit et al. endobj /Group 47 0 R /Worksheet /Part Als je vragen en twijfels hebt over je gezondheid, gevoel, relaties, seks, alcohol & drugs of een ander onderwerp … /S /Slide 9 [200 0 R 201 0 R 202 0 R 203 0 R 204 0 R 205 0 R 206 0 R 207 0 R 207 0 R 208 0 R 16 0 obj << >> /Subject (Principle of quaternary prevention) << /Pg 8 0 R (returning of a patient to a status of maximum usefulness with a minimum risk of recurrenceof the disorder) Quaternary prevention In prevention, the bioethical principle of non-maleficence should prevail as we are dealing with healthy or asymptomatic people, and the oath First Do No Harm should guide GPs’ practice.13 P4 implies an attitudinal shift of self-containment, caution, and reassurance of patients’ integrity when dealing with preventive interventions. endobj The sequence continues with quaternary, quinary, senary, septenary, octonary, nonary, and denary, although most of these terms are rarely used.There's no word relating to the number eleven but there is one that relates to the number twelve: duodenary. Action taken to reduce the chronic effects of a health problem in an individual or a population by minimizing the functional impairment consequent to the … /Marked true /P 3 0 R endobj 15 0 obj >> endobj In epidemiological terms, tertiary prevention aims to reduce the number and/or impact of complications. /Type /Group /Pg 15 0 R Verywell Health. >> /Chart /Sect �"S�;E�1��I�խH��ǅE&ib�X$ 2�"i��*ցm�x%qd�dYs3Jp��Ef{X��B�a��Ao��`��ĺ��< ��̫1��N��6�L��ݍb! 13 0 obj /Type /Page endobj endobj /K [141 0 R 142 0 R 143 0 R 144 0 R 145 0 R 146 0 R 147 0 R 268 0 R 149 0 R 269 0 R] /ParentTreeNextKey 19 Quaternary prevention is a “new term for an old concept: first, do not harm” . endobj >> /StructParents 0 Tertiary prevention: lack of availability and affordability of treatment for early stage cancers is a limiting factor in some countries. Quaternary prevention is defined as an action taken to identify patients at risk of overmedicalisation, to protect them from new medical invasion, and to suggest alternative, acceptable care. >> A "higher" level of prevention, however, has recently been suggested. /S /Slide >> << /Pg 7 0 R << /P 3 0 R /Diagram /Figure /ExtGState 286 0 R /Parent 2 0 R /Resources 45 0 R /Nums [0 [71 0 R 72 0 R 73 0 R 74 0 R 75 0 R 76 0 R 77 0 R 78 0 R 79 0 R 80 0 R Though quaternary prevention has been discussed in the context of related endocrine specialties such as diabetology and menopause, , it has not received the much-needed attention it deserves in thyroidology. /S /Slide /XObject 284 0 R 5 0 obj /Type /StructElem Quaternary Prevention. /Lang (es-AR) voor 12+ jongeren Elke jongere ontvangt een uitnodiging voor een onderzoek vanuit de GGD in de onderbouw en in de bovenbouw op de middelbare school. << The concept of quaternary prevention is nothing more than the systematization of the concept of “primum non nocere” in our modern medical practice, an ethical approach to practice better clinical care and to protect people of excess of medicine. 18 0 obj /Group 50 0 R /Font 287 0 R Potential sources of overdiagnosis are disease screening, altering cut-off points for defining a risk factor or a disease, and financial incentives (for example, pay-for-performance schemes).5, An example of controversial P1 is prescription of statins for individuals with 10% cardiovascular mortality risk in 10 years.7 This increases the overdiagnosis effect and offers minimal individual benefit. 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Wonca international dictionary for general/family practice, Quaternary prevention: reviewing the concept, Quaternary prevention: the basis for its operationalization in the doctor–patient relationship, Screening and overdiagnosis: public health implications, Overdiagnosed: making people sick in the pursuit of health, Twenty five year follow-up for breast cancer incidence and mortality of the Canadian National Breast Screening Study: randomised screening trial, Effect of three decades of screening mammography on breast-cancer incidence, Screening for breast cancer with mammography, Type 2 diabetes: updated evidence requires updated decision making, Differentiating clinical care from disease prevention: a prerequisite for practicing quaternary prevention, Yonder: Autism, home visits, suicidal ideation, and young sudden cardiac death, Bullying during COVID-19: the impact on child and adolescent health, http://www.ph3c.org/PH3C/docs/27/000092/0000052.pdf, © British Journal of General Practice 2019. 30 Euston Square >> /P 3 0 R /Contents 46 0 R Background: According to the Wonca International Dictionary for General/Family Practice Quaternary Prevention is defined as: 'Action taken to identify patient at risk of overmedicalization, to protect him from new medical invasion, and to suggest to him interventions, which are ethically acceptable.' 6 [151 0 R 152 0 R 153 0 R 154 0 R 155 0 R 156 0 R 157 0 R 158 0 R 159 0 R 159 0 R] /P 3 0 R << /Tabs /S /Resources 36 0 R ?� 12 0 obj /Parent 2 0 R /RoleMap 17 0 R << /Tabs /S /Type /Pages /Keywords (family medicine; quaternary prevention) endobj endobj /Font 292 0 R Quaternary prevention framework as an organising principle for demedicalisation. endobj << @BJGPjournal's Likes on Twitter !function(d,s,id){var js,fjs=d.getElementsByTagName(s)[0],p=/^http:/.test(d.location)? /K [160 0 R 161 0 R 162 0 R 163 0 R 164 0 R 271 0 R] /Parent 2 0 R 3 0 obj De snelheid van de inactivatie van het rabiësvirus door fysische en chemische omstandigheden wordt echter sterk …