Preventive Medicine Flashcards
RA that promulgates the inclusion of public health and preventive medicine in medical education and licensure examination
RA 2382 The Medical Act of 1959
Philippine land area
300,000 sq.km.
Philippine population in 2010
92.3 million (100M)
Major source of funds in private hospitals in the Philippines
Philhealth
Major source of funds in public health facilities in the Philippines
Salary/income
Top 10 causes of mortality in the Philippines as of 2009
1) DISEASES OF THE HEART 2) Cerebrovascular diseases 3) Malignant neoplasm 4) Pneumonia 5) Tb 6) COPD 7) DM 8) Nephritis/nephrotic syndrome 9) Assault 10) Perinatal conditions
Top 10 causes of morbidity in the Philippines as of 2010
1) Acute RTI 2) ALRTI and pneumonia 3) Bronchitis/bronchiolitis 4) Htn 5) Acute watery diarrhea 6) Influenza 7) UTI 8) TB 9) Accidents 10) Injuries
T/F MCC of deaths in among Filipinos is non-infectious in nature
T, CV disease is MCC
MC cause of death that has a male preponderance among Filipinos
Acute pancreatitis
IDA is most prevalent in what population in the Philippines
6 mos-1 year (2nd: pregnant women, 3rd: lactating women)
Vitamin A deficiency is most prevalent in what population in the Philippines
6 mos-5 years
MCC of maternal mortality in the Philippines
Complications related to pregnancy occurring in the course of labor, delivery, and puerperium (except hemorrhage)
Age group with the highest % of obesity in the Philippines
40-59 y/o
Cancer with the highest mortality rate in the Philippines
Lung, trachea, bronchus (2nd: breast, 3rd: colon)
MC prohibited drug/substance of abuse in the Philippines
Shabu/methamphetamine HCl (2nd: Marijuana/cannabis sativa)
MCC of accidents and injuries in the Philippines
Assaults
The product of the interaction of the population, the health sector and the health-related socio-economic factors
Health status
Initial step in health system planning
Situational analysis/diagnosis
Describe the population pyramid of the Philippines
Expansive
Increase in life expectancy is mainly due to
Decrease in mortality in the younger age group
When was the PHC adopted in the Philippines
1979
Primary health care should be aimed at self-reliance and self-determination; health for all
DECLARATION OF ALMA ATA - PHC
PHC model referred to as the “health TO people”
Hospital- or clinic-based model
PHC model referred to as the “health FOR people”
Community-oriented PHC model
PHC model described to be democratic, signifying “health WITH the people”
Community-based PHC model
PHC model that denotes “health BY the people”
Community-managed PHC model
First point of contact in a primary health care system
Barangay health worker/community health workers
National health insurance law, RA
RA7875
Goal of primary health care: A service is easily available to users in terms of time, distance and ethos
Accessibility
Goal of primary health care: Services satisfy the reasonable expectations of users
ACCEPTABILITY
Services adapt to the expressed needs of users
Responsiveness
Service that which the users require
Appropriatenes
Users have equal access and benefit from services
EQUITY
Services achieve their intended objectives
EFFECTIVENESS
Services achieve maximum benefit for stated costs
EFFICIENCY
The act by which the national government confers power and authority upon the various local government units to perform specific functions and responsibilities
Devolution
Lead agency in the public health care system
DOH
A group of tasks designed either to determine the risk of subsequent disease or to identify disease in its early symptomless state
Periodic health examination (PHE)
Critical Components of the PHE
Counseling for the prevention of disease and maintenance of health Screening and health protection packages Immunizations Prophylaxis
Who will test positive among the persons with disease
Sensitivity (a/a+c)
Who will test negative among the persons without the disease
Specificity (d/b+d)
Probability of a positive test in people with disease
Sensitivity
Probability of a negative test in people without disease
Specificity
Probability of the person having the disease when the test is positive
PPV (True positive!; a/a+b)
Probability of the person not having the disease when the test is negative
NPV (True negative!; d/c+d)
Prevalence
a+c/a+b+c+d
False negative rate
1-Sn
Total number of cases in a population at a given time
Prevalence
Number of new cases in a population per unit time
Incidence
Characteristic of a testing modality which measures its capacity of ruling in a disease
Specificity (SPIN)
Characteristic of a testing modality which measures its capacity of ruling out a disease
Sensitivity (SNOUT)
High sensitivity vs specificity: Screening test
Sensitivity
High sensitivity vs specificity: Confirmatory test
Specificity
Refers to the proportion of individuals who were sick during a specified period of time
Period prevalence
Relationship of prevalence to incidence
Directly proportional
Relationship of duration of disease to prevalence
Directly proportional
T/F Unlike sensitivity and specificity, predictive values are dependent on the prevalence of disease
T, the higher the prevalence of a disease, the higher the PPV of a test
CRITERIA TO BE CONSIDERED IN POPULATION BASED SCREENING FOR DISEASE
• Disease should be an important health concern • Natural history of the disease should be known • The disease should be treatable at the stage detected by the screening test with a measurably better outcome than if diagnosis is delayed until symptoms occur
The process of inducing immunity against a specific disease
Immunization
Major indications for passive immunization
1) Immunodeficient children 2) Imminent risk of exposure where there is not adequate time to develop an active immune response 3) Part of specific therapy for an infectious disease
Immediate goal of active immunization
Disease prevention
Ultimate goal of active immunization
Disease eradication
Defined as whole or parts of micro- organisms administered to prevent an infectious disease
Vaccine
Vaccine: Tend to induce long-term immune responses; replicate/often similar to natural infections
Live attenuated vaccines
Vaccine: A lot of times administered as single-dose schedules unless there is failure to induce an initial immune response to first dose (e.g. MMR)
Live attenuated vaccines
Vaccine: Require multiple doses to induce an adequate immune response
Inactivated vaccines
Mode of administrations of most inactivated vaccines
IM
Mode of administrations of most live-attenuated vaccines
SC
Mode of administrations of most pneumococcal polysaccharide vaccines
SC or IM
PSMID RECOMMENDED vaccines - FOR ALL ADULTS
• Tetanus booster every 10 years • Rubella • Varicella • Hepatitis B
Supplements recommended in PHC
1) Vitamin A for young children 2) Folic acid for pre- and postnatal care 3) Calcium for all women 4) Iodine
Sangkap Pinoy
1) Vitamin A 2) Iron 3) Iodine
Recommended exercise frequency and duration
30 minutes daily
Epidemiological measure used in chemoprophylaxis
NNT
A discipline that analyzes the supply and demand for health care and provides a structure to understand the choices made therein
