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Community Medicine: A Student's Manual
Parikshit Sanyal
CHAPTER 1:
Health and Disease
INTRODUCTION
The rise of public health
Revival of medicine
The great sanitary awakening
The phases of Public Health
Health promotion (1920–1960)
Preventive medicine
Social medicine
Health
Operational definition
Positive health
Changing concepts of health
Whose headache is health?
Determinants of health
Health Systems
Indicators of health
Three tier health care
Disease
Physical basis of disease
Risk factors
Surveillance
Three levels of struggle against diseases
Prevention
STATISTICS
The mathematicians dilemma
Data
Representation of data
Measurements
Properties of measurement scales
Scale types
Sampling
Random sampling
Matched random sampling
Systematic sampling
Stratified sampling
Cluster sampling
Errors in sampling
Calculation of sample size
Patterns of data
Measures of central tendency
Measures of dispersion
Probability
Testing for truth
Predictive value
Hypothesis testing
The usual hypotheses
Tests for statistical significance (Fig. 1.11)
2:
Epidemiology
THE TWO FACES OF MEDICINE
Three common components (Fig. 2.1)
Aims of epidemiology
Sources of data
What epidemiologists measure
Tools
Suitable denominators
Death
Descriptive epidemiology
Analytic epidemiology
Experimental epidemiology
Association
Uses of epidemiology
Epidemiologic triangle
SCREENING
Types of screening
Screenable diseases
CHAPTER 3:
Health and the Individual
GENES
Chromosomal diseases
Single gene (Mendelian) diseases
Multifactorial diseases
Prevention of genetic diseases
Health promotion
Specific protection
NUTRITION
Energy
Energy requirement
The proteins
Quick facts
Evaluation of protein nutritional status
Evaluation of a protein
Evaluation of amount of protein intake
Protein requirement (g/kgBW/day) – ICMR (Table 3.4)
Lipids
Types of lipids
Carbohydrates
Types of carbohydrates and their importance
Dietary fibers
Vitamins
Vitamin A
Vitamin D
Vitamin E
Vitamin K
Thiamine
Riboflavin
Nicotinic acid / niacin
Pantothenic acid
Pyridoxin
Folate
Ascorbate
Methylcobalamin/cyanocobalamin
Minerals (Table 3.6)
Iron
Iodine
Antioxidants
Water
Nutritional assessment of community
Food hygiene
Household hygiene of cooked food
Milk hygiene
Foodborne diseases
Neurolathyrism
Epidemic dropsy
Nutritional problems in public health
Malnutrition
Primary prevention
Secondary prevention
Tertiary prevention
Protein energy malnutrition
Problem
Agent
Host and environment factors
Classification
Clinical course
Diagnostics
Prevention
Nutritional anemia
Agent
Host
Environment
Diagnosis of anemia (Hb values in g/dL)87
Prevention
Secondary prevention
Vitamin A deficiency
Problem
Agent
Host
Environment
Clinical course
Prevention
Iodine deficiency disorders
Agent
Host
Environment
Clinical course
Goiter
Prevention and control
Criteria for monitoring progress towards sustainable IDD elimination
Endemic fluorosis
Solutions for nutritional problems
Indirect interventions
Direct interventions
National Program of Nutritional Support to Primary Education, 2006 (Mid-Day Meal Scheme)
National IDD control program (earlier, Nation Goiter Control Program, 1962)
Vitamin A prophalaxis program (1970)
Nutritional anemia prophyaxis program (1970)
Status of principal foods
Milk
4:
Health and the Community
PEOPLE
The demographic cycle
Demographic trends in India100
Fertility
Family planning
It is a way of
Eligible couples
Condoms
Diaphragm
Spermicidal jelly/suppository
Intrauterine contraceptive devices
Hormonal contraceptives
Natural methods
Sterilization
Emergency contraception (the ‘casualty’ department of family planning)
National Family Welfare Program, 1977
National population policy 2000
SOCIETY
Social medicine
Social medicine
State medicine
Socialized medicine
Sociology
Society
Medical sociology
Community
Social structure
Social institutions
Socialization
Social values
Social norms
Social contract
Culture
Learning
Social problems
Social defense
Social treatment
Social organizations
The family
Dominance
Fundamental nature of families
Functions of the family
The family in health and disease
Broken family
