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Community Medicine (With Recent Advances)
AH Suryakantha
PART-I: BASIC CONCEPTS IN COMMUNITY MEDICINE
CHAPTER 1:
Introduction to Community Medicine
INTRODUCTION
Hygiene
Preventive Medicine
Social Medicine
Social Anatomy
Social Physiology
Social Pathology
Social Therapy
Community Diagnosis
Community Medicine and Hospital Medicine
CHAPTER 2:
Concept of Health
INTRODUCTION
Physical Dimension
Mental Dimension
Social Dimension
Spiritual Dimension
Emotional Dimension
Vocational Dimension
POSITIVE HEALTH
WELL-BEING
Objective Component
Subjective Component
Human Development Index (HDI)
GDP
HDI
SPECTRUM OF HEALTH
DETERMINANTS OF HEALTH
Genetic (Biological) Factors
Environmental Factors
Life Style: (Way of Living)
Socio-economic Conditions
Education
Occupation
Income
Health Services
Aging of the Population
Other Factors
INDICATORS OF HEALTH
Uses
Mortality Indicators
Morbidity Indicators
Nutritional Status Indicators
Health Care Delivery Indicators
Indicators of Social and Mental Health
Socio-Economic Indicators
Health Policy Indicators
Environmental Indicators
Indicator of Quality of Life
Other Indicators
CHAPTER 3:
Concept of Disease
INTRODUCTION
THEORIES OF DISEASE CAUSATION
Old Theories
Germ Theory of Disease
Limitations of Germ Theory
EPIDEMIOLOGICAL TRIAD
Theory of Multifactorial Causation (Web of Causation)
NATURAL HISTORY OF DISEASE
Pre-pathogenesis Phase
Agent Factors
Host Factors
Environmental Factors
Risk Factors
Risk Groups (Susceptible Population)
Pathogenesis Phase
ICEBERG PHENOMENON OF DISEASE
CHAPTER 4:
Concept of Prevention
INTRODUCTION
PRIMARY PREVENTION
Health Promotion
Specific Protection
PRIMORDIAL PREVENTION
Population Strategy
High Risk Strategy (Individual Strategy)
SECONDARY PREVENTION
Early Diagnosis and Prompt Treatment
TERTIARY PREVENTION
Disability Limitation
Rehabilitation
PART-II: ENVIRONMENT AND HEALTH
CHAPTER 5:
Water
INTRODUCTION
Physical Environment
Biological Environment
Social Environment
Cultural Environment
WATER
WATER CYCLE
Merits of Ground–Water
Demerits of Ground–Water
WELL
Shallow Well
Deep Well (Driven Well)
Differences between Shallow Well and Deep Well
Artesian Well
Sanitary Well
Location
Construction
Protection
HEALTH HAZARDS OF WATER CONTAMINATION
Biological Hazards
Chemical Hazards
PURIFICATION OF WATER
Purification of Water on Large Scale
Storage
Filtration
Modified Filters
Differences between slow sand filters and rapid sand filters
Chlorination
Action of Chlorine
Principles of Chlorination
Orthotoluidine Test
Procedure
Ozonation
Ultra-violet Irradiation
Purification of Water on Small Scale
Household Purification of Water
Disinfection of Wells
Horrock's Apparatus
Procedure
Procedure of Disinfection of Well
Continuous Method of Chlorination
Sanitation of the Swimming Pool
Sanitation Measures
Maintenance of Cleanliness
HARDNESS OF WATER
Definition
Causes
Types
Measurement
Grading of Hardness of Water
Advantages of Hard-water
Disadvantages of Hard-water
Removal of Hardness
CONSERVATION OF WATER RESOURCES
Protection of Water Resources
Building up of Sub-soil Water Reserves
SANITARY ANALYSIS OF WATER
Field Survey
Laboratory Examination of Water Samples
Collection of Sample of Water
Sampling Technique
Laboratory Examination of Water
Physical Examination of Water
Chemical Examination of Water
Biological Examination of Water
Bacteriological Examination of Water
Fecal Streptococci
Clostridium Perfringens
Plate Count (Colony Count)
Standard Tests for Members of Coliform Group
Interpretation of Results of Disinfected Water
Tests for the Presence of Fecal Streptococci and CI. perfringens
Radiological Examination of Water
Virological Examination of Water
CHAPTER 6:
Air and Ventilation
INTRODUCTION
Changes in the Air Due to Human Occupancy
EFFECTS OF VITIATED AIR
INDICATORS OF THERMAL COMFORT
Air Temperature
Air Temperature and Humidity
Air Temperature, Humidity and Air Movement
Effective Temperature (ET)
Corrected Effective Temperature (CET)
McArdle's Maximum Allowable Sweat RATE
Comfort Zone
AIR POLLUTION
Air Pollutants
Chemical Pollutants
Biological Pollutants
Sun Light
Temperature Inversion
Sources of Air Pollution
Hazards of Air Pollution
Immediate and Acute Effects
Delayed and Chronic Effects
Global Effects of Air Pollution
Indicators of Air Pollution
Prevention and Control of Air Pollution
VENTILATION
Standards of Ventilation
Systems of Ventilation
Artificial Ventilation (Mechanical ventilation)
CHAPTER 7:
Noise
INTRODUCTION
Noise Level Values
Instruments used in the Study of Noise
HAZARDS OF NOISE POLLUTION
Auditory Effects
Quantifiable
Nonquantifiable
Nonauditory Effects
PREVENTION AND CONTROL OF NOISE POLLUTION
Control of Noise at Source
Increasing the Distance
Reduction of Exposure Time
Acoustic Barrier
Miscellaneous Measures
CHAPTER 8:
Light
INTRODUCTION
MEASUREMENT OF LIGHT
Natural Lighting
Measures to Improve Natural Lighting
Artificial Lighting
Other Sources of Artificial Light
HEALTH HAZARDS OF LIGHTING
Biologic Effects
CHAPTER 9:
Radiation
INTRODUCTION
NONIONISING RADIATIONS
Ultraviolet Rays
Sources
High Risk Persons
Hazards
On the Skin
On the Eyes
Prevention
Visible Light
Hazards
Poor Lighting
Bright Light
Infrared Rays
Hazards
Micro-waves
Radiofrequency Waves
Laser Radiations
IONISING RADIATIONS
Electromagnetic Radiations
Corpuscular Radiations (Particulate Radiations)
Radiation Units
Treatment
Epidemiological Points
PREVENTION AND CONTROL OF RADIATION HAZARDS
Primary Prevention
Safety of the Machine
Safety of the Worker
Safety of the Environment
Other Measures
Secondary Prevention
CHAPTER 10:
Housing
INTRODUCTION
HOUSING STANDARDS
HOUSING AND HEALTH
INDICATORS OF HOUSING
Physical Indicators
Economic Indicators
Social Indicators
Housing Problem
MEASURES TO SOLVE THE HOUSING PROBLEM
CHAPTER 11:
Meteorology
INTRODUCTION
ATMOSPHERIC PRESSURE
Aneroid Barometer
Barograph
Effects on Health
Effects of Diminished Atmospheric Pressure
Effects of Increased Atmospheric Pressure
Management
AIR TEMPERATURE
Measurement
Health Hazards of Air Temperature
Effects of High Temperature
Prevention of Effects of High Temperature
Treatment
Preventive Measures
HUMIDITY
Absolute Humidity
Relative Humidity (RH)
Measurement
Dry and Wet Bulb Hygrometer
Sling Psychrometer
AIR MOVEMENT
CHAPTER 12:
Disposal of Wastes
METHODS OF REFUSE DISPOSAL
Dumping
Controlled Tipping (Sanitary Landfill)
Composting
Manure Pits
Burial
Incineration
Recycling of Refuse
DISPOSAL OF EXCRETA
Sanitation Barrier
Methods of Disposal of Excreta (Night Soil)
Bore Hole Latrine (Earth Pit Deep Latrine)
Merits
Demerits
Dug Well or Pit Latrine
Merits
Water Seal Type of Latrines
Trap
PRAI Type Latrine
Sulabh Shauchalaya
Septic Tank Latrine
Aqua Privy (Aqua-Water; Privy-Latrine)
Chemical Closet
Sanitary Temporary Latrines for Fair, Mela, Camp, Etc.