Health economics
A sub-discipline under health economics that compares the value of one pharmaceutical drug or drug therapy to another
Pharmacoeconomics
Usefulness that individuals placed on goods and services (i.e., Ferrari=”speed”, Toyota= “safety”)
Utility
Measures how well resources are used in order to achieve a desired output
Efficiency
The total resources consumed in producing a good or service
Cost
The amount of money required to purchase an item
Price
Staff costs, drug acquisition costs, capital costs from the perspective of the health care provider
Direct costs
Costs experienced by the patient, patient’s family or society (loss of productivity, loss of earnings, etc), from the perspective of society as a whole
Indirect costs
Pain, worry and distress experienced by the patient and family (impossible to measure)
Intangible costs
The state recognizes the Filipino family as the foundation of the nation. Accordingly, it shall strengthen its solidarity and actively promote its total development
ARTICLE XIII SECTION 2 - 1987 PHILIPPINE CONSTITUTION
MEMBERS of a family ENTER THROUGH
1) BIRTH 2) MARRIAGE 3) ADOPTION
Minimum number of members in a family
2
The primary social unit
Family
The greatest ally of the doctor in the patient’s treatment
Family
Therapeutic triad
1) Doctor 2) Patient 3) Family
6 essential functions of a family
1) Physical maintenance and care 2) Procreation or adoption and relinquishment 3) Socialization of children for adult roles 4) Maintenance of order 5) Maintenance of family morale and motivation for task performance 6) Production and consumption of goods
Parents + dependent children; occupies a SEPARATE DWELLING not shared with families of origin of either spouse; economically independent
Nuclear
Parents + children + relatives
Extended
Aggregate of families or part of families from 3 or more generations occupying a single or adjacent dwellings
Extended
Children less than 17 y/o + single parent + relative or non-relative
Single-parent
Step parents + step children
Blended
Different families formed for specific ideological or societal purposes
Communal/corporate
Alternative lifestyle for people shoe feel alienated from a predominantly economically-oriented society
Communal/corporate
Characteristics of a well-functioning family
1) Role distinction 2) Individuality and high degree of differentiation 3) Rules clear and reasonable 4) Good communication 5) Authority or power is clearly vested 6) Full range of emotions acceptable, appropriate, and encouraged 7) Conflicts are resolved 8) Tasks or chores shared with a clear understanding of who performs which tasks 9) Individual differences respected 10) High esteem
T/F about Filipino family: Unilaterally extended
F, bilaterally
T/F about Filipino family: Authority is based on who provides for the family
F, based on seniority
T/F about Filipino family: Externally patriarchal, internally matriarchal
T
T/F about Filipino family: Death of father has greater impact
F, mother
T/F about Filipino family: High value on education
T
T/F about Filipino family: Child-centered
T
Average number of children in a Filipino family
5
First vs middle vs youngest: Persevering
First
First vs middle vs youngest: Optimistic
Middle
First vs middle vs youngest: Serious
First
First vs middle vs youngest: Sociable
Middle
First vs middle vs youngest: More responsive to adults
First
First vs middle vs youngest: Aggressive, competitive
Middle
First vs middle vs youngest: Achievement-oriented
First
First vs middle vs youngest: Occasionally manipulative
Middle
First vs middle vs youngest: Demanding
Youngest
First vs middle vs youngest: Outgoing
Youngest
First vs middle vs youngest: Affectionate
Youngest
First vs middle vs youngest: Occasionally narcissistic
Youngest
Family set-up that can adjust to stressful situation
Democratic
Family set-up that responds poorly to stressful situation
Authoritarian
Family set-up: Parents respect their child’s decision and ideas
Democratic
Family set-up: Unquestioned obedience
Authoritarian
Family set-up:Understanding and permissiveness prevails
Democratic
Family set-up: Patterns of punishment than praise
Authoritarian
Family set-up: Patients with low self-reliance, suspicious of adults
Authoritarian
A time period in the life of a family that has a unique structure
Family stage
Composite of individual developmental changes of family members
Family life cycle
Shows the evolution of the marital relationship
Family life cycle
Stages of family life cycle
1) Unattached young adult 2) Newly married couple 3) Family with young children 4) Family with adolescents 5) Launching family 6) Family in later life
Leaving home
Unattached young adult
Joining families through marriage
Newly married couple
The study of the direct pathological effects of various chemical, physical, and biological agents, as well as the effects on health of the broad physical and social environment, which includes housing, urban development, land-use and transportation, industry, and agriculture
Environmental health
Commitment to new system
Newly married couple
Accepting emotional and financial responsibility for self
Unattached young adult
Realignment of relationships with extended families and friends to include spouse
Newly married couple
Accepting new members into the marriage and extended family
Family with young children
Increasing flexibilities to include children’s independence and grandparents’ frailties
Family with adolescents
Joining in child-rearing, financial and household task
Family with young children
Refocus on midlife marital and career issues
Family with adolescents
___ is estimated to be directly responsible for approximately 25 percent of all preventable ill health in the world, with diarrheal diseases and respiratory infections heading the list
Poor environmental quality
Accepting shifting of generational roles
Family in later life
Differentiation of self in relation to family of origin
Unattached young adult
Maintaining own function in face of physiologic decline
Family in later life
Accepting exits from and entries into the family system
Launching family
Support for a more central role of the middle generation
Family in later life
Dealing with loss of spouse, siblings, peers, and preparation for own death; life review integration
Family in later life
Qualitatively measures family functioning (screening for family dysfunction)
Family APGAR (Smilkstein)
Includes 5 questions to assess family function
Family APGAR (Smilkstein)
T/F Family APGAR provides adequate reliability and validity to measure the individual’s level of satisfaction about family relationships
T
T/F Responses in family APGAR are summated and evaluated based on sum
F, NOT SUMMATED
Uses of Applied Family APGAR
1) When the family members will be directly involved in PATIENT CARE. 2) When treating a new patient in order to get information to serve as general view of family functions 3) When treating a patient whose family is deemed in crisis. 4) When a patient’s behavior makes you suspect a psycho-social concern secondary to family dysfunction.