Problem families
Cultural factors in health and disease
Concept of etiology and cure
Environmental sanitation
Food habits
Maternal and child health
Personal hygiene
Marriage
Socioeconomy
Kuppuswamy scale for urban families
Education
Occupation
Per capita income ( Rs. per month )
Total score
Pareek’s SES for rural families
The caste system and reservation
Common terms in economics
Social security
Assistance
WOMEN AND CHILDREN
The maternity cycle
Problems of women and children
Maternal mortality
Problems of Children
Stillbirth
Low birth weight (< 2.5 kg)
Infant mortality
Perinatal mortality
1– 4 year mortality
Under five mortality
Handicapped children
Child abuse and violence
Child labor
Measures to circumvent the problems of MCH
Growth and development
Growth
Assessment of growth: Anthropometry
Growth chart
The RCH package
Changes in RCH from earlier programs
Preconceptional care (i.e. before fertilization takes place)
Adolescent (10–19) health care
Essential obstetric care
Record keeping
Intranatal care
Newborn care
Postnatal care (upto 42 days after delivery)
Breastfeeding
Efforts to promote and protect breastfeeding
Child health and welfare
Family welfare services
RCH II (2005–2010)
Features
New initiatives in RCH
Child health strategies
Integrated Child Development Services
Objectives
Services
School health
School health problems
Postpartum program
THE ELDERLY
Problems of the elderly
Ideal geriatric health services
Goal
Objectives
Primary prevention
INFORMATION, EDUCATION AND COMMUNICATION
Common terms
Communication
Health education
Planning for a session of health education
Counseling
CHAPTER 5:
Health and Environment
SANITATION
WATER
How should ideal water be?
How much water do we need?
From where do we get this water? (Fig. 5.1)
Water pollution
Types of water pollution
Causes of water pollution
What can unsafe water cause? (Fig. 5.4)
How can water be purified?
Principles of chlorination
Household water purification
Disinfection
Case study: How to clean a well?
Case study: Swimming pool sanitation198
Water surveillance: How to investigate a complaint about water?
Sanitary survey
Sampling
Examination
Chemical and physical surveillance
Water quality standards (WHO)
Acceptability
Microbiology
Chemical
Problem village
Water supply programs in India
AIR
Comfort
Determinants of comfort
Air pollution
Prevention of air pollution
Scrubbers
Biofuels
HOUSING
The ‘residential environment’
Overcrowding
Effects of overcrowding
Criteria of overcrowding
Indicators of good housing
WASTE DISPOSAL
Solid wastes
Waste minimization
Sorting and recycling (Fig. 5.11)
Storage
Collection
Methods of disposal
Liquid wastes
Hospital waste disposal
Impact of health care waste
Principles of management
Segregation and collection (Fig. 5.13)
Segregated internal transport
On site treatment
On site segregated disposal
Off site segregated transport
Off site disposal
DISPOSAL OF HUMAN EXCRETA
Excreta disposal in unsewered areas (‘on site’ latrines)
Sanitary latrines
Aqua privy
Trench latrines
Excreta disposal in sewered areas
Sewage treatment
Municipal method
Treatment of the effluent
Secondary sedimentation
NOISE
Measurements of sound
Effects of noise
Auditory
Nonauditory
Control
City planning
RADIATION
Unit of radiation
Types of radiation
Sources
Effects
STERILIZATION AND DISINFECTION
Types of disinfection
Tests for efficiency of a disinfectant
OCCUPATIONAL ENVIRONMENT
Aims of occupational health services
Psychosocial environment
Physical environment
Chemical environment
Occupational dermatitis
Lead poisoning
Biological environment
Sickness absenteeism
Prevention of occupational diseases
Health promotion
Specific protection
Early diagnosis and prompt treatment
Laws
DISASTERS
Classification
Disaster cycle
Short-term response
Mitigation and preparedness
(MEDICAL) ENTOMOLOGY
Vector dynamics
Control of (arthropod) vectors
Integrated pest management
Mosquitoes
Flies
Sandflies
Ticks
Mites
Lice
Fleas
Cyclops
Antivector chemical treatment—Insecticides259
Inorganic insecticides
Organic insecticides
List of vectors
6:
Health and the State
HEALTH CARE DELIVERY
How must a good health care service be?
