09/22/2017

PREVENTIVE AND SOCIAL MEDICINE mci screening test and indian medical examz high yield important topics study tips

By Live Dr - Wed Feb 11, 3:19 am

PREVENTIVE AND SOCIAL MEDICINE

Demographic cycle

First stage- high stationary High birth rate and a high death rate which cancel each other and the population remains stationary
Second  stage early expanding Death rate begins to decline while birth rate remains unchanged
Third stage late expanding Death rate declines still further and the birth rate tends to fall, population continues to grow, as births exceed deaths
Fourth stage- low stationary This Stage is characterised by low birth and low death rate with the population becomes stationary

Population growth

Stationary population No growth
Slow growth < 0.5
Moderate growth 0.5-1
Rapid growth 1-1.5
Very rapid growth 1.5-2
Explosive growth >2
Pqli-physical quality of life index
Infant mortality rate

Life expectancy at 1 year

Literacy

Hdi-human developmental index
Life expectancy at birth

Knowledge

Purchasing power

Kuppuswami index
Education

Occupation

Income

Malaria Cyclopropogative
Filarial Cyclodevelopmental
Plague Propogative
Yellow fever Propogative

QUOTE CORNER

The pessimist sees difficulty in every opportunity. The optimist sees the opportunity in every difficulty.-Winston Churchill

ELEVENTH HOUR P.S.M.                                                                                                                          74

mosquito type breeding place diseases transmitted
Anopheles Clean stagnant water Malaria
Culex Polluted stagnant water Bancroftian filariasis, Japanese encephalitis, west-Nile fever, viral arthritis.
Aedes Artificial collections of water Dengue, yellow fever, Chikungunya
Mansonites Ponds with aquatic plants Malayan filariasis, Chikungunya.

National malaria eradication program

activity api > 2 API <2
Routine spraying Done Not done
Entomological assessment Done Not done
Active and passive surveillance Done Done
Presumptive and radical treatment Given Given
Follow up smear after 1 year Not done Done
Diseases subject to international health regulations
Plague

Yellow fever

Cholera

Diseases under surveillance by WHO
Paralytic polio

Malaria

Louse borne typhus fever

Relapsing fever

Viral influenza

organization location
ILO, WHO, IRC Geneva
UNICEF, UN, UNESCO New York
FAO Rome

*3 by 5 initiative

Global target by WHO and UNAIDS to provide treatment to 3 million people living with hiv/aids in low income and middle income countries with life prolonging anti-retroviral treatment by the end of 2005.

TRIVIAL TRUTH

The only time the human population declined was in the years following 1347, the start of the epidemic of the plague ‘Black Death’ in Europe.

ELEVENTH HOUR P.S.M.                                                                                                                           75

*UNICEF’S GOBI – FFF program-

Growth monitoring

Oral rehydration

Breast feeding

Immunization

Female education

Family spacing

Food supplements

*Slogan of World Health Day 2007

Invest in health, Build a safer future

Factory
An establishment employing.

10 or more workers where power is used

20 or more where power is not used.

A minimum of 500 cubic feet of space has been prescribed for each worker

Prohibits employment of children below 14 years.

Maximum of 48 hours  working hours per week, not exceeding 9 hours per day, with rest for atleast ½ hour after 5 hours of continuous work

Total number of hours in a week (including overtime) shall not exceed 60 hours.

*Net protein utilization= Digestibility coefficient x Biological value

100

= Nitrogen retained X 100

Nitrogen intake

*Protein Energy Ratio = Energy from protein

Total energy in diet

*Protein efficiency ratio = Weight gain per unit protein consumed

*Amino acid score = mg. of amino acid per gram of protein

=mg. of same amino acid per gram egg protein

QUOTE CORNER

Whenever you are asked if you can do a job, tell them, “certainly, I can.” Then get busy and find out how to do it.-Theodore Roosevelt.