APGAR: Capability of the family to utilize and share inherent resources which are either intra-familial or extra-familial
Adaptation
APGAR: Sharing of decision-making
Partnership
APGAR: Physical and emotional growth
Growth
APGAR: Satisfaction with emotional relationships and intimacy within the family
Affection
APGAR: How time, space, and money are shared
Resolve
APGAR: Measures the satisfaction attained in solving problems by communication
Partnership
APGAR: Measures the satisfaction of the available freedom to change
Growth
APGAR: Measures the members’ satisfaction with the emotional interaction that exist in the family
Affection
APGAR: How emotions like love, anger and hatred are shared between members
Affection
APGAR: Measures the members’ satisfaction with the commitment made by other members of the family
Resolve
APGAR part I vs part II: Helps define degree of members’ patient satisfaction with family function
I
APGAR part I vs part II: Delineates relationship with other members
Part II
APGAR part I vs part II: Identifies persons who can provide assistance to the member
Part II
APGAR part I vs part II: Identifies conflict not revealed in Part I
Part II
APGAR: I am satisfied with the way my family and I share time together
Resolve
APGAR: I am satisfied with the way my family expresses affection and responds to my emotion such as anger, sorrow, and love
Affection
APGAR: I am satisfied that my family accepts and supports my wishes to take on new activities or directions
Growth
APGAR: I am satisfied with the way my family talks on things with me and shares problems with me
Partnership
APGAR: I am satisfied that I can turn to my family for help when something is troubling me
Adaptation
APGAR score of a severely dysfunctional family
0-3
APGAR score of a moderately dysfunctional family
7-Apr
APGAR score of a highly functional family
10-Aug
Assesses the capacity of the family’s resources and coping with crisis
SCREEM
SCREEM
Social, cultural, religious, economic, educational, medical (factors affecting health)
Best way to obtain and record information about the family structure
Family genogram
Graphic chart representation of the both the genetic pedigree of the family and the key psychosocial and interactional data using standardized symbols
Family genogram
Male symbol in genogram
Square
Female symbol in genogram
Circle
Used on individuals and small groups; Large circle is drawn on a piece of paper and instruction is given by the family physician
Family circle by Thrower et al
Facilitates the communication of information about a family system to colleagues
FAMILY MAPPING by Salvador Minuchin
____
Functional relationship
__/__
Dysfunction Over-involved relationship
__l__
Rigid boundary (rules are clear but non-negotiable)
_ _ l _ _
Boundary that is clear but negotiable
. . . l . . .
Boundary that is diffuse or unclear
[ ]
Presence of a coalition or alliance between people encompassed
Disease vs. Illness: Primary biologic disorder
Disease
Disease vs. Illness: Includes the sufferer’s experience of the disease and the broad range of dislocations felt by the sufferer and his family
Illness
Normal course of the psychosocial aspects of an illness situation that allows the family physician to predict responses and anticipate problems
Family illness trajectory
Stages in the family illness trajectory
I Onset of illness, II Impact phase, III Major therapeutic efforts, IV Recovery phase, V Adjustment to the permanency of the outcome
Family illness trajectory: Stage experienced prior to contact with health care providers
1
Family illness trajectory: Immediate decision necessary; may have little or no support
1
Family illness trajectory: Reactions of patient and family: initially there is denial, disbelief and anxiety; may be followed by anger and depression
2
Family illness trajectory: A struggle to understand the diagnosis and start problem-solving
2
Family illness trajectory: Denies legitimacy of complaints; feelings of guilt and resentment; mistrust and hostility towards medical profession
1
Family illness trajectory: Issues on non-compliance and shifting of roles
3
Family illness trajectory: Issues on improvement in nurturance & closeness; redefinition of self and reorganization of relationships; affected by quality of coping
4
Family illness trajectory: Family realizes that they must accept and adjust to a permanent disability
5
Task of doctor in Stage 1 of illness trajectory
Explore explanation, fear and anxiety on part of patient/family
Task of doctor in Stage 2 of illness trajectory
Elicit the family’s explanatory models & attempt to explain; Gauge the amount of information the family can take at any given time; Assist in linkages
Task of doctor in Stage 3 of illness trajectory
Keep costs low; coordinate all aspects of tx; anticipate pathology
Task of doctor in Stage 4 of illness trajectory
Psychological support through understanding and repeated reassurance
Most difficult time in the illness episode
Stage 2
Spelunkers
Histoplasmosis
Development of adult-to-adult relationships between growing children and parents
Launching family
Launching children and moving on
Launching family
Brake mechanic
Hydrogen sulfide