Comprehensive
Accessible
Acceptable
Relevant
Community activity
The Indian situation analysis
Public health problems
Nutrition
Environment
Health care
Resources
What solutions may we have
Current targets
Changing terminologies
Primary health care/health for all
The public health sector
National Rural Health Mission (2005–12) (Fig. 6.5)
Targets
Strategies
National health policy 2002
The Indian Public Health Standards
Private health sectors
Voluntary health agencies/NGO
Drugs
Counterfeit medicine
HEALTH INFORMATION
Sources of information
Registration of vital events
Sample registration system
Disease notification
Hospital records
Surveillance
Surveys
PLANNING
7:
Health and the Planet
HEALTH INTERNATIONALE
Beginnings
WHO's WHO
United Nations International Children’s (Emergency) Fund
International Committee of the Red Cross
OTHER INTERMEDIATE HEALTH ORGANIZATIONS
8:
Noncommunicable Diseases
PROBLEM
Epidemiologic transition
CARDIOVASCULAR SYSTEM
Problem
Some figures279
Beyond the figures
Summary of cardiovascular risk factors280
Major modifiable risk factors
Other modifiable risk factors
Nonmodifiable risk factors
“Novel” risk factors
Ischemic heart diseases
Problem
Agent (Fig. 8.1)
Prevention
Hypertension
Definition
Problem
Agent
Prevention
Population strategy
High risk strategy
Secondary prevention
Cerebrovascular accidents (Stroke)
Agent
Host
Prevention
Primary prevention
Secondary prevention
Tertiary prevention
Rheumatic fever/Rheumatic heart disease
Agent
Host
Environment
The WHO 2002–2003 criteria284
Primary prevention
Secondary prevention
Tertiary prevention
CANCER
Problem
Commonest cancers by site
Survival
Agent
Host
Age
Sex
Others
Prevention
Primary prevention
Secondary prevention
Methods
Treatment
Tertiary prevention
Epidemiology of selected cancers
Oral cancer
Agent
Prevention
Stages
Agent
Host
Environment
Prevention
Screening carcinoma cervix
Agent
Host
Prevention
Screening carcinoma breast
Agent
Others
Host
Prevention
Objectives
Schemes
ENDOCRINE
Obesity
Definition and assessment
Problem
Agent
Host
Complications
Aims
Primary (and primordial) prevention
Diabetes mellitus
Definition293
Problem294
Agent
Agent
Host
Environment
Complications295
Population strategy
High risk strategy
Screening
Oral glucose tolerance tests
Treatment of diabetes
Monitoring of therapy
EYES
Blindness
National Program for Control of Blindness
WHO
Problem
India296
Agent
Host
Primary level
Secondary level
Tertiary level
Specific programs
Long-term measures
Objectives
Organization
Activities
Revised Strategies
Eye (cornea) banks
Educational activities
Vision 2020 (WHO, 1999)
Actions
ACCIDENTS
Problem
Agent
Host
Environment
Road traffic accidents
Indicators of traffic accidents
Agent
Host
Environment
Prevention
Preventing accidents
Primary prevention
Secondary prevention
CHAPTER 9:
Communicable Diseases
EPIDEMIOLOGY OF INFECTIOUS DISEASES
The chain of transmission (Fig. 9.1)
Source
Modes of transmission
Susceptible Host
Immunity
Control of communicable disease
Immunization schedules
Vaccines
Immunoglobulins
The 'cold chain'
Investigation of epidemic
What people tell you
What you need to know
INTESTINAL INFECTIONS
Acute diarrheal disease
Control
Diarrheal disease control program, 1980
Cholera
Agent
Host (Fig. 9.15)
Clinical course
Labs
Investigating a cholera epidemic
Enteric fever
Agent
Host
Environment (Fig. 9.16)
Clinical course
Diagnostics
Control
Investigation of typhoid sporadic
Acute bacterial gastroenteritis (Food poisoning)
Dracunculiasis
Poliomyelitis309
