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270 SectiOn ii Public HealtH ScienceS ` PUBLIC HEALTH SCIENCES—HEALTHCARE dELIVERy Public HealtH ScienceS ` PUBLIC HEALTH SCIENCES—HEALTHCARE dELIVERy
` PUBLIC HEALTH SCIENCES—THE WELL PATIENT
Changes in the Sexual changes:
elderly Men—slower erection/ejaculation, longer refractory period, but unchanged libido.
Women—vaginal shortening, thinning, and dryness
Sleep patterns: REM and slow-wave sleep, sleep latency, early awakenings
suicide rate
vision and hearing
immune response
renal, pulmonary, and GI function
muscle mass, fat
Intelligence does not decrease
` PUBLIC HEALTH SCIENCES—HEALTHCARE dELIVERy
Disease prevention
Primary disease Prevent disease before it occurs (eg, HPV vaccination)
prevention
Secondary disease Screen early for and manage existing but asymptomatic disease (eg, Pap smear for cervical cancer)
prevention
Tertiary disease Treatment to reduce complications from disease that is ongoing or has long-term effects
prevention (eg, chemotherapy)
Quaternary disease Quit (avoid) unnecessary medical interventions to minimize incidental harm (eg, imaging studies,
prevention optimizing medications to reduce polypharmacy).
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