Potter
Silica dust
Sewer worker
Hydrogen sulfide
Arc welder
Carbon monoxide
N-naphthylamine (amino naphthalene)
Bladder cancer
A concept of caring for dying or terminally ill so that he can die in dignity
Hospice care
Preventive measure for a cook who is hepatitis A (+)
Stop cooking
Benzene (benzol)
Hematopoietic system cancer
Nickel
Lung cancer
Chromium
Lung cancer
Asbestos
Lung cancer and GI cancers
Silica
Pulmonary fibrosis
Aniline dyes
Bladder cancer
Chromate
Lung cancer
Miners/construction workers/agricultural workers
Trauma
The presence of one or more air contaminants in sufficient quantities, of such characteristics, and of such duration as to threaten human, plant, or animal life or to property or which reasonably interferes with the comfortable enjoyment of life or property
Air pollution
Emission into air of hazardous substances at a rate that exceeds capacity of natural processes in atmosphere to purify itself (assimilative capacity)
Air pollution
Routes of Exposure to air pollution
1) Inhalation 2) Ingestion 3) Skin contact
Outdoor air pollution classification
1) Criteria pollutants 2) Hazardous pollutants
Hazardous pollutants
Asbestos
Criteria pollutants
Sulfur dioxide Nitrogen dioxide Carbon monoxide Ozone Particulate matter
Particles filtered by nose and pharynx; cleared is nasal secretions, coughed out or swallowed
> 10_m
Particles deposited in the tracheo-bronchial tree
Less than 10_m
Particles deposited in the alveoli
1 to 2 _m
Dentist
Hepatitis
Particles carried by diffusion to the alveolar level and impacted on alveolar surfaces
Less than 0.5_m
Either solid or liquid particle dispersed into the air
Aerosol
Dispersed solid particle that usually results from the break-up of larger masses of material, as in drilling, crushing, or grinding operations
Dust
Visible aerosol of a liquid form by condensation
Fog
Aerosol of solid particle formed by condensation of vaporized material, particularly molten metal, which reacts with air to form an oxide
Fume
Dispersion of solid particle that may be in the visible range
Mist
Aerosol that results from incomplete combustion of carbon-containing materials such as wood, coal, tar
Smoke
Gaseous phase of the material that is ordinarily solid or liquid at room temperature and pressure
Vapor
This states that a pollutant released indoors is 1000 times more likely to reach the lungs than a pollutant released outdoors
RULE OF 1000
Air pollutant which is most significant to public health
Particulates (PM10, respirable range)
Air pollutant that can cause pneumoconiosis in occupational exposures
Particulates (PM10, respirable range)
Water-soluble irritant gas predominantly acting on the URT and is the source of acid rain
Sulfor dioxide
Major component of “London fog” phenomenon
Sulfur dioxide
WHO guideline for 24h exposure to NO
150 ug/m3 (0.08 ppm)
WHO guideline for 8h exposure to ozone
100 ug/m3
Produced by incomplete burning of fossil fuel
CO
Odorless and colorless gas slightly heavier than air that is not cleared easily from the circulatory system due to high affinity to hgb
CO
Normal amount of CO in blood
1%
WHO guideline for 8h exposure to CO
10 mg/m3 (9 ppm)
Relationship between lead blood levels and IQ of exposed children
Every 10 ug/dL increase in blood lead levels is associated with 1 - 5 point decrease in IQ of exposed children
Air pollution from fireplaces and stoves
Respirable particles
Air pollution from space heaters, and tobacco smoke
CO
Air pollution from formaldehyde, cleaning fluids and solvents
Volatile organic compounds (VOCs)
Air pollution from pesticides and kerosene
Semivolatile organic compounds
Air pollution that causes a peribronchial inflammatory response involving fibroblasts proliferation and stimulation which eventually leads to fibrosis
Asbestos
Most useful finding in asbestosis
Bilateral pleural thickening
Almost a pathognomonic sign of asbestos exposure
Diaphragmatic or pericardial calcification
Most sensitive imaging method for detecting early asbestosis
HRCT
Air pollutant ingested by alveolar macrophages which then releases cytokines that recruit and activate T lymphocytes stimulationg fibroblast proliferation and collagen deposition
Silicosis
Subacute silicosis occurs after how many years of exposure
2-5
Chronic simple silicosis occurs after how many years of exposure
> 10 years
Small round opacities in both lungs with predilection to upper lung zones and calcified hilar lymph nodes (“egg shell” pattern)
Silicosis
Cannot be removed by alveolar macrophages and mucociliary clearance; Are retained in terminal respiratory units where fibroblasts secrete a limiting layer of reticulin around the macule
Coal dust
The chest radiograph shows small, rounded opacities often seen first in the upper lung zones and in later stages may involve the lower zones
COAL WORKER’S PNEUMOCONIOSIS
Aimed at political actions that will facilitate the necessary organizational, economic, and other environmental supports for the conversion of individual actions into health enhancements and quality of life-gains
Health promotion
Agents are typically found in nature, could be changed to increase their ability to cause disease, make them resistant to current medicines, or to increase their ability to be spread into the environment