Bio-gas Plant
Merits of Bio-gas Plant
Composting
WATER CARRIAGE SYSTEM (SEWERAGE SYSTEM)
House Drainage
Water Closet
Soil Pipes
House Drain
Public Sewer
Sewer Appurtenances
DISPOSAL OF SULLAGE
Sokage Pit
DISPOSAL OF SEWAGE (OR SEWAGE TREATMENT)
Objectives of Sewage Treatment
Biochemical Oxygen Demand (BOD)
Chemical Oxygen Demand (COD)
Suspended Solids
Primary Treatment
Secondary Treatment
Primary Treatment
Secondary Treatment
Advantages of Activated Sludge Process
Secondary Sedimentation
Sludge Digestion
Other Methods of Sewage Disposal
Sewage Dilution
Sewage Lagoon
Sewage Farming
CHAPTER 13:
Management of Hospital Waste
INTRODUCTION
Characteristics of Health Care Waste
Quantity of Health Care Waste
THE OBJECTIVES OF THE WASTE MANAGEMENT SYSTEM
Safe Waste Management Practices Helps
LEGISLATIVE FRAMEWORK
Categories of Waste
Norms of the Color Coding Containers (Table 13.1)
STRATEGIES ADOPTED FOR HOSPITAL WASTE MANAGEMENT
Waste Reduction and Management Strategy
Waste Assessment Strategy
Waste Recycling Strategy
Hospital Waste Disposal
Collection of Wastes
Source Segregation
Transportation
Storage
Treatment
AVAILABLE TREATMENT AND DISPOSAL TECHNOLOGIES
Newer Technologies
EXISTING AVAILABLE TECHNOLOGIES
Incineration (or Mass Burn Technology)
Operating Standards
Emission Standards
Note:
Chemical Disinfection
Wet and Dry Thermal Treatment
Wet Thermal Treatment (Autoclaving)
Dry Thermal Treatment (Screw-feed technology)
Deep Burial
Land Filling
Worm Composting
Microwave Irradiation
Inertization
Hydroclave
DOs AND DONTs OF HEALTH CARE WASTE DOs
DONTs
Waste Sharps Management
Decontamination Procedure
Chemical Treatment
Autoclaving
Plastic Waste Management
SUMMARY
CHAPTER 14:
Medical Entomology
CLASSIFICATION OF ARTHROPODS
ARTHROPOD BORNE DISEASES
Common Terms used in Entomology
a. Incomplete Metamorphosis: (Hemimetabola)
b. Complete Metamorphosis: (Holometabola)
PRINCIPLES OF ARTHROPOD CONTROL
Arthropods of Public Health Importance
I. MOSQUITOES
Morphology
Head
Thorax
Wings
Halters
Legs
Abdomen
Life Cycle and Life Habits
Egg Stage
Larva Stage
Head
Thorax
Abdomen
Pupa Stage
Adult Stage
CLASSIFICATION OF MOSQUITOES
Control of Mosquitoes
Remote Sensing in Vector Control
Integrated Vector Control
II. FLIES
1. House Fly (Musca Domestica)
Head
Thorax
Abdomen
Life Cycle
Egg
Larva
Pupa
Adult
Bionomics
MECHANISM OF TRANSMISSION OF DISEASES
External Carriage System
Internal Carriage System
Control Measures
2. SAND FLY
Life History
Egg Stage
Larva Stage
Pupa Stage
Control Measures
3. TSETSE FLY (GLOSSINA)
Morphology
Life History
Control Measures
4. BLACK FLY
III. FLEAS
Rat Fleas
Morphology
Head
Thorax
Abdomen
Life History
Breeding Places
Egg Stage
Larval Stage
Pupal Stage
Adult Stage
Modes of Transmission of Disease
Biologically
Mechanically
By Defecation
Flea Indices
Control Measures of Fleas
IV. LICE
Morphology
Head
Thorax
Abdomen
Life Cycle
Egg Stage
Larva or Nymph Stage
Adult (Imago) Stage
Diseases Transmitted
Pubic Louse: (Pthirus Pubis; Crab Louse)
Control Measures of Lice
V. BUGS
Bionomics
Control Measures
Cruzi
Morphology
Life Cycle
Control Measures
I. TICKS
Morphology
Life Cycle
Control Measures
II. MITES (CHIGGERS)
A. Trombiculid Mites: (Harvest Mites)
Life Cycle
Egg Stage
Larva Stage
Nymph Stage
Adult Stage
Diseases transmitted
Control Measures
B-ITCH Mites (Sarcoptes scabiei: Acarus scabiei)
Morphology
Life Cycle
Control Measures
C. Other Mites
a. Dust Mite (Dermatophagoides Pteronyssinus)
b. Blood Sucking Mite
CYCLOPS (WATER FLEA)
Morphology
Life Cycle
Control Measures of Cyclops
DISINFECTION
INSECTICIDE TOXICITY
A. Organo-chlorine Compounds
Treatment
B. Organo-phosphorus Compounds and Carbamates
Treatment
C. Pyrethrins and Pyrethroids
CHAPTER 15:
Nutrition and Health
INTRODUCTION
CLASSIFICATION OF FOODS
NUTRIENTS
PROTEINS
Supplementary Actions of Proteins
Functions of Proteins
Daily Requirement
Mixed Vegetable Proteins (Vegetable Blends)
Evaluation (Assessment) of Proteins
Digestibility Coefficient (DC)
Biological Value (BV)
Net Protein Utilization (NPU)
Essential Amino Acid Score (Chemical score)
Protein Efficiency Ratio (PER)
Protein Energy Ratio
FATS
Sources of Fats
Functions
Hydrogenation of Oils
Refined Oils
Daily Requirement
Applied Aspects
CARBOHYDRATES (CHO)
Functions
Sources
CHO and Disease
Dietary Fiber
Functions
FAT SOLUBLE VITAMINS
Vitamin A
Functions
Sources
Animal Sources (as retinol)
Vegetable Sources (as β -carotene)
Extra-occular Manifestations
Assessment of Vitamin A Deficiency
Hypervitaminoses A
Vitamin D
Functions
Sources
Deficiency
Rickets
Investigations
Osteomalacia
Daily Requirement
Hypervitaminosis D
Vitamin E (Tocopherol)
Vitamin K
WATER SOLUBLE VITAMINS
Vitamin B Complex Group
Thiamine (Vitamin B1)
Deficiency
Riboflavin (Vitamin B2)
Sources
Deficiency
Niacin (Nicotinic Acid) (Vitamin B4)
Functions
Sources
Deficiency
Pyridoxine (Vitamin B6)
Deficiency
Folic Acid (Pteroylglutamic acid; folacin) (Latin, folia = leaf)
Cyanocobalamin (Vitamin B12)
Sources
Vitamin C (Ascorbic Acid)
Sources
MINERALS
Calcium
Iron
Recommended daily requirement (or absorption)
Iodine
Sources
Iodine Cycle
Grading of Goiter (WHO 1994)
Fluorine
Laboratory Investigations
Fluoride Testing
Prevention and Control
OTHER TRACE ELEMENTS
Zinc
Copper
Cobalt
Chromium
Selenium
Ultratrace Minerals
Antioxidants
FOOD GROUPS
Cereals
Rice
Milling
Parboiling
Effect of Parboiling
Wheat
Maize (Corn; Bhutta)
Millets
Jowar (Sorghum; Kaffir Corn; Milo)
Ragi
Pulses (Legumes)
Vegetables
Green Leafy Vegetables (GLVs)
Other Vegetables
Roots and Tubers
Nuts and Oil Seeds
Groundnuts (Peanuts; Monkey Nuts)
Fruits
Milk and Milk Products
Milk Products
Types of Milk (Derived Milks)
Milk Standards
Egg, Meat and Fish
Egg
Fish
Meat
Fats and Oils
Sugar and Jaggery
Condiments and Spices
Miscellaneous
Coffee, Tea and Cocoa
Soft Drinks
Alcoholic Beverages
Salt
ENERGY REQUIREMENTS
BALANCED DIET
Suggested Substitution for Nonvegetarians
Additional Allowances During Pregnancy and Lactation
Food Hygiene
FOOD ADDITIVES
FOOD PRESERVATION
Objectives
Principles of Food Preservation
Methods of Food Preservation
FOOD PROCESSING
SANITATION OF FOOD ESTABLISHMENTS (RESTAURANTS, EATING HOUSES)
CONSERVATION OF NUTRIENTS
Before Cooking
During Cooking
After Cooking
FOOD FORTIFICATION
FOOD ADULTERATION
Tests for Adulterants
Physical Tests
Chemical Tests (for the following adulterants)
Prevention and Control of Food Adulteration
Food Standards
Legal Measures
MILK HYGIENE
Pasteurization
Methods of Pasteurization
Holder method (Vat process; Holding process)
HTST method (High Temperature and Short Time process; Flash process)
UHT method (Ultra High Temperature Process)
Sterilization
MEAT HYGIENE
Inspection of Animals (Antemortem Examination)
Slaughter Houses
Inspection of Fish
Tinned Meat and Fish
FOOD ALLERGY
FOOD RELATED DISEASES
Deficiency Diseases
PROTEIN ENERGY MALNUTRITION (PEM)
a. Welcome's Classification
b. Gomez Classification
c. Jelliffe's Classification
d. Indian Academy of Pediatrics (IAP) Classification
e. Waterlow's Classification
Prevention and Control of PEM in the Community
VITAMIN DEFICIENCY DISESES
MINERAL DEFICIENCY DISEASES
Prevention and Control of Nutritional Anemia
Motive
Iodine Deficiency Disorders (IDDs)
Hazards of Iodization
Excess of Food Consumption
FOOD BORNE INTOXICATIONS
Confirmation of the Epidemic
Detection of Argemone Oil (Sanguinerine) in Mustard Oil
Endemic Ascites
Toxic Polyphenols
Aflatoxicosis
Ergotism
FOOD POISONING
FOOD BORNE DISEASES
ASSESSMENT OF NUTRITIONAL STATUS
DIET SURVEY
Oral Questionnaire Method
Questionnaire Method
Food Inventory or Log Book Method
Food List Method
Weighment of Raw Foods
Weighment of Cooked Foods (Recipe method)
Analysis of the Cooked Food
Availability of Health Services
INDICATORS OF MALNUTRITION
NUTRITIONAL SURVEILLANCE
NATIONAL NUTRITION POLICY
Introduction
Strategies
Direct Short-term Strategies
Indirect Long-term Strategies
Implementation
National Programs on Nutrition
ANNEXURE
CHAPTER 16:
Occupational Health
INTRODUCTION
Aims
Objectives
ERGONOMICS
Working (Occupational) Environment
OCCUPATIONAL HAZARDS
Physical Hazards
Chemical Hazards
Biological Hazards
Mechanical Hazards
Psychosocial Hazards
Other Hazards
PNEUMOCONIOSES
Silicosis
Importance
Pathology and Pathogenesis
Incubation Period
Clinical Features
Diagnosis
Complications
Management
Anthracosis (Coal-workers' Pneumoconiosis)
Pathology
Pathogenesis
Asbestosis
Clinical Features
Byssinosis
Bagassosis
Farmer's Lung
Prevention of Control of Pneumoconioses
Mass Sociogenic Illness
LEAD POISONING (PLUMBISM)
Sources of Lead
Absorption, Storage and Elimination
Clinical Features of Plumbism
Inorganic Lead Poisoning
Organic Lead Poisoning
Other Epidemiological Features
Diagnosis
Management
Prevention and Control
Health Promotion
Specific Protection
Early Diagnosis and Treatment
Disability Limitation
Rehabilitation
Prevention of Plumbism among Children
Metal Fume Fever (Brass Founder's Ague)
OCCUPATIONAL CANCERS
Agent Factors
Environmental Factors
Influencing Factors
Features of Occupational Cancers
Health Promotion
Specific Protection
Early Diagnosis and Treatment
Disability Limitation
Rehabilitation
OCCUPATIONAL DERMATOSES
Host Factors
Prevention
Health Promotion Measures
Specific Protection
Early Diagnosis and Prompt Treatment
OCCUPATIONAL HEALTH IN AGRICULTURAL INDUSTRY