ELEVENTH HOUR P.S.M.                                                                                                                           76

Food toxicity

Neurolathyrism boaA- Lathyrus sativus (kesari dal)
Aflatoxins Hepatotoxicity- -Aspergillus flavus, Aspergillus parasiticus infection of groundnut, tapioaca, cereals.
Ergotism cereals and millets , infected by field fungus claviceps fusiformis
Epidemic dropsy Mustard oil adulterated with argemone oil. Toxins are benzophenanthridine alkaloids- sanguinarine and dihydrosanguinarine. Leg edema with diarrhea.
Endemic ascites Panicum miliare- (gondhli) contaminated with weed seeds of crotalaria (jhunjhunia) – ascites with jaundice.
Fusarium toxin Rice, sorghum, Fusarium incamatum.

New ORS formula

NaCl 2.6 gm
Tri sodium citrate dehydrate 2.9 gm / 10mmol / 30meq
KCl 1.5 gm
Glucose 13.5 gm / 75 mmol

ELECTROLYTE CONENTRATRION IN ORS

Na+

75 mmol

Citrate

10mmol / 30meq

K+

120 mmol

Glucose

75 mmol

Cl

65 mmol

Total

245 mmol

ReSoMal RECIPE
2 litres of water

I packet of WHO-ORS

50g sucrose

40 ml of mineral solution

Plus zinc supplements-20 mg. for 10-14 days

ELECTROLYTE CONENTRATION IN RESOMAL

Na+

45 mmol

K+

40 mmol

Cl

70 mmol

Citrate-

7 mmol / 21 meq

Mg+

3 mmol

Cu++

0.045 mmol

Glucose

125 mmol.

deficiency disease
Zinc Acrodermatitis enteropathica
Selenium Keshan’s disease
Copper Menky’s kinky hair disease.

TRIVIAL TRUTH

Beri Beri originates from the Sinhalese language meaning “I cannot, I cannot”.

ELEVENTH HOUR P.S.M.                                                                                                                         77

VITAMIN A PROPHYLAXIS

Newborn 50000 IU at birth
Children below 12 months 100000 IU at 9 months with MMR  and then every after every 6 months
Children more than 12 months 200000 IU  till 3 years of age
Preganant and lactating women 5000 IU every day

Vaccines

Live attenuated vaccines Killed vaccines
Bcg

Plague

Typhoral

Opv

Yellow  fever     mmr

Epidemic typhus Chicken  pox

Influenza

Typhoid

Cholera

Pertussis

Rabies

ipv

Influenza

Hepatitis b

Plague

Cerebrospinal meningitis.

EPI schedules as recommended by Govt. of India.

Birth -15 days BCG + OPV (ZERO DOSE)
6 weeks -8 weeks OPV1 + DPT1
10 weeks – 12 weeks OPV2 + DPT2
14 weeks – 16 weeks OPV3 + DPT3
9 months (completed) Measles vaccine
15 months-18 months 1st booster of OPV + DPT
4 years -6 years OPV+ DT 2nd booster
10 years Tetanus Toxoid
16 years Tetanus Toxoid
Vaccines contraindicated in HIV/AIDS patient
OPV

Varicella

Rotavirus

MMR

BCG

QUOTE CORNER

Genius is one percent inspiration, ninety-nine percent perspiration.- Thomas edison

ELEVENTH HOUR P.S.M.                                                                                                                         78

*A killed and a live vaccine can be administered simultaneously at different sites.

*2 or more killed vaccines can be given simultaneously or at any interval between doses

Exception- cholera and yellow fever, between these 2 gap of atleast 3-4 weeks is necessary

*2 live vaccines should be given either simultaneously or at a gap of 4 weeks

*Measles, mumps and rubella should not be administered in children who have received immunoglobulin in the previous 3 months

*Live virus vaccines should not be given to patients with congenital immunodeficiencies, immunosuppression.