Bioterrorism
CHOKING AGENTS (LUNG IRRITANTS)
1) Phosgene 2) Chloropicrin
BLOOD GASES
Hydrogen cyanide
VESICANTS (BLISTER GASES)
1) Mustard gas 2) Lewisite
NERVE GASES
1) Tabun 2) Sarin
Temp used for thermal treatment of hazardous materials and waste
200-1000F
Any physical, biological or chemical change in water quality that adversely affects living organisms or makes water unsuitable for desired uses
Water pollution
Triad/3 spheres of health promotion
1) Disease prevention 2) Health education 3) Health protection
7 domains of health promotion
1) Prevention 2) Lifestyle 3) Preventive policies 4) Policy-maker education 5) Health education 6) Health protection 7) Policy support
Includes primary and secondary preventive measures
Prevention
Includes education efforts to influence lifestyle to prevent health-related problems
Lifestyle
Includes encouragement to avail of preventive services
Lifestyle
Includes fluoridation of public water supplies and inspections of restaurants
Preventive policies
Includes lobbying by safety-conscious groups to encourage mandated use of automobile seat belts
Policy-maker education
8-hour noise level
90 dB
Includes efforts to stimulate a social environment that demands or accepts preventive health protection measures
Policy-maker education
Includes influencing behavior by helping individuals, groups, or whole communities develop positive health attributes, such as life skills and self- esteem
Health education
Includes implementation of a workplace policy forbidding smoking
Health protection
Includes commitment of public funds to provide safe-walking areas and bicycles paths
Health protection
Embraces raising awareness of, and securing support for, positive health protection measures among the public and policy makers
Policy support
What sphere of health promotion: Prevention
Disease prevention
What sphere of health promotion: Lifestyle
Health education
What sphere of health promotion: Preventive policies
Health protection
What sphere of health promotion: Policy-maker education
Health education for health protection
What sphere of health promotion: Policy support
Health education for health protection
Chlorination and fluoridation of water supply, primary vs secondary vs tertiary prevention
Primary
Fluoridation of drinking water reduces caries by
50%
T/F The advisability of fluoridation is still controversial among dental public health experts
F
The optimum concentration of fluoride in public drinking water depends on
Average daily temperature of the community served
A white brown discolouration of teeth from too much fluoride
Fluorosis
Fluorosis often occurs if fluoride intake exceeds how many mg per day
4-8mg
Immunization, primary vs secondary vs tertiary prevention
Primary
Exercise programs, primary vs secondary vs tertiary prevention
Primary
Pap smears, primary vs secondary vs tertiary prevention
Secondary
Hypertension and Diabetes Mellitus case-finding, primary vs secondary vs tertiary prevention
Secondary
Smoking cessation programs, primary vs secondary vs tertiary prevention
Secondary
Live attenuated vaccines
[BOY Loves CRIME] 1) BCG 2) OPV 3) Yellow fever 4) LIVE 5) Chicken pox 6) Rotavirus 7) Influenza (nasal spray) 8) MMR 9) Endemic typhus
Inactivated vaccines
[HAPIR] 1) Hepatitis A 2) Polio IPV 3) Rabies
Toxoid
DT of DTaP
Administration of single injection of live attenuated measles vaccine results in
Seroconversion in 95% of susceptible children
Prevention of human brucellosis depends on
Pasteurization of dairy products derived from goat, sheep, or cows
Influenze vaccine is generally recommended for
All persons with severe pulmonary disorders regardless of age
Effective means of preventing trichinosis in humans include
Prohibiting the marketing of garbage-fed hogs
The major environmental source of lead absorbed in the human blood stream in adults
Air
Vitamin deficiency: Petechiae, sore gums, hematuria, bone or joint pain
C
Vitamin deficiency: Dermatitis, diarrhea, delirium
Niacin
Vitamin deficiency: Edema, neuropathy, myocardial failure
Thiamine
Vitamin deficiency: Poor mineralization of bones and teeth; osteoporosis
Sodium depletion
Vitamin deficiency: Nausea, diarrhea, muscle cramps, dehydration
Sodium depletion
Vitamin deficiency: Dwarfism, hepatosplenomegaly, poor wound healing
Zinc
2 vitamin deficiencies that impair wound healing
1) Zinc 2) Vitamin C
Vitamin deficiency: Hemolytic anemia in premature infants
E
Hemorrhagic disease of newborn
K
Health measure that has the greatest potential for prevention of disease
Modification of personal health behavior
The measure of dispersion of choice when the mean is used as the reference point
Standard deviation
Vitamin deficiencies to be eliminated as part of DOH goals
A and iodine
Modified bacterial toxin made nontoxic but still able to induce an active immune response
Toxoid
Classification of age as a variable into young or old is an example of what scale of measurement
Nominal
Ability of a test to give a positive result when the variable of interest is present
Sensitivity
Conjugate vaccine (polysaccharide capsules conjugated to protein carrier)