Prevention and Control of Agricultural Hazards
HAZARDS DUE TO INDUSTRIALIZATION AND URBANIZATION
Physical (Environmental) Hazards
Psychological Hazards
Social Hazards
Miscellaneous Hazards
ACCIDENTS IN INDUSTRIES
Following Factors are Responsible for Accidents
Causes
Human Factors
Environmental Factors
Prevention
OFFENSIVE TRADES AND OCCUPATIONS
Keeping of Animals
Slaughtering of Animals
Blood Boiling and Drying
Bone Boiling and Crushing
Gut Scraping
Fat and Tallow Melting (Soap Making)
Fellmongering
Tanning
Paper Mills
Oil Mills
Rice Mills
SICKNESS ABSENTEEISM
Extent of the Problem
Causes (Factors Influencing)
Preventive Measures (Reduction Measures)
WOMEN IN INDUSTRY
Menstruation and Dysmenorrhea
Pregnancy
Menopause
Ability of Women to Work
HEALTH STATUS OF INDUSTRY
PREVENTION AND CONTROL OF OCCUPATIONAL HAZARDS
Primary Prevention
Health Promotion of Workers
Specific Protection
Secondary Prevention
Tertiary Prevention
LEGISLATION
Indian Factories Act, 1948
Employees’ State Insurance ACT, 1948
Scope
Administration
Finance
Benefits to Employees
Sickness Benefit
Maternity Benefit
Disablement Benefit
Dependent's Benefit
Funeral Benefit
Medical Benefit
Miscellaneous Medical Benefits
Cost of Medical Benefit
Rehabilitation Benefit
Benefits to Employers
Workmen's Compensation Act, 1923
SOCIAL SECURITY
Social Insurance
Social Security for Industrial Workers
The Social Security for Civil Servants
The Social Security for General Public
Social Assistance
Difference between Social Insurance and Social Assistance
PART-III: EPIDEMIOLOGY
CHAPTER 17:
Principles and Practice of Epidemiology
DEFINITION
Events
Population
Distribution
Determinants
Disease Frequency
OBJECTIVES OF EPIDEMIOLOGY
EPIDEMIOLOGICAL APPROACH
SCOPE OF EPIDEMIOLOGY
Measurements in Epidemiology
Rate
Ratio
Proportion
MEASUREMENT OF MORBIDITY
Incidence
Related Terms
Attack Rate
Formula
Secondary Attack Rate
Formula
Hospital Admission Rate
Prevalence
Differences between Incidence and Prevalence
PREVALENCE RATE
MEASUREMENT OF MORTALITY
Crude Death Rate (CDR)
Definition
Specific Death Rate
Group Specific Death Rate
Case Fatality Rate (CFR)
Proportional Mortality Rate (PMR)
Survival Rate
Standardized Death Rate (Adjusted Death Rate)
Direct Standardization
Steps
Indirect Standardization
EPIDEMIOLOGICAL STUDIES (METHODS)
Observational Studies
Descriptive Studies (Descriptive Epidemiology)
Common Source Repeated/ Continuous Exposure Epidemic
Propagated Epidemic
Modern or Slow Epidemics
Periodic Fluctuations
Seasonal Trend
Cyclic Trend
Long Term Fluctuations: (Secular Trend)
Place Distribution
International Variations
National Variations
Rural-Urban Variations
Local Distribution of the Disease (in an Area)
Person Distribution
Age
Sex
Marital Status
Occupation
Social Class
Behavior
Stress
Migration
Measurement of Disease
Making Comparison with Known Indices
Formulation of Etiological Hypothesis
Uses of Descriptive Epidemiology
Analytical Studies (Analytical Epidemiology)
Case—Control Study
Study–Design
Selection of Cases
Selection of Controls
Matching
Matching Procedures
Measurement of Exposure in Both the Groups
Analysis
Frame Work of Case-Control Study
The Study Tests the Hypothesis “Smoking Predisposes to Lung Cancer”
Cohort Study
Study Design
Types of Cohort Studies
Prospective Cohort Study
Retrospective Cohort Study (Historical Cohort Study)
Combination of Retrospective and Prospective Cohort Studies
Steps in Cohort Study
Schematic Representation of Case-Control Study and Cohort Studies
Selection of Study Cohorts (or Exposure Cohorts)
Selection of Control Cohorts (or Unexposure Cohorts)
Follow-up
Analysis
Frame Work of Cohort Study
Frame Work
Relative Risk (Risk Ratio; RR)
Risk Difference (RD)
Attributable Risk (AR)
Absolute Risk
Population Attributable Risk (PAR)
Population Attributable Risk Proportion (PARP)
Advantages and Disadvantages of Cohort Studies
Advantages
Disadvantages
Differences between Case-control and Cohort Studies
EXPERIMENTAL EPIDEMIOGY (EXPERIMENTAL EPIDEMIOLOGICAL STUDIES)
Clinical Trial (Randomized Controlled Trial) (RCT)
Types of Study Designs
Field Trial
Community Trail
Non-Randomized Trials
Uncontrolled Tails
Natural Experiments
Before and After Comparison Trials
ASSOCIATION AND CAUSATION
Spurious Association
Indirect Association
Direct (Causal) Association
One to One Causal Relationship
Multifactorial Causation
Additional Criteria for Judging Causalty
Temporal Association
Strength of the Association
Specificity of the Association
Consistency of the Association
Biological Plausibility
Coherence of the Association
USES OF EPIDEMIOLOGY
CHAPTER 18:
Infectious Disease Epidemiology
COMMONLY USED TERMS
THE SURVEILLANCE SYSTEM
Improvement in the Surveillance System
DYNAMICS OF DISEASE TRANSMISSION
Reservoirs are of Three Types—Human, Animal and Soil
I. Human Reservoir
Classification
II. Routes of Transmission
III. Susceptible Host
INCUBATION PERIOD
Related Terms
INVESTIGATION OF AN EPIDEMIC
Importance
Objectives
Steps
PREVENTION AND CONTROL OF AN EPIDEMIC DISEASE
IMMUNIZING AGENTS
1. Vaccines
2. Immunoglobulins
3. Anti-sera
Chemoprophylaxis
Hazards of immunization
IMMUNIZATION PROGRAM
The objectives of UIP were
The strategy under UIP was
Appraisal Points
COLD CHAIN
Definition
Importance
1. Walk in Coolers
2. Cold Box
3. Deep Freezer
4. Ice-Lined Refrigerator (ILR)
Refrigerator (Conventional)
DOs
DON'Ts
Instructions
6. Vaccine Carrier
ESTIMATION OF REQUIREMENTS FOR IMMUNIZATION
ESTIMATION OF VACCINE EFFICACY
SCREENING FOR DISEASE
Aims
Objectives
Uses
Types of Screening
Criteria for Screening
Disease
Screening Test
Diagnosis
Screening Test Result
Interpretation
Exercise
DISINFECTION
Allied Terms
TYPES OF DISINFECTION
Prophylactic Disinfection (Pre-current Disinfection):
Concurrent Disinfection (Concomitant Disinfection)
Terminal Disinfection
CLASSIFICATION OF DISINFECTANTS
Solid Disinfectants
Uses
Liquid Disinfectants
Coaltar Disinfectants
Quaternary Ammonia Compounds
Iodine
Hydrogen Per Oxide
Alcohol (Spirit)
Formalin
Gaseous Disinfectants
STANDARDIZATION OF DISINFECTANT
Miscellaneous Disinfectants
DISINFECTION PROCEDURES
High Level of Disinfection
HOSPITAL ACQUIRED INFECTIONS (NOSOCOMIAL INFECTIONS)
Definition
Causes
Sources and Reservoirs of HAI
Mode of Transmission
Prevention and Control of Nosocomial Infections (HAI)
I. Elimination of the Reservoirs or Sources
II. Breaking the Channel of Transmission
III. Protection of Susceptible Persons
Administrative Measures
EMPORIATRICS
Health Problems of Travelers
Problems Faced by Travelers
Health Advice to Travelers
International Health Regulations
CHAPTER 19:
Epidemiology of Communicable Diseases
STORY OF SMALLPOX (VARIOLA MAJOR) (OBITUARY)
HUMAN MONKEY-POX
CHICKEN-POX
Chicken-pox (Varicella; Water-pox)
Host Factors
Pregnancy
Environmental Factors
Modes of Transmission
Pathology and Pathogenesis
Incubation Period
Clinical Features
Complications
Management
Prevention
Active Immunization
Contraindications
Passive Immunization
ACUTE RESPIRATORY INFECTIONS (ARI)
Magnitude of the Problem
Classification of ARI
Etiological Classification
Anatomical Classification
Etiology
Host Factors
Environmental Factors
Social Factors
Prevention and Control of ARI
Health Promotion
Specific Protection
Eary Diagnosis and Prompt Treatment
Dose Schedule
Supportive Treatment at Primary Health Care Level
MEASLES (MORBILLI; RUBEOLA)
History
Extent of the Problem
Agent Factors
Reservoir of Infection
Host Factors
Complications
Management with Nursing Care
Prevention and Control
Measles Vaccine
Nature
Indication
Composition
Adverse Effects
Vaccine of Multiple Antigen: (Combined Vaccine)
Passive Immunization
Other Points
GERMAN MEASLES (RUBELLA)
History
Clinical Features
Complications
Diagnosis
Congenital Rubella (Rubella Syndrome)
Prevention
Active Immunization
Monovalent Rubella Vaccines
Combined Vaccine
Passive Immunization
MUMPS
Host Factors
Clinical Features
Complications
Prevention and Control
INFLUENZA
Magnitude of the Problem
History
Agent Factors
Agent
Host Factors
Environmental Factors
Clinical Features
Treatment
Prevention and Control
Hurdles in the Control
DIPHTHERIA
Agent Factors
Host Factors
Modes of Transmission
Portal of Entry
Pathology and Pathogenesis
Clinical Features
Shick Test
Procedure
Interpretation
Treatment
Prevention and Control of Diphtheria
Immunization
DPT Vaccine (Triple antigen)
Instructions to the Parents
Community Diagnosis of Diphtheria
WHOOPING COUGH (PERTUSSIS)
Agent Factors
Reservoir
Infective Material
Period of Infectivity
Host Factors
Age Incidence
Sex Incidence
Immunity
Environmental Factors
Mode of Transmission
Incubation Period
Pathology and Pathogenesis
Clinical Features
Catarrhal Stage
Paroxysmal Stage (Spasmodic stage)
Convalescent Stage
Complications
Management
Prevention
MENINGOCOCCAL MENINGITIS (OR CEREBROSPINAL FEVER OR CEREBROSPINAL MENINGITIS)
Distribution
Agent Factors
Causative Agent
Reservoir of Infection
Infective Material
Host Factors
Age and Sex Incidence
Immunity
Environmental Factors
Period of Communicability
Pathogenesis
Incubation Period
Clinical Features
Prognosis
Prevention and Control of Epidemic Meningitis
HEMOPHILUS INFLUENZA MENINGITIS
TUBERCULOSIS (TB)
Memorable Discoveries and Mile-stones
Tuberculosis
Indian Scenario
Daily Burden in India
Points of Serious Concern
Epidemiological Indices (Measurement of TB)