*Normal siblings of immunocompromised children should not be administered OPV, as it is easily transmitted to the latter

POLIO IMMUNISATION

Pulse polio immunisation 2 doses of OPV are given at an interval of 6-8 weeks, to children less than 5 years of age,on a fixed day, through out the nation, irrespective of their immunisation status
Intensified pulse polio immunisation In the 3 days following ppi ,unimmunised  children are visited in their homes and vaccinated
Mop-up round 2 extra doses of OPV are given to children below 3 years of age irrespective of their immunisation sttatus , within a period of 7-14 days
Ring immunisation Outbreak  response immunisation , carried out around 5 km radius of a case of acute flaccid paralysis.

A minimum of 5000 children under 5 years of age are given 2 doses of OPV at aninterval of 6 weeks.the first dose within 48 hours of notification of a case  of  AFP

Who’s measles elimination strategy

Catch up One time nation wide vaccination campaign targeting usually all children aged 9 months to 14 years regardless of history of vaccination status
Keep up Routine services aimed at vaccinating more than 95 % of each successive birth cohorts
Follow up Subsequent nation wide vaccination campaign conducted every 2-4 years targeting all children born after the catch up campaign

*Bcg vaccine

WHO recommends Danish 1331 strain.

It is reconstituted with normal saline.

The site should not be cleaned with spirit.

Mantoux test becomes positive after 8 weeks.

TRIVIAL TRUTH

The mosquito is the most dangerous animal in the world. 3000 people die each day from Malaria. World wide, 515 million people are infected.

ELEVENTH HOUR P.S.M.                                                                                                                           79

Zoonoses

ZOONOSES CHARACTERISTICS EXAMPLES
Anthropozoonoses Infection transmitted from vertebrate animal to man Rabies, plague, anthrax
Zooanthroponosis Infection transmitted from man to vertebrate animals Human tb in cattle
Amphixenosis Infection maintained in both man and lower vertebrate animals that may be transmitted in either directions T. cruzi

S. japonicum

ZOONOSES

type characteristic
Direct Direct transmission from animal to human with /without mechanical vector / fomite.
Cyclozoonoses More than one vertebrate host present
Metazoonoses Transmitted biologically via invertebrate vector
Saprozoonoses Transmitted via non-animal reservoir
Anthropozoonoses Transmitted via vertebrate vector.

Rabies categorization

category infected by preventive measures
Category 1 Touching / licking intact skin No vaccination
Category 2 Minor scratches/ abrasion, lick on broken skin Only vaccine
Category 3 Bites, scratches, contamination of mucus with licks Immunoglobulin and vaccine
color coding waste category
Yellow Human anatomical waste
Red Microbiology and biotechnology waste
Blue/ White translucent/ Puncture proof can Waste sharps
Black Discarded medicines, incineration ash
WASTE CHARACTERISTICS
Sullage Waste water from domestic sources not containing human excreta
Sewage Waste containing human excreta
Market refuse Solid waste matter from markets containing putrid vegetable and animal matters

QUOTE CORNER

Hard work is straight line and luck is a curved line. Follow the straight line and the curved line will follow you.- Author Unknown

ELEVENTH HOUR P.S.M.                                                                                                                           80

Suggested norms

Primary centre 1/ 30000 population in general areas

1/ 20000 population in tribal, hilly and backward areas

Subcentre 1/ 5000 in general areas

1/ 3000 in tribal, hilly and backward areas

Community centre 1 / 80000 to 1.2 lakhs population
Dai 1 per village
Anganwadi worker 1 per 1000 population
Village health guide 1 / 1000 population or village
CAUSES OF Maternal mortality

( IN DESCENDING ORDER )

Hemorrhage

Anemia

Sepsis

Obstructed labour.

*Baby friendly hospital

The criteria for designation as Baby-Friendly include:

1 Have a written breastfeeding policy that is routinely communicated to all health care staff.

2 Train all health care staff in skills necessary to implement this policy.

3 Inform all pregnant women about the benefits and management of breastfeeding.

4 Help mothers initiate breastfeeding within one half-hour of birth.

5 Show mothers how to breastfeed and maintain lactation, even if they should be separated from their infants.

6 Give newborn infants no food or drink other than breast milk, unless medically indicated.

7 Practice rooming in – that is, allow mothers and infants to remain together 24 hours a day.

8 Encourage breastfeeding on demand.

9 Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants.