SHiN organisms (Pneumococcal, Hib, Meningococcal)
Polysaccharide capsules:
1) Pneumococcal 2) Meningococcal
Subunit/part
1) HepB 2) HPV 3) Influenza injection 4) P of DTaP (acellular pertussis)
Study of the distribution and determinants of disease frequency in man
Epidemiology
Uses of epidemiology
1) Causation 2) Natural history 3) Description of health status of population 4) Evaluation of health interventions
NON LIVING, THE EXCESSIVE PRESENCE OR THE RELATIVE LACK OF WHICH IS THE IMMEDIATE OR PROXIMAL CAUSE OF THE DISEASES
Etiologic factor
ABILITY TO LODGE & MULTIPLY IN THE BODY OF THE HOST
Infectivity
ABILITY TO PENETRATE INTO OR GROW WITHIN THE HOST AWAY FROM THE ORIGINAL SITE
INVASIVENESS
ABILITY TO PRODUCE TOXIN
Toxicity
A HABITAT (LIVING OR NON-LIVING), IN WHICH AN INFECTIONS AGENT LIVES, MULTIPLIES AND DEPENDS PRIMARILY FOR ITS SURVIVAL & FROMWHICH IT CAN BE TRANSMITTED TO AN INTERMEDIATE OR SUSCEPTIBLE HOST
Reservoir
A LIVING OR NON-LIVING THING THRU WHICH THE AGENT PASSES IMMEDIATELY OR DIRECTLY TO SUSCEPTIBLE HOST
Source of infection
The ability of an agent to invade and adapt itself to the human host
Infectivity
The measure of the ability of an agent, when lodged in the body, to set up either a local or general tissue reaction
Pathogenicity
Measure of the severity of the reaction produced
Virulence
A person not possessing resistance against a particular pathogenic agent
Susceptible human host
A person who possesses antibodies that are specific and protective
Immune human host
Factors of disease causation
1) Susceptible host 2) Agent 3) Environment
ABILITY TO CAUSE DISEASE or symptomatic illness
Pathogenicity
Stages of disease
1) Susceptibility 2) Pre-symptomatic/pre-clinical /incubation 3) Clinical/symptomatic period (clinical horizon) 4) Disease outcome (complete recovery, disability or defect, carrier state, death)
A logical sequence of factors necessary for disease to ensue
The epidemiological chain
SUM TOTAL OF AN ORGANISM’S SURROUNDINGS, CONDITONS & INFLUENCES THAT AFFECT ITS LIFE & DEVELOPMENT
Environment
Questions about the cycle by which the organism maintains its existence in nature and by means it reaches man
1) Nature? 2) Reservoirs? 3) Spread? 4) Portals of entry and exit?
ABILITY TO INDUCE PRODUCTION OF ANTIBODIES
Antigenicity/immunogenicity
Factors for disease causation
- A causative or etiologic agent 2. A reservoir or source of the causative agent 3. A mode of escape from the reservoir 4. A mode of transmission from the reservoir to the potential new host 5. A mode of entity into the new host
T/F about the epidemiological chain: INTERRUPTION IN ANY STAGE OF THE CHAIN, DISEASE WILL NOT DEVELOP
T
In the epidemiological chain, the reservoir and source are identical if
Transfer is direct from reservoir to host
ESCAPE FROM THE BODY
Period of communicability
Relationship between period of communicability and degree of communicability
Inverse
Measured by the percentage of severe or fatal cases
Virulence
Ability to spread in a population of exposed susceptible persons
Contagiousness
REQUIREMENTS FOR SUCCESSFUL PARASITISM aka Host-Agent Interaction Requirements
- Favorable conditions in the environment for the agent 2. SUITABLE RESERVOIR/receiver 3. PRESENcE OF SUSCEPTIBLE HOST 4. SATISFACTORY PORTAL OF ENTRY TO THE HOST 5. ACCESSIBLE PORTAL OF EXIT FROM THE HOST 6. APPROPRIATE MODE OF TRANSMISSION TO NEW HOST
HOST PARASITE RELATIONSHIP DEPENDS ON
- CHARACTERISTICS AND DOSAGE OF AGENT 2. DURATION OF EXPOSURE OF THE HOST T 3. REACTION OF THE TISSUES OF THE HOST TO THE AGENT 4. PORTAL OF ENTRY AND TISSUES AFFECTED
Infection in which the host is a healthy carrier
Inapparent infection
Refers to EVERY MILD REACTIONS THAT ESCAPES DETECTION
SUBCLINICAL CONDITION
THE INTERVAL BETWEEN THE TIME OF ENTRY OF THE AGENT INTO THE HOST AND THE ONSET OF SIGNS AND SYMPTOMS OF DISEASE
Incubation period
FACTORS THAT AFFECT INCUBATION PERIOD
- VIRULENCE, DOSE & PORTAL OF ENTRY 2. PREVIOUS EXPERIENCE OF THE HOST & THE STATE OF IMMUNITY 3. INHERENT CHARACTER OF THE ORGANISM
THE RESISTANCE OF A GROUP TO INVASION & SPREAD OF AN INFECTIOUS AGENT
Herd immunity
T/F IT IS NOT NECESSARY TO HAVE A 100% LEVEL OF HERD IMMUNITY TO PREVENT THE OCCURRENCE OF AN EPIDEMIC
T
Defined as more the the usual expected occurrence of disease
EPIDEMIC
Defined a a disease constantly occurring in a GEOGRAPHICAL AREA
Endemic
An epidemic occurring within more than 1 country or territory
Pandemic
Occasional or infrequent occurrence of a disease
Sporadic
Epidemic vs endemic vs pandemic: MERS CoV
Pandemic
Epidemic vs endemic vs pandemic: Bird flu
Pandemic
Epidemic vs endemic vs pandemic: HIV
Pandemic
Temporary occurrence in a small community or region, of a group of illness of similar nature, clearly in excess of normal expectancy and derived from a common or propagated source
Epidemic
Highest alert level declared by the WHO
Pandemic level 6, June 12, 2009
FACTORS IN DETERMINNG THE PROPORTION OF THE POPULATION THAT SHOULD BE IMMUNED TO MAKE SPREAD OF INFECTION HIGHLY IMPROBABLE
- INFECTIOUSNESS OF THE INFECTED HOST & THE LENGTH OF TIME HE IS INFECTIOUS 2. STANDARDS OF HYGIENE 3. DENSITY & DEGREE OF MIXING OF THE POPULATION.