Frequency of Infection
Frequency of Disease
Prevalence of Drug Resistant Cases
TB Mortality Rate (Specific Death Rate Due to TB)
Agent Factors
Reservoir of Infection
Infective Material
Period of Infectivity
Host Factors
Age Incidence
Sex Incidence
Heredity
Nutrition
Socio-environmental Factors
Immunity
Mode of Transmission
Incubation Period
Pathology and Pathogenesis
Clinical Features
Complications
Investigations
Sputum Examination
X-ray of the Chest
Tuberculin Test (Mantoux Test; PPD Test)
Interpretation of the Reaction
Prevention and Control of Tuberculosis
Elimination of Reservoirs
Chemotherapy
First Line Drugs
Bactericidal Drugs
Bacteriostatic Drugs
Second Line Drugs
Phases of Chemotherapy
Intensive Phase
Continuation Phase
Domiciliary Treatment
Treatment Regimens
Short Course Chemotherapy (SCC)
Advantages of SCC (Compared to Long Course Chemotherapy)
Disadvantage
Breaking the Channel of Transmission
Protection of Susceptibles
General Measures
Specific Measure
BCG Vaccine
Nature
Indication
Diluent
Dose
Route
Schedule
Immunity
Complications
Multi Drug Resistant – TB (MDR – TB)
Risk Factors for Developing MDR-TB
Diagnosis
Investigations
Principles of Management
Prognosis
Limitations of MDR-TB Treatment
Control of MDR-TB
Newer Anti-TB Drugs
Review on National TB Control Program (NTCP)
Revised National Tuberculosis Control Program (RNTCP)
RNTCP
Strategies: (To achieve the above objectives)
DOTS
POINTS ON RNTCP TREATMENT
Functions of TU
Screening of Contacts
TUBERCULOSIS AND HIV
Magnitude of the Problem
CHAPTER 20:
Epidemiology of Noncommunicable Diseases and Accidents
TYPHOID FEVER
Milestones
Magnitude of the Problem
Agent Factors
Causative Agent
Reservoir of Infection
Treatment of Carriers
Prevention of Carrier State
Source of Infection
Infective Material
Period of Communicability
Age Incidence
Sex Incidence
Immunity
Environmental Factors
Predisposing Factors (Social Factors)
Mode of Transmission
Pathology and Pathogenesis
Ileum
Spleen
Gallbladder
Incubation Period
Clinical Features
Investigations
Complications
Treatment
Prevention and Control of Typhoid Fever
Elimination of Reservoir
Breaking the Channel of Transmission
Protection of Susceptibles
• Cellular Extract Vaccine
ACUTE DIARRHEAL DISEASES
Magnitude of the Problem
Global
India
Causes of Diarrhea
Infectious diarrhea
Viruses
Reservoir
Age Incidence
Sex Incidence
Environmental Factors
Predisposing Factors
Mode of Transmission
Related Terms
Secretory Diarrhea
Osmotic Diarrhea
Effects of loss of fluids and electrolytes
Incubation Period
Clinical Features
Degree of Dehydration
TREATMENT PLAN A (Prevention of dehydration)
Best HAF is “Salt – Sugar Solution” (SSS)
TREATMENT PLAN B: (Correction of “some” dehydration)
Limitations of ORT
Maintenance of hydration: (i.e. by Treatment Plan A)
TREATMENT PLAN C (Treatment of severe dehydration)
Dosage of IV Fluids
Prevention and Control of Diarrheal Diseases
Elimination of Reservoirs
Restoration of nutritional status
Breaking the channel of transmission
Protection of susceptibles by the following measures
Newer Anti-diarrheal Vaccines
ORT – Corner
CHOLERA
History
Magnitude of the Problem
Epidemiological Features
Agent Factors
Causative Agent
Serological classification (Gardner and Venkataraman's classification)
Period of infectivity
Reservoir of infection
Age and Sex
Environmental Factors
Season
Climate
Modes of transmission
Predisposing Factors
Pathology and Pathogenesis
Incubation Period
Clinical Features
Differences between Cholera and Food Poisoning
Laboratory Investigations
Method of Collection of Stools
Method of Collection of Water
Culture
PREVENTION AND CONTROL OF CHOLERA
VIRAL HEPATITIS
Hepatitis A
Magnitude of the Problem
Agent Factors
Causative Agent
Host Factors
Pathology and pathogenesis
Pre-icteric Stage (Prodromal stage)
Convalescent stage (Stage of recovery)
Investigations
Prevention and Control of Hepatitis A
Elimination of Reservoirs
Management
Breaking the Channel of Transmission
Prevention of Susceptibles
Immunization
Hepatitis B
Synonyms
Magnitude of the Problem
Agent Factors
Host Factors
Modes of Transmission
Prevention and Control of Hepatitis B
Elimination of Reservoir
Blocking the channel of transmission
Protection of susceptibles
Pregnant Mother, Newborn, Hepatitis B Vaccine
Hepatitis C
Hepatitis D
Hepatitis E
Hepatitis G
POLIOMYELITIS
(Greek: Polio = grey, Muellos = marrow)
History
Magnitude of the Problem
Agent Factors
Causative Agent
Reservoir of Infection
Infective Materials
Period of Infectivity
Host Factors
Age
Sex Incidence
Immunity
Environmental Factors
Risk Factors (Provocative factors)
Modes of Transmission
Pathology and Pathogenesis
Clinical Spectrum
Polio-encephalitis
Bulbar Poliomyelitis
Diagnosis
Management
Hydrotherapy (Treatment in swimming pool)
Prevention and Control
Immunization
Active Immunization
Inactivated Polio Vaccine (IPV)
Merits
Demerits
Modified IPV
Oral Polio Vaccine
Composition
Route
Schedule
Mechanism of protection
Advantages of OPV
Associated Risk
Contraindications
Storage
Instructions to the Mother
Reasons of Vaccine Failures
Passive Immunization
Vaccine-Vial Monitor (VVM)
How to read VVM?
Eradication of Poliomyelitis
Differential Diagnosis of Poliomyelitis
Transverse Myelitis
Traumatic Neuritis
Pulse Polio Immunization (PPI)
DRACUNCULIASIS
Synonyms: Dracontiasis, Dracunculosis, Guineaworm Disease
Magnitude
Agent Factors
Agent
Life Cycle
In man
In Cyclops
Reservoir of Infection
Host Factors
Age and Sex
Social Factors
Mode of Transmission
Incubation Period
Pathogenic Effects and Clinical Features
Management of a Case
National Guineaworm Eradication Program (1983)
AMOEBIASIS
Agent factors
Agent
Reservoir
Source of Infection
Infective Material
Period of Communicability
Age and sex incidence
Environmental Factors
Mode of Transmission
Pathology and Pathogenesis
Intestine
Liver
Lungs
Brain
Incubation Period
Clinical Features
Intestinal Amoebiasis
Amoebic liver Abscess
Investigations
Examination of Stool
Examination of the blood
Serological Tests
Liver Aspirate
Treatment
Prevention and Control
Elimination of reservoirs
Breaking the Channel of Transmission
Protection of Susceptibles
GIARDIASIS
Agent Factors
Host Factors
CHAPTER 21:
Soil Borne Diseases
ASCARIASIS
Agent Factors
Agent
Life Cycle
Reservoir
Host Factors
Age Incidence
Sex Incidence
Environmental Factors
Mode of Transmission
Incubation Period
Clinical Features
Laboratory Diagnosis
Direct Evidences
Indirect Evidences
Prevention and Control
ANCYLOSTOMIASIS
Distribution
Agent Factors
Agent
Life Cycle
Reservoir
Age and Sex Incidence
Occupation
Environmental Factors
Pathogenic Effects and Clinical Features
Clinical Features of Hookworm Infestation
Prevention and Control
Elimination of Reservoir
Blocking the Channel of Transmission
Protection of Susceptibles
TETANUS
History
Magnitude of the Problem
Agent Factors
Causative Agent
Reservoir of Infection
Age Incidence
Sex Incidence
Occupation
Immunity
Mode of Transmission
Pathology and Pathogenesis
Incubation Period
Clinical Features
Differential Diagnosis
Treatment
Clinical Types of Tetanus
Prognosis
Prevention and Control
Health Promotion
Specific Protection
Basic Prophylactic Measures
Prophylactic Measures in the Event of Injury
NEONATAL TETANUS (NNT)
Extent of the Problem
Public Health Importance
Predisposing Factors
Pathology and Pathogenesis
Clinical Features
Elimination of Neonatal Tetanus
Strategies for the Elimination of NNT
CHAPTER 22:
Vector Borne Diseases
MALARIA
History
Magnitude
Trend of Malaria
Agent Factors
Life History
Host Factors
Environmental Factors
Measurement of Malaria (Malariometry)
A. Prevalence Rates of Malaria
B. Incidence Rates of Malaria
C. Entomological Parameters (Vector indices)
Prevention and Control of Malaria
Elimination of Reservoirs
Breaking the Channel of Transmission
Personal Protection
LYMPHATIC FILARIASIS
History
Current Filariasis Situation
Socioeconomic Burden
Agent Factors
Reservoir of Infection
Host Factors
Environmental Factors
Vectors
Clinical Features
Filaria Survey
Mass Blood Survey
Concentration Techniques
Clinical Survey
Entomological Survey
Xenodiagnosis
Skin and Serological Tests
Filarial Indices
Control of Lymphatic Filariasis
Elimination of Reservoirs: (i.e. Control of Parasites)
Results of treatment
Breaking the Channel of Transmission
Protection of Susceptibles
Integrated Vector Control
National Filaria Control Program (NFCP)
PLAGUE
History
Agent Factors
Host Factors
Environmental Factors
Flea Indices
Modes of Transmission
Pathology and Pathogenesis
Clinical Features
Laboratory Investigations
Elimination of reservoirs
Immunoprophylaxis (Vaccination)
LEISHMANIASES
Magnitude of the Problem
Agent Factors
Life Cycle
Reservoir of Infection
Host Factors
Environmental Factors
Clinical Features
Prevention and Control of Kala-azar
Elimination of Reservoirs
Breaking the Channel of Transmission
Protection of Susceptibles
ARBOVIRAL DISEASES
Classification of Arboviruses
Group A viruses (Alpha viruses)
Group B viruses (Flavi-Viruses)
Bunyamwera Super Group
Others*
Yellow Fever
Distribution and Extent of the Problem
Agent Factors
Host Factors
Investigations
Management
Prevention and Control
Surveillance Program
International Certificate of Vaccination Against Yellow Fever
Prevention of Yellow Fever in India
DENGUE FEVER