10 Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic

*Pearl’s index

Failure rate of contraceptives = Total accidental pregnancies X 1200

Total months of exposure

TRIVIAL TRUTH

If the normal one hundred thousand hairs on a head were woven into a rope, it could support a weight of more than twelve tons.

ELEVENTH HOUR P.S.M.                                                                                                                           81

*Five clean practices for safe delivery

Clean hands

Clean delivery surface

Clean blade,

Clean tie,

No application on cord stump

Leprosy survey

prevalence rate survey type
Low <1/ 1000 Contact
Moderate 1/1000 Group
High >10/1000 Mass

*1 ml IM injection of iodized oil (poppy seed oil)

Provides protection for 4 years against goiter

*Recommended level of fluoride in drinking water is-0.5-0.8 mg/litre

*SAFE strategy for trachoma

s– Trichiasis Surgery

aAntibiotic treatment

fFacial cleanliness

eEnvironmental improvement.

*Variance =  SD2 = sum of squares

n-1

*Coefficient of variation =  sd x 100

Mean

*Standard error of mean =  SD

√n

________________

*Standard error of difference between two means = √  (SD1) 2 (SD2)2

n1 n2

____

*Standard error of proportion = √  PQ

n

QUOTE CORNER

Always remember that your own resolution to succeed is more important than any one thing. – Abrahm Lincoln.

ELEVENTH HOUR P.S.M.                                                                                                                          82

___________

*Standard error of difference of proportions = √  P1Q1 +   P2Q2

n1 n2

*Relative risk   =  incidence in exposed

incidence in not exposed

*Attributable risk = Incidence in exposed – Incidence in not exposed

Incidence in exposed

*Sensitivity = True positive ______________

True positive + false negative

*Specificity = True negative_____________

True negative + false positive

*Positive predictive value = True positive______

True positive + false positive

*Screening time- Time interval between, first possible point and final critical diagnosis

*Lead time- Time interval between first possible time and usual time of diagnosis

data

CHARACTERISTIC

Nominal Cannot be quantified, but divided into qualitative categories, e.g. male-female
Ordinal Data can be arranged in a meaningful order, but difference between the 2 values is not constant, e.g. ranking in a class
Discrete Variables which can take place only certain values but not between them, e.g. number of children immunized in a village
Interval Data can be arrange din meaningful order and the difference between them is meaningful
Continuous Variables can take any value e.g. weight
Median Middle observation when the data is arranged in an ascending or descending order
Mean Average value of an observation
Mode Most commonly occurring value

TRIVIAL TRUTH

While living in Memphis, Tennessee, in 1866-67, Thomas Edison developed a device to electrocute cockroaches.

ELEVENTH HOUR P.S.M.                                                                                                                           83

Mean +/- 1 sd 68.3 %
Mean +/- 2 sd 95.4%
Mean +/- 3 sd 99.7%

*Positive skewing

Mean > median

*Negative skewing

Median > mode

Single blind Participant is not aware whether he belongs to study group or the control group
Double blind Neither the doctor nor the participant is aware
Triple blind Participant, investigator and the person analyzing are unaware.

*Pre-post clinical trial / before -after studies / self-controlled trials

A single set of patients is used and they are studied before and after studies, thus, the patient is his own control

*Berkesonian bias

Due to different rates of admission to the hospital for people with different diseases

*Type I error- the probability of detecting a significant difference when the parameters or treatments are really the same, i.e. the risk of a false positive result.

*Type II error- the probability of not detecting a significant difference when there really is a difference, i.e. the risk of a false negative result.

Primary case First case of communicable disease introduced into the population
Index case First case to come to the attention of the investigators
Secondary case Cases developing from contact with primary case

QUOTE CORNER

Concentrate all your thoughts upon the work at hand. The sun’s rays do not burn until brought to a focus.- Alexander Graham Bell

ELEVENTH HOUR P.S.M.                                                                                                                           84

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