Mode of transmission: IMMEDIATE TRANSFER OF AN INFECTIOUS AGENT FROM AN INFECTED HOST OR RESERVOIR TO AN APPROPRIATE PORTAL OF ENTRY W/O THE INTERVENTION OF INTERMEDIATE OBJECTS
Direct
Mode of transmission: TRANSFER OF INFECTION W/O CLOSE RELATIONSHIP BETWEEN RESERVOIR AND NEW HOST
Indirect
WHO Pandemic phase: Predominantly animal infections; few human infections
1-3
WHO Pandemic phase: Sustained human-to-human transmission
4
WHO Pandemic phase: Widespread human infection
5-6
WHO Pandemic phase: Possibility of recurrent infections
Post peak
WHO Pandemic phase: Disease activity at seasonal levels
Post pandemic
Constant presence in a community of a disease in numbers
Endemic
Disease that is clearly in excess of what is present in other communities
Endemic
Disease in animals transmissible to man
Zoonotic
Type of epidemics: Outbreaks due to exposure of a group of persons to a common, noxious influence
Common Source Epidemics
A common source epidemic wherein the exposure to the source is brief and essentially simultaneous so that the resultant cases all develops within one incubation period of the disease
Point or point source epidemic
S. japonicum is endemic in
1) Samar 2) Leyte 3) Lanao del Sur 4) Maguindanao 5) ARMM
Type of epidemics: Outbreaks due to transmission of an infectious agent from one susceptible host to another
Propagated or progressive epidemics
Type of epidemics: Food intoxication
Common source
Type of epidemics: Chemical poisoning
Common source
Type of epidemics: Influenza
Direct person-to-person, propagated
Type of epidemics: Malaria
Indirect, propagated
Type of epidemics: Hepatitis
Direct person-to-person, propagated
Type of epidemics: Yellow fever
Indirect, propagated
Type of epidemics: Atmospheric pollution
Common source
EPIDEMIC CURVE: Picture of common source epidemics
Classical Epidemic Curve
EPIDEMIC CURVE: Picture of person to person spread
Inverted Epidemic Curve
EPIDEMIC CURVE: Rapid ascending and rapid descending limb
Bell-shaped Epidemic Curve
EPIDEMIC CURVE: Food poisoning
Classical Epidemic Curve
EPIDEMIC CURVE: Malaria
Inverted Epidemic Curve
EPIDEMIC CURVE: Measles
Bell-shaped Epidemic Curve
EPIDEMIC CURVE: Rapid transmission due to big dose of
the identified organism
Classical Epidemic Curve
EPIDEMIC CURVE: Poliomyelitis
Bell-shaped Epidemic Curve
EPIDEMIC CURVE: DHF
Inverted Epidemic Curve
EPIDEMIC CURVE: Short ascending limb and climb
Classical Epidemic Curve
EPIDEMIC CURVE: Long ascending and short descending
limb
Inverted Epidemic Curve
EPIDEMIC CURVE: The spread is rapid; transmission is simple; and rapid elimination and reduction of susceptible cases
Bell-shaped Epidemic Curve
EPIDEMIC CURVE: Indicates that the transmission is more complex and the disease has a longer incubation period
Inverted Epidemic Curve
More deaths on the ascending limb of the classical epidemic curve is due to
Heavier dose of the organism and less resistance
Longer descending limb of the classical epidemic curve represents
Development of secondary cases
Less deaths on the descending limb of the classical epidemic curve is due to
Lesser dose or virulence
Shape of the bell-shaped epidemiological curve indicates that
Those who develop the disease earlier has more deaths as considerations include experience with the disease and resistance
A graphical presentation of the geographic distribution cases
Spot Map
Importance of spot map
1) Orients the epidemic as to place 2) Shows where the epidemic started (located index case’) 2) Pinpoints source of infection
Determines the interval between cases in a person-to-person spread
Generation time
Refers to the period between the receipt of infection by a host and maximal communicability of that host
Generation time
STEPS IN THE INVESTIGATION OF AN EPIDEMIC
- Establish the existence of an epidemic (Preliminary Investigation) 2. Orient the epidemic as to time, place, and person 3. Formulate hypotheses explaining the occurrence of the epidemic 4. Test your hypotheses 5. Make your conclusions and give your recommendations
Measles: Portal of entry
Respiratory tract
Measles: Mode of transmission
Airborne droplets
Measles: Avenue of escape
Respiratory secretion
Colds: Portal of entry
Respiratory tract
Colds: Mode of transmission
Airborne droplets
Colds: Avenue of escape
Respiratory secretion
Typhoid: Portal of entry
GIT
Typhoid: Mode of transmission
Water, food, flies
Typhoid: Avenue of escape
Feces
Polio: Portal of entry
GIT
Polio: Mode of transmission
Water, food, flies
Polio: Avenue of escape
Feces
TB reservoir
1) Man 2) Diseased cattle
TB case definition
- a history of contact with a suspect or confirmed
case of pulmonary tuberculosis - any child who does not return to normal health after measles or whooping cough - loss of weight, cough and wheeze which does not respond to antibiotic therapy for acute respiratory disease - abdominal swelling with a hard painless mass and free fluid - painful firm or soft swelling in a group of superficial lymph nodes - any bone or joint lesion of slow onset - signs suggesting meningitis or disease in the
CNS
MOT of TB
1) Droplet infection 2) Dust inhalation of bacilli which have dried on the surface of the ground or floor and become suspended in the air
Incubation period of TB
~ 4-12 weeks; 1-2 years after infection of pulmonary or extra-pulmonary TB
Average the sum of observations divided by the number of observations
Mean
Middle observation in a series of ordered observations
Median
First step in epidemiological approach or strategy
Identify the problem
Observation that occurs with greatest frequency
Mode
Branch of medicine that deals with the study of the causes, distribution, and control of disease in populations
Epidemiology
Sampling unit in epidemiologic studies
Group of individuals
Ultimate goal of an epidemiological investigation
Institute curative, preventive, and control measures to avoid cases
Studies both the distribution of disease and determinants of the observed distribution
Epidemiology