Agent Factors
Investigations
Prevention and Control of Dengue Fever
JAPANESE ENCEPHALITIS
Agent Factors
Management
Prevention and Control of JE
Safety Precautions
Instructions to the People
Epidemiological Points
Case Definition of JE
CHICKUNGUNYA FEVER (EPIDEMIC POLYARTHRITIS)
Causative Agent
Reservoir
Vector
Extrinsic Incubation Period
Clinical Features
Prevention and Control
KYASANUR FOREST DISEASE (KFD)
History
Agent Factors
Host Factors
Life cycle
Investigations
Management
Prevention and Control of KFD
RICKETTSIAL DISEASES
EPIDEMIC TYPHUS
Prevention and Control
ENDEMIC TYPHUS
SCRUB TYPHUS
INDIAN TICK TYPHUS
ROCKY MOUNTAIN SPOTTED FEVER
RICKETTSIAL POX
TRENCH FEVER
Q-FEVER
Prevention and Control Measures
CHAPTER 23:
Sexually Transmitted Infections (STI)
EXTENT OF THE PROBLEM
Agent Factors
Agent
HOST FACTORS
Age
Sex
Marital Status
Socioeconomic Status
Occupation
Social Factors
Prostitution
Poverty
Illiteracy
Polygamy
Polyandry
Broken Homes
Sexual Disharmony
Social Disruption
Social Stigma
Co-education and Co-work
Demographic Factors
International Travel
Changes in the Lifestyle
High Risk Groups
Prevention and Control of STIs
Elimination of Reservoirs
Breaking the Channel of Transmission
Protection of the Susceptibles
Other Measures
SYNDROMIC CASE MANAGEMENT OF STIs (SYNDROMIC APPROACH)
The syndromes in STI are grouped as:
Roles and Responsibilities of the Doctors while Caring for Patients with STI (6 Cs)
Advantages of the Syndromic Case Management
Disadvantages of the Syndromic Case Management
Managing STI using the Syndromic Approach
Diagnosis and Treatment for Partners based on the First Patient
CHAPTER 24:
HIV/AIDS
HIV Stands for Human Immunodeficiency Virus
History
Magnitude of the Problem
INDIA
Agent Factors
Infective Materials (Source of Infection)
High-risk Groups
Attributable Factor for HIV Transmission
Pathogenesis (Immunology) (Life Cycle)
Opportunistic Organisms
Clinical Spectrum of HIV/AIDS
Stage I: Acute retroviral syndrome (Seroconversion)
Stage II: Early asymptomatic disease (CD4 count >500 mm3)
Stage III: Intermediate HIV infection (CD4 count 200-500/mm3)
Stage IV: Late stage HIV disease (CD4 count 50-200 mm3)
Stage V: Advanced HIV disease (CD4 count < 50 mm3)
Diagnosis of HIV
Diagnosis of AIDS
Clinical Presentation of Children with AIDS
Major Signs
Minor Signs
HIV Counseling
Pre-test Counseling
Post-test Counseling
Clinical Criteria
Laboratory Monitoring
Caution
NNRTIs
Protease Inhibitors
Nucleoside Agents
Standard (Universal) Precautions
Disposal of Wastes
Disposal of Dead Bodies of Individuals who have Died of HIV/AIDS
Postexposure Prophylaxis (PEP)
Mother to Child Transmission of HIV and Breast Feeding (MTCT)
Risk Factors for MTCT during Pregnancy and Delivery
Prevention of Mother to Child Transmission of HIV (PMTCT)
A. Primary Prevention Strategies
B. Secondary Prevention Strategies
C. Measures of PMTCT during Breastfeeding
CHAPTER 25:
Surface Infections
RABIES
Historical Perspective
Extent of the Problem
Etiology
Reservoir of Infection
Infective Material
Period of Infectivity
Susceptibility
Modes of Transmission
Route of Entry of Virus
Pathology and Pathogenesis
Incubation Period
Clinical Features
Clinical Features of Dumb Rabies (Paralytic Rabies)
Laboratory Diagnosis
Antemortem
Postmortem
Management of Hydrophobia Case
Prevention of Rabies in Man
Postexposure Treatment (PET)
Principles of PET
Wound Treatment (First Aid Treatment)
Observation of the Animal (Wherever Possible)
Antirabies Immunization
Indications for Antirabies Immunization
WHO Guidelines for Postexposure Treatment (PET)
Rabies Vaccine History
Vaccines Prepared from Animal Tissues
Vaccines Prepared from Primary Animal Cells (Modern Tissue or Cell Culture Vaccines)
Vaccines Prepared from Standardized Cell Lines (Cell Bank)
Active Immunization
Antirabies Vaccines (ARVs)
THERE IS NO SINGLE DOSE VACCINE OR A VACCINE GIVING LIFELONG IMMUNITY
Nerve Tissue Vaccines
Dosage Schedule
Suckling Mouse Brain Vaccine
Duck Embryo Vaccine (DEV) or Flury's vaccine
Cell Culture Vaccines
Dosage Schedules
Intramuscular Schedules
Intradermal Schedules
Failure with Cell Culture Vaccine
Passive Immunization
Pre-exposure Immunization
Control of Rabies in Dogs
Personal Protection Against Rabies
LEPROSY (In Greek, ‘leper’ means scaly)
History
Magnitude of the Problem
World
India
Agent
Reservoir of Infection
Age Incidence
Sex Incidence
Race
Malnutrition
Immunity
Environmental Factors
Social Factors
Infectivity
Modes of Transmission
Pathology and Pathogenesis
Incubation Period
Classification of Leprosy (Clinical spectrum of leprosy)
WHO Classification
Field workers' Classification
Clinical Presentation
Case Evaluation
Bacteriological Examination
Lepromin Test
Applications
Clinical Spectrum
Skin Lesions
Diagnosis
Investigations
Complications
Lepra Reactions
CONTROL OF LEPROSY
Medical Measures
General Measures
Early Case Detection
Chemotherapy
Definitions of Terminologies (WHO)
Standard Child Treatment Regimen (10-14 yr)
For PB Leprosy
Epidemiological Points
SUMMARY
Management of Leprosy Reaction
“Candidate Vaccines” against Leprosy
ICRC-vaccine
M. vaccae vaccine
Chemoprophylaxis
Deformities in leprosy (Flow chart 25.3)
Rehabilitation
Health education
Key Messages
Social Measures
Managerial Aspects
Evaluation
Operational Indicators
Epidemiological Indicators
Leprosy Organizations in India
National Leprosy Eradication Programme (NLEP)
National Leprosy Elimination Campaign (NLEC)
Myths and Realities of Leprosy Elimination
Leprosy Day
Yaws
Magnitude
Agent
Reservoir of Infection
Age Incidence
Sex Incidence
Immunity
Social Factors
Environmental Factors
Modes of Transmission
Period of Communicability
Incubation Period
Clinical Features
Laboratory Investigation
Treatment
Eradication of Yaws
CHAPTER 26:
Cardiovascular Diseases
CORONARY ARTERY DISEASE (CAD; ISCHEMIC HEART DISEASE, IHD)
Modifiable Risk Factors
Prevention of CAD
Primary Prevention
Population strategy (Mass primary prevention):
Dietary Changes
Smoking Changes
Blood Pressure
Physical Activity
High Risk Strategy
Primordial Prevention
Secondary Prevention
CONGENITAL HEART DISEASES (CHD)
Acyanotic heart diseases without a shunt
Cyanotic heart diseases (Right to left shunt)
Altitude at Birth
Prematurity
Maternal Age
Sex of the Child
Prevention
RHEUMATIC HEART DISEASE
Clinical Features
Major Manifestations
Minor Manifestations
Prevention of Rheumatic Fever and RHD
Health Promotion
Specific Protection
Early Diagnosis and Treatment
Disability limitation
Rehabilitation
HYPERTENSION
Classification
Magnitude
Rule of Halves
First Rule
Second Rule
Third Rule
Tracking of Blood-pressure
Non-modifiable Risk Factors
Modifiable Risk Factors
Clinical Manifestations
Prevention of Hypertension
Primary Prevention (Primordial Prevention)
On Nutrition
The DASH Diet
High Risk Strategy
Secondary Prevention
Tertiary Prevention
CEREBROVASCULAR ACCIDENT (STROKE)
Risk Factors
Prevention and Control
CHAPTER 27:
Obesity
CHAPTER 28:
Cancer
INTRODUCTION
Magnitude of the Problem
Distribution
Agent Factors
Host factors
Age Incidence
Sex
Occupation
Habits
Environmental Factors
Air Pollution
Pre-existing Conditions
Prevention and Control of Cancers
Primary Prevention
Health Promotion
Health Education
Control of Air Pollution
Specific Protection
Secondary Prevention
Treatment
Tertiary Prevention
Disability Limitation
Rehabilitation
EPIDEMIOLOGY OF CANCER CERVIX
Agent Factor
Risk Factors
Age Incidence
Age at Marriage
Marital Status
Occupation
Socio-economic Status
Other Predisposing Factors
Ca-Cx Pattern
PREVENTION AND CONTROL OF CA-Cx
Primary prevention
Health Promotion
Specific Protection
Secondary Prevention
Response Rate
Sensitivity of Pap Test
Treatment
Tertiary Prevention
CHAPTER 29:
Diabetes Mellitus
CLASSIFICATION OF DIABETES MELLITUS
Primary
Type 1
Type 2
Secondary
Pancreatic Pathology
Excessive Production of Hormones Antagonistic to Insulin (called insulin antagonists) such as
Long Term Use of Drugs Like
Diabetes Mellitus Associated with Genetic Syndromes
Impaired Glucose Tolerance
Magnitude of the Problem
Agent Factors
Host Factors
Age
Sex
Genetic Factors
Obesity
Pregnancy
Environmental Factors
Potential Diabetic
Latent Diabetic
Early Complications can be Detected by
Screening for Diabetes
False Positive
False Negative
Prevention and Care of Diabetes
Population Strategy
Genetic Counseling
Prospective Eugenics
Retrospective Eugenics
High Risk Strategy
Self care in Diabetes Mellitus
Should take protective care of the feet as follows
Habits
Exercise
Diet
Drugs
Self Examination
Instructions
Tertiary Prevention
CHAPTER 30:
Accidents
INTRODUCTION
Global Problem
India
Measurements of accidents and injuries
Mortality Indicators
Morbidity Indicators
Disability Rate
Types of Accidents
Road Traffic Accidents
Railway Accidents
Domestic Accidents
Miscellaneous
Violence
Host Factors
Age
Sex
Medical Conditions
Experience and Training
Habits
Other Factors
Environmental Factors
Prevention
Safety Education
Safety Measures
Legislative Measures
CHAPTER 31:
Blindness
INTRODUCTION
Extent of the Problem
Global
India
Causes
Refractive Error
Glaucoma
Causes in the Retina
Avoidable Blindness
Host Factors
Age
Sex
Nutritional Status
Occupation
Environmental Factors
Socio-economic Status
Other Factors
Prevention and Control
Eye Care
Specific Ophthalmic Programs
Rehabilitation