Problem
Polio eradication
Hepatitis A
Agent
Host
Environment
Chain of transmission
Teniasis
Agent
Chain of transmission
Clinical course
Control
Hydatid disease
Agent
Host
Environment
Chain of transmission
Clinical course
Labs
Treatment
Control
PARENTERAL ROUTES
Hepatitis B
Agent
Host
Environment
Chain of transmission (Fig. 9.23)
Clinical course
Complications
Labs
Prevention and control
Hookworm infestation
Agent
Host
Environment
Chain of transmission
Clinical course
Control
Malaria
The problem
Agent
Host
Environment
Chain of transmission (Fig. 9.26)
Clinical course (Fig. 9.27)
A history to learn from – the control of malaria in India
Dengue
Problem
Agent
Host
Environment
Chain of transmission
Clinical course
Labs
Lymphatic filariasis
Agent
Host
Environment
Chain of transmission (Fig. 9.35)
National Filaria Control Program, 1955
Global elimination of LF (WHO), 1997
Yellow fever
Chain of transmission
Control
Protecting India from yellow fever
Kyasanur forest disease
Agent
Host
Environment
Chain of transmission
Clinical course
Labs
Control
Chikungunya fever
Chain of transmission
Clinical course
Labs
Control
Japanese encephalitis
Agent
Host
Environment
Chain of transmission (Fig. 9.38)
Clinical course
Control
Leishmaniasis
Problem
Agent (Fig. 9.39)
Host
Environment
Chain of transmission (Fig. 9.40)
Clinical course
Labs
Treatment
Control
National Vector Borne Disease Control Program
Vision
Mission
Strategies
Plague
Problem
Agent
Host
Environment
Chain of transmission (Fig. 9.42)
Clinical course
Diagnostics
Rabies
Agent
Host
Clinical course
Labs
Control of urban rabies
Tetanus
Agent
Host
Environment
Chain of transmission
Clinical course
Prevention
RESPIRATORY INFECTIONS
Smallpox
Chickenpox (Varicella)
Agent
Host
Environment
Chain of transmission (Fig. 9.52)
Clinical course
Complications
Prevention
Diphtheria
Agent
Host
Environment
Chain of transmission (Fig. 9.53)
Clinical course
Treatment
Control
Pertussis
Agent
Host
Environment
Chain of transmission (Fig. 9.54)
Clinical course
Labs
Control
DPT
Influenza
Agent (Fig. 9.55)
Host
Environment
Chain of transmission (Fig. 9.57)
Clinical course
Labs
Control
The 2009 'swine flu' pandemic
Mumps
Agent
Host
Environment
Chain of transmission
Clinical course
Complications
Control
Rubella
Agent
Host
Environment
Chain of transmission
Clinical course
Severe acute respiratory syndrome (SARS)
Agent (Fig. 9.59)
Clinical course
Chain of transmission (Fig. 9.60)
Measles
Problem377
Agent
Host
Environment
Chain of transmission (Fig. 9.61)
Clinical course
The Measles Initiative (2001)
Acute respiratory infections
Agent
Host
Environment
Chain of transmission (Fig. 9.63)
Tuberculosis
Problem
Agent
Host
Environment
Chain of transmission (Fig. 9.66)
Clinical course
Control
Revised National Tuberculosis Control Program, 1997
Leprosy
Agent
Host
Environment
Chain of transmission (Fig. 9.73)
Clinical course
Lab
Classification of leprosy
Treatment
Reactions
Control of leprosy
National Leprosy Control Program, 1955
National Leprosy Eradication Program phase I, 1993–2000
Special action project for elimination of leprosy (SAPEL)
SEXUALLY TRANSMITTED DISEASES
Reproductive tract infections
Agent
STDs are a public health problem
Syndromic management
Prevention
HIV infection
Problem
Agent
Host
Chain of transmission (Fig. 9.88)
Clinical course (Fig. 9.89)
Labs
Control
National AIDS control program
NACP III (2007–2012)
Surveillance
Appendix
APPENDIX A: WORKOUT
References
INDEX
TOC
Index
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