Epidemiology began as a study of
Infectious disease
Study of the distribution of diseases in animals
Epizootiology
Cause of changes in strain that allow infection despite adequate vaccination
Antigenic drift
Slow and progressive change in antigenic composition of microorganisms
Antigenic drift
Sudden change in the molecular structure of a microorganism and produces NEW STRAINS
Antigenic shift
Explanation for new epidemics or pandemics
Antigenic shift
Measure of central tendency used for numerical data and for symmetric distributions
Mean
Result in influenza with high case fatality rates seen previously with the strain
Vaccine failure
Measure of central tendency used for ordinal data or numeric data if distribution is skewed
Median
Appropriate measure of central tendency in qualitative data (e.g. gender, religion, nationality)
Mode
Decrease rate of infection by decreasing probability that a susceptible person would come in contact with an infected person
Herd immunity
Measure of central tendency used for bimodal distributions
Mode
Distribution when mean=median
Symmetrical
Distribution when mean>median
Skewed to the right/POSITIVELY SKEWED
Distribution when mean is less than median
Skewed to the left/NEGATIVELY SKEWED
T/F Herd immunity affects the clinical presentation of those infected in a group
F
Absence of disease is defined as
1) No cases on record 2) Absent from the beginning 3) Has been eradicated
Study design best for rare cases
Case-control
Study design in which subjects are categorised on the basis of exposure or lack of exposure to a risk factor and then are followed to determine a specific outcome
Prospective cohort
Refers to groups of subjects followed forward in time to see which ones develop the outcome
Cohort
Prospective studies in which an intervention is applied
Clinical trials
Exposure and outcome are measured at the same point in time
Cross-sectional
Study design: Clinical characteristic or outcome from a single subject or event (n=1)
Case report
Study design: Clinical characteristic or outcome from a group of clinical subjects or events (n>1)
Case series
Study design: Prevalence
Cross-sectional
Study design: Determines in each member of the population the presence or absence of a disease and other variables at one point in time
Cross-sectional
Study design: With diseases vs without disease
Case-control
Study design: Population exposed to a risk factor is followed over time and compared to a group not exposed to the risk factors
Cohort
Study design: Retrospective
Case-control
Study design: Prospective
Cohort
Study design: Association of risk factor and disease
Cross-sectional
Study design: Causality cannot be determined
Cross-sectional
Study design: Weakest
Case-control
T/F Case-control study cannot assess incidence and prevalence
T
Study design: For conditions with very low incidence or prevalence
Case-control
Methods used in public health
1) Public education 2) Surveillance systems 3) Environmental control 4) Dissemination of information to health providers
The study of the amount & distribution of disease within a population by person, place & time
Descriptive epidemiology
The study of the determinants of disease or reasons for relatively high or low frequency in specific groups
ANALYTIC EPIDEMIOLOGY
The application of epidemiological principles and methods to the practice of clinical medicine
Clinical epidemiology
The science of making predictions about individual patients by counting clinical events in similar patients
Clinical epidemiology
Health is defined as
A state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity
WHO CASE-DEFINITION FOR AIDS
1) The presence of disseminated Kaposis sarcoma or cryptococcal meningitis OR 2) Two major signs in association with at least one minor sign
Include case studies, case series, ecologic studies, and cross-sectional studies
Descriptive studies
Include cohort studies and case-control studies
Observational studies
Include clinical trials and community trials
Experimental studies
Major signs of AIDS
Weight loss > 10% Fever > 1 month Chronic diarrhea > 1 month
Minor signs of AIDS
Persistent cough > 1 month General pruritic dermatitis Recurrent herpes zoster General lymphadenopathy Chronic herpes simplex Oral candidiasis
T/F About PhilHealth: Govrernment-owned and -controlled
T
Covered under the National Health Insurance Program (NHIP)
1) Employed sector 2) OFWs under the OWWA 3) Individually paying members (self-employed, private practitioners) 4) Non-paying members 5) Dependents of member
Non-paying members covered by NHIP
1) Retirees and pensioners provided they have paid at least 120 monthly contributions and reached 60 y/o upon retirement 2) Permanent and partial disability pensioners 3) Indigent members under Medicare Para Sa Masa
Dependents of member covered by NHIP
1) Legitimate spouse 2) Children below 21, unmarried, unemployed 3) 21 and above but suffering from any illness or disease 4) Parents 60 and above, not retiree/pensioner members and wholly dependent on members for support
Benefits included under the NHIP
1) Inpatient hospital care 2) Outpatient care 3) Emergency and transfer services 4) Other health care services that the corporation determines to be appropriate and cost-effective 5) NSD up to 5, including abortions
Benefits excluded under the NHIP
1) Non-prescription drugs and meds (everything not in the formulary) 2) Out-patient psychotherapy and counselling for mental disorders 3) Drug and alcohol abuse dependency treatment 4) Cosmetic surgery 5) Home and rehab services 6) Optometric services
Who are eligible to avail of PhilHealth benefits
1) At least 3 monthly contributions within the immediate 6 months prior to admission 2) 45-day allowance for room and board has not been consumed yet 3) Confinement in an ACCREDITED hospital of not less than 24 hours
Only hospital admissions of more than 24 hours are covered except
1) Emergency 2) Transferred to another hospital 3) Expired during confinement