Other Preventive Measures
Vision 2020: “The Right To Sight”
PART-IV: HEALTH RELATED DISCIPLINES
CHAPTER 32:
Reproductive and Child Health (Preventive Obstetrics and Preventive Pediatrics)
MOTHER AND CHILD-ONE UNIT
Reasons
MCH Problems
Objectives of MCH Services
Components of MCH Services
Services to the Mothers
Services to the Children
SERVICES TO THE MOTHERS
Preconceptional Care
ANTENATAL CARE (CARE OF THE MOTHER DURING PREGNANCY PERIOD)
Objectives
Visits
First Visit (at 20 Weeks)
Second Visit (at 32 Weeks)
Third Visit (at 36 Weeks)
Components of Antenatal Care
Prenatal Diagnosis of Congenital Anomalies
Nutritional Services
Immunization Services
Medicinal (Supplementation) Services
Family Welfare services
Educational Services
Functions of AN Clinic
Mother Craft
Risk Approach
I Group
II Group
III Group
IV Group
Home Visits
INTRANATAL CARE
Objectives
Clean and Safe Delivery
Prevention of Infections
Contents of DD Kit
Advantages of Domiciliary Care
Disadvantages
Advantages of Institutional Care
Disadvantage
POSTNATAL CARE
Objectives
Promotion of Speedy Recovery Physically by
On Nutrition
On Rest and Exercise
On Personal Hygiene
On Sexual Relation
Promotion of Speedy Recovery Psychologically
Prevention of the Development of Postnatal Complications
Puerperal Sepsis
Thrombophlebitis
Post-partum Hemorrhage (PPH)
Primary PPH
Secondary PPH
To Check Adequacy of Breastfeeding
To Provide Family Welfare Services
Birth Spacing
A Health Measure
To Provide Care of the Newborn
ESSENTIAL AND IMMEDIATE CARE OF THE NEWBORN
Objectives of the Neonatal Care
Care of the Eyes
Care of the Nose and Throat
Care of the Umbilical Cord
Care of the Rectum
Care of the Skin
Recording of Delivery Notes
APGAR SCORE
Bedding-in
Prevention of Neonatal Infections
Prevention of Hypothermia
Importance
Prevention of Birth-Asphyxia
Management
DANGER SIGNS OF THE NEWBORN
AT-RISK NEWBORNS
Care of the “At risk” Newborn
LOW BIRTH WEIGHT BABY (LBW)
Definition
Grading
Determinants of Birth-weight
Pre-term Baby
Small for Date Baby (SFD baby)
Synonyms
Problems of LBW Infant — Illustrated in the Figure 32.3
Importance
Computation of LBW
Magnitude of the Problem
Causes
Medical Causes
Social Causes
Related Terms
Care of LBW Babies
Normal Care at Home
Special Care at Home
Principles
Special Care in the Hospital (Intensive neo-Natal Care)
PREVENTION OF LBW BABY
KANGAROO MOTHER CARE (KMC)
Components of KMC
Kangaroo Position
Material Required
Preparation of the Kangaroo Baby
Kangaroo Positioning
Mechanism of Prevention of Hypothermia
Kangaroo Feeding Policy
Early Discharge and Follow-up
Follow-up
Duration of KMC
Benefits of KMC
Parameters to be Monitored during KMC
FEEDING OF INFANT
Breastfeeding
Process
PHYSIOLOGY OF BREASTFEEDING: (BREASTFEEDING REFLEXES)
Reflexes in the Baby
Reflexes in the Mother
Factors Affecting the Reflexes
Position and technique of feeding
Signs of Good Attachment (Fig. 32.6A)
Signs of Poor Attachment (Fig. 32.6B)
RIGHT TECHNIQUE OF FEEDING IN A RIGHT POSITION OF THE CHILD IS THE KEY TO THE SUCCESS OF BREAST-FEEDING
Composition of the Milk (per 100 ml)
Volume of the Milk
Colustrum
Exclusive Breastfeeding
Principles of Breast-feeding
MERITS OF BREASTFEEDING
Advantages to the Baby
Advantages of the Mother
Advantages to Both Mother and the Child
Advantages to the Family and Nation
THEREFORE BREASTFEEDING IS THE BEST FEEDING
Malpractices in Breastfeeding
Weaning
Dangers of Artificial Feeding
Demand Feeding
Advantages of Demand Feeding
Four Signs of Good Attachments
Four Signs of Proper Positioning
Technique of Feeding
Expression of Milk
Indications
Methods
Manual Expression
Mechanical Expression
Breast Problems
Common Problems
Too Much Milk
Too Little Milk (Milk Dried Up or not Enough Milk)
Use of Galactogogues
Flat or Inverted Nipple
Sore Nipple
Breastfeeding under Special Conditions
Low Birth Weight Baby
New Pregnancy During Lactation
A Newborn with Cleft Lip or Palate or Both
RELACTATION
INDUCED LACTATION
BABY FRIENDLY HOSPITAL INITIATIVE (BFHI)
Aim
Objectives
Importance
Criteria for Recognition of the Hospital as “Baby Friendly”
Ten Steps
Benefits to the Hospitals
IMS-Act
The Act Prohibits
Penalty
Monitoring
Goals
GROWTH MONITORING
Important ones are
WHO Growth Chart (Home Based Chart)
Growth Charts Used in India
UNDER FIVES CLINIC
Aim
Functions
HANDICAPPED CHILDREN
Extent of the Problem
Problems of having a Disability
Classification of Handicapped Children
Physically Handicapped Children
Mentally Handicapped Children (Mentally Retarded)
Causes
Diagnosis
Degree of Mental Retardation
Grading of Mental Retardation (WHO)
Socially Handicapped Children
Prevention of Handicap
Primary Prevention
Secondary Level of Prevention
Tertiary Level of Prevention
CHILD PLACEMENT MEASURES
JUVENILE DELINQUENCY
Causes
Prevention
CHILD GUIDANCE CLINIC
SCHOOL HEALTH SERVICES
Objectives
Components of School Health Program
Health Services
Healthful School Living (Healthful School Environment)
Health Education
INDICATORS OF MCH CARE
Maternal Mortality Rate (MMR)
Magnitude
Causes of Maternal Mortality
Reduction of Maternal Mortality Rate
Mortality During Infancy
Still Birth
Formula
Causes
Perinatal Mortality Rate (PMR)
Incidence
Causes of PMR
Prevention of PMR
Neonatal Mortality Rate (NNMR)
Formula
Causes
Prevention of NNMR
Postneonatal Mortality Rate (PNNMR)
Formula
Causes
Infant Mortality Rate (IMR)
Definition
Formula
Importance
Magnitude of the Problem
Causes of Infant Mortality
Predisposing Factors
Prevention of Infant Mortality
Mortality Occurring During Childhood
1 to 4 Year Mortality Rate
Under-5 Mortality Rate (Child Mortality Rate) (CMR)
Child Survival Index (Child Survival Rate CSR)
RIGHTS OF THE CHILD
The Current Level and Goals of MCH Care
National Programs for the Welfare of Mothers and Children
Organization of MCH and FP Services
CHILD WELFARE AGENCIES
Activities
INTEGRATED CHILD DEVELOPMENT SERVICES–SCHEME [ICDS—SCHEME]
Aim
Objectives
Beneficiaries
Services
Nucleus
Key Person
Functions
Organization Structure of ICDS Project
Anganwadi Worker/Teacher (AWW)
Supervisor (Mukhya Sevika)
Child Development Project Officer
Monitoring and Evaluation
Assistance
Administrative Set-up of ICDS (Table 32.1)
CHAPTER 33:
Demography
DEMOGRAPHIC CYCLE (DEMOGRAPHIC STAGES)
Stages of Demographic Cycle (Fig. 33.1)
SIZE OF THE POPULATION (MAGNITUDE OF THE POPULATION) CENSUS
Errors (Limitations) of Census
Uses of Census
POPULATION TREND IN THE WORLD
POPULATION TREND IN INDIA
COMPOSITION OF THE POPULATION
Age and Sex Composition
Differences Between the Population Pyramids of Developing and Developed Countries
Literacy Level
Dependency Ratio
Occupational Composition
Socio-economic Status
Modified BG Prasad's Classification
Housing (Living Condition)
Marital Status
Religion
Languages Spoken
Life Expectancy (Expectation of Life)
Family Size
DISTRIBUTION OF THE POPULATION
Urbanization
POPULATION DYNAMICS
Marriages
Marriage Rate
Fertility
MEASUREMENT OF FERTILITY (FERTILITY INDICATORS)
Crude Birth Rate (CBR)
General Fertility Rate (GFR)
General Marital Fertility Rate (GMFR)
Age Specific Fertility Rate (ASFR)
Age Specific Marital Fertility Rate (ASMFR)
Total Fertility Rate (TFR)
Total Marital Fertility Rate (TMFR)
Gross Reproduction Rate (GRR)
Net Reproduction Rate (NRR)
Child Woman Ratio
Pregnancy Rate (PR)
Abortion Rate
Abortion Ratio
MEASUREMENT OF MORTALITY
Death Rate
International Death Certificate
Examples:
Infant Mortality Rate (IMR)
Migration
POPULATION EXPLOSION (POPULATION BOMB)
Reasons for Population Explosion
Causes of High Birth Rate
Causes of Low Death Rate
Hazards of Population Explosion
POPULATION STABILIZATION
Reduction of Birth Rate
Improvement of Economic Status
Raising the Housing Standards
Improving the Status of Women
Adopting One Child-norm (Be it a Boy or Girl)
Improving the Quality of Health Services
CHAPTER 34:
Family Planning
NEED FOR FAMILY PLANNING
Demographic Grounds
Socio-economic Grounds
Health Grounds
Women's Health
Fetal Health
Child Health
SCOPE OF FAMILY PLANNING SERVICES
Concept of Family Welfare
Eligible Couple (EC)
Couple Protection Rate (CPR)
Target Couples
CONTRACEPTIVE METHODS (FERTILITY REGULATING METHODS; TECHNIQUES OF BIRTH CONTROL)
Temporary (Non-terminal Methods: Spacing Methods)
Terminal (Permanent Methods; Sterilization Methods)
TEMPORARY METHODS (NON-TERMINAL OR SPACING METHODS)
Physical Methods
Condom
Female Condom (FEMIDOM)
Diaphragm (Vaginal Diaphragm, Dutch Diaphragm)
Method of Insertion
Method of removal
Merits
Demerits
Failure Rate
Cervical Cap
Vault Cap (Dumas Cap)
Vimule Cap
Chemical Methods
Foams
Cream and Paste
Merits:
Combined Methods
INTRAUTERINE DEVICES (IUD)
Types of IUDs
First Generation IUDs
Second Generation IUDs
Third Generation IUDs (Medicated IUDs)
Mechanism of Action of IUDs
Advantages of IUDs
IUD Insertion
Removal of IUD
An Ideal IUD Candidate
Contraindications for IUD Insertion
Time of Insertion
Instructions following IUD insertion
Disadvantages of IUDs (Side Effects and Complications)
Failure Rate
Restoration of Fertility after Removal
HORMONAL CONTRACEPTIVE METHODS: (STEROIDAL CONTRACEPTIVES)
COMBINED ORAL CONTRACEPTIVE PILLS: (COC PILLS; BIRTH CONTROL PILLS)
Monophasic Pills
Mechanism of Action
Instructions
Triphasic Pills
Effectiveness
Merits
Demerits
Contraindications
Progestin Only Pills (POP)
Mechanism of Action
When to Start?
Missed Pills
Effectiveness
Merits
Demerits
Limitations
Estrogen, Post-coital Pills: (Emergency Oral Contraception)
High Dose Estrogens
Estrogen—Progesterone Combination (Yuzpe Method)
Merits
Demerits
Recent Advances
Mechanical Method of Emergency Contraception
Once a Month Pill: (Long Acting Pill)
Male Pill
INJECTABLE CONTRACEPTIVES
Mechanism of Action
Time of Administration
Instructions to the User
Return of Fertility
Failure Rate
Merits
Demerits
Postpartum Use
Contraindications
SUBCUTANEOUS IMPLANTS (NORPLANT IMPLANTS)
Insertion
Mode of Action
Effectiveness
Failure Rate
Failure Rate
VAGINAL RINGS
POSTCONCEPTIONAL METHODS
Menstrual Regulation (MR)
Procedure
Merits
Demerits
Menstrual Induction
Induction of Abortion
THE MEDICAL TERMINATION OF PREGNANCY ACT—1971
Introduction
Methods of MTP
Suction Evacuation
Extraovular Injection
Intra-amniotic Injection
MISCELLANEOUS METHODS
Abstinence
Coitus Interruptus
Merits
Demerits
Failure Rate
Fertility Awareness—Based Methods
Failure Rate
Merits
Demerits
Rhythm Method (Calendar Method; Safe Period Method)
Basal Body Temperature Method (BBT)
Cervical Mucus Method (Billing's Method)
Feel of the Cervix
Symptothermal Method (Multiple indicator method)
Lactational Amenorrhea Method (LAM)
Nonhormonal, Long Acting Oral Pills
Birth Control Vaccines
TERMINAL METHODS
Vasectomy
Procedure
“No Scalpel Vasectomy”
Instructions after Surgery
Effectiveness
Merits
Demerits
Tubectomy
Minilaparotomy (Pomeroy Technique or Interval Procedure)
Laparoscopy Procedure
Instructions after Surgery
Effectiveness
Merits
Demerits
EVALUATION OF CONTRACEPTIVE METHODS
CHAPTER 35:
Bio-statistics
APPLICATIONS OF BIO-STATISTICS
TYPES AND SOURCES OF DATA
Continuous Data
Discrete Data
Sources of Data
Experiments
Surveys
Records
Sources of Health Statistics
PRESENTATION OF STATISTICAL DATA
TABULATION
Qualitative Tables
Quantitative Tables
Cumulative Frequency Table
Two Way Frequency Table
DIAGRAMMATIC PRESENTATION
Points to be Remembered in the Construction of a Diagram or Graph
Bar Diagrams/Charts
Histogram
Age and Sex Pyramid: (Population Pyramid)
Frequency Polygon
Frequency Curve
Line Diagram
Cumulative Frequency Curve or “Ogive”
Scatter Diagram or Dot Diagram
Pie Diagram
Degree
Pictogram
Map Diagram or Statistical Map
Percentage
Spot Map: (Geographic Spot Map)
Shaded Map
MEASURES OF CENTRAL TENDENCY
Median
Graphic Method for Locating the Median
Mode
MEASURES OF LOCATION-QUANTILES
MEASURES OF DISPERSION
Standard Deviation (SD)
Applications of SD
Coefficient of Variation
PROBABILITY
Probability Distributions
Normal Distribution and Normal Curve
Binomial Distribution
Mean Features of the Binomial Distribution
Poisson Distribution
Skewed Distribution
SAMPLING
Characteristics of a Representative Sample
Census Enumeration v/s Sampling Enumeration
Sampling Designs (Sampling Methods; Sampling Techniques)
Simple Random Sampling
Procedure
Systematic Sampling (Systematic Random Sampling)
Stratified Random Sampling
Multistage Sampling
Advantages
Disadvantages
Cluster Sampling
Point or Line Sampling
Biased Sampling
Multiphase Sampling
Size of the Sample
Calculation of Sample Size for Qualitative Data
For Quantitative Data
Errors in Sampling
Sampling Errors
Non-sampling Errors
SAMPLING VARIATION
Standard Error of the Mean
Significance
NULL HYPOTHESIS (DENOTED AS H0)
TESTS OF SIGNIFICANCE
General Procedures for Testing a Hypothesis
Standard Error of the Mean (SE)
Uses of SE x–
Calculation of SE of the Mean
Standard Error of Difference between Two Means (SEDM)
Procedure
Standard Error of Proportion: (SEP)
Uses of SEP
Standard Error of Difference Between two Proportions (SEDP)
Conclusion
“t” test
Degrees of Freedom (DF)
Chi-square Test (x2 Test)
Applications of χ2-test
Steps
Yate's Correction
Result
ANALYSIS OF VARIANCE
NON-PARAMETRIC TESTS
Sign Test
Wilcoxon's Signed Rank Test
Mann-Whitney Test
CORRELATION AND REGRESSION CORRELATION
Interpretation of Bivariate Data
Scatter Diagram
Correlation Coefficient
Calculation of Correlation Coefficient Value (See table below)
Inference
REGRESSION
Regression Coefficient
Regression Equation
Non-linear Regression
Multiple Correlation and Regression
Spearman's Rank Correlation Test
CHAPTER 36:
Social Science
FAMILY SYSTEM
FAMILY CYCLE
FAMILY TYPES
Nuclear Family (Elementary; Primary Family)
Extended Primary Family
Three Generation Family
Joint Family (Joint Extended Family)
Broken Family (Broken Home)
Problem Family
Differences between Joint Family System and Nuclear Family System
FAMILY FUNCTIONS
Homely Life
Economic Security
Reproduction
Education
Socialization
Emotional Support
Social Care
Support
Bridging the Generation Gap
Job Distribution
ROLE OF FAMILY AND CULTURAL FACTORS IN HEALTH AND DISEASE
Health Perception
Housing Condition
Personal Hygiene
Child Rearing
Socialization
Personality Formation
Lifestyle
Dietary Practices
Disposal Practices
Reproductive Behavior
Care of the Sick and Injured
Stabilization of Adult Personality
SOCIAL PROCESS
Socialization
Role
Acculturation
Social Controls
Social Change
Social Stratification
Socioeconomic Status
Classification of Socioeconomic Status
NB.
Modified Method
Poverty Line
Social Class Difference in Health and Disease
SOCIAL FACTORS IN HEALTH AND DISEASE (SOCIAL PATHOLOGY)
Social Constraints
Poverty
Illiteracy and Ignorance
Migration
Industrialization and Urbanization
Social Evils
Smoking Tobacco and Drinking Alcohol
Caste and Casteism
Gender Bias and Gender Discrimination
Child Neglect and Child Abuse
Child Labor and Child Abandonment
Stress and Stress Behavior
Prostitution
Causes of Prostitution
Health Hazards
Dowry System
Social Deviance
Suicide
MANAGEMENT OR PREVENTION OF SOCIAL PATHOLOGY
Management of Social Constraints
Developmental Approach
Educational Approach
Legal Approach
Management of Social Evils
Development Approach
Educational Approach
Legal Approach
Rehabilitation Approach
Management of Social Deviance
Educational Approach
Rehabilitation Approach
Legal Approach
Social Security
Social Defence
SOCIAL RESEARCH
Interview Method
Aims of Interview
Types
Steps of Interview
Advantages
Disadvantages
Questionnaire Method
Requisites
Advantages
Disadvantages
Case Study Method
Requisites
Advantages
Disadvantages
OPERATIONAL RESEARCH
Phases in Operational Research
MEDICO-SOCIAL WORKER (MSW)
Activities
To the Doctor
To the Patient
To the Family
To the Community
Miscellaneous Activities
PERSONAL HYGIENE
Advantages
Rules (Principles) of Personal Hygiene
Habits Affecting the Health (Lifestyle)
Eating
Drinking
Smoking
Chewing
Drugs
Exercise
Meditation
Sleep
Relaxation
Sex
Other Healthful Habits
CHAPTER 37:
Information, Education and Communication
INFORMATION
EDUCATION
COMMUNICATION
Sender
Message
Media
Audience
Feedback
STEPS IN IEC: PLANNING, IMPLEMENTATION AND EVALUATION
Planning
Preparatory Activities
Implementation of IEC Activities
Monitoring
Evaluation
TYPES OF COMMUNICATION
One Way Communication
Two Way Communication
Verbal Communication
Non-verbal Communication
Formal Communication
Informal Communication
Visual Communication
Telecommunication and Internet
BARRIERS OF COMMUNICATION
Physiological Barriers
Psychological Barriers
Environmental Barriers
Cultural Barriers
HEALTH EDUCATION
OBJECTIVES
Health Education vs Health Propaganda (Publicity)
APPROACHES IN HEALTH EDUCATION: THERE ARE FOUR APPROACHES
Regulatory Approach
Merit
Demerits
Service Approach
Health Education Approach
Primary Health Care Approach
CONTENTS OF HEALTH EDUCATION
PRINCIPLES OF HEALTH EDUCATION
PRACTICE IN HEALTH EDUCATION
Audio-visual Aids
Not Requiring Projection
Requiring Projection
Merits of OHP
Demerits of OHP
Advantages of AV Aids
Levels in Health Education
Individual and Family Level
Group Level
LECTURE
Criteriae for Good Lecture
Criteriae for Good Teacher
Demerits
Flip Chart
Flannelgraph
Exhibits
DEMONSTRATION
DISCUSSION METHODS
RULES OF GROUP DISCUSSION
Demerits
Panel Discussion
Advantages
Disadvantages
Symposium
Advantages
Disadvantages
Workshop
Conference
Role Playing (Sociodrama)
Brainstorming
Brainstorming is Done in Four Stages
Snowballing
Tutorial
Colloqy
Debate
Delphi Method
Community Level (Approach)
CHAPTER 38:
Human Genetics
POPULATION GENETICS
Classification of Genetic Disorders
Chromosomal Disorders
Monogenic Disorders (Mendelian Diseases)
Autosomal Dominant Diseases
Autosomal Recessive Diseases
X-linked Dominant Diseases
X-linked Recessive Diseases
Polygenic Disorders
PREVENTION AND CONTROL OF HEREDITARY DISORDERS
Health Promotive Measures
Eugenic Measures
Euthenics
Genetic Counseling
Other General Measures
Specific Measures
Early Diagnosis and Treatment
CHAPTER 39:
Preventive Geriatrics
CHAPTER 40:
Mental Health
MAGNITUDE OF THE PROBLEM
CAUSATIVE FACTORS
TYPES OF MENTAL DISORDERS
Mental Deficiency or Mental Retardation (MR)
Behavioral Disorders
Mental Diseases
Psychosomatic Disorders
PREVENTION AND CONTROL OF MENTAL ILLNESS
Primary Prevention
Secondary Prevention
Tertiary Prevention
CHAPTER 41:
Adolescent Health
CHAPTER 42:
Alcoholism and Drug Addiction
DEFINITIONS
Physical Dependence
Psychological Dependence
Addiction as a Disease
Types of Drug Abuse
Reasons of Drug Abuse
Prevalence
IDENTIFICATION OF DRUG ABUSERS
Dependence Producing Drugs
Alcohol
Opioids
Cannabinoids
Sedatives or Hypnotics
Cocaine
Stimulants
Hallucinogens
Tobacco
Volatile Solvents
Other Drugs
Prevention and Control of Drug Abuse
Individual Level for the Addict
Family Level
Community Level
PART-V: HEALTH ADMINISTRATION AND ORGANIZATION
CHAPTER 43:
Health for All
MEANING
HISTORICAL PERSPECTIVE
IMPORTANCE
HFA Does not Mean That
HFA Does Mean That
Milestones
Health Policy Indicators
Health Care Indicators
Socio-economic Indictors
Health Status Indicators (Demographic Goals)
CHAPTER 44:
Health Care
THE THREE-TIER SYSTEM OF HEALTH CARE
Primary Level of Health Care
Secondary Level of Health Care
Tertiary Level of Health Care
Primary Health Care
Attributes
ELEMENTS OF PRIMARY HEALTH CARE: (IE, COMPONENTS)
PRINCIPLES OF PRIMARY HEALTH CARE
Equitable Distribution
Community-Participation
Advantages of Community Participation
Intersectoral Co-ordination
Appropriate Technology
Organizational Framework of Health Care Systems
PUBLIC HEALTH SECTORS
Primary Health Care
Village Level (Grass-root Level)
Sub-center Level
Primary Health Center Level (PHC)
Functions of the PHC
Job Responsibilities of the Members of the Health Team
Medical Officer (MO) of PHC
Health Worker Female (HWF)
Record Keeping
Ante-natal Care
Care at Home
Care at the Clinic
Intranatal Care
Post-natal Care
Family Planning Services
Care of Infants
Births and Deaths
Notification
Training
Health Education
Health Care
Miscellaneous
HEALTH WORKER MALE (HWM)
Record Keeping
Role in the Control of Communicable Diseases
Malaria
Leprosy
Tuberculosis
Other Communicable Diseases
Improvement of Environmental Sanitation
Immunization
Family Welfare Services
Miscellaneous Activities
HEALTH ASSISTANT FEMALE (HAF)
HEALTH ASSISTANT MALE (HAM)
Community Health Centre (CHC)
Staff Pattern of CHC
Services Provided
Hospitals
Other Agencies
Employees State Insurance (ESI) Hospitals
Central Government Health Scheme (CGHS)
Railway Hospitals
PRIVATE SECTOR
INDIGENOUS SYSTEM OF MEDICINE
CHAPTER 45:
National Rural Health Mission—2005-2012
OBJECTIVES
STATE OF PUBLIC HEALTH IN INDIA
NRHM–VISION
GOALS
STRATEGIES
Core Strategies
Supplementary Strategies
PLAN OF ACTION
Accredited Social Health Activists
Strengthening Sub-centers
Strengthening Primary Health Centers
Strengthening Community Health Centres (30-50 beds)
District Health Plan
Implementation Total Sanitation Campaign (TSC)
Strengthening Disease Control Programs
Public-Private Partnership
New Health Financing Mechanisms
Re-orientation of Medical Education (ROME)
Administrative Set-up of NRHM
Target of the NRHM (by the year 2012)
CHAPTER 46:
Health Planning and Management
COMPONENTS OF HEALTH PLANNING
Community Health Problems
Health Needs
Resources
Goals
Objectives
Target
Plan
Program
Schedule
Procedure
Policies
Planning
Planning Cycle
Recognition and Analysis of the Health Situation
Establishment of Objectives and Goals
Assessment of Resources
Prioritization
Examining Alternative Course of Action
Program Planning
Implementation of the Plain
Identification of the Interventions
Establishment of Feed Back/Monitoring
Evaluation
MANAGEMENT
Methods Based on Behavioral Sciences
Organizational Management
Personnel Management
Communication
Health Information Systems (HIS)
Management by Objectives (MBO)
Quantitative Methods of Management
Cost-benefit Analysis (CBA)
Cost Effective Analysis (CEA)
Cost Accounting
Input-output Analysis
Model
Systems Analysis
Network Analysis
CHAPTER 47:
National Health Planning
NATIONAL DEVELOPMENTAL PLANS
First Five Year Plan (1951-56)
Second Five Year Plan (1956-61)
Third Five Year Plan (1961-66)
Fourth Five Year Plan (1969-74)
Fifth Five Year Plan (1974-79)
Sixth Five Year Plan (1980-85)
Seventh Five Year Plan (1985-90)
Eighth Five Year Plan (1992-97)
Ninth Five Year Plan (1997-2002)
Tenth Five Year Plan (2002-2007)
ORGANIZATION OF INDIAN HEALTH ADMINISTRATION
Central Level
The Union Ministry of Health and Family Welfare
Functions of Union Ministry of Health
Directorate General of Health Services
Central Council of Health and Family Welfare (CCHFW)
STATE LEVEL
District Level
For Urban Areas
For Rural Areas
Panchayati Raj
Village Level
RURAL DEVELOPMENT
Community Development Program
Integrated Rural Development Program (IRDP)
The Village Level Worker (Gram Sevak)
CHAPTER 48:
National Health Policy
MILLENNIUM DEVELOPMENT GOALS
NATIONAL HOUSING POLICY
NATIONAL NUTRITION POLICY (NNP)
Strategies
Direct Short-term Strategies
Indirect Long-term Strategies
Administration
NATIONAL POPULATION POLICY-2000: AN OVERVIEW
Goals
Reproductive Health Targets
Child Health Targets
General Health Targets
NATIONAL POLICY FOR CHILDREN
CHAPTER 49:
National Voluntary Health Agencies Organizations
VOLUNTARY HEALTH AGENCIES (VHA)
Advantages
Limitations of VHAs
Functions of VHAs
Voluntary Health Agencies (NGOs) in India
Indian Red Cross Society
Tuberculosis Association of India (TAI)
Family Planning Association of India (FPAI)
Hind Kusht Nivaran Sangh (HKNS)
Voluntary Health Association of India (VHAI)
Indian Council for Child Welfare (ICCW)
Bharat Sevak Samaj (BSS)
Central Social Welfare Board (CSWB)
Kasturba Memorial Fund (KMF)
All India Women's Conference
All India Blind Relief Society
CHAPTER 50:
International Health Organizations
UNICEF
Regional Offices
Functions
Child Health
Child Nutrition
Family and Child Welfare
Child Education
UNDP: United Nations Development Program
Food and Agricultural Organization (FAO)
International Labor Organization (ILO)
Functions
United Nations Fund for Population Activities
United Nations Educational Scientific and Cultural Organization (UNESCO)
United Nations High Commission for Refugees
World Bank
UNAIDS
United Nations International Drug Control Program
United Nations Environment Program (UNEP)
International Atomic Energy Agency (IAEA)
World Food Program (WFP)
Beneficiaries
Nutritive Value
CHAPTER 51:
Bilateral Agencies
USAID
SIDA
DANIDA
NON-GOVERNMENT (NON-UN) AGENCIES
Ford Foundation
Activities
Rockefeller Foundation
Activities
Care
Red Cross
Freedom from Hunger
Agha Khan Foundation
Save the Children Fund
Oxfam
Other Voluntary Organizations
CHAPTER 52:
National Health Programs (NHPs)
DIFFERENCES BETWEEN VERTICAL AND HORIZONTAL HEALTH PROGRAMS OF INDIA
NATIONAL ANTI-MALARIA PROGRAM
History
NMEP
Preparatory Phase
Attack Phase
Consolidation Phase
Active Surveillance
Presumptive and Radical Treatment of Malaria (Under Current Anti-Malaria Program)
Severe and Complicated Cases of Malaria
Note
Passive Surveillance
Causes
Modified Plan of Operation of Malaria Control: (MPO)
Objectives
Urban Malaria Scheme (UMS)
Operational Details
MPO Achievement
Roll Back Malaria (RBM)
Goals
NATIONAL FILARIA CONTROL PROGRAM (NFCP)
NATIONAL KALA AZAR CONTROL PROGRAM (NKCP)
NATIONAL JAPANESE ENCEPHALITIS CONTROL PROGRAM (NJECP)
NATIONAL DENGUE FEVER / DENGUE HEMORRHAGIC FEVER CONTROL PROGRAM
NATIONAL LEPROSY ERADICATION PROGRAM (NLEP)
National Leprosy Eradication Program (NLEP)
Multidrug Treatment (MDT)
Multibacillary Leprosy
Paucibacillary Leprosy
Infrastructure
Leprosy Control Unit (LCU)
Survey Education Treatment (SET) Centers
Urban Leprosy Centers (ULC)
Mobile Leprosy Treatment Unit (MLTU)
Progress of NLEP
Program Assistance
Modified Leprosy Elimination Campaign (MLEC)
Regimen for Paucibacillary Cases
Regimen for Multibacillary Cases
Leprosy Elimination Monitoring (LEM)
NATIONAL GUINEA-WORM ERADICATION PROGRAM (NGEP)
UNIVERSAL IMMUNIZATION PROGRAM (UIP)
NATIONAL POLIOMYELITIS ERADICATION PROGRAM (NPEP)
CSSM
PPI
Mechanism
Strategies of Polioeradication
Objectives
Types of AFP Surveillance
Surveillance Sensitivity
Components of AFP Surveillance
Note
Reporting
Mop-up Immunization
REVISED NATIONAL TUBERCULOSIS CONTROL PROGRAM (RNTCP)
National TB Control Program (NTCP)
Objectives of NTCP
Organization and Administration
Central Level Organization
District Level Organization
Peripheral Organization
RNTCP
NATIONAL ACUTE RESPIRATORY INFECTIONS CONTROL PROGRAM (NARICP)
Strategy
Administrative Setup
NATIONAL DIARRHEAL DISEASES CONTROL PROGRAM (NDDCP)
NATIONAL AIDS CONTROL PROGRAM (NACP)
Phase I (from 1987 to 1999)
Phase II (from 1999 to 2006)
Aims
Objectives
Strategies (Components of NACP)
Target Intervention
Care of the People Living with AIDS (PLWA)
STD-treatment
Condom Programming/Promotion
Multisectoral Collaboration
Public Private Partnership
Holistic IEC and Social Mobilization
Safe Blood
Voluntary Counseling and Testing (VCT)
Anti-retroviral Treatment
Infrastructure of VCTC
Staff Pattern
Activities of VCTCs
AIDS – Vaccine Initiative
Low Cost Care and Support
Evidence Based Planning
Monitoring and Evaluation
“3 BY 5” INITIATIVE
NATIONAL PROGRAM FOR THE CONTROL OF BLINDNESS: (NPCB)
Objectives
Operational Strategies
Administrative Setup
Procurement and Supplies
Program Components
NPCB Achievement
Revised Strategy
Targets for Tenth Five Year Plan
External Assistance
“RIGHT TO SIGHT” Initiative (Vision 2020)
NATIONAL CANCER CONTROL PROGRAM (NCCP)
Functions of the Organizations
NATIONAL DIABETES CONTROL PROGRAM (NDCP)
Strategies under NDCP
NATIONAL MENTAL HEALTH PROGRAM (NMHP)
Objectives
Tertiary Care Institutions
Mental Hospitals
Supportive Organizations
NATIONAL IODINE DEFICIENCY DISORDERS CONTROL PROGRAM (NIDDCP)
Aim
Objectives
Administrative Set up
NATIONAL VITAMIN ‘A’ PROPHYLAXIS PROGRAM
Aim
Strategy
Vitamin A Prophylaxis Schedule
NATIONAL NUTRITIONAL ANEMIA CONTROL PROGRAM (NNACP)
NATIONAL SPECIAL NUTRITION PROGRAM
NATIONAL BALWADI NUTRITION PROGRAM (NBNP)
NATIONAL MID-DAY SCHOOL MEAL PROGRAM
NATIONAL INTEGRATED CHILD DEVELOPMENT SERVICES (ICDS) SCHEME
NATIONAL FAMILY WELFARE PROGRAM (NFWP)
Evaluation of Family Planning
NATIONAL REPRODUCTIVE AND CHILD HEALTH PROGRAM (RCH-PROGRAM)
Historical Back-ground
Objectives
Interventions / Strategies of RCH Program
Maternal Health (Safe Motherhood)
Obstetric Care
Infection Control Measures
Nutrition Promotion
Child Health (Child Survival)
Reproductive Health
Management Strategies of RCH Program
Bottom-up Planning
Decentralized Training
Management Information and Evaluation System (MIES)
IEC and Community Participation
Highlights of this New Approach
REPRODUCTIVE AND CHILD HEALTH PROGRAM-II
Goals
Components of RCH-II
ALL INDIA HOSPITAL POSTPARTUM PROGRAM (AIHPPP)
Objectives
Rationale
NATIONAL WATER SUPPLY AND SANITATION PROGRAM
MINIMUM NEEDS PROGRAM (MNP)
Components of the MNP
Basic Principles of MNP
Rural Health
Rural Water Supply
Rural Electrification
Elementary and Adult Education
Rural Nutrition
Improvement of Urban Slums
Rural Housing
Rural Roads
Rural Sanitation
TWENTY POINT PROGRAM (20-PP)
PART-VI: ALLIED SUBJECTS
CHAPTER 53:
Emerging and Re-emerging Infectious Diseases
CHAPTER 54:
Severe Acute Respiratory Syndrome (SARS)
CHAPTER 55:
Avian Influenza (Bird Flu)
CHAPTER 56:
Disaster Management
CHAPTER 57:
Integrated Disease Surveillance Project (IDSP): 2004-09
CHAPTER 58:
Bioterrorism
CHAPTER 59:
Public Health Acts
CHAPTER 60:
Annexures
SOME STALWARTS AND THEIR CONTRIBUTION TO COMMUNITYMEDICINE
SIR EDWIN CHADWICK (1800-1890)
“LOUIS PASTEUR (1822-1895)”
JOSEPH LISTER (1827-1912)
ROBERT KOCH (1843-1910)
RONALD – ROSS (1857-1932)
CALENDER OF IMPORTANT DATES AND EVENTS
LIST OF WORLD BREASTFEEDING WEEK THEMES SINCE 1992
LIST OF WORLD HEALTHY DAY THEMES
GOALS TO BE ACHIEVED BY 2000-2015
MILESTONES IN VACCINATION
INDEX
TOC
Index
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